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This article examines the connection between human rights and elder abuse, employing a human rights-based approach. Through a critical examination of a fictional case study on elder abuse, the discussion highlights the vital role of nurses when safeguarding the rights of older individuals in residential care settings. The PANEL framework – encompassing Participation, Accountability, Non-discrimination, Empowerment and Legality – is a comprehensive guide for safeguarding practice and is applied to the example provided. By applying this human rights-based approach, nurses can proactively address elder abuse, ensuring individuals' rights are protected, promoted and supported. Through accountability measures, non-discriminatory practices, empowerment strategies and adherence to legal standards, the authors advocate for a holistic approach to enhance the quality of care and foster a safe environment for older adults. [ABSTRACT FROM AUTHOR]

Background: Elder abuse is a global human rights issue, particularly in residential care settings where there is limited understanding of older people's experiences of this phenomenon. This scoping review aims to map and describe the existing literature on this phenomenon. Methods: Using Arksey and O'Malley's scoping review methodology, further developed by Levac et al. and the Joanna Briggs Institute, a systematic search of six databases was conducted to identify relevant studies published from inception to January 2023. Studies were included if they focused on older people's experience of abuse within residential care settings. A comprehensive data extraction process was employed to identify key themes from the included studies. Results: The initial search yielded a total of 3701 articles of which eight met the inclusion criteria. The findings revealed a range of abusive experiences encountered by older people living in residential care settings, including psychological, physical, financial, neglect and sexual abuse. The common attributes of residents vulnerable to abuse were evident throughout each of the studies. Finally, the theme of organizational neglect was apparent through the absence of effective safeguarding measures in the included studies. The findings revealed the insufficient implementation of safeguarding measures increases the risk of abuse among residents. Conclusion: This scoping review highlights the limited research on the experiences of older people who have encountered elder abuse in residential care settings. The findings stress the need for further research exploring the complex interplay of factors contributing to elder abuse within aged care settings. The insights gained from this scoping review can inform the development of comprehensive safeguarding strategies to prevent and address elder abuse in residential care settings, promoting the well‐being and safety of older people. Patient or Public Contribution: This project is a scoping review of the literature; therefore, no patient or public contribution was deemed necessary. What this paper contributes to the wider global community: Most research on elder abuse has been conducted in the community rather than in Residential Care Settings where there is a limited understanding of older people's experiences of abuse within the published literature.The scoping review highlights the presence of inadequate safeguarding strategies in Residential Care Settings within the reviewed studies, providing recommendations for developing and improving safeguarding measures in Residential Care Settings to prevent abuse, neglect, and harm in the future. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of sexual satisfaction in patients with advanced cancer and their family caregivers. Methods: Cross‐sectional study using baseline survey data from a randomized controlled trial in six European countries. Patients with advanced cancer and their family caregiver completed measures on sexual satisfaction (one item from Functional Assessment of Cancer Therapy ‐ General questionnaire for patients and Caregiver Quality of Life Index‐Cancer scale for family caregivers) and health‐related characteristics. Multivariable linear regressions were performed for all predictors (identified based on literature) with sexual satisfaction as dependent variable. Results: The sample comprised 431 patient‐family caregiver dyads. Patients with prostate or gynecological cancer reported lower sexual satisfaction (respectively B = −0.267 95% CI: −1.674, −0.594 and B = −0.196, 95% CI −2.103, −0.452). Higher emotional (B = 0.278, 95% CI 0.024, 0.057) physical (B = 0.305, 95% CI 0.012, 0.025) and social functioning (B = 0.151, 95% CI 0.001, 0.013), global health (B = 0.356, 95% CI 0.007, 0.013) and social wellbeing (B = 0.161, 95% CI 0.013, 0.082) among patients were associated with higher sexual satisfaction. Among family caregivers, sexual satisfaction was lower with increased age (B = −0.142, 95% CI −0.022, −0.004). Higher emotional functioning (B = 0.027, 95% CI 0.011, 0.043) and quality of life (B = 0.165, 95% CI −0.165, 0.716) were associated with higher sexual satisfaction in family caregivers. Conclusions: The results underscore that sexual wellbeing of patients and family caregivers is related to health related factors in physical, emotional, and social domains. Patients and family caregivers could benefit from a dyadic approach to address sexual wellbeing. [ABSTRACT FROM AUTHOR]

Background: Dying well at home usually requires the help and assistance of an informal caregiver. This role is usually unpaid, wide‐ranging and oftentimes demanding. From diagnosis to death of a loved one, informal caregivers can experience one and frequently numerous transitions, however, little is known about this process. The purpose of this scoping review is to chart, explore and understand caregivers' experiences of transitioning when providing end‐of‐life care. A preliminary search of the literature indicated a paucity of research highlighting a notable absence of caregiver's perspectives and acknowledgements of the support they need to ensure successful transitions during this time. Consequently, this review has the potential to make a valuable contribution to the literature. Methods: Arksey and O'Malley's (2005) framework, further enhanced by Levac et al. (2010) and Peters et al. (2020) was used to conduct this scoping review. The Extension for Scoping Reviews (PRISMA‐ScR) guided reporting. A systematic search of the databases PUBMED, PsychINFO, CINAHL, EMBASE, and Web of Science and a selection of grey literature was undertaken from the year 1990 to date by two researchers. Titles and abstracts of the literature identified were screened and finally, a narrative synthesis of 11 articles was undertaken to answer the following research question: What is known from the literature about informal caregivers' transitions when caring for a dying person in the home? Conclusions: Current knowledge on this topic is limited; however, from this review, two main themes were identified: 'Challenges arising during transitioning' with subthemes of burden of care and fading away. The second theme 'Coping strategies' comprised subthemes of meaning‐making, seeking normality and hope. This evidence may support the development of transitional care interventions in the future and improve patient and caregiver outcome measures and experiences to inform a larger research study exploring this phenomenon. Patient or Public Contribution: N/A as this is a Scoping Review. What this paper contributes to the wider global community: An understanding of the experiences of transitioning when caring for a loved one dying at home could help mitigate challenges informal caregivers face when providing end‐of‐life care in the home.While informal caregivers are crucial to support people who want to die at home, the role is often invisible and family carers need support and recognition to reduce the burden of care and challenges they experience as they transition in their role. [ABSTRACT FROM AUTHOR]

