Systematic review of topical interventions for the management of odour in patients with chronic wounds or malignant fungating wounds: a study protocol

Background: Chronic wounds including venous, arterial, diabetic and pressure ulcers affect up to 2.21 per 1000 population. Malignant fungating wounds affect up to 6.6% of oncology patients. These wounds impact patients and health care systems significantly. Microbes colonising chronic wounds can produce volatile molecules with unpleasant odours. Wound odour adversely affects quality of life, yet management strategies are inconsistent. Clinicians express uncertainty regarding the current range of odour management agents, which therefore requires evaluation for effectiveness. Objective: To determine the effects of topical agents in the management of odour in patients with chronic and malignant fungating wounds. Methods: Searches of Embase, Medline, CINAHL, Cochrane CENTRAL, PubMed, Web of Science, Scopus, and the clinicaltrials.gov and WudracT trial registries from inception to present will be conducted without language limits. Randomised controlled trials including adults with venous, arterial, mixed arterio-venous, diabetic, decubitus or malignant fungating wounds, investigating topical agents to manage odour are eligible. Reference lists of included studies and identified systematic reviews will be scanned, and unpublished studies will be sought in the BASE database, in conference proceedings and through contacting authors. Two reviewers will independently scan titles/abstracts and full text articles against predetermined eligibility criteria, with discrepancies resolved by discussion between reviewers or through third-party intervention. Two reviewers will independently extract data from included studies. Disagreements will be resolved by discussion between reviewers or through third-party intervention. Bias risk and evidence quality will be assessed with the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Meta-analysis will be applied where appropriate. Otherwise, data will be synthesised narratively. Discussion: Wound odour management typically takes a trial-and-error approach. Clinicians are critical of odour management agent effectiveness. This review will evaluate the range of available agents to inform practice and research. PROSPERO registration: CRD42021267668 (14/08/2021)

Boltanski’s dilemma: Mimetics, distance and spectating suffering

Working from the Crucifixion episode or pageant from the York Corpus Christi Play, two questions were asked of the spectator: <list list-type="simple"> <list-item><label>1.</label>How do they look at such a theatre (scene) from their own time and culture and experiences?</list-item> <list-item><label>2.</label>How do we look at such a theatre (scene) from our own time and culture and experiences?</list-item></list>A third question may now be asked by following what we may call ‘Boltanski’s dilemma’: what sort of pity can we really feel for an imaginary scene on the stage? This article will revisit the earlier piece (2010) as archive material to develop key themes now encapsulated by Boltanski’s question and challenge. The article will draw on current neuro-cognitive research that challenges and re-grounds our understanding of empathy and projection of self in the embodied mind. This informs the spectatorial experience, the spectator’s ability to see and accept the ‘double reality’ of the theatre and other visual (mimetic) experience, and the issues of ‘moral distance’ represented by Boltanski, Bandura and others. Boltanski’s dilemma confronts us as knowing spectators with the inherent ethical paradox of any and all representations of suffering in any given cultural and social context. The article will draw on case studies from theatre(s), film and art to illustrate and exemplify the position of the spectator: in the spirit of ethos, a series of musings, of questions and signposts as well as arguments.

Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England

Background: In order to minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of English general practice consultations was modified in March 2020 to enable the separation of patients with diagnosed or suspected COVID-19 from others. Remote triage and consultations became the default, with adapted face-to-face contact used only when clinically necessary. Face-to-face delivery modifications were decided locally and this study aimed to identify the different models used nationwide in spring/summer 2020. Methods: In June 2020, a survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) responsible for planning and commissioning NHS health care services in England to identify the local organisation of face-to-face general practice consultations since March 2020. Results: All CCGs responded. Between March and July 2020, separation of patients with diagnosed or suspected COVID-19 (‘COVID-19 patients’) from others was achieved using the following models: zoned practices (used within 47% of CCGs), where COVID-19 and other patients were separated within their own practice;‘hot’ or ‘cold’ hubs (used within 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices were seen;‘hot’ and ‘cold’ home visits (used within 70% of CCGs). For around half of CCGs, either all their GP practices used zoning, or all used hubs; in other CCGs, both models were used. Demand-led hub availability offered flexibility in some areas. Home visits were mainly used supplementally for patients unable to access other services, but in two CCGs, they were the main/only form of COVID-19 provision. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. Analysis of the modified delivery in terms of management of COVID-19 and other conditions, and other impacts on staff and patients, may both aid future pandemic management and identify beneficial elements for practice beyond this.

