UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework

Background: Studies indicate there is a need to improve the delivery of unexpected news via obstetric ultrasound, but there have been few advances in this area. One factor preventing improvement has been a lack of consensus regarding the appropriate phrases and behaviours which sonographers and ultrasound practitioners should use in these situations. Aims: To develop consensus guidelines for unexpected news delivery in Early Pregnancy Unit and Fetal Anomaly Screening Programme NHS settings. Methods: A workshop was conducted to identify priorities and reach consensus on areas of contention. Contributors included interdisciplinary healthcare professionals, policy experts, representatives from third-sector organisations, lay experts and academic researchers (n = 28). Written and verbal feedback was used to draft initial guidance which was then circulated amongst the wider writing group (n = 39). Revisions were undertaken until consensus was reached. Results: Consensus guidelines were developed outlining the behaviours and phrases which should be used during scans where unexpected findings are identified. Specific recommendations included that: honest and clear communication should be prioritised, even with uncertain findings; technical terms should be used, but these should be written down together with their lay interpretations; unless expectant parents use other terminology (e.g. ‘foetus’), the term ‘baby’ should be used as a default, even in early pregnancy; at the initial news disclosure, communication should focus on information provision. Expectant parents should not be asked to make decisions during the scan. Conclusions: These recommendations can be used to develop and improve news delivery interventions in obstetric ultrasound settings. The full guidelines can be accessed online as supplemental material and at https://doi.org/10.5518/100/24

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Recollint valoracions de la natura : perspectives ecològiques, econòmiques i culturals

En aquest article es presenta una tipologia d'enfocaments per valorar la natura, basant-se en una investigació elaborada per a l'Agència Britànica del Medi Ambient. El context canviant de la conservació de la natura al Regne Unit ha propiciat la invenció de la metàfora del «capital natural», que no considerem oportuna. També s'hi explora una tipologia de quatre enfocaments que revela la importància del diàleg entre disciplines. S'hi planteja que no hi ha una alternativa als sistemes de valoració de política ambiental duts a terme per experts i, de fet, és possible combinar els punts forts d'un procés analític rigorós i justificable amb un enfocament més complet i deliberatiu per acordar valors i directrius que caldria seguir en relació amb la Natura.En este artículo se presenta una tipología de enfoques para valorar la naturaleza, basándose en una investigación elaborada para la Agencia Británica del Medio Ambiente. El contexto cambiante de la conservación de la naturaleza en el Reino Unido ha propiciado la invención de la metáfora del «capital natural», que no consideramos oportuna. También se explora una tipología de cuatro enfoques que revela la importancia del diálogo entre disciplinas. Se plantea que no hay una alternativa a los sistemas de valoración de política ambiental llevados a cabo por expertos y, de hecho, es posible combinar los puntos fuertes de un proceso analítico riguroso y justificable con un enfoque más completo y deliberante para acordar valores y directrices que convendría seguir en relación con la naturaleza.Dans cet article est presentée une tipologie d'approches pour valoriser la nature, en base à une recherche elaborée pour l'Agence Anglaise de l'Environnement. Le contexte changeant de la presevation de la nature au Royaume Uni a porté l'invention de la metafore du «capital naturel», avec laquelle on n'est pas d'acord. Aussi on explore une tipologie de quatre approches que revèle l'importance du dialogue entre disciplines. On voit qu'il n'y a pas une alternative aux systèmes de valorisation de la politique sur l'environnement faite par experts et, en fait, est possible de combiner les points forts d'un procés analitique et justificable avec un approche plus complet et déliberatif pour accorder valorisations et lignes à suivre en rélation à la nature.In this paper, a typology of current approaches to valuing nature is presented, by reference to a research completed for the UK Environment Agency. The changing context of nature conservation in the UK which has facilitated the coining of the metaphor of «natural capital», which we do not feel at all comfortable with. It is also explored a typology of four approaches which reveals the importance of dialogue between disciplines. We address the argument that there is no alternative to expert-driven systems of valuation for environmental policy-making and, in fact, it is possible to combine the strengths of an analytical process which is rigorous and defensible, with a more inclusive and deliberative approach to agreeing values for nature

Recollint valoracions de la natura : perspectives ecològiques, econòmiques i culturals

