The childrens palliative care provider of the future: A blueprint to spark, scale and share innovation

This policy report sets out an optimistic vision of what a world-class provider of children's palliative care (CPC) could look like in the future. It proposes nine key features through which providers can innovate to improve access and quality over time, drawing on best practice and trends as described by 50 CPC service leaders in 27 countries, as well as insights from other healthcare sectors. Recognising that there is huge variation among CPC providers and the systems they work in, this 'blueprint' is intended for inspiration and challenge, not prescription. In addition to key areas for future innovation it also highlights many areas in which CPC providers are already exemplars within the healthcare sector. CPC leaders and other stakeholders are invited to reflect on the opportunities the blueprint describes and how their own organisations might benefit from pursuing these

Evaluating diabetes mobile applications for health literate designs and functionality, 2014

INTRODUCTION: The expansion of mobile health technologies, particularly for diabetes-related applications (apps), grew exponentially in the past decade. This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost (free or not). METHODS: We used diabetes-related keywords to identify diabetes-related apps for iOS devices. A random sample of 110 apps (24% of total number of apps identified) was selected for coding. The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable. RESULTS: Most diabetes apps in this sample addressed diabetes management and therapeutics, and paid apps were more likely than free apps to use plain language strategies, to label links clearly, and to have at least 1 feature (a “back” button) that helps with the organization. CONCLUSION: Paid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy. Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible

Do Anti-Angiogenic VEGF (VEGFxxxb) Isoforms Exist? A Cautionary Tale

Splicing of the human vascular endothelial growth factor-A (VEGF-A) gene has been reported to generate angiogenic (VEGFxxx) and anti-angiogenic (VEGFxxxb) isoforms. Corresponding VEGFxxxb isoforms have also been reported in rat and mouse. We examined VEGFxxxb expression in mouse fibrosarcoma cell lines expressing all or individual VEGF isoforms (VEGF120, 164 or 188), grown in vitro and in vivo, and compared results with those from normal mouse and human tissues. Importantly, genetic construction of VEGF164 and VEGF188 expressing fibrosarcomas, in which exon 7 is fused to the conventional exon 8, precludes VEGFxxxb splicing from occurring. Thus, these two fibrosarcoma cell lines provided endogenous negative controls. Using RT-PCR we show that primers designed to simultaneously amplify VEGFxxx and VEGFxxxb isoforms amplified only VEGFxxx variants in both species. Moreover, only VEGFxxx species were generated when mouse podocytes were treated with TGFβ-1, a reported activator of VEGFxxxb splice selection in human podocytes. A VEGF164/120 heteroduplex species was identified as a PCR artefact, specifically in mouse. VEGFxxxb isoform-specific PCR did amplify putative VEGFxxxb species in mouse and human tissues, but unexpectedly also in VEGF188 and VEGF164 fibrosarcoma cells and tumours, where splicing to produce true VEGFxxxb isoforms cannot occur. Moreover, these products were only consistently generated using reverse primers spanning more than 5 bases across the 8b/7 or 8b/5 splice junctions. Primer annealing to VEGFxxx transcripts and amplification of exon 8b primer ‘tails’ explained the artefactual generation of VEGFxxxb products, since the same products were generated when the PCR reactions were performed with cDNA from VEGF164/VEGF188 ‘knock-in’ vectors used in the generation of single VEGF isoform-expressing transgenic mice from which the fibrosarcoma lines were developed. Collectively, our results highlight important pitfalls in data interpretation associated with detecting VEGFxxxb isoforms using current methods, and demonstrate that anti-angiogenic isoforms are not commonly expressed in mouse or human tissues

N′-[1-(2,4-Dioxo-3,4-dihydro-2H-1-benzopyran-3-yl­idene)eth­yl]thiophene-2-carbo­hydrazide

The title compound, C16H12N2O4S, was obtained by the condensation of 3-acetyl-4-hy­droxy­coumarin with thien-2-ylcarbonyl hydrazide. The pyran ring adopts a 2,4-dione tautomeric form. The benzopyran ring system is almost coplanar with the thio­phene ring [dihedral angle 0.9 (2)°]. The exocyclic C=C double bond has an E geometry. The mol­ecular conformation is stabilized by an intra­molecular N—H⋯O hydrogen bond. In the crystal, inter­molecular N—H⋯O hydrogen bonds link the mol­ecules into chains along the a axis

Interchange II: Transitions, a Collaborative Recital

The KSU School of Music along with Zuckerman Museum of Art and Department of Dance present a special collaboration featuring musical works that explore crossing global boundaries and cultural exchange selected to correspond with themes presented in two ZMA exhibitions: “Sleight of Hand” and “Transitions.”https://digitalcommons.kennesaw.edu/musicprograms/1656/thumbnail.jp

