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Underground hydrogen storage (UHS) has the potential to overcome the infrastructure and safety challenges of large-scale hydrogen storage, support long-term supply security and decrease delivery costs through economies of scale. Depleted hydrocarbon reservoirs and saline aquifers are likely to be significant contributors to UHS capacity in Australia. The principles of subsurface hydrogen storage in porous reservoir rocks are based on experience from both natural gas and carbon dioxide storage projects. However, as field-scale testing is required to demonstrate and mature the technology, a pre-feasibility study of the potential for an early UHS demonstration at the Otway International Test Centre (OITC) has been undertaken. Pre-feasibility studies have shown that while the characterisation of the subsurface storage reservoir is the most important aspect of the site-selection process, above-ground factors, such as facilities design, the logistics of hydrogen supply and the regulatory environment, significantly affect project design. Existing technologies require only minor adaptation to provide the surface infrastructure for a UHS project, but the logistics of hydrogen supply may be a significant factor in the scope of a demonstration project.

For Australia to capitalise on the growing hydrogen (H2) economy, the current capability gap for large-scale, secure and cost-effective H2 storage must be addressed. Large-scale underground hydrogen storage (UHS) in porous reservoirs offers the required capacity to balance discrepancies between demand and supply over seasonal durations, and support decarbonisation and security in Australia’s energy system. This becomes essential for export and domestic markets from 2030 onwards. UHS in depleted gas fields can address the infrastructure and safety challenges, as well as supporting long-term supply security while decreasing delivery price through economies of scale. However, the technical readiness for Australia’s industries to undertake UHS is low, with scientific challenges around how stored H2 interacts with subsurface rocks and fluids, and how this impacts the storage efficiency. A commercially relevant demonstration of UHS is essential for providing the knowledge and confidence for large investment into commercial scale UHS. CO2CRC and CSIRO are collaboratively developing such a demonstration, utilising data and learnings from the Otway International Test Centre, as a proxy for commercial-scale UHS operations.

Despite past geo-political turbulence, Nepal has made significant progress in societal and economic initiatives, particularly in relation to social determinants of health. These improvements, however, belie the suffering of those with life-limiting disease due to pain, stigma, social and financial distress, consequent upon low patient, caregiver and health professional awareness of the need for, and availability of, appropriate care and support. Two Worlds Cancer Collaboration (INCTR-Canada) has been working with partners in Nepal to build capacity for palliative care by: (a) organizational and administrative support – establishing the Nepal Association of Palliative Care (NAPCare), and the creation of the Nepal Strategy for Palliative Care, approved by government in 2017; (b) “twinning” between 2 hospital palliative care units in Nepal and the Nanaimo Hospice and Victoria Hospice, BC, Canada; (c) sustainable growth of palliative care according to WHO foundational measures, implementing facility-based clinical programs, and home-based care aligned with the cultural, social, and economic environment of Nepal; (d) training of health professionals in adult and paediatricpalliative carethrough interactive on-line “distance learning” (Extension of Community Healthcare Outcomes, ECHO);(e) leveraging palliative care training and expertise across the government health system, and (f) local and international support to build a newfacility for Hospice Nepal to provide more support for more patients in a rural ambience on the outskirts of Kathmandu. Palliative care needs to become standard-of-care, providing peace, comfort and dignity for adults and children. Working collaboratively with partners in Nepal, the collective vision is a capable professional Nepali community leading palliative care services for all in need, wherever in need.

Poster E3 For Australia to capitalise on the growing hydrogen (H2) economy, the current capability gap for large-scale, secure and cost-effective H2 storage must be addressed. Large-scale underground hydrogen storage (UHS) in porous reservoirs offers the required capacity to balance discrepancies between demand and supply over seasonal durations, and support decarbonisation and security in Australia’s energy system. This becomes essential for export and domestic markets from 2030 onwards. UHS in depleted gas fields can address the infrastructure and safety challenges, as well as supporting long-term supply security while decreasing delivery price through economies of scale. However, the technical readiness for Australia’s industries to undertake UHS is low, with scientific challenges around how stored H2 interacts with subsurface rocks and fluids, and how this impacts the storage efficiency. A commercially relevant demonstration of UHS is essential for providing the knowledge and confidence for large investment into commercial scale UHS. CO2CRC and CSIRO are collaboratively developing such a demonstration, utilising data and learnings from the Otway International Test Centre, as a proxy for commercial-scale UHS operations. To access the poster click the link on the right. To read the full paper click here

