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As SARS-CoV-2 vaccines have started to be rolled out, a key question facing transplant units has been whether listing for transplantation should be contingent on recipients having received a vaccine. We aimed to provide an ethical framework when considering potential transplant candidates who decline vaccination. We convened a working group comprising transplant professionals, lay members and patients and undertook a literature review and consensus process. This group's work was also informed by discussions in two hospital clinical ethics committees. We have reviewed arguments for and against mandating vaccination prior to listing for kidney transplantation and considered some practical difficulties which may be associated with a policy of mandated vaccination. Rather than requiring that all patients must receive the SARS-CoV-2 vaccine prior to transplant listing, we recommend considering vaccination status as one of a number of SARS-CoV-2-related risk factors in relation to transplant listing. Transplant units should engage in individualised risk-benefit discussions with patients, avoid the language of mandated treatments and strongly encourage uptake of the vaccine in all patient groups, using tailor-made educational initiatives.

The textile industry needs to adopt environmentally sustainable approaches to address ecologically damaging practices. Whilst driven by initiatives such as Textiles 2030, it is current students who will carry this agenda forward. This project investigated pedagogical approaches to develop sustainable textiles for the fashion design curriculum. Pilot studies, using bacterial cellulose (BC) as a material for millinery, revealed members of the public were prepared to experiment with this novel material, and BC was compatible with traditional hat-making techniques. A further study challenged secondary school students, based on an experiential learning model, to grow their own BC biofilm, exploring this as a sustainable apparel fabric. Initial attitudes of reluctance developed into acceptance once engaged in the practical activity. This study illustrates that with appropriate communication and education strategies, the principles of sustainability in fashion, and the acceptability of novel materials, can be engendered in different audiences.

Bacterial cellulose (BC) has been suggested as a sustainable alternative textile for apparel. Previous studies have evaluated the production of BC sheets and the suitability of these to form garment shapes. The laboratory measured physical performance characteristics of BC from an apparel perspective remain relatively unexplored. The aim of this study was to produce reproducible sheets of BC, enabling the evaluation of the performance of the BC in an apparel textile testing context, and comparison to other textile materials. Grown in sterile black tea with glucose, the BC presented as a mesh of non-woven nanofibers, and thus comparison was made with three non-woven fabrics. It has also been suggested that BC could be used as ‘vegetable’ leather; therefore, performance comparisons were conducted with animal skins. Utilizing British, European and International standard test methods, the selected fabrics were evaluated for their performance in tensile, elongation, moisture vapor permeability and abrasion tests, relevant for an apparel end-use. Tensile strength testing revealed that BC is weaker than its animal counterparts but does display similar physical characteristics at the point of failure; however, it displayed a higher tensile strength than the non-woven fabrics chosen for comparison. BC was the least breathable and most moisture-retentive of all the fabrics tested, raising questions regarding its suitability and comfort for apparel applications in its untreated state. However, BC displayed superior performance when tested for resistance to abrasion, suggesting it could be best utilized in the form of encapsulated patches in items subjected to this type of damage.

This chapter is concerned with the use of wearable devices for disabled and extreme sports. These sporting disciplines offer unique challenges for sports scientists and engineers. Disabled athletes often rely on and utilize more specialist equipment than able-bodied athletes. Wearable devices could be particularly useful for monitoring athlete-equipment interactions in disability sport, with a view to improving comfort and performance, while increasing accessibility and reducing injury risks. Equipment also tends to be key for so called “extreme” sports, such as skiing, snowboarding, mountain biking, bicycle motocross, rock climbing, surfing, and white-water kayaking. These sports are often practiced outdoors in remote and challenging environments, with athletes placing heavy demands on themselves and their equipment. Extreme sports also encompass disability sports, like sit skiing and adaptive mountain biking, and the popularity and diversity of such activities is likely to increase with improvements in technology and training, as well as with the support of organizations like the High Fives Foundation ( highfivesfoundation.org ) and Disability Snowsport, United Kingdom ( disabilitysnowsport.org.uk ). Within this chapter in these two sporting contexts, wearable devices are broadly associated with those that can be used to monitor the kinetics and kinematics of an athlete and their equipment. This chapter will first consider image-based alternatives and then focus on wearable sensors, in three main sections covering, (1) sports wearables, (2) disability sport and the use of wearables, and (3) extreme sport and the use of wearables, as well as making recommendations for the future.

Good hand hygiene is necessary to control and prevent infections, but many children do not adequately wash their hands. While there are classroom communications targeted at children, the toilet space, the location of many hand hygiene activities, is neglected. This paper describes an initial evaluation of &ldquo, 123&rdquo, persuasive space graphics (images and messages integrated within an architectural environment that encourage specific actions). The effectiveness (whether hand hygiene improves) and efficiency (the ease with which a setting can adopt and implement an intervention) is evaluated in three UK schools and one museum. Five evaluations (participant demographic, handwashing frequency, handwashing quality, design persuasiveness, stakeholder views) were conducted. In the school settings, persuasive space graphics increased the quality and frequency of handwashing. In the museum setting, frequency of handwashing slightly increased. In all settings children found the graphics persuasive, and stakeholders also believed them to be effective. Stakeholders considered persuasive space graphics a low-cost and time-efficient way to communicate. It can be concluded that persuasive space graphics are effective in increasing hand hygiene, particularly in school settings where children have a longer exposure to the graphics. Persuasive space graphics are also an efficient low-cost means of communicating hand hygiene.

