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Background: Volunteers make a huge contribution to the health and wellbeing of the population and can improve satisfaction with care especially in the hospice setting. However, palliative and end-of-life-care volunteer services in the hospital setting are relatively uncommon. The iLIVE Volunteer Study, one of eight work-packages within the iLIVE Project, was tasked with developing a European Core Curriculum for End-of-Life-Care Volunteers in hospital. Aim: Establish an international consensus on the content of a European Core Curriculum for hospital end-of-life-care volunteer services which support patients in the last weeks of life. Design: Delphi Process comprising the following three stages: 1. Scoping review of literature into palliative care volunteers. 2. Two rounds of Delphi Questionnaire. 3. Nominal Group Meeting. Setting/participants: Sixty-six participants completed the Round 1 Delphi questionnaire; 75% (50/66) took part in Round 2. Seventeen participants attended the Nominal Group Meeting representing an international and multi-professional group including, clinicians, researchers and volunteer coordinators from the participating countries. Results: The scoping review identified 88 items for the Delphi questionnaire. Items encompassed organisational issues for implementation and topics for volunteer training. Three items were combined and one item added in Round 2. Following the Nominal Group Meeting 53/87 items reached consensus. Conclusion: Key items for volunteer training were agreed alongside items for implementation to embed the end-of-life-care volunteer service within the hospital. Recommendations for further research included in-depth assessment of the implementation and experiences of end-of-life-care volunteer services. The developed European Core Curriculum can be adapted to fit local cultural and organisational contexts.

International audience; Problem-solving strategies in visual reasoning tasks are often studied based on the analysis of eye movements, which yields high-quality data but is costly and difficult to implement on a large scale. We devised a new graphical user interface for matrix reasoning tasks where the analysis of computer mouse movements makes it possible to investigate item exploration and, in turn, problem-solving strategies. While relying on the same active perception principles underlying eye-tracking (ET) research, this approach has the additional advantages of being user-friendly and easy to implement in real-world testing conditions, and records only voluntary decisions. A pilot study confirmed that embedding items of Raven's Advanced Progressive Matrices (APM) in the interface did not significantly alter its psychometric properties. Experiment 1 indicated that mouse-based exploration indices, when used to assess two major problem-solving strategies in the APM, are related to final performance—as has been found in past ET research. Experiment 2 suggested that constraining some features of the interface favored the adoption of the more efficient solving strategy for some participants. Overall, the findings support the relevance of the present methodology for accessing and manipulating problem-solving strategies.

INTRODUCTION The prevalence of diabetes mellitus (DM) in patients with myocardial infarction (MI) is estimated at about 25%. Short-and long‑term prognosis is worse in patients with DM and hyperglycemia compared with nondiabetics. OBJECTIVES Our aim was to analyze the impact of DM and transient hyperglycemia on in‑hospital complications and long‑term outcomes in patients with MI. PATIENTS AND METHODS We evaluated a prospective cohort of 58 394 patients with MI in the Polish Registry of Acute Coronary Syndromes (PL-ACS) in terms of in‑hospital complications and 30‑day, 12‑month, and 36‑month outcomes between 2009 and 2012. RESULTS Patients with type 1 DM (T1DM) and type 2 DM (T2DM) underwent invasive diagnostic and therapeutic procedures less frequently than those without diabetes, transient hyperglycemia, and new‑onset DM (P

BACKGROUND: Preterm premature rupture of membranes (P-PROM) exerts a tremendous influence on pregnancy prognosis. Additionally, it is a major public health concern, as the cause of up to 40% of all preterm births. AIM: The objective of this study was to identify predictors of Caesarean Delivery in singleton pregnancies complicated by P-PROM. MATERIALS AND METHODS: This is a retrospective observational study of all consecutive singleton P-PROM deliveries (24-37 weeks) over an 18 months at a tertiary referral centre. Pertinent data was collected comprising demographics, obstetric history, pregnancy-associated pathology and delivery from electronic patient records. Univariate statistical analysis comprised Odds Ratio, 95% Confidence interval and Chi-square test with subsequent p-value with statistical significance set at p < 0.05. RESULTS: A total of 240 women delivered singletons following P-PROM over an 18-month period. Maternal age ranged between 12-41 years with an average age of 28 ± 6.27 years. Vaginal delivery (VD) was the predominant mode of delivery, accounting for 52.9% (n = 127) of deliveries. The following parameters were identified as predictors of Caesarean Section (CS) in P-PROM: vaginal infection (p = 0.04), previous CS (p < 0.0001), primiparity (p = 0.004), gravidity > 5 (p = 0.009), university education (p = 0.0006) and prenatal care (p < 0.0001). CONCLUSION: The advantage of CS over vaginal delivery is expedited delivery of the distressed fetus, while that of vaginal delivery entails avoiding postoperative morbidity. However, large multicentric randomised-controlled studies are needed to elucidate this dilemma definitively.