Background Palliative care requires an integrated, multidisciplinary approach and involves a range of specialities. Despite increasing demand, limited resources are often available to deliver high quality palliative care education and support that is tailored to meet the needs of healthcare professionals. Project ECHO (a tele-mentoring programme) could overcome this gap by using video-conferencing to deliver best practice guidance and education from specialists, and case-based learning with peer discussion. Five ECHO networks in Northern Ireland were established (Cardiology/Heart Failure, District nurses, Community pharmacy, Paediatrics, Marie Curie registered nurses). Participants set the curriculum, network aims and objectives, which included increasing participants’ palliative care knowledge and skills, enhancing confidence, building relationships, and facilitating peer support. 45 ECHO sessions were delivered across five networks between 2018-2019 with 194 participants attending ≥2. Aim The aim of evaluation was to identify if each network achieved its objectives. Methods Retrospective online survey issued to participants after the final ECHO. Results 27% (60/224) registered participants responded. ECHO was identified as a suitable model for education delivery and valued for case-based learning. Each network met their objectives: increased knowledge and management of palliative care patients. ECHO was identified as a suitable model for delivering education and the opportunity for case-based learning was valued. Impacts on practice included improvements in, inter-agency working, networking, communication with patients and families, confidence to make clinical decisions. Professional isolation was also reduced. Barriers to participation included time restraints due to staff shortages or workload. Conclusion Project ECHO may be ideal for delivering palliative care education and support across multiple settings. However, protected time for participation is recommended.

Introduction The Health and Social Care Board identified Project ECHO as a methodology to implement change. The aim was to develop the knowledge and skills of health and social care professionals, transform service delivery, and ultimately improve patient care. Up to 38 ECHO networks across a variety of settings (e.g. palliative care, ophthalmology) were established between 2018-2020. Aim The aim of this study was to use the Consolidated Framework for Implementation Research (CFIR) to guide assessment of the outcomes and impacts, and explore the factors which influence success across different contexts. Methods Qualitative study; key stakeholders including high and low attenders, and hub members were purposively invited to participate in a semi-structured interview; interview schedules guided by the CFIR method utilised for data analysis. Results 28 stakeholders participated. Network purpose varied across contexts, (i) provision of education and support to isolated practitioners; (ii) support practical implementation of strategies/guidelines across sites, (iii) support cross sector working, (iv) build capacity of GPs to manage patients on waiting lists, (v) transform and provide ongoing governance of a new service. Impacts on participants included increased knowledge of conditions and symptoms, increased confidence to treat patients, and increased capacity to manage patients in primary care. Improvements in relationships between primary and secondary care, and across sectors were also reported e.g. improved understanding of regional strategies, service initiatives and referral pathways. Impacts at service level were reported. Conclusion Project ECHO is an ideal methodology for not only delivering education and support to health and social care professionals, but also as a mechanism for delivering service change. CFIR is a useful framework for identifying pre-conditions which should be met before a network is operational to ensure success and sustainability.

Introduction Project ECHO (Extension for Community Healthcare Outcomes) is a tele-mentoring programme that uses video-conferencing technology to deliver, evidence-based education from specialists and case-based learning with peers. The Health and Social Care Board in Northern Ireland identified Project ECHO as a methodology to implement change. The vision was to engage with medical professionals to develop communities of practice, enhance knowledge, skills, and ultimately improve patient/client care. Project ECHO networks were established with a specific focus on (neurology, gynaecology, musculoskeletal, dermatology, ENT, cardiology, diabetes, and gastroenterology), along with a ‘GP support’ network. Network participants identified topics to be included within their curriculum ensuring a tailored approach to education delivery. Participants set the network objectives and the outcomes they hoped to achieve. ECHO sessions were held monthly and each network typically delivered nine sessions. Method Participatory monitoring and evaluation was used to identify outcomes for ECHO network participants. Evaluation surveys were issued after the final session. Results 361 medical professionals attended at least one ECHO session across the networks outlined above. 36% (131/361) responded to the evaluation survey. Results indicated participants valued access to education from specialists, to ask questions directly, and seek advice from secondary care colleagues. Participants reported knowledge of conditions and symptoms, confidence and capacity to treat patients in primary care increased. Improvements in relationships between primary and secondary care were also reported. Benefits reported by ‘GP Support’ included the ability to get advice from experienced colleagues, and that topics covered in the sessions were not usually covered in training for GPs. Also, joining the sessions remotely was a frequently cited as a benefit and to be a productive use of time. Professional isolation was reduced and satisfaction was increased. Conclusion Project ECHO is an ideal methodology for not only delivering education and advice to medical professionals but also as a mechanism for support in an isolated profession.

