Understanding advance care planning for children and young people: a survey of health professionals.

BACKGROUND: A range of polices, documentation, and practices are associated with advance care planning. However, there is a shortage of research to understand advance care planning from a professional viewpoint. AIMS: To explore the views and experiences of health professionals of the advance care planning process with children and young people. METHODS: An online questionnaire was used to collect data, which were analysed thematically. FINDINGS: Key findings related to barriers and facilitators to initiating and documenting advance care planning: understanding the process and the condition of the patient; how advance care planning works in practice; and access to relevant, affordable training options. CONCLUSION: Additional training and standardised documentation can help support the initiation and use of advance care planning, reduce misperceptions, and generate greater confidence in participating in the process. A larger multidisciplinary team, with better communication, will support improved relationships between professionals which will filter down to the families.

Children's Experiences of Death Anxiety and Responses to the Covid-19 Pandemic.

The aim of this study was to explore children's experience and responses to the Covid-19 pandemic through their illustrations and short narrations. During October 2020 and January 2021 data was collected from thirteen children aged 9-10 years old in a primary school in the North-West of England. Children were asked to draw their thoughts and feelings about the pandemic and to write a short narration to accompany the drawing. Thematic analysis of data revealed that during the pandemic children at this age have an understanding of death, experience death anxiety and are able to use creative expression to facilitate meaning of the impact of lockdown on their lives such as feeling isolated, lonely, sad and bored. Creative expression also facilitated adaptive coping mechanisms derived from being able to spend more time with family. The data on primary school children is part of a larger study which involved surveys and interviews with children aged 12-16 years in secondary schools.

The Impact of Continuing Bonds Between Pet Owners and Their Pets Following the Death of Their Pet: A Systematic Narrative Synthesis.

When a pet dies, owners can experience similar levels of grief as when a human dies. Previous research indicates the role of continuing bonds (CB) when a pet is alive. To understand the impact of these bonds after the pet has died, we conducted a systematic narrative synthesis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Findings were heterogenous, yet there were still parallels in the literature. CB can sometimes aggravate and intensify grief experiences, particularly when pet grief is perceived as disenfranchised grief. However, identifying appropriate bonds can be useful to moderate the intensity of grief and be a valuable mechanism of support. CB can also help post-traumatic growth of owners.

Young People's Experiences of Death Anxiety and Responses to the Covid-19 Pandemic.

Capacity for death awareness and death anxiety in young people has been previously documented but the impact of Covid-19 is not currently known. Therefore, the aim of this study of this study was to explore young people's experiences and responses to the Covid-19 pandemic. Qualitative data was collected from young people via a two-stage process across the United Kingdom: Stage One consisted of an online questionnaire; Stage Two comprised online semi-structured interviews. Responses for Stage One of the study totalled 120 young people; 9 of these were interviewed for Stage Two of the study. Thematic analysis of data identified four themes relating to young people's experiences of the Covid-19 pandemic: death anxiety; mental health; normalising death; and identified support needs. Young people experienced heightened death anxiety due to the pandemic but death also became normalized for them and their mental health was negatively affected.

Views and experiences of young people, their parents/carers and healthcare professionals of the advance care planning process: A summary of the findings from a qualitative study.

BACKGROUND: Advance care planning for young people is relatively new in the UK. There is a lack of understanding about the engagement of young people in their own planning process, optimal timing of discussions and the facilitators and barriers to the engagement of young people. AIM: To explore the views and experiences of young people, their parents/carers and HCPs of the advance care planning process. DESIGN: A qualitative study, using semi-structured interviews with young people, their parents/carers and healthcare professionals across four case series. Data were analysed using thematic analysis. PARTICIPANTS: Fifteen participants were interviewed: young people (n = 2), parents/carers (n = 5) and healthcare professionals (n = 8). RESULTS: Three themes were identified from the findings. Key findings related to barriers and facilitators of engaging young people in their own care planning were apparent in the following areas: misperception of terms; hierarchies of power in relationships; and a flexible and innovative organisational structure and culture. CONCLUSION: Participants expressed a variety of views and experiences of advance care planning. Advance care planning was thought to be best initiated by a consultant when the young person is in their mid-teens, their condition is stable, and before they transition to adult care. Engagement was also considered to be facilitated by appropriate communication, developing relationships prior to initiating advance care planning, and written support for everyone involved in the process. These factors were supported by training and education for healthcare professionals and a flexible and innovative structure and cultures of organisations.

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice.

