Recent publications
This study questioned whether knowledge of the employment situation of a person with an intellectual disability affected stigmatising attitudes towards that individual among a sample of 507 people who did not have intellectual disabilities. A hypothetical individual with a mild intellectual disability was described as either (i) in paid employment, or (ii) living entirely on state social security benefits. Sample members, none of whom were themselves intellectually disabled, unemployed, or living on social security benefits, completed a questionnaire concerning their attitudes towards the person. Many participants who were informed that a person with an intellectual disability worked for a living exhibited more positive attitudes towards the individual than participants advised that the person relied on welfare. The results suggest the existence of a “welfare slur” among some sample members. The level of an observer’s self-reported social status impacted on the favorability of certain attitudes.
Relationship and Sex Education (RSE) has been integrated into the National Curriculum within UK schools for the past two decades. RSE aims to teach about the emotional, social, and physical aspects of growing up, relationships, sex, human sexuality and sexual health. Such a curriculum tends to be mainstream oriented, taught in large classes, with limited exploration and clarification for those who need it. There is concern that the development of incomplete knowledge and skills places the pupil with Autism Spectrum Disorder (ASD) in a difficult and potentially vulnerable position. This study was the first of three looking at development of a more appropriate RSE program for pupils with ASD. The study focused upon evaluating the RSE program being utilised at the time (2016) via face-to-face semi-structured interviews with teaching staff. Participants were either senior leadership members or school RSE coordinators and they came from 15 schools providing for pupils with ASD in London, Surrey, and Sussex.
The resulting qualitative data were analyzed for common themes. The resulting themes highlighted difficulties in implementing RSE programs with pupils with ASD, lack of resources and support, and being able to develop positive RSE. The results indicate that although those in charge of RSE implementation are committed, they are frequently faced with a range of barriers. The discussion section highlights the importance of this subject and the need to increase understanding in relation to such programs.
Face Centre Cubic (FCC) lattices with varying porosities were designed and developed via Python scripting and printed using Fused Filament Fabrication (FFF) and Multi-Jet Fusion (MJF). The printed lattices were assessed through compressive tests and the compressive behaviour. Reverse engineering employing 3D scanning was utilised to evaluate the print quality and surface behaviour of the printed specimens. MJF-printed lattices exhibited fewer internal defects with superior surface quality and roughness compared to FFF samples. MJF also had higher compressive strength (~ 16 kN) than FFF samples (~ 10 kN) due to lower internal defects and closer bonding between the layers. The FCC lattices showcased an inverse relationship between porosity percentage and compressive strength with FFF and MJF lattices with 94% porosity outperformed structures with higher porosity in terms of compressive strength. Nonetheless, the deformation patterns in the lattices with 85% and 78% porosity resembled the 94% structure, indicating workable alternatives. Also, MJF-printed lattices with 78% porosity showed promise in simulating the mechanical characteristics of human tibial bones owing to closer match with human bones as well as their improved surface quality, deformability, and moderate compressive strength compared to other structures.
Introduction
Pre-eclampsia is a condition associated with significant maternal and neonatal morbidity and mortality. The prediction of pre-eclampsia in high-risk populations using angiogenic markers, such as serum placental growth factor (PlGF) assessment, has been shown to improve maternal outcomes and is recommended by the National Institute for Health and Care Excellence (NICE). However, such tests are not yet available at the point of care (POC). Glycosylated fibronectin (GlyFn) level for the prediction of pre-eclampsia development is available as a POC test (Lumella) and has the potential to aid rapid clinical decision making. This study aimed to test the hypothesis that the sensitivity of the GlyFn test is not inferior to that of the current gold standard of soluble fms-like tyrosine kinase (sFlt)/PlGF-based laboratory testing for pre-eclampsia.
Methods and analysis
This is a multicentre prospective study. Women at risk for pre-eclampsia based on predefined clinical and/or obstetric risk factors will be invited to participate in the study. The recruitment target is 400 participants. Consenting participants will have paired samples for sFlt/PlGF together with POC GlyFn testing. Two follow-up visits are planned at 2 and 4 weeks after the initial recruitment where repeat testing with both tests will be performed. The clinical team will be blinded to the results of the GlyFn test but not that of the sFlt/PlGF test. Clinical care will be based on established protocols incorporating maternal/fetal evaluation and the results of sFlt/PlGF levels. Maternal and neonatal outcome data will be collected to compare the sensitivity and specificity of the tests, with the primary outcome being delivery for pre-eclampsia within 4 weeks.
