Role of Mass Transport in Electrochemical CO2 Reduction to Methanol Using Immobilized Cobalt Phthalocyanine.

Electrochemical CO2 reduction (CO2R) using heterogenized molecular catalysts usually yields 2-electron reduction products (CO, formate). Recently, it has been reported that certain preparations of immobilized cobalt phthalocyanine (CoPc) produce methanol (MeOH), a 6-electron reduction product. Here, we demonstrate the significant role of intermediate mass transport in CoPc selectivity to methanol. We first developed a simple, physically mixed, polymer (and polyfluoroalkyl, PFAS)-free preparation of CoPc on multiwalled carbon nanotubes (MWCNTs) which can be integrated onto Au electrodes using a poly(3,4-ethylenedioxythiophene) polystyrenesulfonate (PEDOT:PSS) adhesion layer. After optimization of catalyst preparation and loading, methanol Faradaic efficiencies and partial current densities of 36% (±3%) and 3.8 (±0.5) mA cm-2, respectively, are achieved in the CO2-saturated aqueous electrolyte. The electrolyte flow rate has a large effect. A linear flow velocity of 8.5 cm/min produces the highest MeOH selectivity, with higher flow rates increasing CO selectivity and lower flow rates increasing the hydrogen evolution reaction, suggesting that CO is an unbound intermediate. Using a continuum multiphysics model assuming CO is the intermediate, we show qualitative agreement with the optimal inlet flow rate. Polymer binders were not required to achieve a high Faradaic efficiency for methanol using CoPc and MWCNTs. We also investigated the role of formaldehyde as an intermediate and the role of strain, but definitive conclusions could not be established.

Improving personalised care and support planning for people living with treatable-but-not-curable cancer.

People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their cancer experience can support personalised care. A conceptual framework based on personal narratives of living with and beyond cancer (across different cancer types and all stages of the disease trajectory), identified three interlinked themes: Adversity, Restoration and Compatibility, resulting in the ARC framework.Our aim was to use the ARC framework to underpin the HNA to improve the experience of personalised care and support planning for people living with TbnC cancer. We used clinical work experience to operationalise the ARC framework and develop the intervention, called the ARC HNA, and service-level structure, called the ARC clinic. We sought expert input on the proposed content and structure from patients and clinicians through involvement and engagement activities. Delivered alongside standard care, the ARC HNA was piloted with patients on the TbnC cancer (myeloma and metastatic breast, prostate or lung) pathway, who were 6-24 months into their treatment. Iterations were made to the content, delivery and timing of the intervention based on user feedback.Fifty-one patients received the intervention. An average of 12 new concerns were identified per patient, and 96% of patients achieved at least one of their goals. Patients valued the space for reflection and follow-up, and clinicians valued the collaborative approach to meeting patients' supportive care needs. Compared with routine initial HNA and care plan completion rates of 13%, ARC clinic achieved 90% with all care plans shared with general practitioners. The ARC clinic adopts a novel and proactive approach to delivering HNAs and care plans in a meaningful and personalised way.

Consensus-based guidelines for the provision of palliative and end-of-life care for people living with epidermolysis bullosa.

BACKGROUND: Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life. METHODS: This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature. RESULTS: This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted. CONCLUSIONS: Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition.

Prehabilitation in the lung cancer pathway: a scoping review.

BACKGROUND: Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing. Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach. METHODS: A scoping review of empirical primary research was conducted. Five online medical databases from 2016 - February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings. RESULTS: In total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used. CONCLUSION: A standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.

Sex blind: bridging the gap between drug exposure and sex-related gene expression in Danio rerio using next-generation sequencing (NGS) data and a literature review to find the missing links in pharmaceutical and environmental toxicology studies.