Aims Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure. Methods and results A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements. Conclusion This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team. [ABSTRACT FROM AUTHOR]

Since the tropopause was first identified, the quality and resolution of weather balloons has dramatically improved. NOAA Earth System Research Laboratories (ESRL) have provided high resolution and very high quality ozonesondes from eight locations: Fiji; American Samoa; Greenland; Antarctica; and several locations in USA (Hawai'i, Colorado, California and Alabama). These locations collectively cover polar regions, mid‐latitudes and tropics. Using this publicly archived data set, we studied the variability of the tropopause for all eight locations for one complete year (2016). Along with the standard estimates of the tropopause provided by NOAA ESRL, we developed four alternative tropopause definitions each based on changes in one of the following: (a) molar density; (b) temperature lapse rates; (c) water vapor content; (d) ozone content. These old and new tropopause definitions appear to hold over all eight locations—for all seasons and from the tropics to the poles. The cohesiveness between all five of these independent tropopause definitions is remarkable, although the NOAA ESRL estimates sometimes identify higher tropopause onsets than the other estimates. Therefore, each tropopause definition could potentially be used as proxies for other tropopause definitions. However, it also confirms that the troposphere/tropopause transition is a multi‐faceted physical and chemical phenomenon associated with more than just temperature changes. Finally, these high‐resolution results suggest that the original term "tropopause" might be a misnomer since they suggest increases in temperature lapse rate variability, rather than the "pausing" implied by lower resolution data or by lapse rates that are averaged over large distances. Plain Language Summary: In the lower atmosphere ("the troposphere"), the temperature decreases with height. This is why it is colder on mountaintops. Since 1902, it has been known that higher up in the atmosphere, in the region near where commercial airplanes fly, temperatures remain relatively constant with height. This region is called "the tropopause." In 1957, the World Meteorological Organization (WMO) defined the start of the tropopause in terms of a set of rules, that were complex, but designed to be applicable for all latitudes and seasons. However, these rules are often hard to implement and can give ambiguous results. So, other definitions have been developed for specific regions, such as the tropics, that are more straightforward and easier to interpret. In this paper, we have developed four new tropopause definitions that can be used with modern high resolution "ozonesondes" (weather balloons that also measure ozone). These four independent definitions describe different aspects of the atmosphere but each give very similar estimates of the tropopause. This reveals that the tropopause involves many different but synchronous changes in the atmosphere. It also shows that the name "tropopause" is confusing because it is a part of the atmosphere involving lots of changes instead of "pausing." Key Points: Four new tropopause definitions have been developed for use with high‐resolution ozonesondes that work for all latitudes and seasonsAll these definitions yield almost identical tropopause estimates yet are derived from independent physical or chemical metricsSurprisingly, the "tropopause" marks a region with increased lapse rate variability over short altitudes as opposed to long‐term averages [ABSTRACT FROM AUTHOR]

This paper investigates the impact of contemporary lightbars on vehicle fuel efficiency with a focus on quantifying their effects on fuel consumption and exploring strategies to improve drag performance through modifications. Simulations showed an 8–11% increase in drag for square-back vehicles, with greater penalties outlined for vehicles with rear-slanting roofs. Given the moderate drag increase, the impact on the driving range, especially for electric vehicles, remains minimal, supporting the continued use of external lightbars. Positioning experiments suggest marginal drag reductions when lowering the lightbar to its lowest position due to additional drag effects that can be caused by the mounting mechanism in its condensed form. Angling the lightbar showed negligible drag increases up to an angle of 2.5 degrees, but beyond that, a 4% increase in drag was observed for every additional 2.5 degrees. Additionally, fitting drag-reducing ramps ahead of the lightbar yielded no significant drag savings. Noise analysis identified that the lightbar's wake and rear surfaces were responsible for the largest production of noise. The optimal lightbar design was found to incorporate overflow rather than underflow and rear tapering in sync with roof curvature. Appendable clip-on devices for the lightbar, particularly rear clip-ons, demonstrated appreciable drag reductions of up to 2.5%. A final optimised lightbar design produced a minimal 2.8% drag increase when fitted onto an unmarked vehicle, representing a threefold improvement compared with the current generation of lightbars. This study advances the field of lightbar aerodynamics by precisely quantifying drag effects by using highly detailed geometry and examines the significance of optimal positioning, angle adjustment, and appendable clip-on devices in greater depth than any existing published work. [ABSTRACT FROM AUTHOR]

Background: Chronic wasting disease (CWD) is a prion disease of captive and free-ranging cervids. Currently, a definitive diagnosis of CWD relies on immunohistochemistry detection of PrPSc in the obex and retropharyngeal lymph node (RPLN) of the affected cervids. For high-throughput screening of CWD in wild cervids, RPLN samples are tested by ELISA followed by IHC confirmation of positive results. Recently, real-time quacking-induced conversion (RT-QuIC) has been used to detect CWD positivity in various types of samples. To develop a blood RT-QuIC assay suitable for CWD diagnosis, this study evaluated the assay sensitivity and specificity with and without ASR1-based preanalytical enrichment and NaI as the main ionic component in assay buffer. Results: A total of 23 platelet samples derived from CWD-positive deer (ELISA + /IHC +) and 30 platelet samples from CWD-negative (ELISA-) deer were tested. The diagnostic sensitivity was 43.48% (NaCl), 65.22% (NaI), 60.87% (NaCl-ASR1) or 82.61% (NaI-ASR1). The diagnostic specificity was 96.67% (NaCl), 100% (NaI), 100% (NaCl-ASR1), or 96.67% (NaI-ASR1). The probability of detecting CWD prion in platelet samples derived from CWD-positive deer was 0.924 (95% CRI: 0.714, 0.989) under NaI-ASR1 experimental condition and 0.530 (95% CRI: 0.156, 0.890) under NaCl alone condition. The rate of amyloid formation (RFA) was greatest under the NaI-ASR1 condition at 10–2 (0.01491, 95% CRI: 0.00675, 0.03384) and 10–3 (0.00629, 95% CRI: 0.00283, 0.01410) sample dilution levels. Conclusions: Incorporation of ASR1-based preanalytical enrichment and NaI as the main ionic component significantly improved the sensitivity of CWD RT-QuIC on deer platelet samples. Blood test by the improved RT-QuIC assay may be used for antemortem and postmortem diagnosis of CWD. [ABSTRACT FROM AUTHOR]

