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There are conflicting narratives over what drives demand for add-ons. We undertook an online survey of IVF patients to determine whether patients perceive that use of IVF add-ons is driven by patients or practitioners. People who underwent IVF in the UK in the previous five years were recruited via social media Survey questions focussed on the roles of clinician offer and patient request, including who first suggested use of add-ons in IVF consultations, where patients first heard about them, and which information sources they trusted. From a total of 261 responses, 224 met the inclusion criteria. Overall, 67% of respondents had used one or more IVF add-ons, most commonly: time-lapse imaging (27%), EmbryoGlue (27%), and endometrial scratching (26%). Overall, 81% of the add-ons used were offered to participants by clinicians (compared to 19% requested by themselves). Half (54%) reported being offered add-ons during consultations, compared to 24% who initiated discussion about add-ons. Higher proportions of private patients reported being offered (90%), requesting (47%) and using (74%) add-ons than those with NHS funding (74%, 29%, 52%, respectively). The main limitations of this study are the small sample size, recruitment via a convenience sample, and the self-reported data capture which is subject to recall bias.

The COVID-19 pandemic limited older adults’ access to preventative and diagnostic services and negatively affected accessibility to age-appropriate exercise programs. The purpose of this study was to assess the feasibility of conducting guided virtual functional fitness assessments before and after participation in an 8-week virtual, live fitness program (Vivo) designed for older adults. It was hypothesized there would be no significant difference between in-person and virtual functional fitness assessments and function would improve following the program. Thirteen community-dwelling older adults were recruited, screened, and randomly assigned to in-person-first or virtual-first fitness assessment groups. Validated assessments were delivered using standardized scripts by trained researchers and included Short Physical Performance Battery (SPPB) balance, a 30 s Chair Stand Test, 8 Foot Up-and-Go Test, 30 s Arm Curl Test, and 2 min Step Test. The eight-week, twice-a-week live virtual fitness program involved cardiovascular, balance, agility, Dual-Task, and strength training. Results showed no significant differences between all but one assessment measures, and several measures improved following the eight-week program. Fidelity checks demonstrated the high fidelity of program delivery. These findings illustrate that virtual assessments can be a feasible method to measure functional fitness in community-dwelling older adults.

Purpose: Past research highlights the importance of evaluating word learning abilities to build understanding of an individual’s language-learning capacity and make evidence-informed decisions in speech-language pathology practice. However, little research has explored vocabulary and word learning assessment practices among speech-language pathologists (SLPs). This pilot, exploratory study aimed to explore current assessment practices and guide translation of research to practice among SLPs who work with children of all ages. Method: SLPs (N = 127) from three predominantly English-speaking countries (Australia, USA, and UK) completed an online survey. The survey explored methods and purposes for assessing vocabulary knowledge and word learning skills via binary and multiple-choice questions. Responses to three open-ended questions were analysed using conventional content analysis. The survey also asked about perspectives regarding assessment practices with individuals from culturally and linguistically diverse (CALD) backgrounds. Result: Of the surveyed SLPs, 118 (92%) reported using norm-referenced measures of vocabulary, with 27 reporting additional use of non-normed measures. Seventy-seven SLPs (61%) reported that they measure word learning skills, and 20 of these SLPs used dynamic assessment procedures to evaluate word learning. Responding SLPs across all three countries reported using vocabulary and word learning assessment data in a variety of ways (e.g. to support diagnostic decision-making). Regarding the use of standardised, norm-referenced vocabulary assessments with individuals from CALD backgrounds, SLPs reported concerns regarding poor cultural sensitivity and limited access to alternative methods. Conclusion: The findings highlight the need for further development and dissemination of accessible resources to support SLPs’ implementation of word learning assessment, including resources for dynamic assessment. This is especially critical considering the established limitations associated with using standardised, norm-referenced tests with minority groups who are underrepresented in standardisation samples.

In Montgomery v Lanarkshire Health Board, Lords Kerr and Reed referred to the increasing tendency to treat patients ‘as consumers exercising choices’. The question of whether it is helpful to regard patients as consumers is not a new one, but it arises most frequently in discussions about the commercialisation of healthcare. Comparing patients with consumers in relation to informed consent is an interesting development, especially in the light of the growing body of contract and consumer law scholarship which questions the extent to which information disclosures to consumers produce informed choices. If there is evidence that the duties of disclosure which are imposed on retailers, in order to redress the imbalance of knowledge and power in the consumer–retailer relationship, do not always fulfil their intended purpose, might this have any resonance for the duties of disclosure which are imposed upon healthcare professionals?