The sex of both humans and Danio rerio has previously been shown to affect the way individuals respond to drug exposure. Genes which allow identification of sex in juvenile zebrafish show potential to reveal these confounding variables between sex in toxicological and preclinical trials but the link between these is so far missing. These sex-specific, early expressed genes where expression is not altered by drug exposure must be carefully selected for this purpose. We aimed to discover genes which can be used in pharmaceutical trials and environmental toxicology studies to uncover sex-related variations in gene expression with drug application using the model organism Danio rerio. Previously published early sex determining genes from King et al. were evaluated as well as additional genes selected from our zebrafish Next-generation sequencing (NGS) data which are known from previously published works not to be susceptible to changes in expression with drug exposure. NGS revealed a further ten female-specific genes (vtg1, cyp17a1, cyp19a1a, igf3, ftz-f1, gdf9, foxl2a, Nr0b1, ipo4, lhcgr) and five male related candidate genes (FKBP5, apobb1, hbaa1, dmrt1, spata6) which are also expressed in juvenile zebrafish, 28 days post fertilisation (dpf). Following this, a literature review was performed to classify which of these early-expressed sex specific genes are already known to be affected by drug exposure in order to determine candidate genes to be used in pharmaceutical trials or environmental toxicology testing studies. Discovery of these early sex-determining genes in Danio rerio will allow identification of sex-related responses to drug testing to improve sex-specific healthcare and the medical treatment of human patients.

Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial.

INTRODUCTION: There is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70%-80% of patients with lung cancer in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice. METHODS AND ANALYSIS: An open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological well-being are stratified according to a patient's priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Health Research Authority (reference number 22/PR/0390). Results of this study will be disseminated through publication in peer-reviewed articles, presentations at scientific conferences and in collaboration with patient and public involvement representatives. TRIAL REGISTRATION NUMBER: NCT05318807.

Theory and Simulation of Metal-Insulator-Semiconductor (MIS) Photoelectrodes.

A metal-insulator-semiconductor (MIS) structure is an attractive photoelectrode-catalyst architecture for promoting photoelectrochemical reactions, such as the formation of H2 by proton reduction. The metal catalyzes the generation of H2 using electrons generated by photon absorption and charge separation in the semiconductor. The insulator layer between the metal and the semiconductor protects the latter element from photo-corrosion and, also, significantly impacts the photovoltage at the metal surface. Understanding how the insulator layer determines the photovoltage and what properties lead to high photovoltages is critical to the development of MIS structures for solar-to-chemical energy conversion. Herein, we present a continuum model for charge-carrier transport from the semiconductor to the metal with an emphasis on mechanisms of charge transport across the insulator. The polarization curves and photovoltages predicted by this model for a Pt/HfO2/p-Si MIS structure at different HfO2 thicknesses agree well with experimentally measured data. The simulations reveal how insulator properties (i.e., thickness and band structure) affect band bending near the semiconductor/insulator interface and how tuning them can lead to operation closer to the maximally attainable photovoltage, the flat-band potential. This phenomenon is understood by considering the change in tunneling resistance with insulator properties. The model shows that the best MIS performance is attained with highly symmetric semiconductor/insulator band offsets (e.g., BeO, MgO, SiO2, HfO2, or ZrO2 deposited on Si) and a low to moderate insulator thickness (e.g., between 0.8 and 1.5 nm). Beyond 1.5 nm, the density of filled interfacial trap sites is high and significantly limits the photovoltage and the solar-to-chemical conversion rate. These conclusions are true for photocathodes and photoanodes. This understanding provides critical insight into the phenomena enhancing and limiting photoelectrode performance and how this phenomenon is influenced by insulator properties. The study gives guidance toward the development of next-generation insulators for MIS structures that achieve high performance.

Does the sound environment influence the behaviour of zoo-housed birds? A preliminary investigation of ten species across two zoos.