Recruitment challenges to clinical research studies in palliative care settings, particularly in hospices, are well documented. However, a recent study (Hospice Inpatient Deep vein thrombosis Detection (HIDDen) study) performed across five hospices in the UK recruited above target and on time. We describe strategies that aided successful recruitment in this study, and the lessons learnt for improving future studies. A recent review suggested that the ‘Social Marketing Mix Framework’ (SMMF) could help researchers with recruitment strategies in palliative care. We describe the recruiting strategies employed through the Social Marketing Mix lens and consider if it would be a useful framework for future researchers to use at the planning stage. Successful recruitment strategies employed in HIDDen study included: (i) addressing particular study-related factors, (ii) ensuring all patients were screened and offered participation if eligible, (iii) reducing impact on the clinical team through dedicated research nurses at sites, (iv) addressing research team issues with cross-cover between sites, where geographically possible, and (v) regular video conferencing meetings for support and collaborative solving of challenges. Limited pre-existing research infrastructure at most of the recruiting hospices created particular challenges. The SMMF provides a potential structure to help researchers to plan recruitment. However, to fully streamline trial set up and in order for hospice involvement in research to be realised systematically, a centralised approach to governance, organisational culture change whereby hospices embrace research as a legitimate purpose and consistent access to research staff are identified as key strategic elements promoting recruitment to studies in hospices.

The publication of the United Kingdom (UK) Standards for Public Involvement (PI) (UK Standards) in research drew a clear line in the sand regarding the importance of utilising the unique experience, skills and expertise that lay people may offer to the development, conduct and dissemination of clinical research. The UK Standards provide a benchmark which researchers should aim to achieve, yet its implementation continues to be a step wise iterative process of change management. A recent evaluation by a regional research group has suggested that our understanding of PI is enhanced through reflection on the UK Standards. We report on the utility of PI in the design, conduct and dissemination of the HIDDen study, a national, multicentre clinical study based across three UK centres.A retrospective review of PI within the HIDDen study was conducted using field notes taken by the lead author from interactions throughout their involvement as a lay representative on the study. Key members of the HIDDen study were interviewed and data analysed to explore adherence to the UK Standards.There was universal support for PI across the study management group with genuine inclusivity of lay members of the committee. All six of the UK Standards were met to varying degrees. The greatest opportunities lay in 'working together' and 'support and learning'. There were challenges meeting 'governance' with evidence of participation in decision making but less evidence of opportunities in management, regulation, leadership.This study concurs with previous research supporting the utility of the Standards in the conduct and evaluation of PI in clinical research. To our knowledge this is the first multi-national study to be evaluated against the UK Standards.The past decade has seen a genuine increase in patient and public involvement (PI) in clinical research, far beyond a symbolic presence on a trial management committee or inclusion on a grant application. The United Kingdom (UK) Standards for Public Involvement provide a useful structure to support PI throughout a study as well as defining a benchmark that can be used to improve the involvement of patients and the public in studies.The importance of reflecting on and reporting on PI in specific studies has been recognised since it contributes to a stepwise change process which will eventually lead to PI becoming normal practice for clinical research. A recent review identified a myriad of frameworks by which PI may be evaluated, risking an inconsistent approach to PI evaluation and consequently slowing down its progression.The Hospice Inpatient Deep vein thrombosis Detection study (HIDDen) was a national multicentre study to explore the prevalence and associated variables of blood clots in patients with advanced cancer when they were admitted to the specialist palliative care unit.In this paper we will be considering the HIDDen research in terms of the UK Standards for Public Involvement.

Time-lapse (TL) (4D) seismic monitoring of injected CO2 in geological formations is being increasingly employed as the principal method for ensuring containment of CO2 and testing conformance of predicted plume behavior. However, to bring further confidence in this method, the CO2 volume detection limit in the seismic monitoring and key factors controlling it need to be quantitatively understood. The CO2CRC Otway Project attempts to improve this understanding by exploring the capability of seismic reflection method to detect and monitor a 15-kt injection of supercritical CO2/CH4 mixture in a saline aquifer at a depth of 1500 m. The monitoring program consists of TL 3D seismic surveys using a buried geophone array, TL 3D vertical seismic profiling (VSP), and offset VSP. Seismic acquisition was carried out at injection intervals of 5, 10, and 15 kt over a 5-month period and also, 9 and 23 months after the end of injection. The TL seismic images clearly show the distribution and evolution of the stored CO2/CH4 plume. The results demonstrate the potential of TL reflection seismic to provide key information to both operators and regulators for confirming the security and behavior of stored CO2 at very small volumes.