DataSHIELD:An Ethically Robust Solution to Multiple-Site Individual-Level Data Analysis

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; DataSHIELD (Data Aggregation Through Anonymous Summary-statistics from Harmonised Individual levEL Databases) has been proposed to facilitate the co-analysis of individual-level data from multiple studies without physically sharing the data. In a previous paper, we investigated whether DataSHIELD could protect participant confidentiality in accordance with UK law. In this follow-up paper, we investigate whether DataSHIELD addresses a broader range of ethics-related data-sharing concerns. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Ethics-related data-sharing concerns of Institutional Review Boards, ethics experts, international research consortia and research participants were identified through a literature search and systematically examined at a multidisciplinary workshop to determine whether DataSHIELD proposes mechanisms which can address these concerns. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; DataSHIELD addresses several ethics-related data-sharing concerns related to privacy, confidentiality, and the protection of the research participant's rights while sharing data and after the data have been shared. The data remain entirely under the direct management of the study that collected them. Data processing commands are strictly supervised, and the data are queried in a protected environment. Issues related to the return of individual research results when data are shared are eliminated; the responsibility for return remains at the study of origin. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; DataSHIELD can provide an innovative and robust solution for addressing commonly encountered ethics-related data-sharing concerns.</jats:p

Ice-rich (periglacial) vs icy (glacial) depressions in the Argyre region, Mars: a proposed cold-climate dichotomy of landforms

On Mars, so-called “scalloped depressions” are widely observed in Utopia Planitia (UP) and Malea Planum (MP). Typically, they are rimless, metres- to decametres-deep, incised sharply, tiered inwardly, polygonised and sometimes pitted. The depressions seemingly incise terrain that is icy and possibly thermokarstic, i.e. produced by the thermal destabilisation of the icy terrain. Agewise, the depressions are thought to be relatively youthful, originating in the Late Amazonian Epoch.Here, we report the presence of similar depressions in the Argyre region (AR) (30–60° S; 290–355° E). More importantly, we separate and differentiate these landforms into two groups: (ice-rich) periglacial depressions (Type-1); and, (icy) glacial depressions (Type-2a-c). This differentiation is presented to the Mars community for the first time.Based on a suite of morphological and geological characteristics synonymous with ice-complexes in the Lena Peninsula (eastern Russia) and the Tuktoyaktuk Coastlands (Northwest Territories, Canada), we propose that the Type-1 depressions are ice-rich periglacial basins that have undergone volatile depletion largely by sublimation and as the result of thermal destabilisation. In keeping with the terms and associated definitions derived of terrestrial periglacial-geomorphology, ice-rich refers to permanently frozen-ground in which ice lenses or segregation ice (collectively referenced as excess ice) have formed.We suggest that the depressions are the product of a multi-step, cold-climate geochronology:(1) Atmospheric precipitation and surface accumulation of an icy mantle during recent high obliquities.(2) Regional or local triple-point conditions and thaw/evaporation of the mantle, either by exogenic forcing, i.e. obliquity-driven rises of aerial and sub-aerial temperatures, or endogenic forcing, i.e. along Argyre impact-related basement structures.(3) Meltwater migration into the regolith, at least to the full depth of the depressions.(4) Freeze-thaw cycling and the formation of excess ice.(5) Sublimation of the excess ice and depression formation as high obliquity dissipates and near-surface ice becomes unstable.The Type-2 depressions exhibit characteristics suggestive of (supra-glacial) dead-ice basins and snow/ice suncups observed in high-alpine landscapes on Earth, e.g. the Swiss Alps and the Himalayas. Like the Type-1 depressions, the Type-2 depressions could be the work of sublimation; however, the latter differ from the former in that they seem to develop within a glacial-like icy mantle that blankets the surface rather than within an ice-rich and periglacially-revised regolith at/near the surface.Interestingly, the Type-2 depressions overlie the Type-1 depressions at some locations. If the periglacial/glacial morphological and stratigraphical dichotomy of depressions is valid, then this points to recent glaciation at some locations within the AR being precursed by at least one episode of periglaciation. This also suggests that periglaciation has a deeper history in the region than has been thought hitherto. Moreover, if the hypothesised differences amongst the Argyre-based depressions are mirrored in Utopia Planitia and Malea Planum, then perhaps this periglacial-glacial dichotomy and its associated geochronology are as relevant to understanding late period landscape-evolution in these two regions as it is in the AR

Pentacyanoiron(II) as an Electron Donor Group for Nonlinear Optics: Medium-Responsive Properties and Comparisons with Related Pentaammineruthenium(II) Complexes