In the zoo, the sound environment experienced by captive wild animals will contain numerous anthropogenic features that may elicit different responses to those stimulated by naturally created, or more biologically relevant, sounds. Husbandry activities, visitor presence and neighbouring species (free-living and captive) will all influence the sounds around zoo-housed species; an animal's behavioural responses may therefore provide an insight into how its welfare state is influenced by this changing sound environment. This project aimed to investigate how animal behaviour was influenced by the sound environment at two large UK zoos; one situated in a more rural location and the other in an urban location. Species were selected based on their location in the zoo, the relevance of sound to their natural ecology (e.g., as a form of communication and/or for anti-predator responses) and their novelty as research subjects in the scientific literature. Behavioural data collection was conducted for five days per enclosure per zoo at the population and individual level for birds housed in different styles of enclosure. Instantaneous sampling at one-minute intervals was used to collect information on state behaviours, assessed using a pre-determined species-specific ethogram. Event behaviours were collected continuously for each observation period. The sound environment around or in the enclosure was recorded continuously during each behavioural recording session using a recorder mounted on a tripod. Results showed a variety of responses to the presence of visitors and potential associated changes to sound around the enclosure with some behaviours being more influenced by the presence of visitors (and increases in the volume of sound) compared to others, e.g., vigilance and vocalisations. Overall, birds showed few of the changes thought to indicate poor or impoverished welfare states linked to changes to the sound environment in their enclosure or to the presence of visitors, but we recommend that zoos consider further measurement and recording of sound on a species-by-species basis to capture individual responses and behavioural changes to variation in visitor number and the sound environment.

Coping With the Emotional Impact of Working in Cancer Care: The Importance of Team Working and Collective Processing.

Hospitals provide the vast majority of cancer care. A necessary focus on survival has meant that they are less well-developed in terms of supporting patients with the emotional impact of cancer; and in supporting the frontline staff who contend with this. An integration of psychotherapeutic and neurobiological findings is used to develop an understanding of the patient-staff relationship and impact of high levels of distress within it. This includes reference to Transference and Countertransference, Mirror Neurons and Poly Vagal Theory. This paper considers how patients can unconsciously "transfer" emotional distress on to healthcare practitioners; and how this evokes an emotional response from the practitioner via the mirror neuron system (MNS). This can allow the practitioner to "feel into" the patient's experience and develop a more nuanced understanding. However, it may also activate emotions connected to the practitioner's life and can leave them feeling overwhelmed. The practitioner's capacity to regulate their own emotional arousal, via the vagus nerve, has a significant impact on their ability to support the patient and themselves within emotionally distressing interactions. This dynamic often unfolds without either party having significant awareness of it. A Systemic and Process-Oriented perspective is taken to understand this within the broader context of a hospital-based structure; and consider how practitioners on frontline teams may or may not support each other in working collectively with high levels of distress. A team's level of understanding and attunement to emotional experiences as well their primary relational and communication style has significant bearing on capacity for emotion-and-relationship focused coping. A failure to work with the emotional and relational interconnection between patients and staff can contribute to isolated patients, disconnected staff, conflict within teams and an overarching system lacking in compassion. However, due to the often unconscious nature of such processes and limited understanding or training on them, they are regularly left unaddressed. Over time, this can have an accumulated effect on everyone. Group-based collective processing is considered in terms of how it can be used in supporting practitioners to integrate an emotional and relational way of working with a problem-focused approach and integrated into regular daily working.

Engineering Catalyst-Electrolyte Microenvironments to Optimize the Activity and Selectivity for the Electrochemical Reduction of CO2 on Cu and Ag.

The electrochemical reduction of carbon dioxide (CO2R) driven by renewably generated electricity (e.g., solar and wind) offers a promising means for reusing the CO2 released during the production of cement, steel, and aluminum as well as the production of ammonia and methanol. If CO2 could be removed from the atmosphere at acceptable costs (i.e., <$100/t of CO2), then CO2R could be used to produce carbon-containing chemicals and fuels in a fully sustainable manner. Economic considerations dictate that CO2R current densities must be in the range of 0.1 to 1 A/cm2 and selectivity toward the targeted product must be high in order to minimize separation costs. Industrially relevant operating conditions can be achieved by using gas diffusion electrodes (GDEs) to maximize the transport of species to and from the cathode and combining such electrodes with a solid-electrolyte membrane by eliminating the ohmic losses associated with liquid electrolytes. Additionally, high product selectivity can be attained by careful tuning of the microenvironment near the catalyst surface (e.g., the pH, the concentrations of CO2 and H2O, and the identities of the cations in the double layer adjacent to the catalyst surface).We begin this Account with a discussion of our experimental and theoretical work aimed at optimizing catalyst microenvironments for CO2R. We first examine the effects of catalyst morphology on the production of multicarbon (C2+) products over Cu-based catalysts and then explore the role of mass transfer combined with the kinetics of buffer reactions in the local concentration of CO2 and pH at the catalyst surface. This is followed by a discussion of the dependence of the local CO2 concentration and pH on the dynamics of CO2R and the formation of specific products over both Cu and Ag catalysts. Next, we explore the impact of electrolyte cation identity on the rate of CO2R and the distribution of products. Subsequently, we look at utilizing pulsed electrolysis to tune the local pH and CO2 concentration at the catalyst surface. The last part of the discussion demonstrates that ionomer-coated catalysts in combination with pulsed electrolysis can enable the attainment of very high (>90%) selectivity to C2+ products over Cu in an aqueous electrolyte. This part of the Account is then extended to consider the difference in the catalyst-nanoparticle microenvironment, present in the catalyst layer of a membrane electrode assembly (MEA), with respect to that of a planar electrode immersed in an aqueous electrolyte.

