“We should have been told what would happen”; Children’s and parents’ procedural knowledge levels and information seeking behaviours when coming to hospital for a planned procedure.

Children continue to be poorly prepared and informed about clinical procedures, despite increased evidence of the worth of preparation and the availability of information resources. This study used a concurrent mixed-methods approach to explore the information accessed by children and their parents before attending hospital for a procedure. Information was collected separately from 40 children (aged between 8 and 12 years) and their parents using a paper booklet to examine self-reported perceived procedural knowledge and information-seeking behaviours. Data were analysed using descriptive statistics and content analysis techniques. The findings indicate that many children (70%, n = 28) and their parents (65%, n = 26) have low procedural knowledge levels. The majority of children (85%, n = 36) reported not receiving or seeking information about their procedure, despite identifying a desire and preference for more information. This study shows a mismatch between the current provision of procedural information and children and parents’ expectations that information will be provided directly to them by health professionals. In order for this ‘information hole’ to be filled, there needs to be a concerted effort to develop and systematically use meaningful information materials and for children and their parents to have the opportunity to discuss their procedural knowledge with health professionals

Specter

This dissertation is a collection of poems preceded by a critical preface. The preface considers the major changes within the elegy from the traditional English elegy—the touchstone poems for this genre being Milton's "Lycidas," Shelley's "Adonais," and Tennyson's "In Memoriam"—to the contemporary elegy and argues that many of these changes showcase contemporary elegists' active refusal and reversal of the time-honored traditions of the form. The preface is divided into an introduction and three sections, each of which recognizes and explores one significant alteration—or reversal—to the conventions of the form as established by early English elegists. The first discusses the traditional elegiac tradition of consolation in which the speaker, after displaying a series of emotions in reaction to the death of a loved one, ultimately finds comfort in the knowledge that the deceased lives eternally in heaven. This convention is contrasted with a common contemporary rhetorical movement in which the speaker not only lacks comfort by the end of the poem, but often refuses any kind of consolation, preferring instead to continue his grief. The second recognizes and explores the traditional elegiac tradition in which the speaker, listing the virtues of the beloved, replaces the real, historical person with a symbol which represents what society has lost due to this death. This convention is contrasted against a common contemporary theme in which the speaker, in an attempt to evoke authenticity, portrays the deceased subject not as a romanticized symbol, but as a real human being. The final section discusses the definition of the traditional elegy as a reaction to the literal death of a loved one and contrasts this with the more fluid contemporary understanding of the elegy as a poem about loss—either a literal or metaphorical death—and a poem which need not display conventional aspects of mourning but rather a wide variety of responses to the problem of loss

Evidence on the extent of harms experienced by children as a result of online risks: Implications for policy and research

This is an Accepted Manuscript of an article published by Taylor & Francis in Information, Communication and Society on 8/7/2014, available online: http://wwww.tandfonline.com/10.1080/1369118X.2014.934387Intense media and policy focus on issues of online child protection have prompted a resurgence of moral panics about children and adolescents' Internet use, with frequent confounding of different types of risk and harm and little reference to empirical evidence of actual harm. Meanwhile, within the academic literature, the quantity and quality of studies detailing the risks and opportunities of online activity for children and young people has risen substantially in the past 10 years, but this is also largely focused on risk rather than evidence of harm. Whilst this is understandable given the methodological and ethical challenges of studying Internet-related harms to minors, the very concept of risk is dependent on some prior understanding of harm, meaning that without efforts to study what harms are connected with children's online experiences, discussions of risk lack a strong foundation. This article makes a key contribution to the field by reviewing available evidence about the scale and scope of online harms from across a range of disciplines and identifying key obstacles in this research area as well as the major policy implications. The findings are based on a review of 148 empirical studies. Results were found in relation to main types of harms: health-related harms as a result of using pro-eating disorder, self-harm or pro-suicide websites; sex-related harms such as Internet-initiated sexual abuse of minors and cyber-bullying