International audience; ABSTRACT In the context of demographic aging, preventing autonomy loss is a major issue. Adapting care systems to help keep seniors at home is a daily challenge. “La Mutualité Française”, a national mutual insurance company, has implemented in one of its healthcare services an innovative program to strengthen well-being: “The Well-Being Autonomy Pole.” This program comprises five Prevention and Support Care components and hypothesizes that strengthening the well-being of elderly people already suffering from physical limitations would prevent their autonomy decline. The originality of this program is its focus on elderly people who have rarely been studied in terms of preventing autonomy loss, given their existing functional limitations. A first evaluation was carried out over three months to verify the methodological feasibility of an impact assessment and to provide preliminary results on the effectiveness of the program. Key findings suggest improved levels of self-esteem, physical well-being, psychological autonomy and decreased anxiety. Methodological limitations of this first feasibility assessment and perspectives for future research are discussed.; RÉSUMÉ Dans un contexte de vieillissement démographique, prévenir la perte d’autonomie représente un enjeu majeur. Adapter les systèmes de soins pour favoriser le maintien des personnes âgées à domicile est un défi quotidien. La Mutualité Française, Société Mutualiste nationale, a mis en place dans l’une de ses antennes un programme innovant de renforcement du bien-être : le Pôle Bien-Être Autonomie. Composé de cinq Soins de Prévention et de Soutien, ce programme postule que le renforcement du bien-être des personnes âgées présentant déjà certaines limitations physiques permettrait de prévenir le déclin de leur autonomie. L’originalité de ce programme est de s’adresser à un public très peu sollicité dans les études sur la prévention de la perte d’autonomie en raison des limitations fonctionnelles existantes. Une première évaluation sur trois mois a été menée afin de vérifier la faisabilité méthodologique d’une évaluation d’impact et de fournir des résultats préliminaires concernant l’efficacité du programme. Les principaux résultats indiquent une amélioration des niveaux d’estime de soi, de bien-être physique, d’autonomie psychologique et une diminution de l’anxiété. Les limites méthodologiques identifiées par cette première étude de faisabilité et les perspectives pour des recherches futures sont discutées.

Funding Acknowledgements Type of funding sources: None. Background Routine defibrillation testing during implant and replacement of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended per current guidelines. Recently, concerns have been raised about an increase in shock impedance and consequent shock failure during defibrillation testing in S-ICD patients undergoing a generator replacement. Purpose We aim to describe the defibrillation success rate in relation to the shock impedance in patients undergoing S-ICD generator replacement in our large tertiary center. Methods In this retrospective analysis, data from replacement procedures were collected from all patients who underwent an S-ICD generator replacement in our center from June 2014 to December 2020. Defibrillation testing was performed with at least one shock of ≤65J, and a successful shock was defined as terminating the ventricular arrhythmia within 5 seconds after the shock. Results A total of 133 patients underwent an S-ICD generator replacement, 5.8 ± 0.9 years after initial implant. Reasons for replacement were: reaching of elective replacement indicator (n = 119), early battery depletion (n = 9), complaints of generator pocket (n = 3) and device malfunction (n = 2). Defibrillation testing was performed in 111 patients (86.5%) undergoing a replacement procedure. Shock impedance data from both the implant and replacement procedure were available in 101 patients. The median shock impedance of these patients during their replacement procedure was significantly higher than during their implant, 79Ω (IQR 66-94) and 66Ω (IQR 57.5-81) respectively (Z = -5.552, p Conclusion In this large retrospective analysis, we have shown a first shock success rate during S-ICD generator replacement of 94.6%, which is similar to the success rate of defibrillation testing after initial implant. After multiple attempts, defibrillation testing success rate was 100%. Even though the median shock impedance during replacement was significantly higher than during the initial implant, there was no difference in impedance increase in patients with a successful shock compared to patients with an unsuccessful shock. Abstract Figure. Defibrillation success

Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter-defibrillator (ICD) therapy is associated with the risk of inappropriate shocks (IAS). IAS, defined as any shock on a different rhythm than VT or VF, cause psychological stress, decrease the quality of life and may provoke ventricular arrhythmias. In the subcutaneous ICD (S-ICD) the majority of IAS are caused by T-wave oversensing (TWOS), often during exercise. Exercise-optimized programming during an exercise ECG test (X-ECG) after implantation has shown to be successful in reducing IAS in patients known with TWOS. In recent years, new discrimination algorithms in the latest generation S-ICDs have significantly reduced the risk of TWOS. The benefit of performing an X-ECG in these latest generation S-ICDs to reduce IAS is unclear. Purpose We aim to describe the effect of exercise-optimized programming after S-ICD implantation on inappropriate shock rate in the latest generation S-ICDs. Methods In this retrospective multicenter study, data were collected from two experienced S-ICD hospitals in the Netherlands. All patients underwent an S-ICD implantation of second or third generation between February 2015 and December 2020. Patients younger than 21 years were excluded. Patients with an X-ECG after implantation were compared with patients without X-ECG after implantation. Total number of patients with IAS and cause of the first IAS were evaluated. Results In total, 262 patients were included in the X-ECG group and 61 in the no X-ECG group. The median follow-up time was 22 months in the X-ECG group (IQR 9-33) and 23 months in the no X-ECG group (IQR 12-33, P = 0.9). Mean age was 51 ± 15 years and 61 ± 15 years respectively (P< 0.001). Primary prevention indication was similar in both groups (56% for the X-ECG group versus 49% for the no X-ECG group, P = 0.4). A total of 8 patients (3.1%) experienced IAS in the X-ECG group; 3 first shocks (1.15%) were due to TWOS, 2 (0.8%) were given on a SVT and 3 (1.15%) on other non-cardiac activity. In the no X-ECG group, 6 patients (9.8%) experienced IAS; 1 first shock (1.6%) was due to TWOS, 4 (6.6%) were given on a SVT and 1 (1.6%) on other non-cardiac activity. Patients with an X-ECG had a significantly lower risk of IAS compared to patients in the no X-ECG group (hazard ratio 0.32; 95% CI 0.1 to 0.9; P = 0.027). The Kaplan-Meier estimate of IAS-free survival for the X-ECG group was 61 months (95% CI 59 to 62) and 50 months (95% CI 46 to 55) for the no X-ECG group. Results are shown in the figure. Conclusion This study shows that, in the latest generation S-ICDs, exercise-optimized programming after S-ICD implantation results in a significantly lower risk of IAS in adults. Patients with an X-ECG after S-ICD implantation were younger, which may have affected the outcome. Further prospective data with more equal groups is necessary. Until then, we recommend considering exercise testing after S-ICD implantation in the latest generation S-ICDs. Abstract Figure.