Associated factors, assessment, management, and outcomes of patients who present to the emergency department for acute exacerbation of chronic obstructive pulmonary disease: A scoping review.

OBJECTIVE: The purpose of the scoping review was to examine the extant literature for factors contributing to presentations of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) to Emergency Departments (ED). METHODS: The review followed Arksey and O'Malley, and Levac's frameworks supplemented with the PRISMA-ScR checklist. We searched Cochrane Library, CINAHL, JBI, and PubMed from January 1, 2008 to March 23, 2020 for inclusions. We included studies reporting ED presentations for AECOPD among adults (≥18 years). The investigation included: pre-hospital factors; ED-related assessment, management and referral practices; holistic management (i.e., interdisciplinary); patient outcomes, admission/discharge status, and readmission. RESULTS: Forty-four studies were included. Environmental factors (e.g., air pollution, seasonal change); social determinants (e.g., poor literacy, ethnicity); and physical health (e.g., comorbidities, obesity, poor exercise capacity) contributed to ED presentation/re-presentation, and admission to hospital. Cigarette smoking was associated with hospital admission. Mortality was associated with longer-term oxygen therapy, poor exercise capacity, age, and loss of consciousness. Compliance with clinical guideline recommendations were generally low or mixed. Further, there was a lack of appropriate referral practices upon discharge. CONCLUSIONS: While there is considerable literature on factors contributing to AECOPD admission more research is required that investigates the impact that inter-professional care models can have on the discharge planning cycles for patients with COPD who are regular presenters to an ED.

Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

BACKGROUND: The primary goal of chronic obstructive pulmonary disease (COPD) management is to optimise a patient's functional status and quality of life. By encouraging effective patient self-management within primary healthcare, unplanned and potentially avoidable COPD admissions to the emergency department (ED) can be avoided. AIM: The aim of this study is to examine whether distance to hospital influences the rate of ED presentation, hospital admission and hospital length of stay for COPD patients. METHODS: The 2016 to 2018 resulted in a total of 5253 patient presentations with a primary medical diagnosis code of J44 (COPD). These were at the main hospitals of three Queensland Hospital and Health Services: Toowoomba, Ipswich and Gold Coast. To examine the variations in patient characteristics based on distance, a one-way ANOVA (analysis of variance) test was conducted. The Kruskal-Wallis test indicated that there were group differences. RESULTS: This study identified significant variation in COPD-related hospital length of stay and distance to hospital among COPD patients within three hospitals in South East Queensland, Australia. These results confirm that distance plays an important role in determining duration of hospital stay (in number of days) among COPD patients, with clear evidence of the distance 'decay phenomenon'. It appears from the findings of the current study that distance to the hospital is not associated with the greater likelihood of ED presentation but may influence length of stay. CONCLUSIONS: Several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital.

Using eDNA to simultaneously detect the distribution of native and invasive crayfish within an entire country.

The introduction of invasive crayfish has led to a decline of many European native species of crayfish across their range. In this study, novel duplex assays for all crayfish occurring in Switzerland were developed. We aimed to identify the distribution of the seven species using a traditional trap surveillance method as well by collecting water samples to detect eDNA by species-specific quantitative real-time PCR. We reveal our overall experience in finding optimal field and laboratory techniques to discover the distribution and abundance of native and invasive species in order to enhance knowledge of early invasive species invasion and highlight important pockets of populations where native species remain, for implementation of conservation strategies. Using eDNA, important populations of native noble and white-clawed crayfish were revealed in multiple waters across various cantons. The successful identification of native and invasive crayfish species in Switzerland using eDNA can be applied to future nationwide projects. This method which has the ability to detect all species simultaneously across an entire country, will allow an improvement in freshwater crayfish conservation management.