En aquest article es presenta una tipologia d'enfocaments per valorar la natura, basant-se en una investigació elaborada per a l'Agència Britànica del Medi Ambient. El context canviant de la conservació de la natura al Regne Unit ha propiciat la invenció de la metàfora del «capital natural», que no considerem oportuna. També s'hi explora una tipologia de quatre enfocaments que revela la importància del diàleg entre disciplines. S'hi planteja que no hi ha una alternativa als sistemes de valoració de política ambiental duts a terme per experts i, de fet, és possible combinar els punts forts d'un procés analític rigorós i justificable amb un enfocament més complet i deliberatiu per acordar valors i directrius que caldria seguir en relació amb la Natura.En este artículo se presenta una tipología de enfoques para valorar la naturaleza, basándose en una investigación elaborada para la Agencia Británica del Medio Ambiente. El contexto cambiante de la conservación de la naturaleza en el Reino Unido ha propiciado la invención de la metáfora del «capital natural», que no consideramos oportuna. También se explora una tipología de cuatro enfoques que revela la importancia del diálogo entre disciplinas. Se plantea que no hay una alternativa a los sistemas de valoración de política ambiental llevados a cabo por expertos y, de hecho, es posible combinar los puntos fuertes de un proceso analítico riguroso y justificable con un enfoque más completo y deliberante para acordar valores y directrices que convendría seguir en relación con la naturaleza.Dans cet article est presentée une tipologie d'approches pour valoriser la nature, en base à une recherche elaborée pour l'Agence Anglaise de l'Environnement. Le contexte changeant de la presevation de la nature au Royaume Uni a porté l'invention de la metafore du «capital naturel», avec laquelle on n'est pas d'acord. Aussi on explore une tipologie de quatre approches que revèle l'importance du dialogue entre disciplines. On voit qu'il n'y a pas une alternative aux systèmes de valorisation de la politique sur l'environnement faite par experts et, en fait, est possible de combiner les points forts d'un procés analitique et justificable avec un approche plus complet et déliberatif pour accorder valorisations et lignes à suivre en rélation à la nature.In this paper, a typology of current approaches to valuing nature is presented, by reference to a research completed for the UK Environment Agency. The changing context of nature conservation in the UK which has facilitated the coining of the metaphor of «natural capital», which we do not feel at all comfortable with. It is also explored a typology of four approaches which reveals the importance of dialogue between disciplines. We address the argument that there is no alternative to expert-driven systems of valuation for environmental policy-making and, in fact, it is possible to combine the strengths of an analytical process which is rigorous and defensible, with a more inclusive and deliberative approach to agreeing values for nature

Effect of the Colorless non-ripening Mutation on Cell Wall Biochemistry and Gene Expression during Tomato Fruit Development and Ripening

The Colorless non-ripening (Cnr) mutation in tomato (Solanum lycopersicum) results in mature fruits with colorless pericarp tissue showing an excessive loss of cell adhesion (A.J. Thompson, M. Tor, C.S. Barry, J. Vrebalov, C. Orfila, M.C. Jarvis, J.J. Giovannoni, D. Grierson, G.B. Seymour [1999] Plant Physiol 120: 383–390). This pleiotropic mutation is an important tool for investigating the biochemical and molecular basis of cell separation during ripening. This study reports on the changes in enzyme activity associated with cell wall disassembly in Cnr and the effect of the mutation on the program of ripening-related gene expression. Real-time PCR and biochemical analysis demonstrated that the expression and activity of a range of cell wall-degrading enzymes was altered in Cnr during both development and ripening. These enzymes included polygalacturonase, pectinesterase (PE), galactanase, and xyloglucan endotransglycosylase. In the case of PE, the protein product of the ripening-related isoform PE2 was not detected in the mutant. In contrast with wild type, Cnr fruits were rich in basic chitinase and peroxidase activity. A microarray and differential screen were used to profile the pattern of gene expression in wild-type and Cnr fruits. They revealed a picture of the gene expression in the mutant that was largely consistent with the real-time PCR and biochemical experiments. Additionally, these experiments demonstrated that the Cnr mutation had a profound effect on many aspects of ripening-related gene expression. This included a severe reduction in the expression of ripening-related genes in mature fruits and indications of premature expression of some of these genes in immature fruits. The program of gene expression in Cnr resembles to some degree that found in dehiscence or abscission zones. We speculate that there is a link between events controlling cell separation in tomato, a fleshy fruit, and those involved in the formation of dehiscence zones in dry fruits

Adherence to antiretroviral therapy and acceptability of planned treatment interruptions in HIV-infected children

Contains fulltext : 117467.pdf (publisher's version ) (Open Access)There have been no paediatric randomised trials describing the effect of planned treatment interruptions (PTIs) of antiretroviral therapy (ART) on adherence, or evaluating acceptability of such a strategy. In PENTA 11, HIV-infected children were randomised to CD4-guided PTIs (n = 53) or continuous therapy (CT, n = 56). Carers, and children if appropriate, completed questionnaires on adherence to ART and acceptability of PTIs. There was no difference in reported adherence on ART between CT and PTI groups; non-adherence (reporting missed doses over the last 3 days or marking <100 % adherence since the last clinical visit on a visual analogue scale) was 18 % (20/111) and 14 % (12/83) on carer questionnaires in the CT and PTI groups respectively (odds ratios, OR (95 % CI) = 1.04 (0.20, 5.41), chi(2) (1) = 0.003, p = 0.96). Carers in Europe/USA reported non-adherence more often (31/121, 26 %) than in Thailand (1/73, 1 %; OR (95 % CI) = 54.65 (3.68, 810.55), chi(2) (1) = 8.45, p = 0.004). The majority of families indicated they were happy to have further PTIs (carer: 23/36, 64 %; children: 8/13, 62 %), however many reported more clinic visits during PTI were a problem (carer: 15/36, 42 %; children: 6/12, 50 %)