Contains fulltext : 225390.pdf (Publisher’s version ) (Open Access) BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing these systems has been based primarily on observational studies. METHODS: We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for pacing were assigned to receive a subcutaneous ICD or transvenous ICD. The primary end point was the composite of device-related complications and inappropriate shocks; the noninferiority margin for the upper boundary of the 95% confidence interval for the hazard ratio (subcutaneous ICD vs. transvenous ICD) was 1.45. A superiority analysis was prespecified if noninferiority was established. Secondary end points included death and appropriate shocks. RESULTS: A total of 849 patients (426 in the subcutaneous ICD group and 423 in the transvenous ICD group) were included in the analyses. At a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in the subcutaneous ICD group and in 68 patients in the transvenous ICD group (48-month Kaplan-Meier estimated cumulative incidence, 15.1% and 15.7%, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.71 to 1.39; P = 0.01 for noninferiority; P = 0.95 for superiority). Device-related complications occurred in 31 patients in the subcutaneous ICD group and in 44 in the transvenous ICD group (hazard ratio, 0.69; 95% CI, 0.44 to 1.09); inappropriate shocks occurred in 41 and 29 patients, respectively (hazard ratio, 1.43; 95% CI, 0.89 to 2.30). Death occurred in 83 patients in the subcutaneous ICD group and in 68 in the transvenous ICD group (hazard ratio, 1.23; 95% CI, 0.89 to 1.70); appropriate shocks occurred in 83 and 57 patients, respectively (hazard ratio, 1.52; 95% CI, 1.08 to 2.12). CONCLUSIONS: In patients with an indication for an ICD but no indication for pacing, the subcutaneous ICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks. (Funded by Boston Scientific; PRAETORIAN ClinicalTrials.gov number, NCT01296022.).

Background: Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure. Objective: Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score. Methods: The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30–

Background/aim Chronic myeloid leukaemia (CML) rarely affects the paediatric population and has an incidence of 0.06-0.12/100,000 children per year. The dire clinical course of paediatric CML is further exacerbated by the adverse effects of long-term imatinib therapy. Patients and methods Our cohort comprised 14 CML patients who were treated with imatinib between July 2010 and September 2018. The European Leukaemia Net (ELN) standard milestones of response criteria were used to evaluate its therapeutic effectiveness. Results Complete haematological remission and partial cytogenetic response were achieved in all patients. Complete cytogenetic response was achieved in seven patients. Major molecular response was achieved in six patients. Two patients underwent haematopoietic stem cell transplantation due to unsatisfactory response to imatinib. Conclusion Imatinib is effective in treating paediatric CML and limits the progression to advanced stages, however, the quality of life still needs to be optimised.

A 140 liter lab scale shell-and-tube PCM heat storage was built and tested, and the experimental results were compared to a numerical model. Natural convection in the PCM was found to significantly influence the temperature distribution in the storage vessel. A horizontal orientation was found to be beneficial due to increased heat exchange during charging (melting).

The economic decline of the Great Recession has increased the need for a univer- sity degree, which can enhance individuals’ prospects of obtaining employment in a competitive, globalized market. Research in the social sciences has consistently demonstrated that students with low socioeconomic status (SES) have fewer op- portunities to succeed in university contexts compared to students with high SES. The present article reviews the psychological barriers faced by low-SES students in higher education compared to high-SES students. Accordingly, we first review the psychological barriers faced by low-SES students in university contexts (in terms of emotional experiences, identity management, self-perception, and moti- vation). Second, we highlight the role that university contexts play in producing and reproducing these psychological barriers, as well as the performance gap observed between low- and high-SES students. Finally, we present three examples of psychological interventions that can potentially increase both the academic achievement and the quality of low-SES students’ experience and thus may be considered as methods for change.

In transvenous implantable cardioverter-defibrillator (TV-ICD) implants, routine defibrillation testing (DFT) does not improve shock efficacy or reduce arrhythmic death but patients are exposed to the risk of complications related to DFT. The conversion rate of DFT in subcutaneous ICD (S-ICD) is high and first shock efficacy is similar to TV-ICD efficacy rates. STUDY DESIGN: The PRAETORIAN-DFT trial is an investigator-initiated, randomized, controlled, multicenter, prospective two-arm trial designed to demonstrate non-inferiority of omitting DFT in patients undergoing S-ICD implantation in which the S-ICD system components are optimally positioned. Positioning of the S-ICD will be assessed with the PRAETORIAN score. The PRAETORIAN score is developed to systematically evaluate implant position of the S-ICD system components which determine the defibrillation threshold on post-operative chest X-ray. A total of 965 patients, scheduled to undergo a de novo S-ICD implantation without contra-indications for either DFT strategy, will be randomized to either standard of care S-ICD implantation with DFT, or S-ICD implantation without DFT but with evaluation of the implant position using the PRAETORIAN score. The study is powered to claim non-inferiority of S-ICD implantation without DFT in de novo S-ICD patients in respect to the primary endpoint of first shock efficacy in spontaneous arrhythmia episodes. Patients with a high PRAETORIAN score (≥90) in the interventional arm of this study will undergo DFT according to the same DFT protocol as in the control arm. CONCLUSION: The PRAETORIAN-DFT trial is a randomized trial that aims to gain scientific evidence to safely omit a routine DFT after S-ICD implantation in patients with correct device positioning.

