A summary of new NICE guidance on sunlight exposure: encouraging behavioural change in photoprotection

Healthcare professionals can play an important role in preventing skin cancer via raising awareness of the effects of sun exposure and supporting people to revise behaviours that place them at increased risk. The recent revision to NICE guidance on Sunlight Exposure provides up-to-date, evidence-based information that practitioners should seek to pass onto the public with regards to sensible sunlight exposure. The first half of the article gives a brief summary of the at-risk groups, the environmental factors that require consideration, and the myths and misconceptions that persist in relation to sunlight exposure which need to be challenged. The evidence suggests that simply providing information on risk is usually not sufficient to change behaviour in those who actively seek to tan; consequently the second half of this article describes some simple behaviour change techniques for use in dermatology practice

Nickel Impregnated Cerium-Doped Strontium Titanate Fuel Electrode: Direct Carbon Dioxide Electrolysis and Co-Electrolysis

Direct electrolysis of carbon dioxide and co-electrolysis of steam and carbon dioxide offers an efficient and effective method to produce CO or syngas and also utilizes CO2 in a carbon-neutral fuel cycle. Here we report the use of composite fuel electrode containing a Sr0.7Ce0.2TiO3±δ (SCT) and Sm0.20Ce0.80O2-δ (SDC) backbone which has been infiltrated with nickel nitrate and decomposed to form nickel surface decoration on the ceramic scaffold. Maximum cell current during electrolysis at 850◦C was 263 mAcm−2 and 192 mAcm−2 at 1.8V for co-electrolysis and CO2, respectively. The infiltrated nickel particles provided a large surface area and enhanced activity during electrolysis. These findings demonstrate that Ce-doped titanate mixed conductors combined with low volume nickel additions are promising next-generation electrode materials for solid oxide electrolysis cells

Projecting impacts of climate change on hydrological conditions and biotic responses in a chalk valley riparian wetland

Projected changes in climate are likely to substantially impact wetland hydrological conditions that will in turn have implications for wetland ecology. Assessing ecohydrological impacts of climate change requires models that can accurately simulate water levels at the fine-scale resolution to which species and communities respond. Hydrological conditions within the Lambourn Observatory at Boxford, Berkshire, UK were simulated using the physically based, distributed model MIKE SHE, calibrated to contemporary surface and groundwater levels. The site is a 10 ha lowland riparian wetland where complex geological conditions and channel management exert strong influences on the hydrological regime. Projected changes in precipitation, potential evapotranspiration, channel discharge and groundwater level were derived from the UK Climate Projections 2009 ensemble of climate models for the 2080s under different scenarios. Hydrological impacts of climate change differ through the wetland over short distances depending on the degree of groundwater/surface-water interaction. Discrete areas of groundwater upwelling are associated with an exaggerated response of water levels to climate change compared to non-upwelling areas. These are coincident with regions where a weathered chalk layer, which otherwise separates two main aquifers, is absent. Simulated water levels were linked to requirements of the MG8 plant community and Desmoulin’s whorl snail (Vertigo moulinsiana) for which the site is designated. Impacts on each are shown to differ spatially and in line with hydrological impacts. Differences in water level requirements for this vegetation community and single species highlight the need for separate management strategies in distinct areas of the wetland

'Everything's fine, so why does it happen?' A qualitative investigation of patients' perceptions of noncardiac chest pain

Aims and objectives. To examine patients’ perceptions and experiences of noncardiac chest pain, within the framework of the common sense model. Background. Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain. Design. Qualitative thematic analysis with semi-structured interviews. Methods. In 2010, participants recruited from an emergency department (N = 7) with persistent noncardiac chest pain and distress were interviewed using a semistructured schedule, and data were analysed using thematic analysis. Results. Seven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants’ perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause. Conclusion. Patients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain. Relevance to clinical practice. Brief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain

Cancer and changes in facial appearance : a meta-ethnography of qualitative studies