The rationale for the principles of effective school governance in England, as set out in government regulations, has never been made explicit. This article addresses that issue and develops and proposes such principles. We argue that effective school governance secures the legitimacy of schools as institutions. Such institutional legitimacy is achieved through the institutionalization processes in which the institutional primary task is central. Effective governance is therefore concerned with overseeing and ensuring the processes of institutionalization. We identify two general principles that relate to ensuring the school's legitimacy and ensuring that the school's institutionalization processes enable it to be a legitimate institution. We also distinguish six specific principles that relate to: the school's work on the institutional primary task, the resources required and deployed for work on the institutional primary task; the school's compliance with the rules and regulations that apply to the institution; the school's conformance to the norms expected of a school; the way the school operates on a day-to-day basis in relation to wider society's expectations; calling the headteacher or principal (HT/P) to account for the functioning of the school; and ensuring the HT/P's development. Our analysis is relevant to school governance in other countries. [ABSTRACT FROM AUTHOR]

Background: Most government efforts to control the COVID-19 pandemic revolved around non-pharmaceutical interventions (NPIs) and vaccination. However, many respiratory diseases show distinctive seasonal trends. In this manuscript, we examined the contribution of these three factors to the progression of the COVID-19 pandemic. Methods: Pearson correlation coefficients and time-lagged analysis were used to examine the relationship between NPIs, vaccinations and seasonality (using the average incidence of endemic human beta-coronaviruses in Sweden over a 10-year period as a proxy) and the progression of the COVID-19 pandemic as tracked by deaths; cases; hospitalisations; intensive care unit occupancy and testing positivity rates in six Northern European countries (population 99.12 million) using a population-based, observational, ecological study method. Findings: The waves of the pandemic correlated well with the seasonality of human beta-coronaviruses (HCoV-OC43 and HCoV-HKU1). In contrast, we could not find clear or consistent evidence that the stringency of NPIs or vaccination reduced the progression of the pandemic. However, these results are correlations and not causations. Implications: We hypothesise that the apparent influence of NPIs and vaccines might instead be an effect of coronavirus seasonality. We suggest that policymakers consider these results when assessing policy options for future pandemics. Limitations: The study is limited to six temperate Northern European countries with spatial and temporal variations in metrics used to track the progression of the COVID-19 pandemic. Caution should be exercised when extrapolating these findings. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn how participating in a journal club can enhance healthcare staff's understanding of evidence-based practice • To understand the practical steps required to establish and sustain a journal club in a healthcare setting • To recognise how discussing research articles can actively contribute to staff members' professional development With the rise in the number of older people in the population and new developments in older people's services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep up to date with the latest research. This article describes the process of establishing a multidisciplinary journal club in a residential care setting and recognising the potential of such clubs to develop staff members' critical thinking, presentation and communication skills. The authors emphasise the importance of fostering a culture of learning in older people's services and describe how a journal club can support healthcare professionals to maintain their knowledge and improve care. [ABSTRACT FROM AUTHOR]

This article presents a study on the aerodynamic drag of a generic dual-axle flatbed trailer and explores ways to reduce the drag using appendable drag-reducing devices. The primary sources of drag originated from the van and trailer's rear, along with the trailer's wheels. The most-effective initial device for reducing drag was a full trailer underside cover, which offered a 7% drag reduction. Additionally, ladder racks, dropsides, and rear gates were studied, and it was found that protruding ladder racks significantly increased drag. Rear gates added large amounts of drag and should be removed and stored when not needed. The study also explored novel mid-section devices that increased the van's base pressure and reduced drag. An axle test revealed that drag for single-, dual-, and triple-axle trailers was very similar in direct flow, but different in yawed flow. A drawbar length test showed a near-linear relationship between drawbar length and drag, manifesting as a 1.7% change in drag per 250 mm change in drawbar length. Several novel modifications were made to the trailer, including fitting six unique appendable devices, which offered a total 7.3% drag reduction. A novel rear van device known as the multi-stage converging cavity was introduced, which reduced drag by nearly 18%. When all the devices were used together, a total 25% drag reduction was observed for the van–trailer combination. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications. Methods: This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively. Results: Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients. Conclusion: This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications. [ABSTRACT FROM AUTHOR]

A statistical analysis was applied to Northern Hemisphere land surface temperatures (1850–2018) to try to identify the main drivers of the observed warming since the mid-19th century. Two different temperature estimates were considered—a rural and urban blend (that matches almost exactly with most current estimates) and a rural-only estimate. The rural and urban blend indicates a long-term warming of 0.89 °C/century since 1850, while the rural-only indicates 0.55 °C/century. This contradicts a common assumption that current thermometer-based global temperature indices are relatively unaffected by urban warming biases. Three main climatic drivers were considered, following the approaches adopted by the Intergovernmental Panel on Climate Change (IPCC)'s recent 6th Assessment Report (AR6): two natural forcings (solar and volcanic) and the composite "all anthropogenic forcings combined" time series recommended by IPCC AR6. The volcanic time series was that recommended by IPCC AR6. Two alternative solar forcing datasets were contrasted. One was the Total Solar Irradiance (TSI) time series that was recommended by IPCC AR6. The other TSI time series was apparently overlooked by IPCC AR6. It was found that altering the temperature estimate and/or the choice of solar forcing dataset resulted in very different conclusions as to the primary drivers of the observed warming. Our analysis focused on the Northern Hemispheric land component of global surface temperatures since this is the most data-rich component. It reveals that important challenges remain for the broader detection and attribution problem of global warming: (1) urbanization bias remains a substantial problem for the global land temperature data; (2) it is still unclear which (if any) of the many TSI time series in the literature are accurate estimates of past TSI; (3) the scientific community is not yet in a position to confidently establish whether the warming since 1850 is mostly human-caused, mostly natural, or some combination. Suggestions for how these scientific challenges might be resolved are offered. [ABSTRACT FROM AUTHOR]

