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Should I stay or should I go?: how healthcare professionals close encounters with people with dementia in the acute hospital setting

Around a quarter of hospital beds in the UK are occupied by patients living with dementia (PWD), and communication impairments are common across all types of dementia, often exacerbated by the hospital environment. Unsurprisingly, healthcare professionals (HCPs) report particular challenges in caring for this patient group, whilst trying to recognise and value their personhood as per the underpinning ethos of person-centred care. However, whilst there is a growing body of research that underlines the importance of communication in dementia care, there is far less that actually examines this communication in real time interaction. Suggestions and pointers for good communication do exist, but these do not tend to be empirically derived, and sometimes conflict with empirical findings. This paper focuses on a specific area of interaction which has previously received very little attention: the way in which healthcare encounters are ended or closed. There is potentially a conflict between a pressure to manage a patient as efficiently as possible, and endeavouring to ensure person -centred care and deal with communication difficulties arising from dementia. Using conversation analysis, we examined forty-one video recordings of HCP/PWD interactions collected from an acute inpatient ward. We identify three phenomena around which there were recurring troubles in our dataset: ‘open-ended pre-closings’, ‘mixed messages’ and ‘non specifics and indeterminate terms’. We conclude that moves towards closing an encounter that appear intuitive to HCPs as competent interactants, and that may represent best practice in other healthcare settings, may in fact serve to confuse a PWD and create difficulties with closings. Our findings underline the importance of examining best practice guidance as it is actually talked into being, using approaches which can unpack the interactional detail involved. They also emphasise the importance of context in the analysis of healthcare delivery, to avoid a ‘one size fits all’ approach

Smells with cultural value: How to recognise and protect this heritage at risk?

Our engagement with heritage is largely visual whereas the potential of other sensory approaches is largely unexplored. Olfactory heritage is an emerging, interdisciplinary field linking material, intangible, and digital expressions of heritag

Heritage Quay: What Will You Discover? Transforming the Archives of the University of Huddersfield, Yorkshire, UK

The Heritage Quay project is changing how archive services at the University of Huddersfield are delivered. This article examines how the Staff/Space/Collections dependency model and Customer Service Excellence framework have been used, and what lessons can be drawn for other archives

Suono e Spettacolo. Athanasius Kircher, un percorso nelle Immagini sonore.

The Society of Jesus made great propaganda efforts throughout the seventeenth century and chose the images and the play as a privileged means to communicate and persuade. Athanasius Kircher, a key figure of the seventeenth century, he decided to dominate the wild nature of sound through Phonurgia Nova, which includes a gallery of powerful symbolic images for Baroque aesthetics. The essay, through the grant of the images from the Library of the Department of Mathematics "Guido Castelnuovo" Sapienza University of Rome, aims to understand, through the pictures offered by Kircher, the sound phenomenon and the spectacle that this produces. In Phonurgia Nova a process of dramatization sound effects takes place, often through machines and "visions" applied to the theatrical reality, as experimental and astonishing environment beloved in baroque. Kircher illustrates the sound through explanatory figures, so to dominate the sound through the eyes. Sound is seen, admired and represented: its spectacle not only takes place through the implementation of sound machines or the "wonders" applied to the theater, but even through images, creating create a sense of wonder in in the erudite person of the seventeenth century

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Methodologies for city-scale assessment of renewable energy generation potential to inform strategic energy infrastructure investment

In support of national and international policies to address climate change, local government actors across Europe and Asia are committed to reducing greenhouse gas emissions. Many recognise the contribution that decentralised renewable electricity production can bring towards reducing emissions whilst also generating revenue. However, these actors are often subject to significant financial pressures, meaning a reliable and compelling business case is needed to justify upfront investment. This article develops a method for rapid comparison of initial project viability for multiple city sites and installation options using data from wind and solar resource prediction techniques. In doing so, detailed resource assessments grounded in academic research are made accessible and useful for city practitioners. Long term average wind speeds are predicted using a logarithmic vertical wind profile. This employs detailed three-dimensional building data to estimate aerodynamic parameters for the complex urban surface. Solar resource is modelled using a Geographical Information System-based methodology. This establishes the location and geometry of roof structures to estimate insolation, whilst accounting for shading effects from other buildings and terrain features. Project viability for potential installations is assessed in terms of the net present value over the lifespan of the technology and associated Feed-in Tariff incentive. Discounted return on investment is also calculated for all sites. The methodology is demonstrated for a case study of 6,794 sites owned by Leeds City Council, UK. Results suggest significant potential for small-scale wind and solar power generation across council assets. A number of sites present a persuasive business case for investment, and in all cases, using the generated electricity on site improves financial viability. This indicates that initial installations should be sited at assets with high electricity demands. Overall, the work establishes a 2 methodology that enables large city-level asset holders to make strategic investment decisions across their entire portfolio, which are based on financial assessment of wind and solar generation potential accurate to the individual asset scale. Such tools could facilitate strategic planning within cities and help to ensure that investment in renewable energy is focused at the most viable sites. In addition, the methodology can assist with asset management at the city scale by identifying sites with a higher market value as a result of their potential for renewable energy generation than otherwise might be estimated

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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Anticipating Futures for Heritage : ICCROM Foresight Initiative Horizon Scan Study 2021

Strategic Foresight describes a set of approaches, tools and skills that help organizations explore, envision and shape the future. Foresight does not attempt to predict the future per se, but rather seeks to build an awareness of different possible futures for an organization or sector – challenging assumptions and expanding horizons. Conventional strategic planning tends to take a “business-as-usual” approach, extrapolating likely futures from past trends over a short-term horizon. Foresight, by contrast, looks out over a longer horizon – anything from ten to more than 50 years ahead – and engages with change in a more creative way to map out future contexts. Through provoking deeper thinking about the nature, drivers and implications of change, Foresight uses the future to help surface critical decisions to take in the present. This helps to strengthen anticipation, enabling organizations to develop more “future proof” forward-thinking strategies, thus building adaptability and resilience. In July 2021, as part of its Foresight Initiative, ICCROM launched a horizon scan study to gather intelligence about possible macro-environmental changes that might affect cultural heritage in the future. To undertake this work, the project engaged an interdisciplinary team of 18 researchers and two advisors from different world regions who collectively generated over 60 research reports looking out over a 15-year horizon. The study intends to serve as a starting point for an ongoing foresight process to inform the development of ICCROM’s longer-term strategy, and particularly its strategic orientations for the next planning cycle (2026–2031). Although the study was primarily for internal purposes, nevertheless in light of the potential usefulness of this approach for other organizations, we decided to publish this report. It is our sincere hope that this may inspire other groups and organizations working in the cultural heritage field to embark upon their own Foresight journey