Digital adaptation of the Standing up for Myself intervention in young people and adults with intellectual disabilities: the STORM feasibility study.

Background: Stigma contributes to the negative social conditions persons with intellectual disabilities are exposed to, and it needs tackling at multiple levels. Standing Up for Myself is a psychosocial group intervention designed to enable individuals with intellectual disabilities to discuss stigmatising encounters in a safe and supportive setting and to increase their self-efficacy in managing and resisting stigma. Objectives: To adapt Standing Up for Myself to make it suitable as a digital intervention; to evaluate the feasibility and acceptability of Digital Standing Up for Myself and online administration of outcome measures in a pilot; to describe usual practice in the context of the coronavirus disease 2019 pandemic to inform future evaluation. Design: Adaptation work followed by a single-arm pilot of intervention delivery. Setting and participants: Four third and education sector organisations. Individuals with mild-to-moderate intellectual disabilities, aged 16+, members of existing groups, with access to digital platforms. Intervention: Digital Standing Up for Myself intervention. Adapted from face-to-face Standing Up for Myself intervention, delivered over four weekly sessions, plus a 1-month follow-up session. Outcomes: Acceptability and feasibility of delivering Digital Standing Up for Myself and of collecting outcome and health economic measures at baseline and 3 months post baseline. Outcomes are mental well-being, self-esteem, self-efficacy in rejecting prejudice, reactions to discrimination and sense of social power. Results: Adaptation to the intervention required changes to session duration, group size and number of videos; otherwise, the content remained largely the same. Guidance was aligned with digital delivery methods and a new group member booklet was produced. Twenty-two participants provided baseline data. The intervention was started by 21 participants (four groups), all of whom were retained at 3 months. Group facilitators reported delivering the intervention as feasible and suggested some refinements. Fidelity of the intervention was good, with over 90% of key components observed as implemented by facilitators. Both facilitators and group members reported the intervention to be acceptable. Group members reported subjective benefits, including increased confidence, pride and knowing how to deal with difficult situations. Digital collection of all outcome measures was feasible and acceptable, with data completeness ≥ 95% for all measures at both time points. Finally, a picture of usual practice has been developed as an intervention comparator for a future trial. Limitations: The pilot sample was small. It remains unclear whether participants would be willing to be randomised to a treatment as usual arm or whether they could be retained for 12 months follow-up. Conclusions: The target number of groups and participants were recruited, and retention was good. It is feasible and acceptable for group facilitators with some training and supervision to deliver Digital Standing Up for Myself. Further optimisation of the intervention is warranted. Future work: To maximise the acceptability and reach of the intervention, a future trial could offer the adapted Digital Standing Up for Myself, potentially alongside the original face-to-face version of the intervention. Study registration: This study was registered as ISRCTN16056848. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/149/03) and is published in full in Public Health Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

People with intellectual disabilities (or 'learning disabilities' in United Kingdom language) are more likely to experience poor physical and mental health than the general population. Stigma (negative stereotypes, prejudice and discrimination) has been linked to lower self-esteem, quality of life, and mental and physical ill health. Efforts to empower people with intellectual disabilities themselves to challenge stigma with a view to improving well-being, health and self-esteem are lacking. In 2017, we developed Standing Up for Myself, a brief group-based programme for people with mild-to-moderate intellectual disabilities aged 16+ to address this gap. As this study got underway, face-to-face meetings were suspended due to the coronavirus disease 2019 pandemic. We used the opportunity to assess whether Standing Up for Myself could be delivered through web-based meetings. We adapted Standing Up for Myself for digital delivery, with close input from advisors with intellectual disabilities and experienced group facilitators. We then tested the digital version in charity and education settings to evaluate if Digital Standing Up for Myself could be delivered as planned and how acceptable it was to group facilitators and participants. Four groups, with a total of 22 members, signed up to try Digital Standing Up for Myself. One participant dropped out before starting Standing Up for Myself, and the other 21 continued until the end of the programme. Retention and attendance were good; participants on average attended four of the five sessions. Ninety per cent of the core programme requirements were fully delivered as detailed in the Digital Standing Up for Myself manual. Problems with technology were manageable, although facilitators found using the Standing Up for Myself Wiki platform (an online platform for storage and sharing of resources) difficult, particularly when sharing video content. Facilitators felt acceptable levels of privacy were achieved and there were no reports of undue distress. All facilitators and many group members said they would recommend Digital Standing Up for Myself to others. Group members shared how the programme benefitted them, noting increased awareness about disabilities, and for some increased confidence, pride and independence. Some had learnt how to stand up for themselves and manage difficult situations and took pride in this. Completing outcome and health cost measures via web-based meetings was acceptable and data were largely fully complete and useable.

3D Powder Printed Bioglass and ß-Tricalcium Phosphate Bone Scaffolds.

The use of both bioglass (BG) and ß tricalcium phosphate (ß-TCP) for bone replacement applications has been studied extensively due to the materials' high biocompatibility and ability to resorb when implanted in the body. 3D printing has been explored as a fast and versatile technique for the fabrication of porous bone scaffolds. This project investigates the effects of using different combinations of a composite BG and ß-TCP powder for 3D printing of porous bone scaffolds. Porous 3D powder printed bone scaffolds of BG, ß-TCP, 50/50 BG/ß-TCP and 70/30 BG/ß-TCP compositions were subject to a variety of characterization and biocompatibility tests. The porosity characteristics, surface roughness, mechanical strength, viability for cell proliferation, material cytotoxicity and in vitro bioactivity were assessed. The results show that the scaffolds can support osteoblast-like MG-63 cells growth both on the surface of and within the scaffold material and do not show alarming cytotoxicity; the porosity and surface characteristics of the scaffolds are appropriate. Of the two tested composite materials, the 70/30 BG/ß-TCP scaffold proved to be superior in terms of biocompatibility and mechanical strength. The mechanical strength of the scaffolds makes them unsuitable for load bearing applications. However, they can be useful for other applications such as bone fillers.