The Equality Act 2010 was intended to extend its cover to perceived discrimination, such as dismissing a turbaned Sikh barista under pressure from customers mistaking him for a Muslim. Such mistakes are rooted in stereotyping, fear and prejudice. Disability discrimination is particularly prone to these attitudes, but the Act's inadequate drafting renders perceived disability discrimination claims exceptionally difficult. This paper suggests some innovative interpretive solutions, but ultimately recommends statutory reform. [ABSTRACT FROM AUTHOR]

This comprehensive study focused on the standard taxi sign used in Ireland and its impact on drag production, fuel expenses, and CO 2 emissions. Experimental analysis revealed that the conventional taxi sign significantly increased drag, especially when mounted on streamlined vehicles such as saloon cars, due to flow separation issues on the rear roof and rear windshield. Longitudinal reorientation of the sign offered a 14-fold reduction in drag increase compared to the traditional placement. It was found that positioning the sign in the middle of the roof offered the greatest fuel efficiency. Furthermore, the study estimated that implementing longitudinal repositioning on all Irish taxi signs could save drivers approximately EUR 832 per year and reduce national CO 2 emissions by a substantial 22,464 tonnes annually. Comparative analyses with international taxi signs demonstrated that the Irish sign had significantly larger drag contributions, emphasizing the need for improved aerodynamics. To address the inherent drag issue, the study explored novel appendable devices and proposed alternative taxi sign designs. Among the tested solutions, a magnet-mounted front ramp proved the most effective, reducing total drag by nearly 30%. Additionally, a motorized flip-up taxi sign design demonstrated a remarkable 40% reduction in drag. Finally, a newly proposed taxi sign design, featuring longitudinal positioning and pointed triangular front and rear faces, resulted in a minimal 4.3% increase in vehicle drag compared to the baseline car. [ABSTRACT FROM AUTHOR]

The standard worst-case normwise backward error bound for Householder QR factorization of an m x n matrix is proportional to mnu, where u is the unit roundoff. We prove that the bound can be replaced by one proportional to √mnu that holds with high probability if the rounding errors are mean independent and of mean zero and if the normwise backward errors in applying a sequence of m x m Householder matrices to a vector satisfy bounds proportional to √mu with probability 1. The proof makes use of a matrix concentration inequality. The same square rooting of the error constant applies to two-sided transformations by Householder matrices and hence to standard QR-type algorithms for computing eigenvalues and singular values. It also applies to Givens QR factorization. These results complement recent probabilistic rounding error analysis results for inner product-based algorithms and show that the square rooting effect is widespread in numerical linear algebra. Our numerical experiments, which make use of a new backward error formula for QR factorization, show that the probabilistic bounds give a much better indicator of the actual backward errors and their rate of growth than the worst-case bounds. [ABSTRACT FROM AUTHOR]

The article focuses on gender disparity in nursing editorials, noting that while nursing is a primarily female profession, male voices dominate editorial discourse regarding future nursing policy, leadership, and research. The authors argue that women in nursing need to assert themselves strategically and confidently to take their rightful place at the table.

Background: This paper investigates the palliative care competencies (knowledge, behaviours, attitudes) and education needs of nurses and healthcare assistants (HCAs) who provide supportive (Level 2) palliative care. Methods: A mixed-methods study using a sequential exploratory design was used, with findings integrated across sources. Qualitative focus groups were conducted in 2018 with a sample of staff (n=11, all female; nurses=4; HCAs=7) providing supportive palliative care in a single service setting. A quantitative survey, also conducted in 2018, explored the issue with a wider sample within the same setting (n=36; nurses=18; HCAs=18; female=32). Results: Qualitatively, communication was highlighted as an important domain of the competence framework, with many participants acknowledging that the ability to communicate effectively is essential. Quantitatively, participants scored in the lower range for competency variables. A significant difference was observed between HCAs and nurses on measures of knowledge (t= -2.718; df=30; p<.05) and behaviour (t=-3.576; df=30; p<.05), with HCAs scoring significantly higher than nurses. In relation to education, while some participants report being indecisive regarding engaging in education/training, others highlighted the benefit of education, especially its ability to impact on their practice. Conclusion: This research contributes to understanding palliative care competencies among nurses and HCAs working in palliative care, and has important implications for the education and training of nurses and HCAs working in Level 2 palliative care in Ireland. [ABSTRACT FROM AUTHOR]

Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs. Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term. Furthermore, it is often unclear how integrated care can be delivered to children with CCNs, therefore reinforcing the need for further clarification on how to define integrated care. An evolutionary concept analysis was conducted to clarify how integrated care for children with CCNs is defined within current literature. We found that integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. Conclusion: Given the variation in terms of study design, outcomes, and patient populations this paper highlights the need for further research into methods to measure integrated care. What is Known: • Children with complex care needs require long-term care, and are in need of improved services, communication, and information from healthcare professionals to provide them with the ongoing support they need to manage their condition. • Integrated care is a key component in healthcare delivery for children with complex care needs as it has the potential to improve access to family-centred care across the entire health spectrum. What is New: • Integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. • There is a need for the development of measurement tools to effectively assess integrated care within practice. [ABSTRACT FROM AUTHOR]