Comparison of hospitalizations and deaths from COVID-19 2021 versus 2020 in Italy: surprises and implications

Data from the Istituto Superiore di Sanità (ISS) emphasized by the media indicate that COVID-19 vaccination reduces related infections, hospitalizations and deaths. However, a comparison showed significantly more hospitalizations and intensive care unit accesses in the corresponding months and days in 2021 versus 2020 and no significant differences in deaths. The combination of non-alternative hypotheses may help explain the discrepancy between the results in the entire population and the vaccination’s success claimed by the ISS in reducing infections, serious cases and deaths: a bias: counting as unvaccinated also "those vaccinated with 1 dose in the two weeks following the inoculation", and as incompletely vaccinated also "those vaccinated with 2 doses within two weeks of the 2nd inoculation".a systematic error: counting as unvaccinated also "vaccinated with 1 dose in the two weeks following the inoculation", and as incompletely vaccinated also "vaccinated with 2 doses within two weeks of the 2nd inoculation". Many reports show an increase in COVID-19 cases in these time-windows, and related data should be separated levels of protective effectiveness in vaccinated people, often considered stable, actually show signs of progressive reduction over time, which could contribute to reducing the overall population resultunvaccinated people show more severe disease than in 2020, supporting also in humans the theory of imperfect vaccines, which offer less resistance to the entry of germs than the resistance later encountered inside the human body. This favors the selection of more resistant and virulent mutants, that can be spread by vaccinated people. This damages first the unvaccinated people, but ultimately the whole community. An open scientific debate is needed to discuss these hypotheses, following the available evidence (as well as to discuss the inconsistent theory of unvaccinated young people as reservoirs of viruses/mutants), to assess the long-term and community impact of different vaccination strategies.

Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England

Background: To minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of English general practice consultations was modified in March 2020 to enable separation of diagnosed or suspected COVID-19 patients from others. Remote triage and consultations became the default, with adapted face-to-face contact used only when clinically necessary. This study aimed to identify the modified face-to-face delivery models used nationwide in spring/summer 2020. Information was also sought concerning COVID-19 outbreaks linked to English general practice. Methods: In June 2020, a survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) in England to identify local organisation of face-to-face general practice consultations since March 2020. An email was sent to Public Health England (PHE) requesting data on COVID-19 outbreaks linked to general practice. Results: All CCGs responded. Between March and July 2020, separation of COVID-19 patients from others was achieved using combinations of the following models: zoned surgeries (reported by 47% of CCGs), where COVID-19 and other patients were separated within their own practice;‘hot’ or ‘cold’ hubs (reported by 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices were seen;‘hot’ and ‘cold’ home visits (reported by 70% of CCGs). One of seven combinations of these models was used across each CCG, with some flexibility shown according to changing demand through hub availability. PHE data indicated 25 possible or confirmed COVID-19 outbreaks or clusters in English general practice to July 31st 2020. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. Analysis of the modified delivery in terms of management of COVID-19 and other conditions, and impacts on staff and patients, together with learning from investigations into confirmed COVID-19 outbreaks, may both aid future pandemic management and identify beneficial elements for practice beyond this.

Using ACES Look Modification Transforms (LMTs) in VFX Environments – Part 2: Gamut Mapping

In modern moving image production pipelines, it is unavoidable to move the footage through different color spaces. Unfortunately, these color spaces exhibit color gamuts of various sizes. The most common problem is converting the cameras’ widegamut color spaces to the smaller gamuts of the display devices (cinema projector, broadcast monitor, computer display). So it is necessary to scale down the scene-referred footage to the gamut of the display using tone mapping functions [34].In a cinema production pipeline, ACES is widely used as the predominant color system. The all-color compassing ACES AP0 primaries are defined inside the system in a general way. However, when implementing visual effects and performing a color grade, the more usable ACES AP1 primaries are in use. When recording highly saturated bright colors, color values are often outside the target color space. This results in negative color values, which are hard to address inside a color pipeline. "Users of ACES are experiencing problems with clipping of colors and the resulting artifacts (loss of texture, intensification of color fringes). This clipping occurs at two stages in the pipeline: <list list-type="simple"> <list-item>- Conversion from camera raw RGB or from the manufacturer’s encoding space into ACES AP0</list-item> <list-item>- Conversion from ACES AP0 into the working color space ACES AP1" [1]</list-item> </list>The ACES community established a Gamut Mapping Virtual Working Group (VWG) to address these problems. The group’s scope is to propose a suitable gamut mapping/compression algorithm. This algorithm should perform well with wide-gamut, high dynamic range, scene-referred content. Furthermore, it should also be robust and invertible. This paper tests the behavior of the published GamutCompressor when applied to in- and out-ofgamut imagery and provides suggestions for application implementation. The tests are executed in The Foundry’s Nuke [2].