Effect of androgen treatment during foetal and/or neonatal life on ovarian function in prepubertal and adult rats

We investigated the effects of different windows of testosterone propionate (TP) treatment during foetal and neonatal life in female rats to determine whether and when excess androgen exposure would cause disruption of adult reproductive function. Animals were killed prepubertally at d25 and as adults at d90. Plasma samples were taken for hormone analysis and ovaries serial sectioned for morphometric analyses. In prepubertal animals, only foetal+postnatal and late postnatal TP resulted in increased body weights, and an increase in transitory, but reduced antral follicle numbers without affecting total follicle populations. Treatment with TP during both foetal+postnatal life resulted in the development of streak ovaries with activated follicles containing oocytes that only progressed to a small antral (smA) stage and inactive uteri. TP exposure during foetal or late postnatal life had no effect upon adult reproductive function or the total follicle population, although there was a reduction in the primordial follicle pool. In contrast, TP treatment during full postnatal life (d1-25) resulted in anovulation in adults (d90). These animals were heavier, had a greater ovarian stromal compartment, no differences in follicle thecal cell area, but reduced numbers of anti-Mullerian hormone-positive smA follicles when compared with controls. Significantly reduced uterine weights lead reduced follicle oestradiol production. These results support the concept that androgen programming of adult female reproductive function occurs only during specific time windows in foetal and neonatal life with implications for the development of polycystic ovary syndrome in women

Infographic. Enhancing performance and stability: the role of abdominal binding in wheelchair rugby

This infographic offers guidance for sports practitioners and wheelchair rugby (WR) players to enhance performance and stability during WR using abdominal binders. The Paralympic sport of WR is played by individuals with an impairment that affects all four limbs, including cervical spinal cord injuries (SCIs) (tetraplegia), limb deficiencies, polio, cerebral palsy and other neurological disorders. SCI results in lesion-dependent impairments in cardiorespiratory, musculoskeletal and autonomic function, due to disruption of the neural pathways that control these systems. This impairment can manifest in many ways, including reduced lung capacity, decreased cardiovascular capacity and a loss of trunk stability. Abdominal binding may partially offset impaired cardiorespiratory function and reduced or loss of trunk stability in highly trained Para athletes with SCI, despite exercise capacity limitations.1–

The acceptability and impact of the Xploro digital therapeutic platform to inform and prepare children for planned procedures in a hospital: Before and after evaluation study

Background: There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, X-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective: This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent's procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods: We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children's hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results: A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=-2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=-4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions: This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use

Macrophages sustain HIV replication in vivo independently of T cells

Macrophages have long been considered to contribute to HIV infection of the CNS; however, a recent study has contradicted this early work and suggests that myeloid cells are not an in vivo source of virus production. Here, we addressed the role of macrophages in HIV infection by first analyzing monocytes isolated from viremic patients and patients undergoing antiretroviral treatment. We were unable to find viral DNA or viral outgrowth in monocytes isolated from peripheral blood. To determine whether tissue macrophages are productively infected, we used 3 different but complementary humanized mouse models. Two of these models (bone marrow/liver/thymus [BLT] mice and T cell–only mice [ToM]) have been previously described, and the third model was generated by reconstituting immunodeficient mice with human CD34+ hematopoietic stem cells that were devoid of human T cells (myeloid-only mice [MoM]) to specifically evaluate HIV replication in this population. Using MoM, we demonstrated that macrophages can sustain HIV replication in the absence of T cells; HIV-infected macrophages are distributed in various tissues including the brain; replication-competent virus can be rescued ex vivo from infected macrophages; and infected macrophages can establish de novo infection. Together, these results demonstrate that macrophages represent a genuine target for HIV infection in vivo that can sustain and transmit infection

UK: racial violence and the night-time economy

This article examines fifty-five racist attacks over a six-month period in the UK’s night-time economy, showing the risks faced by members of the public and workers at taxi firms, takeaways, convenience stores and service stations. It argues that flexible and highly casualised labour conditions exacerbate the risk of racial violence