Introduction: A diagnosis of chronic illness posed a serious threat to people during the recent COVID‐19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self‐care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID‐19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self‐care behaviors and accessing altered healthcare services to inform future practices. Design: A population survey design. Methods: A mixed methods survey was designed, combining validated questionnaires and scales with open‐ended questions. A convenience sample was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open‐ended responses. Results: There were 147 responses, with approximately half reporting no changes in face‐to‐face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non‐face‐to‐face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self‐Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re‐engaging and that access to care was more difficult. Conclusion: This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self‐care education is required. Clinical relevance: This research concluded that the experience of access to one healthcare professional as opposed to diverse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID‐19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the policies and procedures related to safeguarding nursing home residents at risk of abuse • To be aware of the categories and possible indicators of elder abuse • To learn about the role of nurses in the assessment and management of suspected incidents of elder abuse Elder abuse is a growing concern for nurses who work with older people, and safeguarding incidents can be challenging and complex to manage. In the Republic of Ireland, safeguarding agencies claim there is a lack of reporting of abuse to the authorities, raising questions as to whether nurses know how, when and where to report safeguarding concerns. Despite varying strategies and laws concerning the reporting of elder abuse worldwide, the principles of recognising and responding to abuse are similar. However, to date, there is no specific legislation governing safeguarding for adults in Ireland. This article discusses elder abuse and safeguarding nursing home residents from an Irish perspective, explaining the process of managing concerns in practice using an analysis of a case study. [ABSTRACT FROM AUTHOR]

Users show a growing interest in expanding the implementation of digital tools as a support of technical and management issues in healthcare. This medical care has focused on telemedicine but does not include the recognition of needs as an important part of patient-centred healthcare. Nurses interact with patients at critical times in their life journeys, including birth and death, which are historical events linked with religious beliefs. Furthermore, large migration flows have led to multicultural societies in which religion and spirituality are experienced in distinct ways by different people. Finally, most healthcare professionals lack the proper skills to handle the spiritual needs of their patients, especially for core and digital competences. This article shows the results of qualitative research applying as a research tool an open-ended questionnaire, which allows detecting the educational needs for nurses' interventions aimed at providing spiritual support to their patients using digital tools. The results obtained reveal that nurses need education and training on fundamental spiritual concepts and digital competencies to meet the multiple demands of their patients' spiritual needs. Finally, we present an open digital educational proposal for the development of competencies for nurses and other health professionals to provide spiritual care with the support of digital tools. [ABSTRACT FROM AUTHOR]

Aim : To identify the nature of the evidence reporting hospital-based palliative and end-of-life care during the COVID-19 pandemic. Background : The COVID-19 pandemic has seen an increase in the numbers of seriously ill people being cared for across all health services worldwide. Due to the rapid progression of severe symptoms, the majority of staff working in hospitals and other healthcare centres were providing end-of-life care. Little is known about the level of hospital-based palliative care service provided during the COVID-19 pandemic, particularly during surges in admission rates with an increased number of deaths accruing. Methods: A scoping review was conducted to search and select potential studies. The scoping review was guided by the framework of Arskey and O'Malley and advanced by the use of the methodology of the Joanna Briggs Institute. Results: Eighteen studies published between March 2020 and July 2021 were identified. Three broad categories included overall management strategy and logistics, symptom prevalence and management of patients with COVID-19 and end-of-life care needs within the current pandemic. Conclusions: This review highlights increased awareness and knowledge of palliative and end-of-life care provided in hospitals. The review also highlights the response of hospital-based palliative care teams to an evolving crisis, within the context of developed health systems under sustained and overwhelming pressure. Implications: Newly established clinical links and referral pathways developed during the initial COVID-19 surge between hospital-based palliative care and other healthcare teams, be continued and further enhanced. Understanding of the role of specialist palliative care providers in supporting palliative and end-of-life care within the hospital setting needs further investigation. [ABSTRACT FROM AUTHOR]

This article reports on a fictional case study focusing on a person with dementia with a history of wandering behaviour, who was admitted to a residential care setting for 2 weeks of respite care. Caring for people with behavioural and psychological symptoms of dementia is complex. It is imperative that gerontology nurses have a sound knowledge of dementia in order to provide person-centred, safe, integrated, high-quality and appropriate care. Furthermore, gerontology nurses are in a position to support people with dementia and their carers by undertaking a comprehensive assessment of the person's needs to advise on possible and appropriate solutions to enable ageing in place. Community care and support to enable people with dementia to remain in their own home is recommended. While previous research shows a small positive effect of respite care for carers of people with dementia, there is no current evidence showing the benefits or adverse effects of respite care for care recipients. [ABSTRACT FROM AUTHOR]

The chromosphere is a highly dynamic outer plasma layer of the Sun. Its physical processes accounting for the variability are poorly understood. We reconstructed the solar chromospheric flare index (SFI) to study the solar chromospheric variability from 1937 to 2020. The new SFI database is a composite record of the Astronomical Institute Ondřejov Observatory of the Czech Academy of Sciences from 1937 – 1976 and the records of the Kandilli Observatory of Istanbul, Turkey from 1977 – 2020. The SFI records are available in daily, monthly, and yearly resolutions. We carried out the time-frequency analyses of the new 84-year long SFI records using the wavelet transform. We report the periodicities of 21.88 (Hale cycle), 10.94 (Schwabe cycle), 5.2 (quasi-quinquennial cycle), 3.5, 1.7, 1, 0.41 (or 149.7 days, Rieger cycle), 0.17 (62.1 days), 0.07 (25.9 days, solar rotational modulation) years. All these periodicities seem always present and persistent throughout the observational interval. Thus, we suggest that there is no reason to assume these solar periodicities are absent from other solar cycles. Time variations of the amplitude of each oscillation or periodicity were also studied using the inverse wavelet transform. We found that for the SFI the most active flare cycles over the record were Cycles 17, 19, and 21, while Cycles 20, 22, 23, and 24 were the weakest ones with Cycle 18 was intermediate in flare activity. This shows several differences to the equivalent relationships for solar activity implied by sunspot number records. Furthermore, this confirms that solar activity trends and variability in the chromosphere as captured by SFI are not necessarily the same as those of the Sun's photosphere, as implied by the sunspot number activity records, for instance. We have also introduced a new signal/noise wavelet coherence metric to analyze two different chromospheric indices available (i.e. the SFI and the disk-integrated chromospheric Ca ii K activity indices) and to quantify the differences and similarities of the oscillations within the solar chromosphere. Our findings suggest the importance of carrying out additional co-analyses with other solar activity records to find physical inter-relations and connections between the different solar layers from the photosphere, the chromosphere to the corona. [ABSTRACT FROM AUTHOR]