What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community.Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making.Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis.Results: <list id="list1" list-type="bullet"> <list-item>Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints.</list-item> <list-item>Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group.</list-item> <list-item>Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department.</list-item> <list-item>Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals.</list-item> </list>Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services.

Child development with the D-score: turning milestones into measurement

The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.

Design and Development of Optical Waveguide Architectures for Real-Time Temperature Monitoring in Extreme Environments

This dissertation prompts on the research and development of a new real-time, reusable, and reversible optical sensor for integrated temperature monitoring in harsh environments. This is achieved through integrating the photonic properties of optical waveguides/optical fiber and the phase change properties of chalcogenide glasses (ChGs). ChG materials have very specific crystallization temperatures beyond which these materials transform from being a dielectric material to a metallic material. When such ChG material is coated over a dielectric optical waveguide, in the crystalline phase, highly localized surface plasmon polariton (SPP) modes are generated at the waveguide: metallic ChG interface. In this case, the modes are characterized by very large propagation losses compared to that when the ChG is in its amorphous phase. By monitoring the output power in the two different phases of ChG, ambient temperature can be determined. In ChG materials, the crystalline state of ChGs can be reverted back to its initial amorphous condition through the application of a short intense voltage pulse that melts the material, facilitating multiple time use of the sensors. Based on the phase change property of ChG glasses, and light confinement offered by optical waveguides, we proposed to construct two types of sensor architectures for sensing temperature: Architecture 1: An optical fiber based reflection mode sensor. Architecture 2: An integrated silicon waveguide:ChG based compact plasmonic temperature sensor. These sensors are typically suitable for the real-time monitoring of component temperatures up to 500 ˚C, although with specific adjustment of the composition of the ChG material, these sensors can become useful for metallic or ceramic SFR reactors where the cladding temperature can reach 650 ˚C. This will provide a temperature monitoring method for multiple components in the reactor design domain of multiple reactors. It can be further employed as in a number of hybrid electron/photonic tandem ChG/Si solutions (for example, when non-volatile memory is necessary to be introduced based also on the phase changes in the ChG) in the nuclear facilities since the chalcogenide glasses are radiation hard materials.

Nature-Based Nutrient Reduction for Seagrass Restoration

Seagrasses provide the following benefits worldwide. <list list-type="bullet"><list-item>Habitat for Marine Life</list-item><list-item>Nursery for Juvenile Fish</list-item><list-item>Food</list-item><list-item>Biodiversity</list-item><list-item>Carbon Storage (Blue Carbon)</list-item><list-item>Ocean Acidification Control</list-item><list-item>Oxygen Production</list-item><list-item>Sediment Erosion Control</list-item><list-item>Nutrient Cycling</list-item></list> Seagrass loss has been persistent for the past 100 years and is now accelerating at 7 percent (21,000 square kilometers) per year. We are addressing seagrass loss resulting from nutrient pollution which is about one third of the total.The technical objective is to remove at least as much total nitrogen from the sediment and bottom waters to allow restoration with the subsequent successful planting of seeds from nearby meadows.Our nature-based process starts with the eutrophication-induced restriction on the process to remove excess nitrogen from the top layer of sediment, coupled nitrification denitrification (CND). Decaying organic matter and biogeochemical processes consume enough oxygen to reduce the efficiency and capacity of the CND process.The solution is to increase the rate of dissolved oxygen flux in the bottom waters. Although science has known this for 20 years, how to do it has been a mystery. To facilitate oxygen dissolution, we will use nanoscale oxygen bubbles mixed with bottom water and delivered to the water/sediment interface.