Making the diagnosis of Chronic Fatigue Syndrome/Myalgic Encephalitis in primary care: a qualitative study

<p>Abstract</p> <p>Background</p> <p>NICE guidelines emphasise the role of the primary care team in the management of patients with Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME). A key stage in effective management is making an accurate early diagnosis, supported by appropriate referral.</p> <p>Methods</p> <p>A nested qualitative study within a multi-centre randomised controlled trial which aimed to explore GPs' views on their role in making the diagnosis of CFS/ME and subsequent management of patients in primary care. Semi-structured interviews with 22 GPs. Interviews were transcribed verbatim and an iterative approach used to develop themes from the dataset.</p> <p>Results</p> <p>GPs described difficulties in defining CFS/ME and suggested that their role in making a diagnosis was to exclude physical causes for the patient's symptoms, but they reported little confidence in positively attributing the label of CFS/ME to a patient and their symptoms. GPs suggested that the label of CFS/ME could be potentially harmful for the patient. The role of referral to secondary care was debated and GPs struggled defining their own role in management of this group of patients.</p> <p>Conclusions</p> <p>Until GPs feel comfortable making the diagnosis of CFS/ME and facilitating initial management, and have appropriate services to refer patients to, there will continue to be delays in confirming the diagnosis and patients presenting in primary care with fatigue may not receive appropriate care.</p> <p>Trial Registration</p> <p>ISRCTN 74156610</p

Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors

Background: Limits on the frequency of whole blood donation exist primarily to safeguard donor health. However, there is substantial variation across blood services in the maximum frequency of donations allowed. We compared standard practice in the UK with shorter inter-donation intervals used in other countries. Methods: In this parallel group, pragmatic, randomised trial, we recruited whole blood donors aged 18 years or older from 25 centres across England, UK. By use of a computer-based algorithm, men were randomly assigned (1:1:1) to 12-week (standard) versus 10-week versus 8-week inter-donation intervals, and women were randomly assigned (1:1:1) to 16-week (standard) versus 14-week versus 12-week intervals. Participants were not masked to their allocated intervention group. The primary outcome was the number of donations over 2 years. Secondary outcomes related to safety were quality of life, symptoms potentially related to donation, physical activity, cognitive function, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin. This trial is registered with ISRCTN, number ISRCTN24760606, and is ongoing but no longer recruiting participants. Findings: 45 263 whole blood donors (22 466 men, 22 797 women) were recruited between June 11, 2012, and June 15, 2014. Data were analysed for 45 042 (99·5%) participants. Men were randomly assigned to the 12-week (n=7452) versus 10-week (n=7449) versus 8-week (n=7456) groups; and women to the 16-week (n=7550) versus 14-week (n=7567) versus 12-week (n=7568) groups. In men, compared with the 12-week group, the mean amount of blood collected per donor over 2 years increased by 1·69 units (95% CI 1·59–1·80; approximately 795 mL) in the 8-week group and by 0·79 units (0·69–0·88; approximately 370 mL) in the 10-week group (p&lt;0·0001 for both). In women, compared with the 16-week group, it increased by 0·84 units (95% CI 0·76–0·91; approximately 395 mL) in the 12-week group and by 0·46 units (0·39–0·53; approximately 215 mL) in the 14-week group (p&lt;0·0001 for both). No significant differences were observed in quality of life, physical activity, or cognitive function across randomised groups. However, more frequent donation resulted in more donation-related symptoms (eg, tiredness, breathlessness, feeling faint, dizziness, and restless legs, especially among men [for all listed symptoms]), lower mean haemoglobin and ferritin concentrations, and more deferrals for low haemoglobin (p&lt;0·0001 for each) than those observed in the standard frequency groups. Interpretation: Over 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency. Funding: NHS Blood and Transplant, National Institute for Health Research, UK Medical Research Council, and British Heart Foundation