Background: Memory making is the process of creating mementos of a child with a life limiting condition, who may be at or near end of life, providing a tangible and visual connection to the child who has died. Aim: This study explored the lived experience a memory making process had on parents of children who were at or near end-of-life. Design: A qualitative approach was used. Hermeneutic phenomenology methods provided guidance to the data collection, with a more limited interpretative phenomenological analysis conducted. Setting: A purposive selected sample of 6 parents whose child had died and who had engaged in memory making participate. The sample was drawn from parents whose child had received care from a children's hospice. Results: Individual interviews were conducted with 6 parents, all mothers. Three main themes emerged: Making the memories; the impact of memory making; and the end-of-life care journey. Parents experienced an overwhelmingly positive impact from memory making, as well as tangible and precious mementos that were created. The positive impact the process had on coping with grief and loss was also demonstrated, as well as the effect of helping to keep the deceased child's memory alive and include them in conversation. Conclusions: The importance of skilled and sensitive staff with the ability to introduce the concept of memory making, and choice at end of life were highlighted by the parents who took part. Clinicians may benefit from understanding how memory making can positively impact the bereavement experience of parents whose child has died. [ABSTRACT FROM AUTHOR]

The aim of this review was to explore the evidence surrounding patients and families' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic from the perspective of nursing practice. While there is a plethora of research and publications related to COVID-19 and there are reports of increasing attention to nurses' psychological distress, there is little understanding of experiences related to patients' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic. A scoping review was conducted to search and select potential studies and undertake data extraction and synthesis. Twenty-one studies published between March 2020 and August 2021 were identified. Themes and subthemes that emerged from analysis of the studies included spiritual needs, new awareness of spiritual needs and spiritual interventions, chaplaincy referrals, and improved well-being. The potential requirement for spiritual care during these times has anecdotally never been greater. At the same time the existent ethical challenges persist, and nurses remain reticent about the topic of spirituality. This is evident from the clear lack of attention to this domain within the published nursing literature and a limited focus on spiritual care interventions or the experiences and spiritual needs of patients and their families. Greater attention is needed internationally to improve nurses' competence to provide spiritual care and to develop and advance nursing and research practice in the field of spiritual care. [ABSTRACT FROM AUTHOR]

Historically, there has be a close relationship between the nursing services and spiritual care provision to patients, arising due to the evolvement of many hospitals and nursing programmes from faith-based institutions and religious order nursing. With increasing secularism, these relationships are less entwined. Nonetheless, as nurses typically encounter patients at critical life events, such as receiving bad news or dying, nurses frequently understand the need and requirement for both spiritual support and religious for patients and families during these times. Yet there are uncertainties, and nurses can feel ill-equipped to deal with patients' spiritual needs. Little education or preparation is provided to these nurses, and they often report a lack of confidence within this area. The development of this confidence and the required competencies is important, especially so with increasingly multicultural societies with diverse spiritual and religious needs. In this manuscript, we discuss initial field work carried out in preparation for the development of an Erasmus Plus educational intervention, entitled from Cure to Care Digital Education and Spiritual Assistance in Healthcare. Referring specifically to post-COVID spirituality needs, this development will support nurses to respond to patients' spiritual needs in the hospital setting, using digital means. This preliminary study revealed that while nurses are actively supporting patients' spiritual needs, their education and training are limited, non-standardised and heterogeneous. Additionally, most spiritual support occurs within the context of a Judeo-Christian framework that may not be suitable for diverse faith and non-faith populations. Educational preparation for nurses to provide spiritual care is therefore urgently required. [ABSTRACT FROM AUTHOR]

Background In Australia, iron deficiency anaemia can be managed by ferric carboxymaltose, and iron polymaltose given via either a traditional slow or new rapid infusion protocol. These differ in their manufacturing, administration, and monitoring requirements, with unknown associated costs. Aim To compare the direct costs of iron infusions used in Australia; and explore potential savings associated with increased uptake of the least-expensive option at a local hospital. Method A time-motion method was used to determine the labour and consumables associated with each infusion protocol. Secondly, a frequency analysis identified the most common iron infusion doses prescribed at the study site. The total direct costs per protocol were compared at these doses and then the potential savings from switching to the lowest-costing of these protocols where possible were explored. Results The most common doses were 0.5 g, 1 g, 1.5 g and 2 g. At these dose points, ferric carboxymaltose infusions are the least expensive, but only if national health subsidies are applied. In cases where they do not apply, iron polymaltose prepared from ampoules and infused using the rapid protocol ('Iron Polymaltose Ampoules Rapid') is the least expensive. Switching all applicable ferric carboxymaltose infusions and iron polymaltose infusions administered using the slow infusion protocol to Iron Polymaltose Ampoules Rapid is projected to yield up to $12,000 worth of savings annually. Conclusions Increased use of the Iron Polymaltose Ampoules Rapid protocol when government-subsidised options are not available is projected to have cost-saving outcomes. Investigation of implementation strategies to increase the use of this protocol are warranted. [ABSTRACT FROM AUTHOR]