'Still living with it even though it's gone': Using interpretive phenomenological analysis to explore shared experiences of living with and beyond breast, prostate, and colorectal cancer.

PURPOSE: Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyond cancer by complementing idiographic knowledge with multiple perspectives from a group of participants who are living with and beyond cancer, to explore how individual experiences may be relevant to others. METHOD: Semi-structured interviews were conducted with people who had received treatment for breast (n = 6), prostate (n = 6) or colorectal cancer (n = 6). Data were analysed using interpretive phenomenological analysis. The early findings were then shared with a wider group of people who had received treatment for breast, prostate or colorectal cancer (n = 26) in six focus groups, to explore whether they had similar experiences. RESULTS: While individual accounts of living with and beyond cancer detail unique features specific to each person's experience, focus group discussions illustrated how participant life worlds interact and overlap. The findings identified thematic similarities within and between individual and group levels and across cancer types. Three super-ordinate themes describe the shared experience of living with and beyond cancer: i) the cancer shock, ii) managing cancer and getting through and iii) getting over cancer. CONCLUSIONS: A multiple perspective approach informs our understanding of shared experiences of living with and beyond cancer. This knowledge can be used to direct, design, and deliver relevant supportive cancer care.

Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies.

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2-4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48-3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72-4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42-13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35-2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26-0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06-0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.

Medication and healthcare use, parent knowledge and cough in children: A cohort study.

INTRODUCTION: Cough is an important contributor to the health burden of children and their families. There are limited data describing healthcare utilization and medication use over the course of a cough illness beyond the initial presentation. Our primary objective was to describe medication and healthcare use in children with a respiratory illness with cough as a symptom over the course of the illness. METHODS: A cohort study of children aged less than 15-years presenting to three primary healthcare centers and three emergency departments with a cough illness between July 7, 2015 and October 6, 2018. Children with immunosuppression, known chronic lung diseases (except asthma) and those requiring hospitalization at screening were excluded. The primary outcomes were cough-related frequency and type of healthcare seeking and medication use up to 28 days following enrolment. RESULTS: Data for 465 children were analyzed; median age 2.2-years (interquartile range = 1.1-5.3). Cough at Day 28 persisted in 117 children (25.2%). Overall, 436 (94%) children received medications in the week before and/or 4 weeks following enrolment. Half with upper respiratory tract infections were prescribed antibiotics. Among children with no diagnosis of asthma, reactive airways disease or croup (n = 404), 16.8% were given steroids. Fifty-eight percent of children sought healthcare at least once before their baseline presentation (median = 1, range = 0-20) and 49.7% had at least one further presentation in the following 28 days. CONCLUSIONS: High healthcare utilization, inappropriate medication use, and suboptimal parent knowledge regarding cough suggests targeted education is needed to improve management and reduce cough burden.

Anxiety and stress in women with suspected endometrial cancer: Survey and paired observational study.

OBJECTIVE: To determine the anxiety and stress levels of women with suspected endometrial cancer and factors affecting this. METHODS: Prospective survey and paired observational study of consecutive women with suspected endometrial cancer in a rapid access gynaecology clinic. Structured questionnaire including a GAD-7 anxiety test and a modified stress thermometer were used. Patients ranked their perception of a cancer diagnosis on 0-5 Likert scale (0 = confident not cancer and 5 = cancer). Patients requiring an endometrial tissue biopsy were asked to rank their pain on a visual analogue scale (VAS), this was paired with the survey results. RESULTS: 250 patients completed the study and 23 of which underwent an endometrial tissue biopsy. The median age was 50-59 years old and 59% of women spoke English as their first language. 32% of patients had significant levels of anxiety with GAD-7 score ≥10. The median stress score was three out of five on Likert scale. GAD-7 anxiety scores were higher in women who perceived that they received insufficient information prior to clinic (sufficient information 5 vs. insufficient information 9.5, P = 0.00036) or had a disability (disability 9 vs. no disability 5.5, P = 0.00374). The median VAS score from the biopsies was seven out of 10 (range 1-10). Patients with higher anxiety levels (GAD-7 scores) were more likely to believe they had cancer P <0.00001. CONCLUSIONS: These findings confirm high levels of anxiety and stress in women with suspected endometrial cancer. Adequate pre-clinic information is essential, particularly for minority groups.

