Woven Endobridge (WEB) Device as a Re-treatment Strategy after Unsuccessful Surgical Clipping

BACKGROUND: Surgical clipping of intracranial aneurysms is typically robust and durable. However, residual aneurysmal components may be seen after clipping. Furthermore, there may be occasional aneurysmal recurrence. These factors are both clinically relevant because subarachnoid hemorrhage after clipping is a rare but important event. The rationale for any treatment is to substantially decrease the future risk of hemorrhage. Small series have shown coiling as a retreatment strategy after unsuccessful clipping, but none has explored the feasibility of Woven Endobridge (WEB) implantation. CASE DESCRIPTION: We examined the feasibility of WEB implantation as second-line treatment for wide-necked residual aneurysms after unsuccessful clipping. We also recorded the safety and efficacy in this small series of 6 patients. To determine safety, we measured the modified Rankin Scale score before and after the procedure, and at 2 later time points (mean follow-up, 5 months and 15 months). To determine efficacy, we obtained radiographic aneurysm occlusion outcomes (including WEB Occlusion Scale) at these 2 time points. Four middle cerebral artery and 2 anterior communicating artery complex aneurysms were treated with WEB implantation, showing feasibility in 6/6 cases (100%). Follow-up at 15 months showed no change from preprocedural modified Rankin Scale score and there were no other complications. There was adequate occlusion in 5/6 cases (83%). CONCLUSIONS: WEB implantation provided a feasible option in this challenging retreatment scenario. This is a small series and prospective data are required to make outcome inferences for this population. Nonetheless, we observed no complications and high adequate occlusion rates

Cochrane Qualitative and Implementation Methods Group guidance paper 6:Methods for question formulation, searching, and protocol development for qualitative evidence synthesis

This paper updates previous Cochrane guidance on question formulation, searching, and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry and mapping the available information to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility, and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Furthermore, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route map, particularly in qualitative reviews that ask more exploratory and open-ended questions

Complete Reversible Refolding of a G-Protein Coupled Receptor on a Solid Support

The factors defining the correct folding and stability of integral membrane proteins are poorly understood. Folding of only a few select membrane proteins has been scrutinised, leaving considerable deficiencies in knowledge for large protein families, such as G protein coupled receptors (GPCRs). Complete reversible folding, which is problematic for any membrane protein, has eluded this dominant receptor family. Moreover, attempts to recover receptors from denatured states are inefficient, yielding at best 40-70% functional protein. We present a method for the reversible unfolding of an archetypal family member, the β1-adrenergic receptor, and attain 100% recovery of the folded, functional state, in terms of ligand binding, compared to receptor which has not been subject to any unfolding and retains its original, folded structure. We exploit refolding on a solid support, which could avoid unwanted interactions and aggregation that occur in bulk solution. We determine the changes in structure and function upon unfolding and refolding. Additionally, we employ a method that is relatively new to membrane protein folding; pulse proteolysis. Complete refolding of β1-adrenergic receptor occurs in n-decyl-β-D-maltoside (DM) micelles from a urea-denatured state, as shown by regain of its original helical structure, ligand binding and protein fluorescence. The successful refolding strategy on a solid support offers a defined method for the controlled refolding and recovery of functional GPCRs and other membrane proteins that suffer from instability and irreversible denaturation once isolated from their native membranes

Supporting parent-child conversations in a history museum

BACKGROUND: Museums can serve as rich resources for families to learn about the social world through engagement with exhibits and parent-child conversation about exhibits. AIMS: This study examined ways of engaging parents and child about two related exhibits at a cultural and history museum. Sample participants consisted of families visiting the Animal Antics and the Gone Potty exhibits at the British Museum. METHODS: Whilst visiting two exhibits at the British Museum, 30 families were assigned to use a backpack of activities, 13 were assigned to a booklet of activities, and 15 were assigned to visit the exhibits without props (control condition). RESULTS: Compared to the families in the control condition, the interventions increased the amount of time parents and children engaged together with the exhibit. Additionally, recordings of the conversations revealed that adults asked more questions related to the exhibits when assigned to the two intervention conditions compared to the control group. Children engaged in more historical talk when using the booklets than in the other two conditions. CONCLUSIONS: The findings suggest that providing support with either booklets or activities for children at exhibits may prove beneficial to parent-child conversations and engagement with museum exhibits