Aim: To explore the mobilization of nurses/midwives in a designated hospital group in Ireland during a global pandemic. Background: The recent global pandemic has resulted in the large‐scale worldwide mobilization of registered nurses and midwives working in the acute care sector. There is a dearth of literature reporting the mobilization of this professional workforce. Method: Mixed‐methods design using an electronic survey and facilitated discussion across one Irish hospital group. Results: Eight of 11 hospitals responded to the survey. There was a 2% vacancy rate prior to the pandemic. Mobilization included reconfiguration of clinical areas and redeployment of 9% of the nursing/midwifery workforce within 2 weeks of the pandemic. A total of 11% (n = 343) of nurses/midwives were redeployed in 3 months. Nurses/midwives required re‐skilling in infection prevention control, enhancement of critical care skills and documentation. Conclusions: Three key areas were identified to enable the nursing workforce readiness. These are referred to as the three 'R's': Reconfiguration of specific resources, Redeployment of nurses to dedicated specialist areas and Re‐skilling of nurses to safely care for the patients during the pandemic. Implications for Nursing Management: A centralized approach to reconfiguration of clinical areas.Redeployment is enabled by closing non‐essential departments.Hands‐on re‐skilling and reorientating staff are essential. [ABSTRACT FROM AUTHOR]

Background: Worldwide, millions of people with advanced cancer and their family caregivers are experiencing physical and psychological distress. Psychosocial support and education can reduce distress and prevent avoidable healthcare resource use. To date, we lack knowledge from large-scale studies on which interventions generate positive outcomes for people with cancer and their informal caregivers' quality of life. This protocol describes the DIAdIC study that will evaluate the effectiveness of two psychosocial and educational interventions aimed at improving patient-family caregiver dyads' emotional functioning and self-efficacy. Methods: We will conduct an international multicenter three-arm randomized controlled trial in Belgium, Denmark, Ireland, Italy, The Netherlands, and the United Kingdom. In each country, 156 dyads (936 in total) of people with advanced cancer and their family caregiver will be randomized to one of the study arms: 1) a nurse-led face-to-face intervention (FOCUS+), 2) a web-based intervention (iFOCUS) or 3) a control group (care as usual). The two interventions offer tailored psychoeducational support for patient-family caregiver dyads. The nurse-led face-to-face intervention consists of two home visits and one online video session and the web-based intervention is completed independently by the patient-family caregiver dyad in four online sessions. The interventions are based on the FOCUS intervention, developed in the USA, that addresses five core components: family involvement, optimistic outlook, coping effectiveness, uncertainty reduction, and symptom management. The FOCUS intervention will be adapted to the European context. The primary outcomes are emotional functioning and self-efficacy of the patient and the family caregiver, respectively. The secondary outcomes are quality of life, benefits of illness, coping, dyadic communication, and ways of giving support of the patient and family caregiver. Discussion: DIAdIC aims to develop cost-effective interventions that integrate principles of early palliative care into standard care. The cross-country setup in six European countries allows for comparison of effectiveness of the interventions in different healthcare systems across Europe. By focusing on empowerment of the person with cancer and their family caregiver, the results of this RCT can contribute to the search for cost-effective novel interventions that can relieve constraints on professional healthcare. Trial registration: Registration on ClinicalTrials.gov on 12/11/2020, identifier NCT04626349. Date and version identifier: 20211209_DIAdIC_Protocol_Article. [ABSTRACT FROM AUTHOR]

The article offers information on the 50th anniversary of the volunteer program of the Montana Historical Society.

Background: Special palliative care is provided in a range of settings including a patient's home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods: This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results: Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions: This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff. [ABSTRACT FROM AUTHOR]

Background: The provision of palliative care (PC) for individuals with a life-threatening condition is fundamental to the role of the physician, in order to improve quality of life; however, little research has assessed the competence of the physicians in PC in Saudi Arabia. Aim: To conduct a baseline assessment of self-assessed palliative care competences among medical physicians in Saudi Arabia. Design: A survey-based cross-sectional study was employed using a specifically designed questionnaire. Setting: The participants in the study were selected from 6 specialist medical departments (Family medicine, cardiology, internal medicine, pulmonary medicine, neurology and oncology) in 4 Saudi Arabian Hospitals, based on inclusion criteria. Results: The study was conducted using a validated questionnaire used in Ireland to evaluate the competence skills of physicians for the provision of palliative care. All categories showed internal reliability and normal distribution of the data. However, the score of the knowledge, attitude and practice among the physicians was higher than the expected. The clinical specialty of the physicians demonstrated greater influence on knowledge, attitude and practice related to the palliative care compared to medical education. This highlighted the importance of training in palliative care to the medical doctors working in a range of specialist area. Conclusion: The study provides baseline data on the level of competence of palliative care of physicians in Saudi Arabia. This study can be used as an assessment tool to further evaluate the effectiveness of palliative care in other areas as primary and secondary care settings [ABSTRACT FROM AUTHOR]

Background: This paper investigates the palliative care competencies (knowledge, behaviours, attitudes) and education needs of nurses and healthcare assistants (HCAs) who provide supportive (Level 2) palliative care. Methods: A mixed-methods study using a sequential exploratory design was used, with findings integrated across sources. Qualitative focus groups were conducted in 2018 with a sample of staff (n=11, all female; nurses=4; HCAs=7) providing supportive palliative care in a single service setting. A quantitative survey, also conducted in 2018, explored the issue with a wider sample within the same setting (n=36; nurses=18; HCAs=18; female=32). Results: Qualitatively, communication was highlighted as an important domain of the competence framework, with many participants acknowledging that the ability to communicate effectively is essential. Quantitatively, participants scored in the lower range for competency variables. A significant difference was observed between HCAs and nurses on measures of knowledge (t= -2.718; df=30; p<.05) and behaviour (t=-3.576; df=30; p<.05), with HCAs scoring significantly higher than nurses. In relation to education, while some participants report being indecisive regarding engaging in education/training, others highlighted the benefit of education, especially its ability to impact on their current practice. Conclusion: This research contributes to understanding palliative care competencies among nurses and HCAs working in palliative care, and has important implications for the education and training of nurses and HCAs working in Level 2 palliative care in Ireland. [ABSTRACT FROM AUTHOR]