Introduction: Living with an altered facial appearance as a result of treatment for cancer requires considerable psychological adjustment. As such it is essential that health care professionals understand the lived experience of people affected. This systematic review provides a metaethnography of studies that have explored the experience of changed facial appearance as a result of cancer. Methods: A search of four databases (Web of Science, CINAHL, PsycInfo and Scopus) took place using terms relating to qualitative research, cancer, and changed facial appearance. Thirteen studies were identified, appraised and included in the synthesis. The findings and interpretations within the studies were subject to meta-ethnography procedures so as to elicit novel cross cutting themes. Findings: The experience of changed facial appearance after cancer was clustered into three contexts. In the context of the disease, subthemes were the primacy of survival, the changing relationship with the disease and the impact of the care team on the experience of changed appearance. In the context of the social world, subthemes were positive reactions, negative reactions and coping strategies. In the context of the self, subthemes were the self under attack, self-to-self relating, the self in the world and rebuilding the self. Conclusions: The findings indicate that healthcare professionals must conduct holistic assessments, so as to fully recognise and where necessary address the impact upon self. The meta-ethnography shows that the experience of facial appearance change following cancer is complex and requires awareness of a number of theoretical areas including identity construction, social support, stigmatisation, and the specific literature on visible difference

A qualitative examination of the experience of skin camouflage by people living with visible skin conditions

Background People with a visible skin conditions can experience anxiety and intrusive reactions from others when in social situations. The use of products to conceal marks on the skin is provided in a number of different hospital services and by charities. However, little is known about the experience of people using camouflage as a tool for enhancing quality of life. Aim This study aimed to examine the experience of using skin camouflage to cover a visible mark on the skin. It sought to gain a detailed account of the issues associated with camouflage use and the needs of people using it. Methods Interpretative Phenomenological Analysis (IPA) was used to gain a detailed understanding of the meaning of camouflage use for participants. Six skin camouflage service‐users completed semi‐structured interviews. Results The IPA analysis revealed that the experience of using camouflage was influenced by socio‐cultural factors and the views of others. The use of camouflage was linked to investment in appearance maintenance and functioned to give a sense of control over social interactions, increase social confidence and manage concern about the responses of others. Conclusions This study provides an in‐depth insight into the experience of using skin camouflage and suggests that camouflage can play a valuable role in maintaining wellbeing in those living with a visible skin condition

HIF-mediated innate immune responses: cell signaling and therapeutic implications

Leukocytes recruited to infected, damaged, or inflamed tissues during an immune response must adapt to oxygen levels much lower than those in the circulation. Hypoxia inducible factors (HIFs) are key mediators of cellular responses to hypoxia and, as in other cell types, HIFs are critical for the upregulation of glycolysis, which enables innate immune cells to produce adenosine triphosphate anaerobically. An increasing body of evidence demonstrates that hypoxia also regulates many other innate immunological functions, including cell migration, apoptosis, phagocytosis of pathogens, antigen presentation and production of cytokines, chemokines, and angiogenic and antimicrobial factors. Many of these functions are mediated by HIFs, which are not only stabilized posttranslationally by hypoxia, but also transcriptionally upregulated by inflammatory signals. Here, we review the role of HIFs in the responses of innate immune cells to hypoxia, both in vitro and in vivo, with a particular focus on myeloid cells, on which the majority of studies have so far been carried out

‘Conflict versus Congruence’: A qualitative study exploring the experience of gender dysphoria for adults with autism spectrum disorder

An emergent evidence base indicates a higher prevalence of autism exists amongst people attending gender identity clinics. This qualitative study explored adults’ with autism experiences of coming to understand and address their gender dysphoria (GD). Data were collected and analysed using Grounded Theory. Ten adults with autism and GD undertook semi-structured interviews. A tentative theoretical framework of common processes involved in understanding and addressing GD for individuals with autism was developed. The experience is captured in the core category—Conflict versus Congruence. A key finding was the impact of autism as a barrier but sometimes a protective factor in participants’ understanding and addressing GD. Participants appeared to achieve greater personal congruence and wellbeing upon transition. Nevertheless, conflicts remained as they navigated the social world with a continuing fear of hostility and sense of difference due to having two stigmatised identities