External validation of the lumbosacral plexus-contouring protocol developed by Yi et al. (IJROBP 2012; 84: 376-82) for pelvic malignancies.

PURPOSE: To evaluate interobserver variability in contouring lumbosacral plexuses (LSP) using the protocol developed by Yi et al. (IJROBP 2012; 84: 376-82) and to review LSP dosimetries for conventional radiotherapy and intensity-modulated radiotherapy (IMRT) for pelvic cancers. METHODS AND MATERIALS: Using the above-mentioned protocol, seven outliners independently contoured LSPs of 10 consecutive patients (five patients treated with conventional radiotherapy and five with IMRT). Interobserver variability was reviewed visually by using planning axial CT images and anteroposterior digitally reconstructed radiographs. Dosimetries of LSPs were also calculated and compared. RESULTS: There was a notable learning curve for each outliner; duration to outline the first patient was 45-185 minutes, versus 15-50 minutes after six patients. We found significant interobserver variability among outliners below the level of the S2 nerve roots. The LSP volumes (mean volume range of 40.9-58.4 cc) were smaller than those described in the atlas paper (71-138 cc). The mean values of mean dose, maximum dose, V40 Gy, V50 Gy and V55 Gy, respectively, for patients treated with conventional radiotherapy versus those treated with IMRT were 35.5 Gy versus 33.6 Gy, 52.2 Gy versus 52.2 Gy, 61.3% versus 54.4%, 14.9% versus 18.8% and 0% versus 2.5%. CONCLUSION: We conclude that the protocol developed by Yi et al. is a useful set of guidelines but suggest that additional at-risk components of the LSP also be contoured. We recommend that radiation oncologists practise 'nerve-sparing' radiotherapy by contouring LSPs, especially when using IMRT. We propose the term 'lumbosacral plexus regions' (LSPRs) to highlight the fact that LSPs are not always radiologically visible, only the regions where they are likely to be present.

Protection and functionalisation of silver as an optical sensing platform for highly sensitive SPR based analysis.

Silver thin films are well known as the most sensitive material for surface plasmon resonance (SPR) based analysis. However, the use of silver for this purpose is limited by three main issues, namely poor adhesion to plastic substrates, chemical instability in both air and aqueous environments and hence the difficulty in functionalizing the silver coated substrate for immobilizing biomolecular ligands by conventional liquid phase methods. In this work, we have successfully addressed these problems using gas-phase coating processes. We demonstrate highly adherent sputter-deposited silver coatings on low cost polymer substrates using a sputter-deposited thin gold adhesion layer. The problems of chemical instability and functionalisation have been addressed by using the gas phase process of plasma enhanced chemical vapour deposition (PECVD) to deposit thin films with a base SiO(x)C(y)H(z) layer (using tetraethyl orthosilicate precursor) functionalised with carboxylic acid (from sequential deposition with acrylic acid precursor). The resultant coating serves as a protective layer against degradation of the optical properties of silver under long term storage and use in ambient conditions. The reactive carboxyl functionality is used for the covalent immobilization of biomolecules. The successful stabilisation and functionalization of silver films on plastic sensor chips is demonstrated by mouse IgG immunoassays. The expected superior performance of the silver thin films over gold thin films for SPR analysis is demonstrated.

Understanding the supportive care needs of parents of children with cancer: an approach to local needs assessment.

The objective of this study was to conduct an assessment of supportive care needs from the perspective of parents of children diagnosed with cancer within an urban-rural region in Eastern Ontario, Canada. Guided by a conceptual framework for supportive care, the exploratory, mixed-method study used a standard needs survey and semistructured interviews. Fifteen parents completed (75% response rate) the survey, and 3 parents participated as key informants in the follow-up interview. Parents reported needs in all 6 of the need categories outlined within the Supportive Care Needs Framework. The proportion of parents expressing a need ranged from 23% to 39%. Dealing with the fear of their child's cancer spreading was frequently identified by parents. Emotional and informational needs were the 2 most frequently acknowledged categories of need. With further refinement, the use of the conceptual framework will provide a methodology for planning care based on the individual needs identified by parents of children with cancer.

Supportive care needs of parents of children with cancer: transition from diagnosis to treatment.

PURPOSE/OBJECTIVES: To analyze research related to the pediatric oncology population supportive care needs from diagnosis to treatment. DATA SOURCES: Articles published from 1992-2002. DATA SYNTHESIS: 49 studies were included. All six categories of the Supportive Care Needs Framework were found, with most studies addressing one to three of the need categories. Informational (88%) and emotional (84%) needs were identified most frequently. CONCLUSIONS: No one study examined the entire range and types of supportive care needs from diagnosis to treatment. This knowledge is key to planning appropriate care and services. Future research should be directed at understanding the full constellation of needs encountered by parents during this time. Further refinement of the Supportive Care Needs Framework is required to fully define the categories of need. IMPLICATIONS FOR NURSING: Although more research is required, supportive care that focuses on informational and emotional support appears to be most important from diagnosis to treatment. Using a conceptual framework such as the Supportive Care Needs Framework provides a methodology for planning care based on needs.