BACKGROUND: The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. METHODS: A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. RESULTS: Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling 'very confident' in managing ASI; the majority feeling 'somewhat confident' (70.4 %, n = 95/135) or 'not confident' (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. CONCLUSION: Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.

The post-traumatic stiff elbow: A review.

Upper extremity function is highly dependent on elbow motion in order to adequately position the hand in space. Loss of this motion due to stiffness following trauma can cause patients substantial disability, leading to difficulties with performing activities of daily living. Post-traumatic elbow stiffness is challenging to treat, and therefore prevention is of paramount importance. Key measures that can be used to prevent elbow stiffness are early surgical intervention for fracture or joint instability, as well as active mobilisation, which helps to prevent oedema and an increase in viscosity of inflammatory exudates. Other options include splinting and continuous passive mobilisation. Once non-operative methods of addressing post-traumatic stiffness have been exhausted, arthrolysis of the stiff elbow can be performed via open or arthroscopic means depending on the type of pathology involved (intrinsic or extrinsic contracture) and experience of the surgeon with elbow arthroscopy. The particular open approach used depends on several factors, which include the formation and location of any heterotopic ossification present. Improvements in range of motion can be expected with both open and arthroscopic techniques, which can be effective and rewarding for patients. Post-operative rehabilitation, particularly early active mobilisation, should be considered essential in order to optimise patient outcomes following surgery. This review aims to explore elbow stiffness following traumatic aetiology, assessing its pathogenesis and prevention, as well as reviewing surgical treatment options and post-operative rehabilitation.

Electro-optical measurement of intense electric field on a high energy pulsed power accelerator.

We describe a direct electro-optical approach to measuring a strong 118 MV/m narrow pulse width (~ 33 ns) electric field in the magnetically insulated transmission line (MITL) of a pulsed power accelerator. To date, this is the highest direct external electric field measured electro-optically in a pulsed power accelerator, and it is between two to three orders of magnitude higher than values reported in comparable high energy scientific experiments. The MITL electric field is one of the most important operating parameters in an accelerator and is critical to understanding the properties of the radiation output. However, accurately measuring these high fields using conventional pulsed power diagnostics is difficult due to the strength of interfering particles and fields. Our approach uses a free-space laser beam with a dielectric crystal sensor that is highly immune to electromagnetic interference and does not require an external calibration. Here we focus on device theory, operating parameters, laboratory and pulsed power accelerator experiments as well as challenges that were overcome in the measurement environment.

Preclinical development of a molecular clamp-stabilised subunit vaccine for severe acute respiratory syndrome coronavirus 2.

OBJECTIVES: Efforts to develop and deploy effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue at pace. Here, we describe rational antigen design through to manufacturability and vaccine efficacy of a prefusion-stabilised spike (S) protein, Sclamp, in combination with the licensed adjuvant MF59 'MF59C.1' (Seqirus, Parkville, Australia). METHODS: A panel recombinant Sclamp proteins were produced in Chinese hamster ovary and screened in vitro to select a lead vaccine candidate. The structure of this antigen was determined by cryo-electron microscopy and assessed in mouse immunogenicity studies, hamster challenge studies and safety and toxicology studies in rat. RESULTS: In mice, the Sclamp vaccine elicits high levels of neutralising antibodies, as well as broadly reactive and polyfunctional S-specific CD4+ and cytotoxic CD8+ T cells in vivo. In the Syrian hamster challenge model (n = 70), vaccination results in reduced viral load within the lung, protection from pulmonary disease and decreased viral shedding in daily throat swabs which correlated strongly with the neutralising antibody level. CONCLUSION: The SARS-CoV-2 Sclamp vaccine candidate is compatible with large-scale commercial manufacture, stable at 2-8°C. When formulated with MF59 adjuvant, it elicits neutralising antibodies and T-cell responses and provides protection in animal challenge models.

The engagement of young people in their own advance care planning process: A systematic narrative synthesis.

BACKGROUND: An increasing number of young people are living with life-limiting conditions. Current research about advance care planning for young people indicates differing experiences for those involved. Understanding how far young people are engaged in their own advance care plan is important to shape future practice and facilitate young people's wishes. AIM: To identify and assess the current evidence to determine the barriers and facilitators to the engagement of young people in their own advance care planning process. DESIGN: A systematic narrative synthesis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a quality assessment framework previously used in similar research. DATA SOURCES: CINAHL Complete, MEDLINE, PubMed and PsycINFO were searched for articles published between 1 January 1990 and 31 October 2017. Grey literature was searched using Google Scholar and Open Grey. RESULTS: Most studies related to the engagement of young people were conducted in hospitals or other institutions. Research reported not only the aim to include young people in their own advance care planning but also potential barriers to engagement. Barriers include poor communication, conflict within relationships of those in the planning process and patchy education and training for healthcare professionals. Some existing studies are characterised by a lack of rigorous, high-quality research, limiting their impact. CONCLUSION: Irrespective of setting, engagement of young people would benefit their advance care planning. More detailed, high-quality research is needed to understand the extent of the barriers to young people's engagement in their own advance care plan and how to facilitate their involvement.

