Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [RCPCH Poster]

Conflicts over the care of children with life-limiting conditions can reach the point where courts have to intervene,but giving evidence causes distress, unwanted media attention and costs. The decision in Charlie Gard’s case in Englandincluded a plea for parties to mediate. No case has arisen in Scotland, where law and practice differ, but there are approximately 16,000 children with complex conditions where care might potentially be disputed. This study seeks to understand reasons for disputes, identify potential solutions (including mediation) and reduce the risk of a case coming before a Scottish court. In-depth interviews (online and face-to-face) with NHS Grampian clinicians and parents were conducted from which qualitative data were obtained on their experiences and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches. This is being funded by the NHS Grampian Endowment Fund. Ten clinicians and five parents were interviewed. Preliminary thematic analysis suggests that clinicians feel multidisciplinary team meetings improve conflict resolution for patients with complex requirements, where specialism boundaries can blur. When disputes arise, the type of intervention varied depending on its scale, urgency and impact on other care teams. A cause of disputes is variation in goals within and between care teams, but micro-discussions and step-bystep approaches from the outset work well and mitigate risk of disputes. The settings, timing and language used in conversations with parents is important. Findings suggest that clinicians may prefer a two-stage process where meetings are held without parents in the first instance. A strong Chair facilitates useful meetings, but parents still find it difficult to know who to address questions to. Families' use of social media/online searches can be problematic and lead to strained relationships, but emphasis on 'good death' and 'doing what's right' were highlighted. When a child is hospitalised, 'handing over' a child who has been looked after at home can be difficult for parents and home care teams. A desire to connect with parents facing similar challenges was expressed. It is clear that conflict exists in Scottish paediatric care. Practice suggests that there are strategies which can be employed to minimise risk of intractable disputes arising which could be used to assess the suitability of mediation and formalised into a toolkit to support families and clinicians

Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [NHS Grampian R&D Poster]

Conflicts between parents and clinicians over the care of children with life-limiting conditions can reach the point where courts must intervene, causing distress, unwanted media attention and costs. This NHS Grampian case study sought to understand reasons for disputes, identify potential solutions and reduce the risk of a case coming before a Scottish court. In-depth semi-structured interviews with 20 participants (a mix of NHS Grampian clinicians and parents) were conducted from which qualitative data were obtained on their experiences of and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches

Chromosomal radiosensitivity of lymphocytes in South African breast cancer patients of different ethnicity: An indirect measure of cancer susceptibility

Background. Breast cancer is the leading cancer among South African (SA) women. SA has citizens from diverse ethnic groups, and the lifetime risk of breast cancer differs according to ethnicity. Candidate genes for increased breast cancer risk are those involved in DNA damage repair pathways, and mutations in these genes are characterised by increased chromosomal radiosensitivity. Several European studies have shown that breast cancer patients are more sensitive to ionising radiation than healthy individuals.Objectives. To investigate the in vitro chromosomal radiosensitivity of SA women with breast cancer and the possible influence of ethnicity and clinical parameters on chromosomal radiosensitivity.Methods. Chromosomal radiosensitivity was analysed with the micronucleus assay using lymphocytes of breast cancer patients and healthy individuals of different ethnic groups. Lymphocytes were irradiated in vitro with 2 Gy or 4 Gy, and micronuclei (MN) were scored 70 hours after irradiation. These MN frequencies were correlated with the ethnicity and clinical parameters of the breast cancer patients.Results. MN values were higher in breast cancer patients than in healthy controls. This was noted for black and white breast cancer patients at the different radiation doses. No correlations could be demonstrated between MN values and clinical parameters of the breast cancer, except that MN values were significantly higher in oestrogen receptor (ER)-positive breast cancers.Conclusion. SA breast cancer patients have elevated chromosomal radiosensitivity compared with healthy controls. ER positivity also influences chromosomal radiosensitivity

