Developing a multimedia learning resource for allied health professionals: exploring the challenges of prolonged disorders of consciousness

Relevance: Recognising the increasing number of people being sustained with prolonged disorders of consciousness (PDoC), this study introduces new research with allied health professionals (AHPs) that is being used to create a range of digital resources to support AHP undergraduate education and practitioner CPD. Purpose: Previous research (Latchem et al., 2015) identified a mismatch between understandings that families of people with a PDoC hold of AHP interventions and the aims and understandings of AHPs delivering those interventions. This study explores a) how AHPs understand and navigate practical, ethical and legal issues surrounding the care of these patients, b) the learning needs of both qualified and pre-registration AHPs and c) uses the data to create e-learning resources for AHPs and their students. Methods/analysis: This qualitative study uses video-taped interviews with 15 physiotherapists, occupational therapists and speech and language therapists purposively sampled from NHS and independent care providers, and workshops conducted with mixed AHP pre-registration students. The interviews/workshops were transcribed and analysed thematically, adopting a grounded-theory approach to examine experience and learning needs surrounding PDoC care. Emergent themes informed the focus and structure of the e-learning resource. Results: AHPs described how the needs of PDoC patients shifted the focus of, and extended their clinical skills. They reported struggling adjusting to, and finding satisfaction in, their work with this client group who don’t ‘improve’, have a clear rehabilitative nor declining trajectory. Satisfaction however was derived through close multidisciplinary team working. The intertwining of their therapeutic work occurred to such an extent that AHPs resisted defining a distinct disciplinary role and instead discussed their work as entirely interdisciplinary. AHPs repeatedly identified the dilemmas faced by families and discussed the tensions in their own thinking as their clinical objectivity clashed with their own sense of and feelings about the patients’ level of consciousness. They highlighted concerns about the ethics of medical ‘advancements’ and life-sustaining treatments and expressed uneasiness and uncertainty regarding their role in treatment withdrawal situations. Pilot workshops are being developed around these key issues and e-learning resources to support needs for training will be ready for dissemination at conference. Discussion and conclusions: Both families and AHPs can question patients’ level of awareness and the rationale of treatments. However, when families expect ongoing therapeutic input for their relative, or conversely see them as ‘irretrievably gone’, this sits in tension with AHP's clinical reasoning or at times, their relentless striving to capture signs of awareness and for ‘rehabilitation’. Ethical, legal, social and clinical dilemmas collide in the care of PDOC patients, challenging much contemporary clinical practice and pre-registration education. This study and the developing multimedia learning resource demonstrate the interplay between these elements and the scope for CPD support. Impact and implications: The research is developing a new multi-media resource to improve understandings of caring for PDoC patients/their families and related ethical/social/clinical issues. The resource builds on Kitzinger and Kitzinger's successful healthtalk.org module for families and has buy-in from the core AHP Professional Bodies. Our aim is that this AHP-facing resource will have high accessibility, MDT value and impact on personal, practice and curricula development

Anatomical study of serotonergic innervation and 5-HT1A receptor in the human spinal cord

Serotonergic innervation of the spinal cord in mammals has multiple roles in the control of motor, sensory and visceral functions. In rats, functional consequences of spinal cord injury at thoracic level can be improved by a substitutive transplantation of serotonin (5-HT) neurons or regeneration under the trophic influence of grafted stem cells. Translation to either pharmacological and/or cellular therapies in humans requires the mapping of the spinal cord 5-HT innervation and its receptors to determine their involvement in specific functions. Here, we have performed a preliminary mapping of serotonergic processes and serotonin-lA (5-HT1A) receptors in thoracic and lumbar segments of the human spinal cord. As in rodents and non-human primates, 5-HT profiles in human spinal cord are present in the ventral horn, surrounding motoneurons, and also contact their presumptive dendrites at lumbar level. 5-HT1A receptors are present in the same area, but are more densely expressed at lumbar level. 5-HT profiles are also present in the intermediolateral region, where 5-HT1A receptors are absent. Finally, we observed numerous serotonergic profiles in the superficial part (equivalent of Rexed lamina II) of the dorsal horn, which also displayed high levels of 5-HT1A receptors. These findings pave the way for local specific therapies involving cellular and/or pharmacological tools targeting the serotonergic system

ID-HALL, a new double stage Hall thruster design. I. Principle and hybrid model of ID-HALL