Ethics and dissemination
Ethical approval has been obtained from the Health Research Authority and Health and Care Research Wales Ethics Committee. The results of this study will be published in peer-reviewed journals and presented at scientific conferences.
Trial registration number
ISRCTN13430018
Objective
To evaluate the effectiveness of Listen, a self-management support intervention, for people living with long covid who were not in hospital.
Design
Pragmatic, multicentre, parallel group, randomised controlled trial.
Setting
Twenty four sites in England and Wales.
Participants
Identified from long covid clinic waiting lists, word of mouth, and adverts/social media self-referred to the trial, 554 adults with long covid were randomised to receive either the Listen trial intervention or NHS usual care.
Interventions
The Listen intervention involved up to six one-to-one personalised sessions with trained healthcare practitioners and an accompanying handbook co-designed by people with lived experience and health professionals. Usual NHS care was variable, ranging from no access, access to mobile applications and resources, and to specialist long covid clinics.
Main outcome measures
The primary outcome was the Oxford participation and activities questionnaire (Ox-PAQ) routine activities scale score at three months assessed in the intention-to-treat population. Secondary outcomes included Ox-PAQ emotional wellbeing and social engagement scale scores, the Short Form-12 (SF-12) health survey, the fatigue impact scale, and the generalised self-efficacy scale at three months. The EuroQol five-dimension five-level (EQ-5D-5L) assessed health utility. Serious adverse events were recorded.
Results
Between 27 May 2022 and 15 September 2023, 554 people with long covid (mean age 50 (standard deviation 12.3) years; 394 (72.4%) women) were randomly assigned. At three months, participants assigned to the intervention group reported small non-significant improvements in the primary outcome of capacity for daily activities as assessed by Ox-PAQ routine activities scale score (adjusted mean difference −2.68 (95% confidence interval (CI) −5.38 to 0.02), P=0.052) compared with usual NHS care. For the secondary outcomes, people receiving the intervention also reported significant improvements in mental health (Ox-PAQ emotional wellbeing −5.29 (95% CI −8.37 to −2.20), P=0.001; SF-12 2.36 (95% CI 0.77 to 3.96), P=0.004), reductions in fatigue (fatigue impact score −7.93 (95% CI −11.97 to −3.88), P<0.001), and increases in self-efficacy (generalised self-efficacy scale 2.63 (95% CI 1.50 to 3.75), P<0.001). No differences were found in social engagement (−2.07 (95% CI −5.36 to 1.22), P=0.218) or SF-12 physical health (0.32 (95% CI −0.93 to 1.57), P=0.612). No intervention related serious adverse events were reported.
Conclusions
The personalised self-management support intervention of the Listen trial resulted in non-significant short term improvements in routine activities when compared with usual care. Improvements in emotional wellbeing, fatigue, quality of life, and self-efficacy for people living with long covid were also reported. Physical health and social engagement were not affected by the trial intervention. The limited understanding of how much change is clinically meaningful in this population along with the unblinded design, the use of self-referral as a recruitment method and variable usual care may have introduced unintended bias and thus limits robust conclusions about this intervention. Further research is required to fully establish the impact of the intervention.
Trial registration number
ISRCTN36407216, ISRCTN registry, registered 27 January 2022.
Background
Good healthcare worker (HCW) wellbeing positively impacts service user outcomes, yet the United Kingdom (UK) National Health Service (NHS) is suffering workforce burnout and retention issues. While urgently needing evidence-based wellbeing strategies, participatory interventions using positive psychology have been under-investigated. We aimed to develop a caring, collegial NHS labour ward environment wherein HCWs created paths to enhancing individual and collective workplace wellbeing.
Methods
Insider Participatory Action Research (IPAR) used positive psychology within a social constructionist, pragmatic approach. All clinical and non-clinical HCWs on a consultant-led labour ward in the East Midlands, England, UK were invited to identify current sources of workplace wellbeing on which to collectively construct future ways of working. Qualitative data from several methods (below) were inductively thematically analysed.