Objective: The objective of this scoping review is to identify and map the range of evidence in relation to preventative education or intervention for cyberbullying among neurodivergent adolescents (aged 10 to 19). Introduction: Many young people with a neurodevelopmental disorder (NDD) are more likely to experience cyberbullying victimisation than their peers. Considerable resources have been dedicated to managing this issue among mainstream adolescents; however, it is unclear whether prevention and intervention programs, resources, and/or strategies have been developed specifically to suit the learning needs of those who have an NDD. Methods: A scoping review following the PRISMA guidelines will be conducted in August-September 2022 using search terms in English. The following databases will be searched: ProQuest (including dissertations, theses, and conference papers and proceedings), PsychInfo, MEDLINE, Scopus (including conference papers and technical reports), and Google Scholar. Additional grey literature will be identified via targeted Google searches, as well as searches of government agency websites and organisations that focus on cyberbullying and digital safety in adolescents who are neurodivergent (e.g., eSafety Commissioner). Using EndNote, all references will be uploaded and organised for review. Two independent reviewers will screen the identified studies in accordance with the eligibility criteria. The data from included materials will be charted and presented as a narrative summary. Discussion: The findings from this scoping review will provide readers with an overview of the existing evidence, including unpublished online resources, that are currently available to support cyberbullying among adolescents with an NDD. The review will identify gaps in the existing evidence base to guide future directions for research. The findings of this review will be disseminated through methods such as journal publication and presentation at conferences relevant to adolescent communication, education, and mental health.

Background: Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD. Aims: This paper aims to describe the families of children with DLD and adults with DLD in the database thus far. Methods & Procedures: E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire. Outcomes & Results: The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD. Conclusions & Implications: The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers. What This Paper Adds: What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD.

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing students with a stand-alone resource. This chapter examines assisted dying. It looks at the current law, with particular emphasis upon the pressures currently being exerted on the status quo through British patients travelling to Dignitas in Switzerland for assisted suicides. The implications of the Nicklinson and Conway decisions are considered. The chapter sets out arguments for and against the legalization of voluntary euthanasia and assisted suicide; and examines other countries’ experience with decriminalization.

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses mental health law in the UK. It begins with a brief history of mental health law and policy. This is followed by discussions of: admission to the mental health system; treatment of the mentally ill under the Mental Health Act 1983; Deprivation of Liberty Safeguards (DoLS) and Cheshire West, and Community Treatment Orders. It also looks at the implications of the Human Rights Act and the UN Convention on the Rights of Persons with Disabilities (UNCRPD) for mental health law. It also considers the conclusions of the Independent Review of the Mental Health Act 1983.

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing students with a stand-alone resource. This chapter examines the regulation of access to genetic information. It first discusses various third parties’ interests in genetic test results and DNA profiles, and the extent to which genetic privacy is protected by the law. The chapter then considers the issue of whether genetic discrimination should be treated in the same way as other illegitimate discriminatory practices and also discusses recent developments in the field of genetics, namely direct-to-consumer genetic testing and pharmacogenetics.

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing students with a stand-alone resource. This chapter examines embryo research, stem cell therapies and other emerging biotechnologies. It begins with a review of philosophical debates over the moral status of the embryo and then discusses regulation in the UK, through the statutory provisions in the Human Fertilisation and Embryology Act 1990, as amended, and the Human Fertilisation and Embryology Authority’s (HFEA) licensing regime. It then turns to consider stem cell therapies, before examining some other emerging biotechnologies, including neurotechnologies and AI, and debates over human enhancement.

This chapter first discusses the legitimacy of surrogacy, and the particular issues raised by cross-border surrogacy arrangements. It then turns to the regulation of surrogacy in the UK. Although commercial involvement in surrogacy is prohibited, the court has a wide discretion retrospectively to authorize payments to surrogates. In addition, the courts have adopted a flexible approach to some of the other criteria for the making of parental orders. Finally, it evaluates the Law Commissions’ proposed reforms.

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter examines the provision of health care services. It first considers the way in which NHS services are commissioned. Secondly, it covers the issue of resource allocation or rationing. It examines different rationing strategies, and considers the role of the National Institute of Health and Care Excellence, and the use of judicial review to challenge funding decisions. Finally, it examines public health law, and role of the state in encouraging healthy behaviour and addressing health inequalities.