Substernal Pacing in Humans IntroductionThe objective of this study was to assess feasibility of ventricular pacing and thresholds from within the substernal space to examine a new extravascular ICD configuration with pacing capabilities. MethodsIn patients undergoing midline sternotomy, a duodecapolar diagnostic pacing catheter was positioned in the substernal space anterior to the pericardium, and a cutaneous patch in left lateral position. Different unipolar and bipolar pacing configurations were assessed. Strength-duration curves were performed to identify the optimal output, starting at 25 mA with a pulse width of 10 milliseconds. ResultsEight patients with mean age 69 9 years were included. In 5, ventricular capture was achieved in 1 configuration. The mean bipolar pacing thresholds at PW 10, 5, 3, 1 milliseconds were 12.4 +/- 3.7 mA (5 patients), 13.3 +/- 5.8 mA (3 patients), 18.3 +/- 5.7 mA (3 patients), and 25 +/- 0 mA (2 patients), respectively. The 60-mm electrode spacing was the most successful bipolar configuration. Unipolar pacing was successful in 3 out of 4 patients with mean thresholds of 10 +/- 0 mA at 10 milliseconds (3 patients), 15 +/- 0 mA at 5 milliseconds (3 patients), 16.7 +/- 2.9 mA at 3 milliseconds (3 patients), and 20 +/- 7.1 mA at 1 milliseconds (2 patients). ConclusionVentricular pacing from the substernal space in patients with midline sternotomy is feasible. Closed sternum studies are needed to determine pacing thresholds more accurately

To assess the effects of muscle strength, as determined by grip strength, on changes in health status in adolescents.Risk variables included excess body fat, elevated fasting glucose, high blood pressure, elevated serum triglycerides, and low high-density lipoprotein cholesterol. Multinomial logistic regression was used to quantify the odds of experiencing health maintenance (no risk factors identified at either time point) or health improvement (presence of ≥1 baseline risk factor and fewer or no risk factors at follow-up) over a 2-year period. The primary exposure variable was grip strength normalized by body mass (normalized grip strength [NGS]), and previous cut-offs were used to determine whether adolescents were weak or strong.Adolescents who had low NGSs had a significantly greater prevalence of health decline or poor health persistence as compared with those who were strong (boys: 60.2% vs 15.3%; girls: 51% vs 21.9%; all P .001). Moreover, adolescents who were strong had an increased adjusted odds for health maintenance (OR 3.54; 95% CI 1.80-6.97) and health improvement (OR 1.30; 95% CI 1.05-1.60), even after we adjusted for baseline fat-free mass index, cardiorespiratory fitness, and objectively measured physical activity.Greater NGS is associated with longitudinal health maintenance and health improvements in adolescents. Low NGS could be used as a prognostic indicator of cardiometabolic risk and to identify adolescents who would benefit most from lifestyle interventions to improve muscular fitness.

Currently, there is no consensus regarding the benefits of physical activity in terms of upper respiratory tract infections (URTIs) among different age groups of children. The number of school students avoiding physical education is on the rise. Children of all ages spend more time on sedentary behavior, eat less nutritious food and spend less time sleeping. All of these concomitant aspects adversely affect the immune system. A coexisting problem of a growing society is a large number of URTIs which is the main reason for general practitioner intervention. The aim of this study is to determine whether there is a correlation between the frequency of respiratory tract infections and the level of physical exercise in a cohort of pre-school children. This will be a cross-sectional, short-term study conducted on a single study population. We aim to recruit four-, to seven-year-old children who will be receiving activity monitoring devices for 24 h a day for 40 days. Daily step count, mean intensity of physical exercise and sleep duration will be measured. Simultaneously, their parents will receive a series of 60 questionnaires, one questionnaire per day, for the daily assessment of upper respiratory infection (URI) symptoms. Our study conducted on a cohort of healthy pre-school children using uniform tools, aims to scientifically establish and quantify the relationship between physical activity and health outcomes over a specified period of time.

1. The present study examined the relationship between centrally measured stroke volume variation (SVV) and peripherally derived pulse pressure variation (PPV) in the setting of increased total arterial compliance (CA rt ). 2. Ten male Wistar rats were anaesthetized, paralysed and mechanically ventilated before being randomized to receive intrapulmonary lipopolysaccharide (LPS) or no LPS. Pulse pressure (PP) was derived from the left carotid artery, whereas stroke volume (SV) was measured directly in the left ventricle. Values of SVV and PPV were calculated over three breaths. Balloon inflation of a catheter positioned in the inferior vena cava was used, for a maximum of 30 s, to decrease preload while the SVV and PPV measurements were repeated. Values of CA rt were calculated as SV/PP. 3. Intrapulmonary LPS increased CA rt and SV. Values of SVV and PPV increased in both LPS-treated and untreated rats during balloon inflation. There was a correlation between SVV and PPV in untreated rats before (r = 0.55; P = 0.005) and during (r = 0.69; P < 0.001) occlusion of the vena cava. There was no such correlation in LPS-treated rats either before (r = -0.08; P = 0.70) or during (r = 0.36; P = 0.08) vena cava occlusion. 4. In conclusion, under normovolaemic and hypovolaemic conditions, PPV does not reflect SVV during an increase in CA rt following LPS-induced pneumonia in mechanically ventilated rats. Our data caution against their interchangeability in human sepsis.

Thermochemical (TC) heat storage is an interesting technology for future seasonal storage of solar heat in the built environment. This technology enables high thermal energy storage densities and low energy storage losses. A small-scale laboratory prototype TC storage system has been realized at ECN, applying an open sorption system concept. The packed bed contains 17 dm 3 of sorption material and is capable of generating 150 W of thermal power. An effective energy storage density of approximately 0.5 GJ/m 3 was obtained.