Results
Between October 2018 and July 2020, data were generated from 83 paper and 13 online questionnaires; 59 interviews; three action groups; six peer participant reviewers; 16 comments on data displays; and three emails. Three themes represented sources of workplace wellbeing: emotional, professional, and physical nourishment. Culture shifted to be more compassionate and inclusive, and morale, positivity, and atmosphere improved. Ways of working changed. Colleagues more proactively cared for each other, worked well together in teams, expressed thanks and feedback, and instigated interventions for colleagues’ and women’s welfare. Participants proposed that IPAR activities prompted change including: the researcher being considered an accessible colleague wellbeing resource; raised awareness of the importance of HCW wellbeing; and strengthened HCW relationships. The HEARS wellbeing intervention model (HCW driven, Everyone involved, Ask what makes a person feel good at work, Responses displayed, Steps taken) was developed to frame processes by which HCW participation catalysed impact towards workplace wellbeing.
Conclusions
To our knowledge, this is the first English language study using IPAR to enhance HCW wellbeing. Colleagues from diverse occupational groups improved individual and collective wellbeing through self-determined action. Using participatory methodology and positive psychology encouraged a more compassionate and inclusive culture. Subject to implementation research evaluating these strategies’ impact in different settings, we propose the HEARS wellbeing intervention model and workplace-based Colleague Support Volunteers as actions towards wellbeing and retention in healthcare organisations.
Inhalation of biopersistent nanoplastics may have adverse effects on lung health. By varying the acetate content of poly(vinyl acetate‐co‐alcohol) (PVAc), model nanoplastics with different surface hydrophobicity can be produced to study the effects of nanoplastic hydrophobicity in the lung. PVAc nanoplastics with a high hydrophobicity, administered by oropharyngeal aspiration to C57BL/6j mice (300 µg; ∼10 mg/kg), show transient pulmonary inflammation which peaks at 24 h post‐administration and resolves by day 7. Hydrophilic PVAc induces no inflammatory effects at the same dose. Pulmonary administration of hydrophilic and hydrophobic PVAc nanoplastics increases the prevalence (∼30%–35%) of distinctive coarsely vacuolated alveolar macrophages over 28 days. Hydrophobic PVAc and silica nanoparticles (control) induce minor increases in collagen deposition, but do not stimulate tissue remodeling to the same extent as a bleomycin model of fibrosis. Longitudinal micro‐CT imaging is explored as a non‐invasive methodology for detection of lung fibrosis. A bespoke image analysis method to quantify high density tissue signal volume correlates moderately well with histopathology‐derived collagen deposition data (R² = 0.73). In summary, inhaled nanoplastics with high surface hydrophobicity induce transient inflammation following a single administration of 300 µg, an increase in coarsely vacuolated macrophages and mild increases in collagen deposition.
Background
Due to medical advancements the number of children living with life-limiting and life-threatening conditions is rising, meaning more children and their families will require palliative and end-of-life care in the future. While ‘home’ is often the preferred place of end-of-life care, the evidence around best practice for decision-making about place of end-of-life care remains inadequate.
Aim
To synthesise evidence on the factors influencing decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions.
Design
A systematic integrative literature review. The review protocol was registered in Prospero: CRD42023406800.
Data sources
CINAHL, MEDLINE, EMBASE, PsycINFO, and Maternal and Infant Health were searched for studies published between 2013 and 2024. Any empirical, peer-reviewed journal articles published in English that included data pertaining to decision-making about place of end-of-life care for children (≤ 18 years) with life-limiting or life-threatening conditions were considered. Quality appraisal was conducted using the Mixed Methods Appraisal Tool.
Results
Eleven eligible studies were included. Using an iterative process of constant data comparison, four themes were identified, highlighting that (i) consideration of the child, (ii) availability and suitability of end-of-life care services, (iii) parents’ capacity and control in providing care, and (iv) family and sibling well-being were factors influencing decision-making about place of end-of-life care.
Conclusion
There are a complex range of factors surrounding decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions. Studies focused primarily on parents’ perspectives. Further research is needed to identify how to best support decisions about place of end-of-life care for families of children with life-limiting and life-threatening conditions.