Background: Observational Pain Tools (OPTs) are widely recommended in healthcare policies, clinical guidelines and recommendations for pain assessment and management. However, it is unclear whether and how these tools are used for patients with advanced dementia approaching the end of life. Aim: To explore hospice, secondary and primary care physicians’ and nurses’ use of OPTs with patients dying with advanced dementia and their perspectives on practice development and training needs. Methods: Twenty-three physicians and 24 nurses with experience of caring for people dying with advanced dementia were recruited from primary care surgeries (n=5), hospitals (n=6), hospices (n=4) and nursing homes (n=10). Semi-structured, face-to-face interviews were conducted. Interviews were digitally recorded, transcribed verbatim and thematic analysis applied to identify core themes. Results: Three key themes emerged: (1) use of OPTs in this vulnerable patient population; (2) barriers to the use of OPTs and lack of perceived ‘added value’ and (3) perspectives on practice development and training in pain assessment in advanced dementia at end of life. Just over one-quarter of participants (n=13) routinely used OPTs. Reasons for non-use included perceived limitations of such tools, difficulties with their use and integration with existing practice and lack of perceived ‘added value’. Most participants strongly emphasised a need for ongoing training and development which facilitated transfer of knowledge and multidisciplinary skills across professions and specialties. Conclusions: Health professionals require ongoing support in developing and integrating change to existing pain assessment protocols and approaches. These findings have important implications for health education, practice and policy.

Time-lapse (4D) seismic monitoring of injected CO2 in geological formations is being increasingly employed as the principal method for ensuring containment of the CO2 and testing conformance of predicted plume behaviour. However, to bring further confidence in this method, the CO2 volume detection limit in the seismic monitoring and key factors controlling it need to be quantitatively understood. The CO2CRC Otway Project attempts to improve this understanding by exploring the capability of seismic reflection method to detect and monitor a 15,000 t injection of supercritical CO2/CH4 mixture in a saline aquifer at a depth of 1500 m. To increase the signal to noise ratio and to reduce the disruption to land users, seismic acquisition is performed using a buried geophone array. Seismic acquisition occurred at injection intervals of 5000, 10,000 and 15,000 t over a 5-month period. The seismic images clearly show the distribution and evolution of the stored CO2/CH4 plume. The analysis confirms that signal from pure CO2 would be of similar magnitude to the signal from CO2/CH4 mixture. The results demonstrate the potential of time-lapse reflection seismic to provide key information to both operators and regulators for confirming the security and behaviour of stored CO2 at very small volumes.

Future CO 2 storage projects will require Monitoring and Verification (M&V) operations at the CO 2 storage site to understand the behavior of the CO 2 plume, including the assurance that leakage of the CO 2 has not occurred. Current surface based monitoring technologies may be unable to yield sufficient resolution or accuracy. CO2CRC, in conjunction with its Australian partners, is developing the Otway Stage 3 Project to identify and validate sub-surface monitoring techniques and configurations as a key element of a risk-based M&V program in large scale CCS projects. Subsurface monitoring approaches will be tested on a plume of CO 2 from an array of monitoring wells. Primary monitoring methods will be pressure tomography and downhole seismic, although other modalities (gravity, electromagnetic) are also being considered.

AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

Background There is a need for high quality palliative care education and support, but often limited resources are available. Project ECHO™ (Extension for Community Healthcare Outcomes) is a tele-mentoring programme which could overcome this gap by using video-conferencing technology to deliver: Evidence–based, best practice guidance and education from specialists; Case–based learning with opportunities for questions and discussion with peers. Five ECHO™ networks in Northern Ireland (NI) delivered palliative care education and support: Cardiology/heart failure; District nurses; Palliative care pharmacy; Paediatric palliative care; Marie Curie registered nurses. Network participants identified educational topics for their curriculum, and set network aims and objectives. Objectives included increasing participants’ knowledge, skills and confidence in palliative care related areas, improving collaboration, and facilitating peer support. Network leads were responsible for evaluating how well objectives were met. Aim To evaluate how successful each ECHO™ network was in achieving it aims and objectives. Methods Retrospective online survey designed specifically for each network issued to registered participants after the final ECHO™ session. Results Across the five networks, 45 ECHO™ sessions were delivered with 194 participants attending at least two. 27% (60/224) registered participants across each network responded to the survey. Overall, each network was successful in achieving its aims. The majority of participants reported increased knowledge and confidence in relation to the areas assessed. ECHO™ was identified as a suitable model for delivering education and the opportunity for case-based learning was valued. Direct impacts on practice included improved inter-agency working and networking, improved communication with patients and families, and improved confidence to manage similar cases in the future. Barriers to participation included time restraints due to staffing issues or workload. Conclusion Project ECHO™ may be an ideal methodology for delivering palliative care education and support to a range of practitioners. However, protected time for participation is recommended. Funders Health and Social Care Board NI/Hospice UK.

