1,865 research outputs found

    Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [RCPCH Poster]

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    Conflicts over the care of children with life-limiting conditions can reach the point where courts have to intervene,but giving evidence causes distress, unwanted media attention and costs. The decision in Charlie Gard’s case in Englandincluded a plea for parties to mediate. No case has arisen in Scotland, where law and practice differ, but there are approximately 16,000 children with complex conditions where care might potentially be disputed. This study seeks to understand reasons for disputes, identify potential solutions (including mediation) and reduce the risk of a case coming before a Scottish court. In-depth interviews (online and face-to-face) with NHS Grampian clinicians and parents were conducted from which qualitative data were obtained on their experiences and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches. This is being funded by the NHS Grampian Endowment Fund. Ten clinicians and five parents were interviewed. Preliminary thematic analysis suggests that clinicians feel multidisciplinary team meetings improve conflict resolution for patients with complex requirements, where specialism boundaries can blur. When disputes arise, the type of intervention varied depending on its scale, urgency and impact on other care teams. A cause of disputes is variation in goals within and between care teams, but micro-discussions and step-bystep approaches from the outset work well and mitigate risk of disputes. The settings, timing and language used in conversations with parents is important. Findings suggest that clinicians may prefer a two-stage process where meetings are held without parents in the first instance. A strong Chair facilitates useful meetings, but parents still find it difficult to know who to address questions to. Families' use of social media/online searches can be problematic and lead to strained relationships, but emphasis on 'good death' and 'doing what's right' were highlighted. When a child is hospitalised, 'handing over' a child who has been looked after at home can be difficult for parents and home care teams. A desire to connect with parents facing similar challenges was expressed. It is clear that conflict exists in Scottish paediatric care. Practice suggests that there are strategies which can be employed to minimise risk of intractable disputes arising which could be used to assess the suitability of mediation and formalised into a toolkit to support families and clinicians

    Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [NHS Grampian R&D Poster]

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    Conflicts between parents and clinicians over the care of children with life-limiting conditions can reach the point where courts must intervene, causing distress, unwanted media attention and costs. This NHS Grampian case study sought to understand reasons for disputes, identify potential solutions and reduce the risk of a case coming before a Scottish court. In-depth semi-structured interviews with 20 participants (a mix of NHS Grampian clinicians and parents) were conducted from which qualitative data were obtained on their experiences of and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches

    Adaptation of Rhizobium leguminosarum to pea, alfalfa and sugar beet rhizospheres investigated by comparative transcriptomics

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    BACKGROUND: The rhizosphere is the microbe-rich zone around plant roots and is a key determinant of the biosphere's productivity. Comparative transcriptomics was used to investigate general and plant-specific adaptations during rhizosphere colonization. Rhizobium leguminosarum biovar viciae was grown in the rhizospheres of pea (its legume nodulation host), alfalfa (a non-host legume) and sugar beet (non-legume). Gene expression data were compared to metabolic and transportome maps to understand adaptation to the rhizosphere. RESULTS: Carbon metabolism was dominated by organic acids, with a strong bias towards aromatic amino acids, C1 and C2 compounds. This was confirmed by induction of the glyoxylate cycle required for C2 metabolism and gluconeogenesis in all rhizospheres. Gluconeogenesis is repressed in R. leguminosarum by sugars, suggesting that although numerous sugar and putative complex carbohydrate transport systems are induced in the rhizosphere, they are less important carbon sources than organic acids. A common core of rhizosphere-induced genes was identified, of which 66% are of unknown function. Many genes were induced in the rhizosphere of the legumes, but not sugar beet, and several were plant specific. The plasmid pRL8 can be considered pea rhizosphere specific, enabling adaptation of R. leguminosarum to its host. Mutation of many of the up-regulated genes reduced competitiveness for pea rhizosphere colonization, while two genes specifically up-regulated in the pea rhizosphere reduced colonization of the pea but not alfalfa rhizosphere. CONCLUSIONS: Comparative transcriptome analysis has enabled differentiation between factors conserved across plants for rhizosphere colonization as well as identification of exquisite specific adaptation to host plants

    Technical Design Report for PANDA Electromagnetic Calorimeter (EMC)

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    This document presents the technical layout and the envisaged performance of the Electromagnetic Calorimeter (EMC) for the PANDA target spectrometer. The EMC has been designed to meet the physics goals of the PANDA experiment. The performance figures are based on extensive prototype tests and radiation hardness studies. The document shows that the EMC is ready for construction up to the front-end electronics interface

    Sepsis carries a high mortality among hospitalised adults in Malawi in the era of antiretroviral therapy scale-up: A longitudinal cohort study

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    Objective: To assess mortality risk among adults presenting to an African teaching hospital with sepsis and severe sepsis in a setting of high HIV prevalence and widespread ART uptake. Methods: Prospective cohort study of adults (age ≥16 years) admitted with clinical suspicion of severe infection between November 2008 and January 2009 to Queen Elizabeth Central Hospital, a 1250-bed government-funded hospital in Blantyre, Malawi. Demographic, clinical and laboratory information, including blood and cerebrospinal fluid cultures were obtained on admission. Results: Data from 213 patients (181 with sepsis and 32 with severe sepsis; M:F = 2:3) were analysed. 161 (75.6%) patients were HIV-positive. Overall mortality was 22%, rising to 50% amongst patients with severe sepsis. The mortality of all sepsis patients commenced on antiretroviral therapy (ART) within 90 days was 11/28 (39.3%) compared with 7/42 (16.7%) among all sepsis patients on ART for greater than 90 days (p = 0.050). Independent associations with death were hypoxia (OR = 2.4; 95% CI, 1.1-5.1) and systolic hypotension (OR 7.0; 95% CI: 2.4-20.4). Conclusions: Sepsis and severe sepsis carry high mortality among hospitalised adults in Malawi. Measures to reduce this, including early identification and targeted intervention in high-risk patients, especially HIV-positive individuals recently commenced on ART, are urgently required

    The rise of the citizen author: Writing within social media

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    The concept of the citizen author is defined and explored within the publishing industry. In order to understand what positions the citizen author currently, and potentially could, hold it begins with a historical view of their rise, including concepts of their eighteenth century antecedents. But the focus of this research is on their growth alongside that of social media platforms. This allows for drawing out relationships between genre fiction, publishers, and the citizen author, which provides a more full understanding of the power dynamics involved when publishers, social media, and the citizen authors mix in the current industry climate.N/

    High-resolution computed tomography reconstructions of invertebrate burrow systems

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    The architecture of biogenic structures can be highly influential in determining species contributions to major soil and sediment processes, but detailed 3-D characterisations are rare and descriptors of form and complexity are lacking. Here we provide replicate high-resolution micro-focus computed tomography (μ-CT) data for the complete burrow systems of three co-occurring, but functionally contrasting, sediment-dwelling inter-tidal invertebrates assembled alone, and in combination, in representative model aquaria. These data (≤2,000 raw image slices aquarium−1, isotropic voxel resolution, 81 μm) provide reference models that can be used for the development of novel structural analysis routines that will be of value within the fields of ecology, pedology, geomorphology, palaeobiology, ichnology and mechanical engineering. We also envisage opportunity for those investigating transport networks, vascular systems, plant rooting systems, neuron connectivity patterns, or those developing image analysis or statistics related to pattern or shape recognition. The dataset will allow investigators to develop or test novel methodology and ideas without the need to generate a complete three-dimensional computation of exemplar architecture

    Special Libraries, October 1922

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    Volume 13, Issue 8https://scholarworks.sjsu.edu/sla_sl_1922/1007/thumbnail.jp
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