Aims The subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemaker (LP) are evolving technologies that do not require intracardiac leads. However, interactions between these two devices are unexplored. We investigated the feasibility, safety, and performance of combined LP and S-ICD therapy, considering (i) simultaneous device-programmer communication, (ii) S-ICD rhythm discrimination during LP communication and pacing, and (iii) post-shock LP performance. Methods and results The study consists of two parts. Animal experiments : Two sheep were implanted with both an S-ICD and LP (Nanostim, SJM), and the objectives above were tested. Human experience : Follow-up of one S-ICD patient with bilateral subclavian occlusion who received an LP and two LP (all Nanostim, SJM) patients (without S-ICD) who received electrical cardioversion (ECV) are presented. Animal experiments : Simultaneous device-programmer communication was successful, but LP-programmer communication telemetry was temporarily lost (2 ± 2 s) during ventricular fibrillation (VF) induction and 4/54 shocks. Leadless pacemaker communication and pacing did not interfere with S-ICD rhythm discrimination. Additionally, all VF episodes ( n = 12/12), including during simultaneous LP pacing, were detected and treated by the S-ICD. Post-shock LP performance was unaltered, and no post-shock device resets or dislodgements were observed (24 S-ICD and 30 external shocks). Human experience : The S-ICD/LP patient showed adequate S-ICD sensing during intrinsic rhythm, nominal, and high-output LP pacing. Two LP patients (without S-ICD) received ECV during follow-up. No impact on performance or LP dislodgements were observed. Conclusion Combined LP and S-ICD therapy appears feasible in all animal experiments ( n = 2) and in one human subject. No interference in sensing and pacing during intrinsic and paced rhythm was noted in both animal and human subjects. However, induced arrhythmia testing was not performed in the patient. Defibrillation therapy did not seem to affect LP function. More data on safety and performance are needed.

Background A training programme was developed and delivered to a cohort of volunteers who were preparing for a unique role to provide companionship to dying patients in the acute hospital setting. This comprehensive programme aimed to provide an opportunity for participants to fully understand the nature and responsibilities of the role, whilst also allowing sufficient time to assess the qualities and competencies of participants for their ongoing volunteering role. Participants completed reflective diaries throughout the training course to record their ongoing thoughts and feelings. The purpose of this paper is to present a phenomenological analysis of these entries to understand participants’ experiences, perceptions and motivations. Method The wider study was structured into three phases. Phase 1 was the delivery of a 12 week, bespoke training programme; Phase 2 involved a 26 week pilot implementation of the Care of the Dying Volunteer Service and Phase 3 was the research evaluation of the training and implementation which would inform the further development of the training programme. Self-reflection is a common component of End of Life training programmes and volunteers in this study completed a reflective diary after participation in each of the training sessions. A thematic analysis was undertaken to explore and understand the participants’ experience, perceptions and motivations in relation to their participation in the training. Results All 19 volunteers completed the reflective diaries. From a potential 228 diary entries over the 12 week training programme, 178 diary entries were submitted (78 %). The following key themes were identified: Dying Alone and the importance of being present, Personal loss and the reconstruction of meaning, Self-Awareness and Personal growth, Self-preservation and Coping strategies and group unity/cohesion. Conclusions The participants in this study demonstrated that they were able to use the diaries as an appropriate medium for reflection. Their reflections were also instrumental in the ongoing revision and development of the training programme. Analysis of their entries illustrated that the diaries could provide the opportunity for a reappraisal of their world view and personal philosophy around death and dying. Further research is undoubtedly required, however this paper suggests that self-reflection in this way, supports preparation in honing the appropriate attitudes and qualities required to work in this role.

Objectives: We hypothesized that resveratrol administration would reverse sepsis-dependent downregulation of peroxisome proliferator activated receptor-γ coactivator 1α, preserve mitochondrial integrity, and rescue animals from sepsis-induced myocardial failure. Setting: Teaching hospital research laboratory. Interventions: Cecal ligation and puncture in mice was performed to induce sepsis. Mice that underwent cecal ligation and puncture were randomly assigned to receive resveratrol (30 mg/kg or 60 mg/kg) or vehicle 1 mL sodium chloride 0.9% subcutaneously in the scruff of the neck directly after surgery and at 16, 24, and 40 hrs, respectively. Measurements and Results: Forty-eight hrs after cecal ligation and puncture, cardiac performance was established using echocardiography. Mitochondrial integrity was evaluated with electron microscopy, and changes in gene expression were evaluated with microarray analysis. Survival at 48 hrs was just under 50% and comparable between groups. Myocardial contractile function significantly improved after resveratrol treatment. Resveratrol-treated mice developed focal areas of edema, whereas vehicle-treated mice developed significant, diffuse myocardial edema. Electron microscopy revealed widespread swollen mitochondria with ruptured outer membranes, autophagosomes, and vacuolation of the internal compartment, which were significantly attenuated in resveratrol-treated animals. Resveratrol treatment significantly increased cardiac expression of peroxisome proliferator–activated receptor-γ coactivator 1a. Microarray analysis revealed that resveratrol treatment resulted in upregulation of the peroxisome proliferator–activated receptor-γ coactivator gene set containing genes known to be regulated by this transcriptional coactivator. Our data strongly suggest that administration of resveratrol modulates bioenergy metabolism, substrate utilization, oxidative stress, and detoxification pathways associated with both mitochondrial and cardiac pathological conditions, but does not alter mortality from sepsis. Conclusions: The salutary effects of resveratrol on cecal ligation and puncture-induced myocardial dysfunction are associated with increased peroxisome proliferator–activated receptor-γ coactivator 1a abundance and function. Preservation of myocardial energy production capacity, prevention of secondary injury, mitigation of inflammation, and reversal of sepsis-induced myocardial remodeling are likely to underlie its beneficial effects. This however, does not result in improved survival.