This chapter examines the ethical justifications for protecting patient confidentiality. It then discusses the different legal sources of the duty of confidence; exceptions to the duty of confidence; and the remedies available for its breach. It briefly considers patients’ rights to gain access to their medical records. Finally, the chapter covers the implications of ‘big data’ and machine learning for healthcare, and the increasing use of mobile technology in order to generate, store and transmit health data.

This chapter examines the law on abortion, beginning with debates over the moral legitimacy of abortion. It then examines the current legal position, and considers how the Abortion Act 1967, as amended, works in practice, as well as considering the prospects for law reform. Finally, the chapter looks briefly at the regulation of abortion in Northern Ireland, Ireland, and the United States.

Introduction: There have been significant advances in systemic therapies for metastatic renal cell carcinoma (mRCC). There are currently 11 drugs approved by Health Canada: sunitinib, sorafenib, pazopanib, axitinib, everolimus, temsirolimus, nivolumab, ipilimumab, cabozantinib, lenvatinib, and pembrolizumab. These novel medications have dramatically altered the prognosis and patient experience. Despite proven benefits and recommendations for funding of most of these drugs, public access has been uneven across Canadian provinces. Methods: We describe the provincial differences and timelines in public funding for approved systemic therapies for mRCC in Canada. Drug funding data was collected from the pan-Canadian Oncology Drug Review (pCODR) database and provincial drug formularies. Missing information was obtained from provincial cancer center pharmacists or drug formulary managers. We compared these dates to data available through regulatory bodies in the U.S., Europe, and Australia. Results: There have been significant differences in the dates of approval for public funding among the provinces, with lags spanning between 17 and 57 months. Funding approval was typically earlier in western provinces and those with denser populations, and most delayed in smaller, eastern provinces. Approval timelines in Canada were similar to those in the U.S., Europe, and Australia. Conclusions: Most drugs approved for use in mRCC are publicly funded for specific patient populations across Canada. However, we illustrate considerable disparities in public funding implementation across the Canadian provinces. These funding lags may create inequities and differences in the patient experience across the Canadian healthcare system.

Objectives Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based fall prevention program that led to a 25% reduction in falls in hospitalized adults. Because it would be helpful to assess nurses' perceptions of burdens imposed on them by using Fall TIPS or other fall prevention program, we conducted a study to learn benefits and burdens. Methods A 3-phase mixed-method study was conducted at 3 hospitals in Massachusetts and 3 in New York: (1) initial qualitative, elicited and categorized nurses' views of time spent implementing Fall TIPS; (2) second qualitative, used nurses' quotes to develop items, research team inputs for refinement and organization, and clinical nurses' evaluation and suggestions to develop the prototype scale; and (3) quantitative, evaluated psychometric properties. Results Four "time" themes emerged: (1) efficiency, (2) inefficiency, (3) balances out, and (4) valued. A 20-item prototype Fall Prevention Efficiency Scale was developed, administered to 383 clinical nurses, and reduced to 13 items. Individual items demonstrated robust stability with Pearson correlations of 0.349 to 0.550 and paired t tests of 0.155 to 1.636. Four factors explained 74.3% variance and provided empirical support for the scale's conceptual basis. The scale achieved excellent internal consistency values (0.82-0.92) when examined with the test, validation, and paired (both test and retest) samples. Conclusions This new scale assess nurses' perceptions of how a fall prevention program affects their efficiency, which impacts the likelihood of use. Learning nurses' beliefs about time wasted when implementing new programs allows hospitals to correct problems that squander time.

Falls represent a persistent and costly patient safety issue. Fall TIPS (Tailored Interventions for Patient Safety) is a patient-centered and clinical decision-supported, fall prevention program that has led to fewer falls and related injuries among hospitalized patients. We aimed to identify dominant facilitators and barriers to Fall TIPS adoption. This multisite qualitative study was conducted in 11 hospitals representing three academic health systems, where Fall TIPS had been implemented for at least one year. Interviews with 50 patients and focus groups with 71 staff were analyzed using a conventional content analysis. Fall TIPS resulted in a partnership between staff and patients, in which fall prevention interventions were patient-specific and enabled by clinical decision support. We identified three facilitators to program adoption. First, staff were motivated to address falls as staff recognized fall prevention as a priority and the limitations of previous fall prevention programs. Second, patients welcomed their role in fall prevention. Third, Fall TIPS was integrated into existing staff workflows. We identified three dominant barriers to program adoption. First, poor engagement practices among staff limited patients’ active participation in fall prevention. Second, the use of residual fall prevention approaches perpetuated a ‘one-size fits all’ approach to fall prevention. Third, patient willfulness i.e., patients’ conscious deviation from fall plans challenged program fidelity. Fall TIPS changed the paradigm of fall prevention by placing an unprecedented focus on patient engagement. Actions that improve staffs’ engagement of patients and patient’s partnership in fall prevention will assist Fall TIPS adoption.