Genome-wide association studies for feedlot and growth traits in cattle

A genome wide-association study for production traits in cattle was carried out using genotype data from the 10K Affymetrix (Santa Clara, CA) and the 50K Illumina (San Diego, CA) SNP chips. The results for residual feed intake (RFI), BW, and hip height in 3 beef breed types (Bos indicus, Bos taurus, and B. indicus × B. taurus), and for stature in dairy cattle, are presented. The aims were to discover SNP associated with all traits studied, but especially RFI, and further to test the consistency of SNP effects across different cattle populations and breed types. The data were analyzed within data sets and within breed types by using a mixed model and fitting 1 SNP at a time. In each case, the number of significant SNP was more than expected by chance alone. A total of 75 SNP from the reference population with 50K chip data were significant (P < 0.001) for RFI, with a false discovery rate of 68%. These 75 SNP were mapped on 24 different BTA. Of the 75 SNP, the 9 most significant SNP were detected on BTA 3, 5, 7, and 8, with P ≤ 6.0 × 10 . In a population of Angus cattle divergently selected for high and low RFI and 10K chip data, 111 SNP were significantly (P < 0.001) associated with RFI, with a false discovery rate of 7%. Approximately 103 of these SNP were therefore likely to represent true positives. Because of the small number of SNP common to both the 10K and 50K SNP chips, only 27 SNP were significantly (P < 0.05) associated with RFI in the 2 populations. However, other chromosome regions were found that contained SNP significantly associated with RFI in both data sets, although no SNP within the region showed a consistent effect on RFI. The SNP effects were consistent between data sets only when estimated within the same breed type

The changing of the guard: groupwork with people who have intellectual disabilities

This paper considers the impact of service systems on group activities. It describes an inter-professional groupwork project facilitated by a social worker and a community nurse. The project provided an emancipatory experience for a group of adults who had intellectual disabilities. The group was charged with the task of reviewing and updating the recruitment and interview processes used by a 'Learning Disability Partnership Board', when employing new support workers. The paper begins with a brief history of intellectual disability and provides a context to the underpinning philosophical belief that people should be encouraged and supported to inhabit valued social roles no matter what disability they may have. It then identifies the ways in which the sponsoring health, education and social care services impacted on the creation and development of a groupwork project. It might have been expected that the nature of the intellectual disability would have been the major influence on group process. However the paper reveals that organisational constraints had a significant impact on group functioning. Issues including, staffing budgets and transport contracts impacted on group process and function. The results of the project show how, with adequate support, people with intellectual disability can make important decisions that have long-reaching impacts on the services

Effectiveness of early intervention programs for parents of preterm infants: a meta-review of systematic reviews

Background: Various intervention programs exist for parents of preterm babies and some systematic reviews (SRs) have synthesised the evidence of their effectiveness. These reviews are, however, limited to specific interventions, components, or outcomes, and a comprehensive evidence base is lacking. The aim of this meta-review was to appraise and meta-synthesise the evidence from existing SRs to provide a comprehensive evidence base on the effectiveness of interventions for parents of preterm infants on parental and infant outcomes. Methods: We conducted a comprehensive search of the following databases to identify relevant SRs: Cochrane library, Web of science, EMBASE, CINAHL, British Nursing Index, PsycINFO, Medline, ScienceDirect, Scopus, IBSS, DOAJ, ERIC, EPPI-Centre, PROSPERO, WHO Library. Additional searches were conducted using authors’ institutional libraries, Google Scholar, and the reference lists of identified reviews. Identified articles were screened in two stages against an inclusion criteria with titles and abstracts screened first followed by full-text screening. Selected SRs were appraised using the AMSTAR tool. Extracted data using a predesigned tool were synthesised narratively examining the direction of impact on outcomes. Results: We found 11 SRs eligible for inclusion that synthesised a total of 343 quantitative primary studies. The average quality of the SRs was ‘medium’. Thirty four interventions were reported across the SRs with considerable heterogeneity in the structural framework and the targeted outcomes that included maternal-infant dyadic, maternal/parental, and infant outcomes. Among all interventions, Kangaroo Care (KC) showed the most frequent positive impact across outcomes (n = 19) followed by Mother Infant Transaction Program (MITP) (n = 14). Other interventions with most consistent positive impact on infant outcomes were Modified-Mother Infant Transaction Program (M-MITP) (n = 6), Infant Health and Development Program (IHDP) (n = 5) and Creating Opportunities for Parent Empowerment (COPE) (n = 5). Overall, interventions with both home and facility based components showed the most frequent positive impact across outcomes. Conclusions: Neonatal care policy and planning for preterm babies should consider the implementation of interventions with most positive impact on outcomes. The heterogeneity in interventions and outcomes calls for the development and implementation of an integrated program for parents of preterm infants with a clearly defined global set of parental and infant outcomes

Characterization and Profiling of Liver microRNAs by RNA-sequencing in Cattle Divergently Selected for Residual Feed Intake

