Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

Trade, knowledge and networks: the activities of the Society of Apothecaries and its members in London, c.1670-c.1800.

This article explores the activities of the Society of Apothecaries and its members following the foundation of a laboratory for manufacturing chemical medicines in 1672. In response to political pressures, the guild created an institutional framework for production which in time served its members both functionally and financially and established a physical site within which the endorsement of practical knowledge could take place. Demand from state and institutional customers for drugs produced under corporate oversight affirmed and supported the society's trading role, with chemical and pharmaceutical knowledge utilized to fulfil collective and individual goals. The society benefited from the mercantile interests, political connections and practical expertise of its members, with contributions to its trading activities part of a much wider participation in London's medical, scientific and commercial milieu. Yet, as apothecaries became increasingly engaged in the practice of medicine rather than the preparation and sale of drugs, the society struggled to reconcile the changing priorities of those it represented, and tensions emerged between its corporate and commercial activities.

Stills, status, stocks and science: the laboratories at Apothecaries' Hall in the nineteenth century.

This paper focuses on one site of chemistry that served multiple functions over its lifetime and played a pivotal role in the development of British pharmaceutical manufacturing. At the beginning of the nineteenth century, the Society of Apothecaries' premises in Blackfriars housed the largest pharmaceutical manufacturing laboratories in London and supplied drugs for use throughout the British Empire. Under the guidance of William Brande, the laboratories developed as sites of teaching, research and consultancy, activities which shaped the Society's public image and enhanced its commercial, regulatory and professional roles. However, as competition from other pharmaceutical firms increased, inherent contradictions in the Society's various remits, combined with its conservative approach to business, meant that there was no clear direction for the laboratories' development. In an era of growing specialisation, this multifunctional site became increasingly outdated by the end of the nineteenth century.

Analysis of 363 Genetic Variants in F5 via an Interactive Web Database Reveals New Insights into FV Deficiency and FV Leiden.

The inherited bleeding disorder Factor V (FV) deficiency and clotting risk factor FV Leiden are associated with genetic variants in the F5 gene. FV deficiency occurs with mild, moderate, severe, or asymptomatic phenotypes, and either dysfunctional or reduced amounts of plasma FV protein. Here we present an interactive web database containing 363 unique F5 variants derived from 801 patient records, with 199 FV deficiency-associated variants from 245 patient records. Their occurrence is rationalized based on the 2,224 residue sequence and new FV protein structures. The 199 FV deficiency variants correspond to 26 (13%) mild, 22 (11%) moderate, 49 (25%) severe, 35 (18%) asymptomatic, and 67 (34%) unreported phenotypes. Their variant distributions in the FV domains A1, A2, A3, B, C1 and C2 were 28 (14%), 32 (16%), 34 (17%), 42 (21%), 16 (8%), and 19 variants (10%), respectively, showing that these six regions contain similar proportions of variants. Variants associated with FV deficiency do not cluster near known protein-partner binding sites, thus the molecular mechanism leading to the phenotypes cannot be explained. However, the widespread distribution of FV variants in combination with a high proportion of buried variant residues indicated that FV is susceptible to disruption by small perturbations in its globular structure. Variants located in the disordered B domain also appear to disrupt the FV structure. We discuss how the interactive database provides an online resource that clarifies the clinical understanding of FV deficiency.

Robert Warington and Heinrich Will: Friendship and Co-operation in Chemistry in Nineteenth Century Britain and Germany.

This paper discusses fourteen letters that Heinrich Will (1812-1890), Justus Liebig's (1803-1873) successor at the University of Giessen, sent to Robert Warington (1807-1867), the chemical operator at Apothecaries' Hall in London, between 1842 and 1854. The correspondence illuminates a range of topics related to the development of the British chemical community in mid-Victorian Britain - its organisations, networks, and commercial opportunities, as well as offering insights into the importance of family, friendship, and collegiality in sustaining scientific careers. Studying such an exchange of material and textual knowledge helps to further understand how science was organised and ideas disseminated in a key period for institutional development in chemistry.

A multidisciplinary team approach to screening, assessment and early intervention for young people with type 1 diabetes and disordered eating behaviour.

INTRODUCTION: Recent NICE guidelines have emphasised the need for diabetes and eating disorder teams to collaborate in order to provide safe and effective treatment for young people with type 1 diabetes and eating disorders. AIM: Our aim was to examine and describe the current treatment journeys for young people under the care of our paediatric diabetes team who presented with eating difficulties and body image concerns. We also sought to increase staff awareness, communication and opportunities for joint working across the diabetes and eating disorders teams. METHOD: Information regarding the screening, assessment and interventions offered to young people with type 1 diabetes and eating difficulties was collected. A joint training event was developed and attended by healthcare professionals from the diabetes and eating disorder teams. RESULTS: Information collected regarding patient's treatment journeys was used to inform the multidisciplinary pathway. The joint training event offered the opportunity for shared learning, and identification of areas for service improvement.

A Life of "Continuous and Honourable Usefulness:" Chemical Consulting and the Career of Robert Warington (1807-1867).

Robert Warington (1807-1867) was a central figure in the mid-nineteenth century chemical community, notably through his role in the foundation of the Chemical Society of London in 1841. As demand for chemical services grew, Warington constructed an ultimately lucrative career in chemistry in which consulting played a major part. His formative years laid ideal foundations for establishing himself as a consultant, whilst his appointment as chemical operator to the Society of Apothecaries' pharmaceutical trade provided the status and infrastructure to sustain this activity. Here I explore the nature of the chemical services he performed for a range of customers through a survey of his experimental notes. At a time when professional boundaries in the subject were being delineated, this case study provides an example of how chemistry could be commercialised outside the academic environment and how consulting merged into a broader scientific career.

Medicines, monopolies and mortars: the chemical laboratory and pharmaceutical trade at the Society of Apothecaries in the eighteenth century.

In 1672, a laboratory was founded by the Society of Apothecaries at its premises in Blackfriars, London, to manufacture chemical medicines. By exploring the society's motivations for constructing a laboratory and its development during the eighteenth century, this paper examines the roles that chemistry played within the activities of the institution. While the chemistry's primary utility was in drug manufacturing for the society's pharmaceutical trade, through its laboratory, the society used chemistry to develop its corporate and educational aims, thus helping to secure its institutional authority in London's medical marketplace.