Background Despite increasing demand, limited resources are often available to deliver high quality palliative care education. Project ECHO is a tele-mentoring programme that could address this disparity by using video-conferencing to deliver (i) best practice guidance and education from specialists, and (ii) case-based learning with peer discussion1. Five ECHO networks in Northern Ireland delivered palliative care education and support (Cardiology/Heart Failure, District nurses, Community pharmacy, Paediatrics, Marie Curie registered nurses). Participants set the curriculum and network aims and objectives, which included increasing participant’s palliative care knowledge and skills, enhancing confidence, improving collaboration, and facilitating peer support. 45 ECHO sessions were delivered across five networks with 194 participants attending ≥2. Aim Identify if each ECHO network achieved it aims and objectives. Methods Retrospective online survey designed for each network administered after final ECHO session. Results 27% (60/224) registered participants across each network responded. Overall, each network achieved its aims and objectives with participants reporting increased palliative care knowledge and increased confidence in managing end of life care scenarios. Benefits included case-based learning, professional networking, and avoidance of travel to access education. Participants reported improved communication with patients and families, and improved decision making in relation to patient care. Time restraints due to staffing issues or workload were identified as barriers to participation. Conclusion Project ECHO may be an ideal solution for meeting the demand for palliative care education across multiple settings. To ensure practitioners fully benefit, protected time for participation is recommended. Funders Health and Social Care Board/Hospice UK.

ObjectivesTo gain preliminary data regarding the prevalence of proximal deep vein thrombosis (DVT) in those with non-malignant conditions admitted to specialist palliative care units (SPCUs).MethodsData were collected as part of a prospective longitudinal observational study in five SPCUs in England, Wales and Northern Ireland (Registration:ISRCTN97567719) to estimate the prevalence of proximal femoral vein DVT in people admitted to SPCUs. The primary outcome for this exploratory substudy was the prevalence of DVT in patients with non-malignant palliative conditions. Consecutive consenting adults underwent bilateral femoral vein ultrasonography within 48 hours of admission. Data were collected on symptoms associated with venous thromboembolism. Patients were ineligible if the estimated prognosis was Results1390 patients were screened, 28 patients had non-malignant disease and all were recruited. The mean age 68·8 (SD 12·0), range 43–86 years; men 61%; survival mean 86 (SD 108.5) range 1–345 days. No patient had a history of venous thromboembolism. Four (14%) were receiving thromboprophylaxis. Of 22 evaluable scans, 8 (36%, 95% CI: 17% to 59%) showed femoral vein DVT. The level of reported relevant symptoms (leg oedema, leg pain, chest pain and breathlessness) was high irrespective of the presence of DVT.ConclusionsOur exploratory data indicate one in three people admitted to an SPCU with non-malignant disease had a femoral vein DVT. Although definitive conclusions cannot be drawn, these data justify a larger prospective survey.

Mann highlights concerns about liaison between primary and secondary care expressed by general practitioners across the United Kingdom in these days of ever increasing pressure.12 As a GP, I hugely valued the opportunity to learn from and be supported by my colleagues at the local district general hospital on Friday lunchtimes. Sadly those days have all but disappeared across …

Background The deep venous thrombosis (DVT) prevalence in advanced cancer is unconfirmed and it is unknown whether current international thromboprophylaxis guidance is applicable to this group. We determined prevalence and predictors of femoral DVT in patients admitted to specialist palliative care units (SPCU). Methods Prospective longitudinal observational study in five SPCUs in England, Wales and Northern Ireland. Consecutive adults with cancer underwent bilateral femoral vein ultrasonography on admission and weekly until death or discharger for a maximum of three weeks. Data were collected on performance status, attributable symptoms and variable known to be associated with venous thromboembolism. Patients were ineligible if admitted for terminal care (estimated prognosis Results 343 participants (68·2 [SD 12·8] 25 to 102 years; men 52%; AKPS 49 [SD 16·6] 20% to 90%) were recruited. Of 273 evaluable scans, 92 (34%, CI 28% to 40%) showed DVT. Excluding early scans, 64/232 (28%, 22% to 34%) showed DVT. Four participants with a ‘no DVT’ scan on admission developed a DVT on repeat scanning over 21 days. Previous thromboembolism, bedbound ≤12 weeks for any reason (p=0.003) and lower limb oedema (p=0.009) independently predicted DVT. Serum albumin (p=0.430), thromboprophylaxis (p=0.173) and survival (p=0.473) were unrelated to DVT. Conclusions These novel data show approximately one third of SPCU admissions with advanced cancer had a femoral DVT. DVT was not associated with thromboprophylaxis, survival or symptoms other than leg oedema. Findings are consistent with VTE being a manifestation of advanced disease rather than a cause of premature death. Thromboprophylaxis for SPCU in-patients with poor performance status seems of little benefit.