MicroRNAs (miRNAs) are short non-coding RNAs that post-transcriptionally regulate expression of mRNAs in many biological pathways. Liver plays an important role in the feed efficiency of animals and high and low efficient cattle demonstrated different gene expression profiles by microarray. Here we report comprehensive miRNAs profiles by next-gen deep sequencing in Angus cattle divergently selected for residual feed intake (RFI) and identify miRNAs related to feed efficiency in beef cattle. Two microRNA libraries were constructed from pooled RNA extracted from livers of low and high RFI cattle, and sequenced by Illumina genome analyser. In total, 23,628,103 high quality short sequence reads were obtained and more than half of these reads were matched to the bovine genome (UMD 3.1). We identified 305 known bovine miRNAs. Bta-miR-143, bta-miR-30, bta-miR-122, bta-miR-378, and bta-let-7 were the top five most abundant miRNAs families expressed in liver, representing more than 63% of expressed miRNAs. We also identified 52 homologous miRNAs and 10 novel putative bovine-specific miRNAs, based on precursor sequence and the secondary structure and utilizing the miRBase (v. 21). We compared the miRNAs profile between high and low RFI animals and ranked the most differentially expressed bovine known miRNAs. Bovine miR-143 was the most abundant miRNA in the bovine liver and comprised 20% of total expressed mapped miRNAs. The most highly expressed miRNA in liver of mice and humans, miR-122, was the third most abundant in our cattle liver samples. We also identified 10 putative novel bovine-specific miRNA candidates. Differentially expressed miRNAs between high and low RFI cattle were identified with 18 miRNAs being up-regulated and 7 other miRNAs down-regulated in low RFI cattle. Our study has identified comprehensive miRNAs expressed in bovine liver. Some of the expressed miRNAs are novel in cattle. The differentially expressed miRNAs between high and low RFI give some insights into liver miRNAs regulating physiological pathways underlying variation in this measure of feed efficiency in bovines

Recommended Maximum Temperature For Mars Returned Samples

The Returned Sample Science Board (RSSB) was established in 2015 by NASA to provide expertise from the planetary sample community to the Mars 2020 Project. The RSSB's first task was to address the effect of heating during acquisition and storage of samples on scientific investigations that could be expected to be conducted if the samples are returned to Earth. Sample heating may cause changes that could ad-versely affect scientific investigations. Previous studies of temperature requirements for returned mar-tian samples fall within a wide range (-73 to 50 degrees Centigrade) and, for mission concepts that have a life detection component, the recommended threshold was less than or equal to -20 degrees Centigrade. The RSSB was asked by the Mars 2020 project to determine whether or not a temperature requirement was needed within the range of 30 to 70 degrees Centigrade. There are eight expected temperature regimes to which the samples could be exposed, from the moment that they are drilled until they are placed into a temperature-controlled environment on Earth. Two of those - heating during sample acquisition (drilling) and heating while cached on the Martian surface - potentially subject samples to the highest temperatures. The RSSB focused on the upper temperature limit that Mars samples should be allowed to reach. We considered 11 scientific investigations where thermal excursions may have an adverse effect on the science outcome. Those are: (T-1) organic geochemistry, (T-2) stable isotope geochemistry, (T-3) prevention of mineral hydration/dehydration and phase transformation, (T-4) retention of water, (T-5) characterization of amorphous materials, (T-6) putative Martian organisms, (T-7) oxidation/reduction reactions, (T-8) (sup 4) He thermochronometry, (T-9) radiometric dating using fission, cosmic-ray or solar-flare tracks, (T-10) analyses of trapped gasses, and (T-11) magnetic studies

Meat production and maintaining biodiversity: Grazing by traditional breeds and crossbred beef cattle in marshes and grasslands

Questions: Sustainable rangeland utilization considering traditions and economic reasons is compulsory for harmonising the needs of the agricultural and nature conservation sectors. For proper rangeland management it is crucial to compare the grazing effects of traditional breeds and crossbred animals of the same species that might have different effects on the rangelands. To fill this knowledge gap, in a grazing experiment, we investigated the effect of cattle breeds on the vegetation to test the effects on nature conservation value and agricultural production value. We hypothesized that the effects of cattle grazing on habitat conservation values and forage quality depend on the grazing breed, because breeds differ in selectivity, body size and trampling effect. Location: Marshes and alkaline wet grasslands in Hortobágy National Park, Hungary. Methods: We recorded the percentage cover of vascular plants in three consecutive years in a total of 60 plots in 12 areas grazed by traditional (0.61 AU/ha) and largesized crossbred beef cattle (0.68 AU/ha). Results: We found that the effect of cattle breed on the habitat conservation values and forage quality is dependent on the habitat type. The traditional breed maintained a significantly higher species number and Shannon diversity in marshes than the crossbred beef cattle. Grazing of crossbred cattle led to decreasing moisture indicator values in marsh habitats. Conclusions: Our findings revealed that traditional breeds should be prioritized in the management of wet alkaline grasslands and marshes. Crossbred beef cattle might be a substitute but only in case traditional breeds are not available for the management of alkaline wet grasslands. In marshes, however, we recommend prioritizing the traditional breeds as they maintain higher diversity compared to crossbred beef cattle