Wind tunnel and numerical data on the ventilation performance of windcatcher with wing wall.

The data presented in this article were the basis for the study reported in the research articles entitled "Evaluation of a two-sided windcatcher integrated with wing wall (as a new design) and comparison with a conventional windcatcher" (P. Nejat, J.K. Calautit, M.Z.A. Majid, B.R. Hughes, I. Zeynali, F. Jomehzadeh, 2016) [1] which presents the effect of wing wall on the air flow distribution under using the windcatchers as a natural ventilation equipment. Here, we detail the wind tunnel testing and numerical set-up used for obtaining the data on ventilation rates and indoor airflow distribution inside a test room with a two-sided windcatcher and wing wall. Three models were integrated with wing wall angled at 30°, 45° and 60° and another windcatcher was a conventional two-sided device. The computer-aided design (CAD) three-dimensional geometries which were produced using Solid Edge modeler are also included in the data article.

Data on the natural ventilation performance of windcatcher with anti-short-circuit device (ASCD).

This article presents the datasets which were the results of the study explained in the research paper 'Anti-short-circuit device: a new solution for short-circuiting in windcatcher and improvement of natural ventilation performance' (P. Nejat, J.K. Calautit, M.Z. Abd. Majid, B.R. Hughes, F. Jomehzadeh, 2016) [1] which introduces a new technique to reduce or prevent short-circuiting in a two-sided windcatcher and also lowers the indoor CO2 concentration and improve the ventilation distribution. Here, we provide details of the numerical modeling set-up and data collection method to facilitate reproducibility. The datasets includes indoor airflow, ventilation rates and CO2 concentration data at several points in the flow field. The CAD geometry of the windcatcher models are also included.

CFD and experimental data of closed-loop wind tunnel flow.

The data presented in this article were the basis for the study reported in the research articles entitled 'A validated design methodology for a closed loop subsonic wind tunnel' (Calautit et al., 2014) [1], which presented a systematic investigation into the design, simulation and analysis of flow parameters in a wind tunnel using Computational Fluid Dynamics (CFD). The authors evaluated the accuracy of replicating the flow characteristics for which the wind tunnel was designed using numerical simulation. Here, we detail the numerical and experimental set-up for the analysis of the closed-loop subsonic wind tunnel with an empty test section.

Wind tunnel data of the analysis of heat pipe and wind catcher technology for the built environment.

The data presented in this article were the basis for the study reported in the research articles entitled 'Climate responsive behaviour heat pipe technology for enhanced passive airside cooling' by Chaudhry and Hughes [10] which presents the passive airside cooling capability of heat pipes in response to gradually varying external temperatures and related to the research article "CFD and wind tunnel study of the performance of a uni-directional wind catcher with heat transfer devices" by Calautit and Hughes [1] which compares the ventilation performance of a standard roof mounted wind catcher and wind catcher incorporating the heat pipe technology. Here, we detail the wind tunnel test set-up and inflow conditions and the methodologies for the transient heat pipe experiment and analysis of the integration of heat pipes within the control domain of a wind catcher design.

Multi-channel absolute distance measurement system with sub ppm-accuracy and 20 m range using frequency scanning interferometry and gas absorption cells.

We present an implementation of an absolute distance measurement system which uses frequency scanning interferometry (FSI). The technique, referred to as dynamic FSI, uses two frequency scanning lasers, a gas absorption cell and a reference interferometer to determine the unknown optical path length difference (OPD) of one or many measurement interferometers. The gas absorption cell is the length reference for the measurement system and is traceable to international standards through knowledge of the frequencies of its absorption features. The OPD of the measurement interferometers can vary during the measurement and the variation is measured at the sampling rate of the system (2.77 MHz in the system described here). The system is shown to measure distances from 0.2 m to 20 m with a combined relative uncertainty of 0.41 × 10⁻6 at the two sigma level (k = 2). It will be shown that within a scan the change in OPD of the measurement interferometer can be determined to a resolution of 40 nm.

High-throughput ClonePix FL analysis of mAb-expressing clones using the UCOE expression system.