Background: end-of-life decision making is an important aspect of end-of-life care that can have a significant impact on the process of dying and patients’ comfort in the last days of life. Aim: the aim of our study was to identify issues and considerations in end-of-life decision making, and needs for more evidence among palliative care experts, across countries and professions. Participants: 90 palliative care experts from nine countries participated in a modified Delphi study. Participants were asked to identify important issues and considerations in end-of-life decision making and to rate the need for more evidence. Results: experts mentioned 219 issues in end-of-life decision making related to the medical domain, 122 issues related to the patient wishes and 92 related to relatives’ wishes, regardless of profession or country ( p > 0.05). In accordance, more than 90% of the experts rated the comfort and wishes of the patient and the potential futility of treatment as important considerations in end-of-life decision making, although some variation was present. When asked about issues that are in need of more evidence, 87% mentioned appropriate indications for using sedatives and effects of artificial hydration at the end of life. A total of 83% mentioned adequate communication approaches. Conclusions: palliative care experts from different professions in different countries encounter similar issues in end-of-life decision making. Adequate communication about these issues is universally experienced as a challenge, which might benefit from increased knowledge. This shared experience enables and emphasizes the need for more international research.

PURPOSE OF REVIEW To relate personal experience and reflections on the tasks and role of a volunteer in an academic palliative care unit into the context of the English publications of 2009. We took a snapshot of the most recent publications as a way of placing the rather unique experiences of this German volunteer in an international context. RECENT FINDINGS Five recent studies were found discussing the importance of volunteers in an interdisciplinary context, but mainly focusing on the volunteer's role in the community, interacting with terminally ill patients and their caregivers. Furthermore, aspects of ethical issues, reasons for starting and continuing to volunteer for hospice and the role of male volunteers were evaluated in these studies. SUMMARY The studies feature on the one hand the positive recognition of volunteers, for example, two studies revealed a significant interest by the respondents of having volunteers if they were dying. Also, these articles focused on family carers, who voted for the service of hospice/palliative care volunteers; on the other hand, efforts have to be made to improve the recruitment of volunteers especially if it comes to male support. A further study, reporting on ethical issues, indicates that little is known about these issues when it comes to a volunteer's interaction with a patient in difficult situations, how these are to be managed. These studies give us valuable clues on how and where to make continuous improvements.

Bei einer Sterberate von ca. 1% liegt die jahrliche Inzidenz eines Trauerereignisses durch einen Todesfall in der Gesamtbevolkerung bei vorsichtiger Schatzung bei mindestens 2–3%. Etwa 2 Mio. Menschen erleiden in Deutschland demzufolge jahrlich einen schwerwiegenden Verlust, der nicht nur mit einer schweren psychosozialen Belastung, sondern auch mit einer Vielzahl gesundheitlicher Risiken und erhohter Mortalitat verbunden ist. Angesichts dieser Dimensionen ist es umso erstaunlicher, dass das Thema „Trauer“ in Deutschland in der arztlichen Aus-, Fort- und Weiterbildung allenfalls am Rande beruhrt wird. Die vorliegende Arbeit mochte Arzten einige Hinweise darauf geben, wie sie Trauernden sinnvoll und hilfreich zur Seite stehen konnen. Nach einer kurzen Einfuhrung in die aktuellen Vorstellungen zum Trauerprozess, wie sie von der modernen Trauerforschung entwickelt wurden, liegt der Fokus auf den spezifischen arztlichen Moglichkeiten. Grundlage ist dabei die Auffassung, dass der Arzt in der Regel kein „Trauerbegleiter“ im engeren Sinn ist und es auch nicht sein kann. Wohl aber ist er „Trauerbegegner“ und kann wichtige Weichenstellungen vornehmen, damit Menschen einen Trauerprozess durchschreiten konnen, der es ihnen ermoglicht, emotional dem Verstorbenen einen neuen Platz zuzuweisen und das eigene Leben wieder aufzunehmen.

Background In the UK, the majority of people die in hospital.1 Community presence is considered to be a significant component to achieving a “good death”,2,3 however many patients die with no/few visitors, spending their last weeks of life isolated or alone. Aim To establish a Volunteer Service and offer: A presence to dying patients. A connexion to the community outside the Hospital. Support to families, unable to visit or emotionally exhausted from their bedside vigil. Methods The Service was piloted on 6 wards (October 2012–March 2013) within a large NHS Trust, in the North of England. This was followed by a comprehensive evaluation, according to MRC guidance. Results Analysis of the service evaluation indicated that the service was extremely beneficial, meeting its aims in providing an emotional support and spiritual presence to dying patients, and their families. Conclusion The Service provides a model of best practice that could be replicated in other Trusts and within other care settings. There are plans to further develop and expand service provision across the Trust. References National End of Life Care Intelligence Network. What we know now. 2013. http://www.endoflifecare-intelligence.org.uk/resources/publications/what_we_know_now_2013 Department of Health. End of Life Care Strategy. 2008. https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life Kellehear A. The end of death in late modernity, an emerging public health challenge. Crit Public Health 2007;17(1):71–79

Fur die Palliativmedizin ergeben sich in der Sterbephase folgende Aufgaben: 1. die Sterbebegleitung des Patienten selbst, 2. die Vorbereitung der Angehorigen auf Verlust und Trauer, 3. die Identifizierung von Angehorigen mit erhohtem Risiko fur pathologische Trauerprozesse, 4. die Trauerbegleitung der Angehorigen nach dem Tod sowie die Intervention bei manifester pathologischer Trauerreaktion. Die Ubergange zwischen normaler und pathologischer Trauer sind fliesend. Die Differenzierung bezieht sich auf das Mas, die Zeit und die Intensitat der Trauer.

A proposal for a descriptive or topological farm food web is derived from field observations and from references in literature. Important themes in the food-web theory are tentatively applied to this preliminary model, explaining differences between local farm food-web structures and how they are related to farm and/or ecological infrastructure (EI) management. Predictions are made for four different farm food-web structures for extremes of farm and environmental gradients corresponding to the length of organic duration and amount/quality of El. The implications with regard to farming practices and nature conservation are that both organic duration and the amount/quality of ecological infrastructure may contribute to ecosystem services and nature conservation. However, an optimisation of the farm food web with regard to ecosystem services, may possibly run counter to nature conservation goals. (C) 2003 Published by Elsevier Science B.V.