Wind is an important yet understudied environmental influence on foraging behaviour. We investigated the direct and indirect effects of wind on foraging worker honey bees, Apis mellifera. Bees were trained to an array of artificial flowers providing nectar rewards in a location sheltered from natural wind. To examine the direct effect, fans produced four different wind speeds between 0 and 3 m/s at three different flower spacings: 5 cm (flowers touching) and 10 cm and 20 cm (flowers not touching). To examine the indirect effect of wind moving flowers, flowers were moved 10 cm at three frequencies between 50 and 110 cycles/min at zero wind speed. We recorded the number of successful flower visits, time spent flying, search time on a flower and hesitancy to take off. Bees visited significantly fewer flowers with increasing wind speed which was caused by a significant increase in hesitancy to take off. This difference in flower visits between wind speeds was highest at the 20 cm spacing. Flower movement had no effect on foraging rate; however, there was a significant positive relationship between flower movement and the total time spent flying. This was counterbalanced by a significant reduction in time spent searching for the nectary after landing on a flower at the higher flower frequencies. Our results suggest that it is the direct effect of wind on hesitancy to take off that has the greatest effect on honey bee foraging rate.

The CD226 (DNAM-1) axis has emerged as an important immune-modulatory pathway that regulates T cell and NK cell effector functions in the solid tumor microenvironment. Three inhibitory receptors, TIGIT, CD96, and PVRIG, inhibit the activating receptor CD226 by competing for shared ligands (CD112 and CD155) expressed on tumor cells and myeloid cells. Blocking the TIGIT receptor with monoclonal antibodies is a major focus of current clinical development efforts. However, the effectiveness of targeting TIGIT alone in a clinical setting has yet to be demonstrated. We hypothesize that blocking TIGIT alone may not lead to an optimal clinical outcome since immuno-stimulatory interaction between the ligands CD112 and CD155 with CD226 can be competed by inhibitory receptors CD96 and PVRIG in addition to TIGIT. It is therefore interesting to investigate whether all these checkpoints play critical roles in the tumor environment and if inhibiting one or more may be necessary to achieve the maximum CD226 activation in both innate and adaptive immune cells. To address that, we have conducted single-cell analysis and demonstrated high expression levels and co-expression of the three inhibitory receptors on T cell subsets and NK cells in the tumor microenvironment for multiple tumor types. Thus, simultaneous blockade of two or more of these receptors might be required for full CD226 activation and T and NK cell-mediated anti-tumor immunity. We envision developing blocking antibodies to these receptors in the CD226 axis toward potential combinations or multi-specific antibody therapies against solid tumors. Antibodies against all three checkpoints, i.e., TIGIT, CD96, and PVRIG, were selected based on receptor binding and their ability to block the receptor interaction with their ligands. We have demonstrated the functionality of the antibodies against these three targets and explored the best approach to alleviate the suppressive regulation of CD226 signaling. Detailed characterizations of these antibodies have been performed, and multi-specific antibodies have been generated and evaluated. Through this effort, we aim to define and develop the best therapeutic strategy for unleashing the CD226 axis for T and NK cell-mediated anti-tumor immunity. Citation Format: Tom Li Stephen, Qian Zhang, Byung-Kwon Lee, Chao Kong, Rain Sun, Jia Wu, Jie Cui, Hillary Shah, Wenhua Xu, Yun-Yueh Lu, Joshua Whitener, Emily Jackson, Jinping Gan, Francisco Adrian, Liang Schweizer. Maximizing the outcome of CD226 stimulation through targeting beyond TIGIT signaling with combination and multi-specific approaches for cancer immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3477.