Severe baclofen toxicity can result in respiratory failure, hemodynamic instability, bradycardia, hypothermia, seizures, coma, and death. While hemodialysis (HD) is well-described in treating acute baclofen toxicity in patients with end-stage kidney disease or acute kidney injury, the utility of HD for patients with normal kidney function is uncertain. Implementing HD to speed recovery after a large acute baclofen ingestion is appealing, considering: (a) potential for prolonged coma and ventilator-associated morbidity, and (b) baclofen's low protein-binding, low molecular-weight, and moderate volume of distribution. We report a 51 kg, 14-year-old girl who presented to the emergency department (ED) with hypotension, obtundation, and status epilepticus after an intentional ingestion of 1200 mg baclofen. Her post-intubation neurologic examination was concerning for coma. A 14-hour post-ingestion baclofen concentration was 882 ng/mL (therapeutic range 80–400 ng/mL). Three urgent-HD sessions were performed to reduce her time on the ventilator. The total baclofen removed in the first three-hour HD session was 3.05 mg. The total urinary elimination of baclofen 42 mg over 24-hours on day one. She was discharged without neurologic deficits to psychiatry on day-14. In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function. [ABSTRACT FROM AUTHOR]

Stochastic rounding rounds a real number to the next larger or smaller floating-point number with probabilities 1 minus the relative distances to those numbers. It is gaining attention in deep learning because it can increase the success of low precision computations. We compare basic properties of stochastic rounding with those for round to nearest, finding properties in common as well as significant differences. We prove that for stochastic rounding the rounding errors are mean independent random variables with zero mean. We derive a new version of our probabilistic error analysis theorem from [N. J. Higham and T. Mary, SIAM J. Sci. Comput., 41 (2019), pp. A2815-- A2835], weakening the assumption of independence of the random variables to mean independence. These results imply that for a wide range of linear algebra computations the backward error for stochastic rounding is unconditionally bounded by a multiple of √nu to first order, with a certain probability, where n is the problem size and u is the unit roundoff. This is the first scenario where the rule of thumb that one can replace nu by √nu in a rounding error bound has been shown to hold without any additional assumptions on the rounding errors. We also explain how stochastic rounding avoids the phenomenon of stagnation in sums, whereby small addends are obliterated by round to nearest when they are too small relative to the sum. [ABSTRACT FROM AUTHOR]

Accepted definitions of educational leadership practice typically view it as influence to achieve organisational goals. Such definitions have been widely used over the last 30 years. During that time, the number of educational leadership theories/models has increased and cover the many aspects of educational leadership all of which implicitly or explicitly use the accepted definition. However, the accepted definition is open to critique in a range of important ways and we consider that a more robust definition is required. In this article, we reconceptualise and redefine educational leadership practice as 'legitimate interaction in an educational institution intended to enhance engagement with the institutional primary task'. We analyse the concepts underpinning the key aspects of that definition: the institutional context of educational leadership practice; legitimacy and educational leadership practice; the interactional nature of educational leadership practice; institutionalisation and institutions; the notion of engagement and the necessary conditions of capability, opportunity and motivation; and the institutional primary task. [ABSTRACT FROM AUTHOR]

Background: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. Aim: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. Method: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. Findings: Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. Conclusion: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops. [ABSTRACT FROM AUTHOR]

Peptoids belong to a class of sequence‐controlled polymers comprising of N‐alkylglycine. This study focuses on using tandem mass spectrometry techniques to characterize the fragmentation patterns of a set of singly and doubly protonated peptoids consisting of one basic residue placed at different positions. The singly protonated peptoids fragment by producing predominately high‐abundant C‐terminal ions called Y‐ions and low‐abundant N‐terminal ions called B‐ions. Computational studies suggest that the proton affinity (PA) of the C‐terminal fragments is generally higher than that of the N‐terminal fragments, and the PA of the former increases as the fragments are elongated. The B‐ions are likely formed upon dissociating the proton‐activated amide bonds via an oxazolone structure, and the Y‐ions are produced subsequently by abstracting a proton from the newly formed B‐ions, which is energetically favored. The doubly protonated peptoids prefer to fragment closest to either the N‐ or the C‐terminus and produce corresponding B/Y‐ion pairs. The basic residue seems to dictate the preferred fragmentation site, which may be the result of minimizing the repulsion between the two charges. Water and terminal neutral losses are a facile process accompanying the peptoid fragmentation in both charge states. The patterns appear to be highly influenced by the location of the basic residue. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial. Methods: The aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care. Results: The financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration. Conclusions: Various groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving. [ABSTRACT FROM AUTHOR]

Background: palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit. Aim: the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis. Methods: a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses. Findings: the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education. Conclusion: nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of dual-energy (DE) virtual non-contrast computed tomography (vNCT) to non-contrast CT (NCT) for the diagnosis of adrenal adenomas.Methods: Search of multiple databases and grey literature was performed. Two reviewers independently applied inclusion criteria and extracted data. Risk of bias was assessed using QUADAS-2. Summary estimates of diagnostic accuracy were generated and sources of heterogeneity were assessed.Results: Five studies (170 patients; 192 adrenal masses) were included for diagnostic accuracy assessment; all used dual-source dual-energy CT. Pooled sensitivity for adrenal adenoma on vNCT was 54% (95% CI: 47-62%). Pooled sensitivity for NCT was 57% (95% CI: 45-69%). Pooling of specificity was not performed since no false positives were reported. There was a trend for overestimation of HU density on vNCT as compared to NCT which appeared related to contrast timing. Potential sources of bias were seen regarding the index test and reference standard for the included studies. Potential sources of heterogeneity between studies were seen in adenoma prevalence and intravenous contrast timing.Conclusions: vNCT images generated from dual-energy CT demonstrated comparable sensitivity to NCT for the diagnosis of adenomas; however the included studies are heterogeneous and at high risk for some types of bias.Key Points: • Similar sensitivity of vNCT to NCT for diagnosis of adenoma • Heterogeneity could be related to vNCT from early (<=60 sec) CECT studies • Could not pool specificity as there were no false positives • Small number of heterogeneous studies at high risk of bias. [ABSTRACT FROM AUTHOR]