Ensuring an Essential Supply of Allied Health Professions (AHP) Placements: Using Crowdsourcing to Develop a National Call to Action

Sustainable growth in the Allied Health Professions (AHP) workforce is an ambition of the United Kingdom’s NHS Long Term Plan. However historically, access to good quality placements has been a barrier to increasing pre-registration training numbers. This article focuses on work carried out by Health Education England (HEE) to gain insights on the impact of the COVID-19 pandemic on capacity. Using a pragmatic, embedded mixed-methods approach, insights were gathered using an online workshop, crowdsourcing, open for two weeks in the summer of 2020. AHP placement stakeholders could vote, share ideas or comment. Descriptive data were extracted, and comments made were analysed using inductive thematic analysis. Participants (N = 1,800) made over 8,500 comments. The themes identified included: diversity of placement opportunity, improved placement coordination, a more joined-up system, supervision models and educator capacity. Alongside considering the challenges to placement capacity, several areas of innovative practice owing to the pandemic were highlighted. Generated insights have shaped the aims and objectives of the Health Education (HEE) pre-registration AHP student practice learning programme for 2020/2021 and beyond. The COVID-19 pandemic has disrupted the delivery of AHP placements. In the absence of face-to-face activities, crowdsourcing provided an online data collection tool offering stakeholders an opportunity to engage with the placement capacity agenda and share learning. Findings have shaped the HEE approach to short-term placement recovery and long-term growth

What makes health promotion research distinct?

There have been concerns about the decline of health promotion as a practice and discipline and alongside this, calls for a clearer articulation of health promotion research and what, if anything, makes it distinct. This discussion paper, based on a review of the literature; the authors’ own experiences in the field; and a workshop delivered by two of the authors at the 8th Nordic Health Promotion Conference, seeks to state the reasons why health promotion research is distinctive. While by no means exhaustive, the paper suggests four distinctive features. The paper hopes to be a catalyst to enable health promotion researchers to be explicit in their practice and to begin the process of developing an agreed set of research principles

A decision framework to identify populations that are most vulnerable to the population level effects of disturbance

This study was supported by Office of Naval Research grant N00014-16-1-2858: “PCoD+: Developing widely-applicable models of the population consequences of disturbance.”We present a decision framework to identify when detailed population-level assessments are required to understand the potential impacts of a disturbance-inducing activity on a marine mammal population and discuss how the framework can be applied to other taxa. Species at high risk of population-level effects can be identified using information on the number of individuals that are likely to be disturbed by the activity, total population size, the probability of repeated disturbance, the species’ reproductive strategy, and the life stages (e.g., feeding, pregnant, lactating) of the individuals most likely to be exposed. This hierarchical approach provides those responsible for conducting impact assessments with a time-efficient, cost-effective and reproducible workflow that allows them to prioritise their efforts and assign funds to those species with the most pressing conservation needs. A fully worked case study using marine mammals in the vicinity of a naval training activity is supplied.Publisher PDFPeer reviewe

Balancing act: exploring the tone of The Life Aquatic with Steve Zissou

This paper provides an analysis of The Life Aquatic in the context of debates around tone, irony, the Smart Film, the New Sincerity and the Quirky. It argues that Anderson is one of a small but significant number of filmmakers to escape from the indiscriminate irony of fin de sie`cle cinema, and finds The Life Aquatic Aquatic a particularly interesting film in which to explore such matters because of its ready artifice, strong elements of pastiche and measuredly preposterous excesses. Offering a critical analysis, the paper balances an engagement with some of the systemic elements of the film’s tone with the detailed organisation of tonal elements in particular sequences

Empowerment: Challenges in Measurement

Empowerment is core to health promotion however, there is a lack of consensus in the wider literature as to how to define it and at what level it may occur. Definitional inconsistency inevitably leads to challenges in measuring empowerment yet, if it is as important as is claimed this must be addressed. This paper discusses the complexities of measuring empowerment and puts forward a number of recommendations for researchers and policy makers as to how this can be achieved noting some of the tensions that may arise between theoretical considerations, research and practice. We argue that empowerment is a culturally and socially defined construct and that this should be taken into account in attempts to measure it. Finally we conclude that, in order to build up the evidence base for empowerment, there is a need for research clearly defining what it is and how it is being measured