Background: High tidal volume ventilation has shown to cause ventilator-induced lung injury (VILI), possibly contributing to concomitant extrapulmonary organ dysfunction. The present study examined whether left ventricular (LV) function is dependent on tidal volume size and whether this effect is augmented during lipopolysaccharide(LPS)-induced lung injury. Methods: Twenty male Wistar rats were sedated, paralyzed and then randomized in four groups receiving mechanical ventilation with tidal volumes of 6 ml/ kg or 19 ml/kg with or without intrapulmonary administration of LPS. A conductance catheter was placed in the left ventricle to generate pressure-volume loops, which were also obtained within a few seconds of vena cava occlusion to obtain relatively load-independent LV systolic and diastolic function parameters. The end-systolic elastance / effective arterial elastance (Ees/Ea) ratio was used as the primary parameter of LV systolic function with the end-diastolic elastance (Eed) as primary LV diastolic function. Results: Ees/Ea decreased over time in rats receiving LPS (p = 0.045) and high tidal volume ventilation (p = 0.007), with a lower Ees/Ea in the rats with high tidal volume ventilation plus LPS compared to the other groups (p < 0.001). Eed increased over time in all groups except for the rats receiving low tidal volume ventilation without LPS (p = 0.223). A significant interaction (p < 0.001) was found between tidal ventilation and LPS for Ees/Ea and Eed, and all rats receiving high tidal volume ventilation plus LPS died before the end of the experiment. Conclusions: Low tidal volume ventilation ameliorated LV systolic and diastolic dysfunction while preventing death following LPS-induced lung injury in mechanically ventilated rats. Our data advocates the use of low tidal volumes, not only to avoid VILI, but to avert ventilator-induced myocardial dysfunction as well.

Analysis of the feasibility and effect of hyperbaric oxygen treatment (HBO) on cognitive functioning in patients with cognitive disorders after irradiation of the brain. Patients and Method: Seven patients with cognitive impairment after brain irradiation, with an interval of at least 1.5 years after treatment, were treated with 30 sessions of HBO in a phase I–II study. A comprehensive neuropsychological test battery was performed before treatment, at 3 and 6 months thereafter. Patients were randomized into an immediate treatment group and a delayed treatment group. The delayed group had a second neuropsychological test at 3 months without treatment in that period and started HBO thereafter. Results: All eligible patients completed the HBO treatment and the extensive neuropsychological testing. One out of seven patients had a meaningful improvement in neuropsychological functioning. At 3 months there was a small, but not significant benefit in neuropsychological performance for the group with HBO compared to the group without HBO treatment. Six out of seven patients eventually showed improvement after HBO in one to nine (median 2.5) of the 31 tests, although without statistical significance. Conclusion: HBO treatment was feasible and resulted in a meaningful improvement of congitive functioning in one out of seven patients. Overall there was a small but not significant improvement.

A procedure is presented for restyling the lay-out and management of farms in order to increase the biodiversity in the agricultural landscape as well as the sustainability of farming. The protocol for the development of an on-farm Nature Management Plan explicitly uses landscape ecology characteristics, local biotic and abiotic data and potential, as well as the farming system data and farmer’s personal interests. It may also enhance the farmer’s interest and understanding of agro-ecological pattern and process and induce a more conscious approach to elements of nature on the farm, which may be the starting point in ecologising agricultural practice.

Transvenous lead-related complications occur throughout the spectrum of cardiac rhythm management device therapies [(1)][1]. These complications incur significant cost to the health care system and have tremendous impact on patient quality of life. The subcutaneous implantable-cardioverter

Background: Intratracheal aspiration and sepsis are leading causes of acute lung injury that frequently necessitate mechanical ventilation (MV), which may aggravate lung injury thereby potentially increasing the risk of acute kidney injury (AKI). We compared the effects of ventilation strategies and underlying conditions on the development of AKI. Methods: Spraque Dawley rats were challenged by intratracheal acid instillation or 24 h of abdominal sepsis, followed by MV with a low tidal volume (LVT) and 5 cm H2O positive end-expiratory pressure (PEEP) or a high tidal volume (HVT) and no PEEP, which is known to cause more lung injury after acid instillation than in sepsis. Rats were ventilated for 4 hrs and kidney function and plasma mediator levels were measured. Kidney injury was assessed by microscopy; apoptosis was quantified by TUNEL staining. Results: During sepsis, but not after acid instillation, MV with HVT caused more renal apoptosis than MV with LVT. Increased plasma active plasminogen activator inhibitor-1 correlated to kidney apoptosis in the cortex and medulla. Increased apoptosis after HVT ventilation during sepsis was associated with a 40% decrease in creatinine clearance. Conclusions: AKI is more likely to develop after MV induced lung injury during an indirect (as in sepsis) than after a direct (as after intra-tracheal instillation) insult to the lungs, since it induces kidney apoptosis during sepsis but not after acid instillation, opposite to the lung injury it caused. Our findings thus suggest using protective ventilatory strategies in human sepsis, even in the absence of overt lung injury, to protect the kidney.