Summary Background The prevalence of deep venous thrombosis in patients with advanced cancer is unconfirmed and it is unknown whether current international thromboprophylaxis guidance is applicable to this population. We aimed to determine prevalence and predictors of femoral deep vein thrombosis in patients admitted to specialist palliative care units (SPCUs). Methods We did this prospective longitudinal observational study in five SPCUs in England, Wales, and Northern Ireland (four hospices and one palliative care unit). Consecutive adults with cancer underwent bilateral femoral vein ultrasonography on admission and weekly until death or discharge for a maximum of 3 weeks. Data were collected on performance status, attributable symptoms, and variables known to be associated with venous thromboembolism. Patients with a short estimated prognosis (

The CO2CRC Otway Project “Stage 3” is planned to be an injection of between 15,000 and 30,000 tonnes, to be carried out at the Otway site in South Western Victoria, Australia. The objective of the project is to test unobtrusive, continuous monitoring methods that would operate with a small environmental footprint and limited impact on other land use activities such as farming. Progress since GHGT13 falls into three broad areas; reservoir characterisation, dynamic modelling, and feasibility and design of the monitoring methods. The appraisal well CRC-3 was successfully drilled and a wide range of core and log data was collected. While only 600-700 metres from existing logged wells, it was crucial to confirm that the injection concept was feasible and that the plume would migrate towards the proposed monitoring wells. In addition, injection tests were performed that confirmed pressure continuity to the existing wells. As there are many small faults in the area this was an important outcome. The geological and dynamical models for the experiment have been updated with the data from CRC-3; and model predictions have benefited from the ongoing performance history match to the stage 2C time-lapse seismic monitoring experiment. Currently the Stage 3 project is in its Define phase, having completed its Opportunity Definition and Evaluate phases. By the time of GHGT14 we expect to be commencing the Execution phase, with designs finalised and the drilling programme imminent.

The Carbon Sequestration Leadership Forum (CSLF) is an international climate change initiative at ministerial level, with the mission to advise ministers and other decision makers on the acceleration of deployment of CO2 capture, utilisation and storage (CCUS). To this end, CSLF’s Technical Group issues a Technology Roadmap every three – four years. The roadmap receives input from two other major activities of the Technical Group, reports on selected issues, prepared by Task Forces; and cooperation with CCUS projects that are recognized by the CSLF, as well as from the CSLF delegates and external experts. Its representation of 80% of global CO2 emissions along with its high political backing and legitimacy, makes CSLF an excellent and unique avenue for the promotion of CCUS related issues with the aim to accelerate deployment. The paper describes the work mode of the CSLF Technical Group and its latest activities and achievements of its three major activities.

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Setting/participants: A total of 23 physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care ( n = 9), psychiatry ( n = 7) and hospice care ( n = 7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialities. Cross-speciality mentoring and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusion: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

ObjectivesTo assess the acceptability and use of a low-cost patient-held communication tool.DesignLongitudinal qualitative interviews at three time points over 18 months and document content analysis.SettingPrimary and community services.ParticipantsTwenty-eight dyads: People living with dementia in Northern Ireland and their informal carers.InterventionsA patient-held healthcare ‘passport’ for people living with dementia.Primary and secondary outcomesAcceptability and use of the passport—barriers and facilitators to successful engagement.ResultsThere was a qualified appreciation of the healthcare passport and a much more nuanced, individualistic or personalised approach to its desirability and use. How people perceive it and what they actually do with it are strongly determined by individual contexts, dementia stage and other health problems, social and family needs and capacities. We noted concerns about privacy and ambivalence about engaging with health professionals.ConclusionSuch tools may be of use but there is a need for demanding, thoughtful and nuanced programme delivery for future implementation in dementia care. The incentivisation and commitment of general practitioners is crucial. Altering the asymmetrical relationship between professionals and patients requires more extensive attention.

CO2CRC is developing subsurface monitoring technologies which can significantly reduce the cost and environmental footprint compared to traditional 4D surface seismic. These can be applicable to both hydrocarbon production and CO2 injection projects. These methodologies involve continuous seismic monitoring using well-based distributed acoustic sensors and pressure tomography. CO2CRC’s Otway Stage 3 Project is aiming to validate these techniques while injecting 15000 t of CO2 into the Paaratte Formation in the Otway basin and monitoring the plume using an array of six wells. The main technical risks for subsurface monitoring are migration of the plume outside of the survey area and lack of communication between the wells. Moreover, given some amount of CO2 is already in the injection formation (from CO2CRC Otway Stage 2C Project), it is required to understand the chance of the new plume merging with the existing plume and the possible timeframe. This paper summarises the workflow followed to de-risk the project and optimise the injection and monitoring wells location to reduce the abovementioned risk factors. As a result of the de-risking process, by changing different parameters and mitigating some of the risks, we gained a high degree of confidence that the CO2 plume will stay within the survey area and that the chance of pressure communication between the wells was increased. A thorough sensitivity analysis was also performed to understand the influence of each parameter on the plume speed. This process provided a higher confidence to decision makers to make a final AU$45 million investment decision.