International audienceIn Hall thrusters, ions are extracted from a quasineutral plasma by the electric field induced by the local drop of electron conductivity associated with the presence of a magnetic barrier. Since the electric field is used both to extract and accelerate ions and to generate the plasma, thrust and specific impulse are not independent in a Hall thruster. There is a need for versatile thrusters that can be used for a variety of maneuvers, i.e., that can operate either at high thrust or at high specific impulse for a given power. The double stage Hall thruster (DSHT) design could allow a separate control of ionization and acceleration, and hence separate control of thrust and specific impulse. In the DSHT configuration, a supplementary plasma source (ionization stage), independent of the applied voltage, is added and placed upstream of the magnetic barrier (acceleration stage). The DSHT concept is also well adapted to the use of alternative propellants, lighter and with a less efficient ionization than xenon. Several designs of double stage Hall thrusters have been proposed in the past, but these attempts were not really successful. In this paper, we present a brief review of the main DSHT designs described in the literature, we discuss the relevance of the DSHT concept, and, on the basis of simple physics arguments and simulation results, we propose a new design, called ID-HALL (Inductive Double stage HALL thruster). In this design, the ionization stage is a magnetized inductively coupled RF plasma. The inductive coil is inside the central cylinder of the thruster and located nearby the acceleration stage. Preliminary modeling results of this DSHT are described. Published by AIP Publishing. https://doi

Test Bench Of The Barrel Calorimeter Modules

A systematic procedure to qualify the barrel calorimeter modules is an essential step to guarantee a 0.7% constant term, which is the collaboration objective. The procedure detailed in this note consists of quality monitoring during mechanical assembling and of a set of electrical tests such as electrical continuity, cell and cross-talk capacitance measurement, and high-voltage behaviour. For the whole test, it has been necessary to develop dedicated electronic boards, to develop measurement methods, and the whole operation software. Making the procedure automatic will guarantee the quality of each module during assembling, cabling, and test in liquid argon

Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study.

BACKGROUND: Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions. METHODS: A three-round online Delphi study was conducted in England with health and social care professionals, data scientists, researchers, people living with multimorbidity and their carers. RESULTS: Our findings suggest a care system which is still predominantly single condition focused. 'Person-centred and holistic care' and 'coordinated and joined up care', were highly rated determinants in relation to improved care for multimorbidity. We further identified a range of non-medical determinants that are important to providing holistic care for this cohort. CONCLUSIONS: Further progress towards a holistic and patient-centred model is needed to ensure that care more effectively addresses the complex range of medical and non-medical needs of people living with multimorbidity. This requires a move from a single condition focused biomedical model to a person-based biopsychosocial approach, which has yet to be achieved

Clinico-toxicological effects of ceftriaxone after intramuscular administration of graded doses in Basenji dogs

Purpose: The recent ceftriaxone-induced anaemia and mortalities at the dose of 50 mg/kg in Veterinary Teaching Hospital, University of Nigeria prompted this study which sought to assess the clinicotoxicological effects of ceftriaxone (CFZ) after intramuscular administration of graded doses in Basenji dogs.Methods: The effects of CFZ on the haematological indices, physiological parameters, liver and kidney functions were assessed in 4 group of dogs (n = 4) designated A – D. They were given CFZ intramuscularly for 21 days at doses of 12, 25 and 50 mg/kg for groups A, B, C, respectively, while thecontrol (group D) received the diluent (lignocaine 0.2 mL)Results: The mean pulse and heart rate of dogs in group C were significantly (p < 0.05) higher than those of group A, B and D. Significant (p < 0.05) decrease in red blood cell count (RBC), haemoglobin concentration (Hb) and packed cell volume (PCV) was observed in group C on days 7 and 14, while on day 21, these parameters were significantly (p < 0.05) higher in group D than in the treated groups. On day 14 of CFZ administration, the alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) activities of dogs in group C was significantly (p < 0.05) elevated than the control group.Conclusion: These findings suggest that CFZ, at the doses of 12.5 - 25 mg/kg, appears safe in dogs as most of the adverse effects observed are reversed following the withdrawal of the drug on day 28. However, CFZ at 50 mg/kg causes anaemia, tachycardia and bilateral paralysis of the hind limbs which did not revert to normal after one week; hence, it is not recommended for use in dogs at this dose

Olympic legacy and cultural tourism: Exploring the facets of Athens' Olympic heritage

This study examines the effects of the Olympic Games on Athens’ cultural tourism and the city’s potential to leverage the Olympic legacy in synergy with its rich heritage in order to enhance its tourism product during the post-Games period. In doing so, a qualitative and interpretive approach was employed. This includes a literature review on Athens’ 2004 Olympics to identify the sport facilities and regeneration projects, which constitute the Olympic legacy and heritage. Based on that, an empirical analysis was undertaken, by collecting official documents about the 2004 Olympics, and conducting five semi-structured interviews with tourism/administrative officials. The findings indicate that the Olympiad contributed significantly to Athens’ built and human heritage, revealing the dimensions of new venues/facilities, infrastructure, transportation and aesthetic image of the city, and human capital enhancement. Hence, the Games affected to the multifaceted representation and reconstruction of the city’s identity and cultural heritage. However, the potential afforded from the post-Olympic Athens remains unrealised due to lack of strategic planning/management. The study concludes that there is a need to develop cross-leveraging synergies between the Olympic legacy and cultural tourism for the host city. Finally, a strategic planning framework for leveraging post-Games Olympic tourism is suggested in order to maximise the benefits of Olympic legacy and heritage in a host city’s tourism development