This study investigates the impact of supply chain digitalization on agility through the lens of innovation within firms. Employing a resource‐based view and dynamic capabilities approach, we analyze the relationship between supply chain digitalization and agility. This exploration is essential for fostering an agile supply chain capable of addressing challenges post COVID‐19. The empirical data were gathered through a survey administered in the Emirates. Factor analysis was performed to validate the measurement models and structural equation modeling techniques were employed to test the hypotheses. Further, the study analyses the mediating role of firm innovation between digitalization and supply chain agility within companies. The findings suggest that firm innovation serves as a significant mediator. Moreover, a multigroup analysis was conducted to examine the moderating effects in the research models, revealing that firm innovation plays a pivotal role in elucidating the mechanism between supply chain digitalization and agility. This study offers valuable insights into supply chain agility and resilience post COVID‐19 and makes a significant contribution to the literature on supply chain digitalization.
Innovative synthetic biodegradable polymers containing amino acid moieties are used as pulmonary anticancer drug delivery systems to efficiently administer drugs in a controlled manner while also altering the physical and chemical characteristics of therapeutic molecules and the way they are delivered to the lungs. In this study, the aim was to prepare a new polyamide based on l-cystine amino acid loaded with a combination of thymoquinone (TQ) and doxorubicin (DOX) nanocapsules (TQ-DOX/Cys-Py/PA NCs) to be delivered directly to the lungs. TQ-DOX/Cys-Py/PA NCs were created using a single-step interfacial polycondensation method. The aerodynamic performance assessment shows that the prepared TQ-DOX/Cys-Py/PA NCs were able to deliver 98.7% and 97.1% of the TQ and DOX nominated dose, respectively. TQ and DOX with emitted doses of 2008.2 and 110.2 μg can reach the lower parts of the respiratory system and have an aerodynamic particle size between 1 and 5 μm, which revealed that the optimum formulation would produce a small particle size (19.89 nm) with high entrapment efficiency (TQ: 85.4%, DOX: 99.49%) and loading efficiency (TQ: 52.2%, DOX: 15.03). The targeted release of TQ and DOX in 0.1 M GSH-containing buffer solution demonstrated a faster onset of action, with 50% released within the first 2 hours. In vivo studies were conducted to demonstrate the efficacy of TQ-DOX/Cys-Py/PA NCs in enabling targeted drug delivery to the lungs for the treatment of lung cancer. The results demonstrate exceptional lung targeting and sustained lung retention for at least 24 hours. Furthermore, the toxicity of the TQ-DOX/Cys-Py/PA NCs was assessed by quantifying the protein carbonyl content. The results showed that the TQ-DOX/Cys-Py/PA NCs exhibited reduced toxicity to the heart, liver, and kidney compared to free DOX and DOX/Cys-Py/PA NCs.
The standard Poisson‐Boltzmann (PB) model for molecular electrostatics assumes a sharp variation of the permittivity and salt concentration along the solute‐solvent interface. The discontinuous field parameters are not only difficult numerically, but also are not a realistic physical picture, as it forces the dielectric constant and ionic strength of bulk in the near‐solute region. An alternative to alleviate some of these issues is to represent the molecular surface as a diffuse interface, however, this also presents challenges. In this work we analyzed the impact of the shape of the interfacial variation of the field parameters in solvation and binding energy. However we used a hyperbolic tangent function to couple the internal and external regions, our analysis is valid for other definitions. Our methodology, restricted to the linear PB, was based on a coupled finite element (FEM) and boundary element (BEM) scheme that allowed us to have a special treatment of the permittivity and ionic strength in a bounded FEM region near the interface, while maintaining BEM elsewhere. Our results suggest that the shape of the function (represented by ) has a large impact on solvation and binding energy. We saw that high values of induce a high gradient on the interface, to the limit of recovering the sharp jump when , presenting a numerical challenge where careful meshing is key. Using the FreeSolv database to compare with molecular dynamics, our calculations indicate that an optimal value of for solvation energies was around 3. However, more challenging binding free energy tests make this conclusion more difficult, as binding showed to be very sensitive to small variations of . In that case, optimal values of ranged from 2 to 20.