BackgroundInternationally, it is widely accepted that holistic care is as an integral part of the care for people with motor neurone disease (MND), and their informal carers. However the optimal role of generalist and specialist palliative care, and how it integrates with specialist neurology services, is not fully established. Using a qualitative approach we sought to examine end of life care for people with MND in Northern Ireland, and the role of specialist and generalist palliative care.MethodsQualitative study involving a convenience sample of 13 bereaved carers recruited using the Northern Ireland MND Register. Data collection consisted of semi-structured interviews with the bereaved carers of patients who had died 3–24 months previously with a diagnosis of MND. Data were analysed using thematic analysis.ResultsFindings illuminated variations in relation to the levels of holistic care provided to this cohort of patients. Unmanaged respiratory and psychological symptoms caused perceived distress amongst patients. Participants’ experiences additionally highlighted reluctance amongst patients with MND to engage with services such as specialist palliative care. Conversely, for those who received input from specialist palliative care services carers portrayed these services to be of great benefit to the patient.ConclusionsPatients with MND in Northern Ireland may have many unmet holistic care needs. Key areas that require particular focus in terms of service development include neuromuscular respiratory physiotherapy and psychological services for patients. Future research must explore an optimal model of holistic care delivery for patients with MND and how this can be effectively integrated to best meet this patient cohorts palliative care needs.

Background Patient held records need to be evaluated in palliative care settings. Objectives To evaluate how patients, families and professionals in a specialist palliative setting use a patient held record created through close consultation with patients and carers. Methods A mixed methods prospective longitudinal cohort study in the UK—adult patients under community specialist palliative care nurse review or attending day hospice were given questionnaires at record introduction and after 4–6 weeks. Hospice staff completed a questionnaire and focus group after 8 months. Results From Sept 2016 to June 2017, 550 patients were screened, 347 (63.1%) were offered records and 259 accepted (74.6%). 238 accepted a research pack, 105 returned questionnaire 1 (44.1% response rate) and 26 returned questionnaire 2 (24.8% of initial respondents). Questionnaire 1 (patients): 40% found it burdensome repeating information, and almost 70% were interested in a record to reduce this. Questionnaire 2 (patients): 74% found the record easy to use, but few (4, 15.4%) used it regularly. Over 60% stated the record was useful and would recommend it to others, despite not using it themselves. Professionals indicated that it was mainly patients and relatives who used the record, not non-palliative professionals. Conclusions While initial uptake of the record was high, use appeared low. While people saw real value in the record for others, they did not generally use it themselves. This evaluation demonstrates that patient held records are unlikely to be used by palliative care patients even though they see value in the concept.

Introduction: Nepal is beginning to develop palliative care services across the country. Most people live in rural areas, where the Mid-Level Health Workers (MHWs) are the major service providers. Their views on providing palliative care are most important in determining how the service is organized and developed. Aim: This study aims to ascertain the perceptions of MHWs about palliative care in their local community, to inform service development. Methods: A qualitative descriptive design, using focus group discussions, was used to collect data from a rural district of Makwanpur, 1 of the 75 districts of Nepal. Twenty-eight MHWs participated in four focus group discussions. The data were analyzed using content analysis. Result: Four themes emerged from the discussion: (i) suffering of patients and families inflicted by life-threatening illness, (ii) helplessness and frustration felt when caring for such patients, (iii) sociocultural issues at the end of life, and (iv) improving care for patients with palliative care needs. Conclusion: MHWs practicing in rural areas reported the suffering of patients inflicted with life-limiting illness and their family due to poverty, poor access, lack of resources, social discrimination, and lack of knowledge and skills of the health workers. While there are clear frustrations with the limited resources, there is a willingness to learn among the health workers and provide care in the community.

Background: Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management. Aim: To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting. Design: This is a systematic review. Data sources: MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction, and undertook a thematic analysis. Results: In total, 13 studies were included in the review comprising randomised trials ( n = 3), observational ( n = 4) and descriptive studies ( n = 6). Most research was conducted in specialist palliative care units, targeting either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation, raising questions on the existence and comparability of baseline prevalence figures, the physical and psychological impact on patients, resource impact on staff and service, the subjective and objective methods of assessing constipation, and key aspects of constipation management, including a lack of focus on non-pharmacological management in this setting. Conclusion: The results of this review are being used to inform the development of an educational intervention targeting healthcare professionals. Gaps in the evidence base include lack of consistent definition of constipation, constipation prevention, non-pharmacological management, and the consideration of the management of constipation for the dying patient.

