Paediatricians' Views on Pain in Children with Profound Intellectual and Multiple Disabilities

Pain is a frequent issue in children with profound intellectual and multiple disabilities (PIMD). Its identification and treatment can prove highly challenging for primary care physicians, mainly because of the children’s limited communication abilities. We used an online survey to explore paediatricians’ views regarding the experience and management of pain in children with PIMD and invited 480 professionals working in the canton of Vaud, Switzerland, to take part. We received 121 responses (participation rate 25.5%). A large majority of respondents provided care to children with PIMD. All paediatricians considered that these children feel pain at least as much as typically developing children. However, paediatricians had mixed views on their tolerance to pain. More than 90% held the view that their pain is under-assessed and undertreated. The principal barriers they reported to appropriate management were communication limitations with the child, difficulties in pain assessment, lack of knowledge about children with disabilities and lack of experience. Paediatricians have complex opinions regarding how children with PIMD experience pain and how to manage this problem. Professional education and training on the specificities of children with PIMD, including how to address their pain, seem necessary to foster paediatricians’ ability and confidence in approaching this complex issue

Exoskeleton energetics: Implications for planetary extravehicular activity

Humans first visited another world nearly 50 years ago and are poised to return to the Moon and visit Mars in the coming decade(s). Developing a space suit that supports safe, efficient, and effective exploration despite the extremes of temperature, pressure, radiation, and environmental hazards like dust and topography remains a critical challenge. Space suits impose restrictions on movement that increase metabolic rate and limit the intensity and duration of extravehicular activity. In this study, a lower body exoskeleton was used to test a simple model that predicts the energy cost of locomotion across gait and gravity. Energetic cost and other variables were measured during treadmill locomotion, with and without a lower body exoskeleton, in simulated reduced gravity and in Earth gravity. Six subjects walked and ran at constant Froude numbers, non-dimensional parameters used to characterize gait. The springlike energy recovery of the exoskeleton legs was estimated using energetics data in combination with the model. Model predictions agreed with the observed results (no statistical difference). High spring-like energy recovery of the exoskeleton legs lowered measures of the energetic cost of locomotion. For planetary extravehicular activity, our work reveals potential approaches to optimizing space suits for efficient locomotion, for example, tuning the stiffness and spring-like energy recovery of space suit legs

Marketers’ Use Of Alternative Front-Of-Package Nutrition Symbols: An Examination Of Effects On Product Evaluations

How front-of-package (FOP) nutrition icon systems affect product evaluations for more and less healthful objective nutrition profiles is a critical question facing food marketers, consumers, and the public health community. We propose a conceptually-based hierarchical continuum to guide predictions regarding the effectiveness of several FOP systems currently used in the marketplace. In Studies 1a and 1b, we compare the effects of a broad set of FOP icons on nutrition evaluations linked to health, accuracy of evaluations, and purchase intentions for a single product. Based on these findings, Studies 2 and 3 test the effects of two conceptually-different FOP icon systems in a retail laboratory in which consumers make comparative evaluations of multiple products at the retail shelf. While there are favorable effects of each system beyond control conditions with no FOP icons, results show that icons with an evaluative component that aid consumers’ interpretations generally provide greater benefits (particularly in product comparison contexts). We offer implications for consumer packaged goods marketers, retailers, and the public policy and consumer health communities

A very British coup: Lessons from the draft UK Regulations for Cubesats

Discusses the recently promulgated UK Draft recommendations for the regulation of Cubesats. The article explores the role of regulation more broadly within the small satellite industry. The solution proposed by the UK will be compared and contrasted to the current regulation employed by the United States

Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up?

Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children’s characteristics and (3) to assess parents’ reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child’s age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child’s condition (50.7%), parents’ decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence

A complex interprofessional intervention to improve the management of painful procedures in neonates

During hospitalization, neonates are exposed to a stressful environment and a high number of painful procedures. If pain is not treated adequately, short- and long-term complications may develop. Despite evidence about neonatal pain and available guidelines, procedural pain remains undertreated. This gap between research and practice is mostly due to limited implementation of evidence-based knowledge and time constraints. This study describes in detail the development process of a complex interprofessional intervention to improve the management of procedural pain in neonates called NEODOL© (NEOnato DOLore). The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a methodological guide for the design of the NEODOL© intervention. The development of the intervention is based on several steps and multiple methods. To report this process, we used the Criteria for Reporting the Development of Complex Interventions in Healthcare (CReDECI 2). Additionally, we evaluated the content of the intervention using a Delphi method to obtain consensus from experts, stakeholders, and parents. The complex interprofessional intervention, NEODOL©, is developed and designed for three groups: healthcare professionals, parents, and neonates for a level IIb neonatal unit at a regional hospital in southern Switzerland. A total of 16 panelists participated in the Delphi process. At the end of the Delphi process, the panelists endorsed the NEODOL© intervention as important and feasible. Following the MRC guidelines, a multimethod process was used to develop a complex interprofessional intervention to improve the management of painful procedures in newborns. Complex interprofessional interventions need theoretical bases, careful development, and integration of stakeholders to provide a comprehensive approach. The NEODOL intervention consists of promising components and has the potential to improve the management of painful procedures and should facilitate the knowledge translation into practice. KEYWORDS bundle of care, complex interventions, interprofessional relations, knowledge translation, neonate, procedural pai

Structures of Two Melanoma-Associated Antigens Suggest Allosteric Regulation of Effector Binding

The MAGE (melanoma associated antigen) protein family are tumour-associated proteins normally present only in reproductive tissues such as germ cells of the testis. The human genome encodes over 60 MAGE genes of which one class (containing MAGE-A3 and MAGE-A4) are exclusively expressed in tumours, making them an attractive target for the development of targeted and immunotherapeutic cancer treatments. Some MAGE proteins are thought to play an active role in driving cancer, modulating the activity of E3 ubiquitin ligases on targets related to apoptosis. Here we determined the crystal structures of MAGE- A3 and MAGE-A4. Both proteins crystallized with a terminal peptide bound in a deep cleft between two tandem-arranged winged helix domains. MAGE-A3 (but not MAGE-A4), is pre- dominantly dimeric in solution. Comparison of MAGE-A3 and MAGE-A3 with a structure of an effector-bound MAGE-G1 suggests that a major conformational rearrangement is required for binding, and that this conformational plasticity may be targeted by allosteric binders

Development of the Central Dogma Concept Inventory (CDCI) Assessment Tool

Scientific teaching requires scientifically constructed, field-tested instruments to accurately evaluate student thinking and gauge teacher effectiveness. We have developed a 23-question, multiple select–format assessment of student understanding of the essential concepts of the central dogma of molecular biology that is appropriate for all levels of undergraduate biology. Questions for the Central Dogma Concept Inventory (CDCI) tool were developed and iteratively revised based on student language and review by experts. The ability of the CDCI to discriminate between levels of understanding of the central dogma is supported by field testing (N = 54), and large-scale beta testing (N = 1733). Performance on the assessment increased with experience in biology; scores covered a broad range and showed no ceiling effect, even with senior biology majors, and pre/posttesting of a single class focused on the central dogma showed significant improvement. The multiple-select format reduces the chances of correct answers by random guessing, allows students at different levels to exhibit the extent of their knowledge, and provides deeper insight into the complexity of student thinking on each theme. To date, the CDCI is the first tool dedicated to measuring student thinking about the central dogma of molecular biology, and version 5 is ready to use

Geometry of Generic Isolated Horizons

Geometrical structures intrinsic to non-expanding, weakly isolated and isolated horizons are analyzed and compared with structures which arise in other contexts within general relativity, e.g., at null infinity. In particular, we address in detail the issue of singling out the preferred normals to these horizons required in various applications. This work provides powerful tools to extract invariant, physical information from numerical simulations of the near horizon, strong field geometry. While it complements the previous analysis of laws governing the mechanics of weakly isolated horizons, prior knowledge of those results is not assumed.Comment: 37 pages, REVTeX; Subsections V.B and V.C moved to a new Appenedix to improve the flow of main argument