Background
We aimed to examine the relationship between disease symptoms and disease phenotype in a large Canadian cohort of persons with Crohn’s disease (CD).
Methods
Adults (n=1515) with CD from 14 Canadian centers participated in the Mind And Gut Interactions Cohort (MAGIC) between 2018 and 2023. Disease activity was measured using the 24-item IBD Symptom Inventory-Short-Form (IBDSI-SF). We compared the symptoms commonly associated with active versus inactive disease, and explored symptoms patterns in relation to disease phenotype, based on the Montreal Classification. To assess psychological status the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used.
Results
The mean disease duration was 15.6±11.8 years. The 5 most common symptoms were similar for those with active disease, although at higher prevalence (89% to 98%) versus those with inactive disease (47% to 79%), and included fatigue, diarrhea, gas, bloating, and urgency. The intensity of symptoms was higher in those with active than inactive IBDSI-SF scores. The rank order and relative distribution of the symptoms and intensity of the symptoms reported were similar between those with different disease phenotypes B1, B2, and B3 and L1, L2, and L3. Persons with active IBDSI-SF had a higher prevalence of anxiety (24.6%) and depression (38.2%) versus persons with inactive IBDSI-SF (6.3% and 8%, respectively)
Conclusions
Individuals with CD with active and inactive disease by IBDSI, experience similar symptoms, but the prevalence of symptoms and their intensity is greater in persons with active IBDSI. Persons with inactive IBDSI report many symptoms. There was no difference in symptom reporting by disease behavior or location.
I argue that Horace Satire 1.5 presents a day in the life of a bumbling, inept Epicurean, one who constantly succumbs to the pitfalls and stereotypes associated with his philosophical school of choice. I draw attention to the narrator’s eager memorization of doctrine, aspirations towards Lucretian scientific analysis, idealization of friendship, constant sickness, exaggerated reaction to “death”, and obsession over food. I then demonstrate how these caricatures help explain the narrator’s complete apathy towards the political embassy, defang the vitriol of potential detractors, and facilitate in-group bonding among fellow Epicureans within the Circle of Maecenas.
The latest pulmonary function guideline from the Brazilian Thoracic Association was published in 2002, since which there have been updates to international guidelines (mainly those from the European Respiratory Society and the American Thoracic Society), as well as new national and international publications on various aspects of the performance, interpretation, and clinical implications of spirometry. Despite those updates, a careful analysis of what applies to the reality in Brazil is essential, because there have been studies that evaluated individuals who are representative of our population and who could show responses different from those of individuals in other regions of the world. This document is the result of the work of a group of specialists in pulmonary function who evaluated relevant scientific articles that could be applicable to the population of Brazil. After the discussions, new spirometry guidelines were drawn up, covering various aspects such as its technical parameters and performance; its indications and contraindications; its interpretation; concepts of normality and their related variability; reference values; classification of functional severity; and response to an inhaled bronchodilator. Finally, the guidelines emphasize the need to always interpret spirometry results in the context of the clinical condition of the patient and of the pretest probability.
Descriptors: Respiratory function tests; Spirometry; Respiratory physiological phenomena
To expand the applications of hydrophobic silica aerogels derived from rice husk ash (HSA) through simple traditional methods (without adding special materials or processes), this paper employs machine learning to establish mathematical models to identify optimal conditions for extracting water glass and investigates how preparation conditions and heat treatment temperatures affect properties such as the porosity and hydrophobicity of HSA. The results indicate that the decision tree regression model provides the most accurate predictions for the extraction rate and modulus of water glass. Notably, the water contact angle of HSA produced using nitric acid as a catalyst can reach as high as 159.5°, classifying it as a superhydrophobic material. Additionally, while moderately increasing the concentration of the hydrophobic modifier enhances HSA’s hydrophobicity, it concurrently reduces its porosity. The HSA maintained hydrophobicity until 500 °C. The pore structure of HSA collapsed gradually with the increase in heat temperature. After treatment at 700 °C, HSA lost its hydrophobicity and the porous structure was severely damaged. Compared with silica aerogel using traditional silicon sources, the damage to pore structure and the crystallization occurred at lower temperatures, but the hydrophobicity remained at higher temperatures.
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