In this article, we describe a series of complex salts in which electron-rich {Fe^(II)(CN)_5}^(3-) centers are coordinated to pyridyl ligands with electron-accepting N-methyl/aryl-pyridinium substituents. These compounds have been characterized by using various techniques including electronic absorption spectroscopy and cyclic voltammetry. Molecular quadratic nonlinear optical (NLO) responses have been determined by using hyper-Rayleigh scattering (HRS) at 1064 nm, and also via Stark (electroabsorption) spectroscopic studies on the intense, visible d → π* metal-to-ligand charge-transfer (MLCT) bands. The relatively large static first hyperpolarizabilities, β_0, increase markedly on moving from aqueous to methanol solutions, accompanied by large red-shifts in the MLCT transitions. Acidification of aqueous solutions allows reversible switching of the linear and NLO properties, as shown via both HRS and Stark experiments. Time-dependent density functional theory and finite field calculations using a polarizable continuum model yield relatively good agreement with the experimental results and confirm the large decrease in β0 on protonation. The Stark-derived β0 values are generally larger for related {Ru^(II)(NH_3)_5}^(2+) complexes than for their {Fe^(II)(CN)_5}^(3-) analogues, consistent with the HRS data in water. However, the HRS data in methanol show that the stronger solvatochromism of the Fe^(II) complexes causes their NLO responses to surpass those of their Ru^(II) counterparts upon changing the solvent medium

Over-expression of Grhl2 causes spina bifida in the Axial defects mutant mouse

Cranial neural tube defects (NTDs) occur in mice carrying mutant alleles of many different genes, whereas isolated spinal NTDs (spina bifida) occur in fewer models, despite being common human birth defects. Spina bifida occurs at high frequency in the Axial defects (Axd) mouse mutant but the causative gene is not known. In the current study, the Axd mutation was mapped by linkage analysis. Within the critical genomic region, sequencing did not reveal a coding mutation whereas expression analysis demonstrated significant up-regulation of grainyhead-like 2 (Grhl2) in Axd mutant embryos. Expression of other candidate genes did not differ between genotypes. In order to test the hypothesis that over-expression of Grhl2 causes Axd NTDs, we performed a genetic cross to reduce Grhl2 function in Axd heterozygotes. Grhl2 loss of function mutant mice were generated and displayed both cranial and spinal NTDs. Compound heterozygotes carrying both loss (Grhl2 null) and putative gain of function (Axd) alleles exhibited normalization of spinal neural tube closure compared with Axd/+ littermates, which exhibit delayed closure. Grhl2 is expressed in the surface ectoderm and hindgut endoderm in the spinal region, overlapping with grainyhead-like 3 (Grhl3). Axd mutants display delayed eyelid closure, as reported in Grhl3 null embryos. Moreover, Axd mutant embryos exhibited increased ventral curvature of the spinal region and reduced proliferation in the hindgut, reminiscent of curly tail embryos, which carry a hypomorphic allele of Grhl3. Overall, our data suggest that defects in Axd mutant embryos result from over-expression of Grhl2

Validation of the Bluebelle Wound Healing questionnaire (WHQ) for assessment of surgical site infection in primary surgical wounds after hospital discharge

Background Accurate assessment of surgical‐site infection (SSI) is crucial for surveillance and research. Self‐reporting patient measures are needed because current SSI tools are limited for assessing patients after leaving hospital. The Bluebelle Wound Healing Questionnaire (WHQ) was developed for patient or observer completion; this study tested its acceptability, scale structure, reliability and validity in patients with closed primary wounds after abdominal surgery. Methods Patients completed the WHQ (self‐assessment) within 30 days after leaving hospital and returned it by post. Healthcare professionals completed the WHQ (observer assessment) by telephone or face‐to‐face. Questionnaire response rates and patient acceptability were assessed. Factor analysis and Cronbach's α examined scale structure and internal consistency. Test–retest and self‐ versus observer reliability assessments were performed. Sensitivity and specificity for SSI discrimination against a face‐to‐face reference diagnosis (using Centers for Disease Control and Prevention criteria) were examined. Results Some 561 of 792 self‐assessments (70·8 per cent) and 597 of 791 observer assessments (75·5 per cent) were completed, with few missing data or problems reported. Data supported a single‐scale structure with strong internal consistency (α greater than 0·8). Reliability between test–retest and self‐ versus observer assessments was good (κ 0·6 or above for the majority of items). Sensitivity and specificity for SSI discrimination was high (area under the receiver operating characteristic (ROC) curve 0·91). Conclusion The Bluebelle WHQ is acceptable, reliable and valid with a single‐scale structure for postdischarge patient or observer assessment of SSI in closed primary wounds