Supporting sexuality for people living with epidermolysis bullosa: clinical practice guidelines.

This article presents evidence-based Clinical Practice Guidelines (CPG) for the provision of healthcare services to address sexuality for people living with epidermolysis bullosa (EB). Currently, a lack of EB-specific research limits these services to sexual health assessment and intervention strategies designed for the general population. Due to the unique challenges of EB, a rare skin-fragility condition causing blistering responses to minor skin trauma and other systemic and secondary complications, condition-specific strategies are needed to support people with EB in achieving valued sexual lifestyles. This CPG represents the work of an international panel comprised of thirteen members including a medical doctor, nurses, psychologists, a social worker, an occupational therapist, and patient population involvement members living with EB. It describes the development of EB-specific recommendations for two primary domains of assessment and intervention related to sexuality: psychosocial and mechanical. Following a rigorous evidence-based guideline development process, this CPG establishes the first internationally actionable clinical practice recommendations for sexuality-related assessment and intervention for this population. Future research priorities are identified. Supplemental materials included provide additional support to clinicians in developing the necessary understanding and skills to promote equity and efficacy in this care domain.

Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand.

OBJECTIVES: To investigate patient-level factors predictive for computed tomography of the brain (CTB) use and abnormality in head injured children in Australia and New Zealand. METHODS: Retrospective data from tertiary, urban/suburban and regional/rural EDs including factors predictive for CTB use and abnormality. RESULTS: Of 3072 children at 31 EDs, 212 (6.9%) had a CTB scan, of which 66 (31%) were abnormal. Increasing age, serious mechanisms of injury and decreasing Glasgow Coma Score were predictive for ordering CTB. Decreasing age was predictive for CTB abnormalities. Other factors were not. CONCLUSION: Patient-level drivers of CTB use in children in Australia and New Zealand are consistent with international data.

Fully Conjugated Pyrene-BODIPY and Pyrene-BODIPY-Ferrocene Dyads and Triads: Synthesis, Characterization, and Selective Noncovalent Interactions with Nanocarbon Materials.

Several pyrene-boron-dipyrromethene (BODIPY) and pyrene-BODIPY-ferrocene derivatives with a fully conjugated pyrene fragment appended to the α-position(s) of the BODIPY core have been prepared by Knoevenagel condensation reaction and characterized by one-dimensional (1D) and two-dimensional (2D) nuclear magnetic resonance (NMR), UV-vis, fluorescence spectroscopy, high-resolution mass spectrometry as well as X-ray crystallography. The redox properties of new donor-acceptor BODIPY dyads and triads were studied by electrochemical (cyclic voltammetry (CV) and differential pulse voltammetry (DPV)) and spectroelectrochemical approaches. Formation of weakly bonded noncovalent complexes between the new pyrene-BODIPYs and nanocarbon materials (C60, C70, single-walled carbon nanotube (SWCNT), and graphene) was studied by UV-vis, steady-state fluorescent, and time-resolved transient absorption spectroscopy. UV-vis and fluorescent spectroscopy are indicative of the much stronger and selective interaction between new dyes and (6,5)-SWCNT as well as graphene compared to that of C60 and C70 fullerenes. In agreement with these data, transient absorption spectroscopy provided no evidence for any significant change in excited-state lifetime or photoinduced charge transfer between pyrene-BODIPYs and C60 or C70 fullerenes when the pyrene-BODIPY chromophores were excited into the lowest-energy singlet excited state. Density functional theory (DFT) and time-dependent DFT (TDDFT) calculations suggest that the pyrene fragments are fully conjugated into the π-system of BODIPY core, which correlates well with the experimental data.