Therapeutic recombinant monoclonal antibodies (mAbs) are commonly produced by high-expressing, clonal, mammalian cells. Creation of these clones for manufacturing remains heavily reliant on stringent selection and gene amplification, which in turn can lead to genetic instability, variable expression, product heterogeneity and prolonged development timelines. Inclusion of cis-acting ubiquitous chromatin opening elements (UCOE™) in mammalian expression vectors has been shown to improve productivity and facilitate high-level gene expression irrespective of the chromosomal integration site without lengthy gene amplification protocols. In this study we have used high-throughput robotic clone selection in combination with UCOE™ containing expression vectors to develop a rapid, streamlined approach for early-stage cell line development and isolation of high-expressing clones for mAb production using Chinese hamster ovary (CHO) cells. Our results demonstrate that it is possible to go from transfection to stable clones in only 4 weeks, while achieving specific productivities exceeding 20 pg/cell/day. Furthermore, we have used this approach to quickly screen several process-crucial parameters including IgG subtype, enhancer-promoter combination and UCOE™ length. The use of UCOE™-containing vectors in combination with automated robotic selection provides a rapid method for the selection of stable, high-expressing clones.

Lymph node metastasis in intermediate-risk penile squamous cell cancer: a two-centre experience.

BACKGROUND: The risk of lymph node (LN) metastasis in G2T1 penile cancer has been previously reported as 0-50% and is classified as "intermediate" in the European Association of Urology (EAU) guidelines. The management of impalpable regional nodes in this cohort of patients remains contentious and varies among treatment centres depending on tumour factors and local resources. OBJECTIVES: To establish the risk of LN metastasis in G2T1 disease. DESIGN, SETTINGS, AND PARTICIPANTS: We interrogated the databases of two referral centres for penile cancer. MEASUREMENTS: Out of 902 patients, 117 (13%) patients were identified with G2T1 cancers. Those with palpable inguinal nodes (cN1) underwent early inguinal LN dissection (iLND). Those with clinically node negative (cN0) inguinal basins were either observed or surgically staged with iLND or by dynamic sentinel LN biopsy (DSLNB). Median follow-up was 44 mo, with minimum follow-up of 6 mo. RESULTS AND LIMITATIONS: Fifteen of 117 (13%) patients with G2T1 cancer had LN metastasis at initial staging or during follow-up. Six of 12 (50%) cN1 patients had histologically proven LN metastasis on iLND. One hundred five patients were cN0 at presentation. Ten cN0 patients had prophylactic iLND, none of which yielded LN metastasis; 5 of 64 (8%) cN0 patients who had DSLNB had tumour-positive LNs, and 4 of 31 (13%) cN0 patients who were observed developed LN metastasis during follow-up. In cN0 patients, the risk of LN metastasis at initial staging or during surveillance was 9%. CONCLUSIONS: We consider that in cN0 patients with G2T1 penile cancer, the risk of developing metastases during surveillance warrants surgical and potentially curative staging. However, the morbidity of prophylactic bilateral iLND is too great to justify a detection rate of 9%. Less morbid alternatives such as DSLNB are advisable in G2T1 disease.

Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis.

PURPOSE: Sentinel node biopsy is used to evaluate the nodal status of patients with clinically node-negative penile carcinoma. Its use is not widespread, and the majority of patients with clinically node-negative disease undergo an elective inguinal lymph node dissection. Reservations about the use of sentinel node biopsy include the fact that most current results come from one institution and the supposedly long learning curve associated with the procedure. The purpose of this study was to address these issues by analyzing results from two centers and by evaluating the learning curve. PATIENTS AND METHODS: All patients undergoing sentinel node biopsy for penile carcinoma at two centers were included. The sentinel node identification rate, false-negative rate, and morbidity of the procedure were calculated. RESULTS: from the first 30 procedures were assessed for a potential learning curve. Results A total of 323 patients with penile squamous cell carcinoma, which included 611 clinically node-negative groins, were scheduled for sentinel node biopsy. A sentinel node was found in 572 of the 592 groins (97%) that proceeded to sentinel node biopsy. In 79 groins, a sentinel node was positive for tumor. Six inguinal node recurrences occurred after a negative sentinel node procedure, all within 15 months after sentinel node biopsy. The combined false-negative rate was 7%. Complications occurred in 4.7% of explored groins. None of the false-negative procedures occurred in the initial 30 procedures. CONCLUSION: Sentinel node biopsy is a suitable procedure to stage clinically node-negative penile cancer, and it has a low complication rate. No learning curve was demonstrated in this study.