Introduction The Royal College of GPs in Northern Ireland created a Patient Held Record (PHR) for patients with progressive, life-limiting illness and their families. This study evaluates its usefulness in the specialist palliative care context. Methods A prospective longitudinal cohort study through a hospice community service. Patients were given questionnaires with the passport and after 4–6 weeks. Hospice Healthcare Professionals (HCPs) completed a questionnaire and focus group after 8 months. Results From September 2016–June 2017, 550 patients were screened, 347 (63.1%) were offered a passport and 259 accepted it (74.6% of those offered). 238 patients accepted a research pack, with 105 returning questionnaire 1 (44.1% response rate), and 26 returning questionnaire 2 (24.8% of initial respondents). Questionnaire 1 (patients) – 40% found it difficult or burdensome repeating information to HCPs, and almost 70% were interested in a PHR to reduce repeating information. Questionnaire 2 (patients)- 74% found it the passport easy to use, but only a few actually used it regularly. Some felt the passport helped conversations with family and HCPs about day-to-day and future care. Over 60% stated the PHR was ‘very’ or ‘quite’ useful’, and would recommend it to others. Questionnaire and focus group with HCPs indicated it was mainly patients and relatives who used the passport, not non-palliative HCPs. Half felt the passport was initially well received, but only 4 (22%) felt it was used regularly by patients or their families. More found it useful to talk about facilitation discussion about future care compared with day-to-day care. Conclusions While initial uptake of the passport was high, use appeared low. This evaluation does not support widespread use of a PHR in palliative care, but it may be helpful to individuals, especially earlier in their disease trajectory.

This chapter describes linking spirituality and Advanced Care Planning (ACP); fear and ACP; how thinking about death changes people; religious views of ACP; denial and ACP; personal control and ACP; ethical principles and ACP; the spiritual work of ACP, including objective asessment; adaptation and ACP; and ritual, sacrament, and ACP. The discussion holds that dying is not primarily a medical event. The process of thinking about end-of-life issues can significantly impact on an individual’s attitudes, values, and belief systems. Dying patients can challenge the cultural illusion that life is going to last forever. This can be hard for families and professionals to accept and challenges their own fears around mortality. The importance and wisdom of religious rituals and religious symbolism cannot be ignored even in the most secular of contexts as they bring comfort to many. ACP is about life before death and can foster resilience and hope.

Improving our understanding of trapping, including how we might be able to enhance it temporally and spatially, would add to our level of confidence in the long term secure geological storage of CO2 in both open and closed saline aquifer systems. This knowledge could also provide the basis for designing quantitative rules for site abandonment based on measured trapping and residual gas saturations. Fluid transport, geochemical processes and associated CO2 trapping mechanisms in geological reservoirs are highly dependent on the nature of structural and lithological heterogeneities. But important centimetre to meter scale heterogeneities are incorrectly incorporated or not incorporated at all into storage complex models, because they can neither be seismically imaged nor represented by grid cells. The GeoCquest Project is focused on determining residual, dissolution and mineral trapping over time for open and closed saline aquifers, through a series of coordinated studies at a range of scales, using experimental, analytical and numeric approaches. This paper describes some of the GeoCquest work currently underway.

Early critics of the euro’s design pointed to the disruptive potential — both political and economic — of country-specific shocks in a monetary union that is a far cry from an optimal currency area. The euro crisis has confirmed the risks associated with a ‘one-size-fits-all’ monetary policy, decentralized financial supervision, and inadequate fiscal backstops. This article examines how the active use of national fiscal policies and macroprudential policies can mitigate these risks. Cross-border coordination of macroprudential policies is essential to ensure their effectiveness. In addition, area-wide reforms are necessary including a more complete banking union with a well-funded common backstop.

There is great potential within general practice for doctors to neglect their own physical, emotional and spiritual needs as a result of the ever-increasing demands of their role. Such neglect is neither in the interests of doctors, their families or their patients. Ultimately, a healthy, balanced and emotionally stable doctor is a doctor who is likely to make better decisions. Looking after patients with palliative care needs can place particular burdens on GPs, especially if there has been a long-term relationship with the patient; the patient evokes memories of close personal experiences from the past; or the physical and emotional burdens that the patient faces are unusually difficult. This article will look at the issues surrounding compassion fatigue, burnout and resilience, and discuss the ways in which a GP can devise strategies to manage the former while trying to build the latter.

Requests to GPs for nutritional supplements for patients approaching the end of life are common. Commercially available food supplements are expensive and often prescribed inappropriately, costing the NHS large sums every year. Judging whether it is appropriate to prescribe nutritional supplements in palliative care situations is difficult. The decision will depend on many different factors including the stage of the patient’s illness, and the wishes of the patient and family. This article explores nutrition in palliative care with the aim of providing GPs with some simple tools to use to decide whether nutritional supplements are appropriate and what form they should take.