Background Mechanical ventilation (MV) may cause ventilator-induced lung injury (VILI) and may thereby contribute to fatal multiple organ failure. We tested the hypothesis that injurious MV of lipopolysaccharide (LPS) pre-injured lungs induces myocardial inflammation and further dysfunction ex vivo, through calcium (Ca2+)-dependent mechanism. Materials and methods N = 35 male anesthetized and paralyzed male Wistar rats were randomized to intratracheal instillation of 2 mg/kg LPS or nothing and subsequent MV with lung-protective settings (low tidal volume (Vt) of 6 mL/kg and 5 cmH2O positive end-expiratory pressure (PEEP)) or injurious ventilation (high Vt of 19 mL/kg and 1 cmH2O PEEP) for 4 hours. Myocardial function ex vivo was evaluated in a Langendorff setup and Ca2+ exposure. Key mediators were determined in lung and heart at the mRNA level. Results Instillation of LPS and high Vt MV impaired gas exchange and, particularly when combined, increased pulmonary wet/dry ratio; heat shock protein (HSP)70 mRNA expression also increased by the interaction between LPS and high Vt MV. For the heart, C-X-C motif ligand (CXCL)1 and Toll-like receptor (TLR)2 mRNA expression increased, and ventricular (LV) systolic pressure, LV developed pressure, LV +dP/dtmax and contractile responses to increasing Ca2+ exposure ex vivo decreased by LPS. High Vt ventilation aggravated the effects of LPS on myocardial inflammation and dysfunction but not on Ca2+ responses. Conclusions Injurious MV by high Vt aggravates the effects of intratracheal instillation of LPS on myocardial dysfunction, possibly through enhancing myocardial inflammation via pulmonary release of HSP70 stimulating cardiac TLR2, not involving Ca2+ handling and sensitivity.

Heat pump technologies offer a significant potential for primary energy savings in industrial processes. Thermally driven heat pumps can use waste heat as driving energy source to provide either heating or cooling. A chemi-sorption heat transformer can upgrade a waste heat source to temperatures of 150–200 °C. The specific heat transformer process however requires waste heat temperatures in the range of 120 °C, whereas waste heat sources of lower temperatures are more abundant. Using this lower temperature waste heat, and still reach the desired higher output temperatures can be achieved by the integration of a chemisorption and mechanical compression step in a single hybrid heat pump concept. This concept can offer an increased flexibility in temperatures, both for the waste heat source as for the heat delivery. The technical and economical feasibility of the proposed hybrid heat pump concept is evaluated. The range of operating temperatures of different chemi-sorption working pairs for as heat driven and as hybrid systems are defined, as well as their energy efficiencies. Investment costs for the hybrid systems are derived and payback times are calculated. The range of payback times is from 2 to 9 years and are strongly influenced by the number of operating hours, the electrical COP of the compression stage, and the energy prices.

Reducing comparative optimism regarding risk perceptions in traffic accidents has been proven to be particularly difficult (Delhomme, 2000). This is unfortunate because comparative optimism is assumed to impede preventive action. The present study tested whether a road safety training course could reduce drivers' comparative optimism in high control situations. Results show that the training course efficiently reduced comparative optimism in high control, but not in low control situations. Mechanisms underlying this finding and implications for the design of road safety training courses are discussed.

Increased nitric oxide production and altered mitochondrial function have been implicated in sepsis-induced cardiac dysfunction. The molecular mechanisms underlying myocardial depression in sepsis and the contribution of nitric oxide in this process however, are incompletely understood.To assess the transcriptional profile associated with sepsis-induced myocardial depression in a clinically relevant mouse model, and specifically test the hypothesis that critical transcriptional changes are inducible nitric oxide synthase-dependent.Laboratory investigation.University affiliated research laboratory.C57/BL6 wild type and congenic B6 129P2-Nos2tm1Lau/J (iNOS) mice.Assessment of myocardial function after 48 hrs of induction of polymicrobial sepsis by caecal ligation and perforation.We compared the myocardial transcriptional profile in C57/BL6 wild type mice and congenic B6 129P2-Nos2tm1Lau/J litter mates after 48 hrs of polymicrobial sepsis induced by caecal ligation and perforation. Profiling of 22,690 expressed sequence tags by gene set enrichment analysis demonstrated that inducible nitric oxide synthase -/- failed to down regulate critical bioenergy and metabolism related genes including the gene for peroxisome proliferator-activated receptor gamma coactivator 1. Bioinformatics analysis identified a striking concordance in down regulation of transcriptional activity of proliferator-activated receptor gamma coactivator 1-related transcription factors resulting in sepsis associated myocardial remodeling as shown by isoform switching in the expression of contractile protein myosin heavy chain. In inducible nitric oxide synthase -/- deficient mice, contractile depression was minimal, and the transcriptional switch was absent.Metabolic and myosin isoform gene expression switch in sepsis-induced myocardial depression is inducible nitric oxide synthase-dependent. Furthermore, we suggest that the molecular switch favoring the expression of fetal isoforms of contraction related proteins is associated with regulation of proliferator-activated receptor gamma coactivator 1 and related transcription factors in an inducible nitric oxide synthase-dependent manner.

We tested whether the goal to attain normative superiority over other students, referred to as performance-approach goals, is particularly distractive for high-Working Memory Capacity (WMC) students-that is, those who are used to being high achievers. Indeed, WMC is positively related to high-order cognitive performance and academic success, a record of success that confers benefits on high-WMC as compared to low-WMC students. We tested whether such benefits may turn out to be a burden under performance-approach goal pursuit. Indeed, for high achievers, aiming to rise above others may represent an opportunity to reaffirm their positive status-a stake susceptible to trigger disruptive outcome concerns that interfere with task processing. Results revealed that with performance-approach goals-as compared to goals with no emphasis on social comparison-the higher the students' WMC, the lower their performance at a complex arithmetic task (Experiment 1). Crucially, this pattern appeared to be driven by uncertainty regarding the chances to outclass others (Experiment 2). Moreover, an accessibility measure suggested the mediational role played by status-related concerns in the observed disruption of performance. We discuss why high-stake situations can paradoxically lead high-achievers to sub-optimally perform when high-order cognitive performance is at play.