Microfluidic technologies provide many advantages for studying differentiation of three-dimensional (3D) stem cell aggregates, including the ability to control the culture microenvironment, isolate individual aggregates for longitudinal tracking, and perform imaging-based assays. However, applying microfluidics to studying mechanisms of stem cell differentiation requires an understanding of how microfluidic culture conditions impact cell phenotypes. Conventional cell culture techniques cannot directly be applied to the microscale, as microscale culture varies from macroscale culture in multiple aspects. Therefore, the objective of this work was to explore key parameters in microfluidic culture of 3D stem cell aggregates and to understand how these parameters influence stem cell behavior and differentiation. These studies were done in the context of differentiation of embryonic stem cells (ESCs) to motor neurons (MNs). We assessed how media exchange frequency modulates the biochemical microenvironment, including availability of exogenous factors (e.g., nutrients, small molecule additives) and cell-secreted molecules, and thereby impacts differentiation. The results of these studies provide guidance on how key characteristics of 3D cell cultures can be considered when designing microfluidic culture parameters. We demonstrate that discontinuous perfusion is effective at supporting stem cell aggregate growth. We find that there is a balance between the frequency of media exchange, which is needed to ensure that cells are not nutrient-limited, and the need to allow accumulation of cell-secreted factors to promote differentiation. Finally, we show how microfluidic device geometries can influence transport of biomolecules and potentially promote asymmetric spatial differentiation. These findings are instructive for future work in designing devices and experiments for culture of cell aggregates.

This article describes how nurse leaders in one organization led an interdisciplinary team to develop an evidence-based fall prevention program, Fall TIPS (Tailoring Interventions for Patient Safety), that is now used in hospitals across the country. A common barrier to fall prevention is developing new programs rather than adopting and using evidence-based approaches. The Fall TIPS program overcomes this barrier by providing a comprehensive suite of tools that nurse leaders can use to promote adoption and spread of evidence-based fall prevention best practices in their organization. This article is a call to action to inform nurse leaders about the decade of evidence behind the Fall TIPS program, how they can join the Fall TIPS Collaborative, and how they can access Fall TIPS resources to support implementation at their hospitals.

We report a generic smartphone app for quantitative annotation of complex images. The app is simple enough to be used by children, and annotation tasks are distributed across app users, contributing to efficient annotation. We demonstrate its flexibility and speed by annotating >30,000 images, including features of rice root growth and structure, stem cell aggregate morphology, and complex worm (Caenorhabditis elegans) postures, for which we show that the speed of annotation is >130-fold faster than state-of-the-art techniques with similar accuracy.

Background/objectives To assess nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. Design Survey research. Setting Seven adult acute-care hospitals in 2 hospital centers located in Boston and NYC. Participants A total of 298 medical-surgical nurses on 14 randomly selected units. Intervention Three-step FallTIPS fall prevention program that had been in use as a clinical program for a minimum of 2 years in each hospital. Measurements Fall Prevention Efficiency Scale (FPES), range 13-52; four-factorilly derived subscales: valued, efficiency, balances out and inefficiency; and 13 psychometrically validated individual items. Results Nurses perceived the FallTIPS fall prevention program to be efficacious. The FPES mean score of 38.55 (SD = 5.05) and median of 39 were well above the lowest possible score of 13 and scale midpoint of 32.5. Most nurses (N = 270, 90.6%) scored above 33. There were no differences in FPES scores between nurses who had only used FallTIPS and nurses who had previously used a different fall prevention program. Conclusion The nurses who used FallTIPS perceived that efficiencies in patient care compensated for the time spent on FallTIPS. Nurses valued the program and findings confirmed the importance of patient and family engagement with staff in the fall prevention process. Regardless of the fall prevention program used, organizations should examine staff perceptions of their fall prevention program because programs that are not perceived as being useful, efficient, and valuable will lead to nonadherence over time and then will not reduce falls and injuries. The recently developed FPES used in this study is a brief tool available for organizations to assess nurses' perceptions of the efficacy of their fall prevention program. Additional FPES research is needed with larger and more diverse samples.

Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. TheParent Mental Health and Family Functioning Working Groupof the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.

This chapter will argue that the core justification for the United Kingdom’s ‘blanket ban’ on assisted suicide—namely that it is necessary in order to protect ‘the vulnerable’—has tended to obscure two other important sets of interests. First, it has served to marginalize the interests of patients who are not vulnerable, and who have been used to exercising considerable control over their lives. There is evidence from countries which have legalized assisted dying that it is this non-vulnerable group of patients who are its principal users. Second, the core justification for the ‘blanket ban’ has deflected attention away from the interests of the medical profession itself, which in the United Kingdom has a long tradition of organized and powerful opposition to assisted suicide.