This book provides researchers, students and professionals in materials science and engineering with tactics and information as they face increasingly complex challenges around the development, selection and use of construction and ...

Functional electrical stimulation is commonly used as a rehabilitation therapy to support the movement of individuals who have suffered traumatic spinal cord injury. Recently, there has been a focused interest on the development of textile electrodes, as they pose many benefits over traditional electrodes. This study presents design considerations and the feasibility of a wearable FES garment sleeve using flexible and extensible screen-printed electrodes.

Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes of prescribing psychiatrists and service users towards long-term use of hypnosedative medication, and their perceptions of barriers to evidence-based nonmedication alternatives. Qualitative data from focus groups in Aotearoa/NZ were analysed thematically. A novel research design involved a service user researcher contributing throughout the research design and process. Service users and psychiatrists met to discuss each other's views, initially separately, and subsequently together. Analysis of the data identified four key themes: the challenge, for both parties, of sleep disturbance among service users with mental health problems; the conceptual and ethical conflicts for service users and psychiatrists in managing this challenge; the significant barriers to service users accessing evidence-based nonmedication alternatives; and the initial sense of disempowerment, shared by both service users and psychiatrists, which was transformed during the research process. Our results raise questions about the relevance of the existing guidelines for this group of service users, highlight the resource and time pressures that discourage participants from embarking on withdrawal regimes and education programmes on alternatives, highlight the lack of knowledge about alternatives and reflect the complex interaction between sleep and mental health problems, which poses a significant dilemma for service users and psychiatrists.

Background Patients with life-limiting disease often do not achieve their preferred place of care and death. The Hospital2Home service (H2H) has been created to enable patients whose treatment has moved to palliation only, to leave hospital and safely achieve their priorities and preferences. The H2H service is facilitated by a team of palliative care Clinical Nurse Specialists and is based on a successful research project undertaken in Australia (Abernethy, 2006). Aim To demonstrate the effectiveness and impact of the Hospital2Home telephone case conference model. This service delivery model coordinates advance care planning, transition of care, enhances communication between the hospital and specialist community services, and where appropriate, establishes a shared digital Urgent Care Plan (Co-ordinate My Care). Conversations with the patient and those close to them form the agenda of the telephone case conference with community teams and GP. Symptoms, social needs, family issues and preferences are discussed. Methods The data for this evaluation have been retrospectively extracted from the Hospital2Home database between January 2015 to June 2017. Demographics, diagnoses, preferences and service data have been analysed. Results The data demonstrates that by establishing patient preferences, and sharing priorities via telephone case conferences, 76% of 544 patients were enabled to achieve their preferred place of death ie home or hospice and only 20.4% died in hospitals. Conclusion Telephone case conferencing is an effective tool to promote safer complex discharges.

A reluctance to diagnose asthma in children under three who have recurrent cough and wheeze causes delays in the commencement of appropriate asthma treatment. Timely inhaled corticosteroid use may reduce asthma exacerbations and unnecessary visits to the emergency department and GPs. To address this delay, an advanced nurse practitioner in one children's community nursing team set up a respiratory assessment clinic for children under three who had recurrent respiratory difficulties. This article describes the rationale and the evidence base that supports a clinic of this kind and reports on its initial results.

Substance use disorders (SUD) confer risk for suicide yet there are no empirically supported suicide prevention training curricula tailored to SUD treatment providers. We assessed the efficacy of a 2-hour training that featured a suicide prevention training video produced by the Department of Veterans Affairs (VA). The video was based on Treatment Improvement Protocol Number 50, TIP 50, a practical manual to manage suicide risk produced by the Substance Abuse and Mental Health Services Administration (SAMHSA). The training was provided in small groups to 273 SUD treatment providers in 18 states. Results were evaluated using self-report assessments obtained at pre-test, post-test, and 2-month follow-up. Statistically significant changes (p

Over the past twenty years phenomenal developments in technology have changed the nature of education. Students now have access to a vast range of resources 24/7. This instant access has created a certain expectation on the part of the student and there must now be very few, if any, courses taught in higher education where the lecturer does not maintain a virtual learning environment (VLE). This VLE will be used to communicate with the students and will commonly provide access to significant resources supporting teaching. A review of teaching and learning at Coventry Law School indicated that, although all staff used the VLE in this way, the extent to which technology was embedded into our pedagogy was limited and consisted, primarily, of a small number of online quizzes. As a Law School we had not taken the step of moving from using technology to deliver resources to embedding technology-enhanced learning into our pedagogy. A recent JISC Report (2009) defines technology-enhanced learning and provides exa...

In the post-human rights era the question has arisen on several occasions as to whether the automatic and arbitrary termination of the registered owner’s title through the common law and statutory principles governing adverse possession of land is contrary to the Article 1, Protocol 1 of the European Convention. The matter fell to be decided in J.A. Pye (Oxford) Ltd v United Kingdom ([2005] 3 EGLR 1) where the European Court of Human Rights held that the automatic termination of a registered owners title after 12 years possession was indeed a violation of Article 1, Protocol 1. More recently, the decision of the European Court has been overturned by the Grand Chamber of the European Court of Human Rights where the Grand Chamber has held that a squatters’ right to another persons land are not disproportionate (J. A. Pye (Oxford) Ltd and Another v United Kingdom, The Times, October 1st 2007). This short article examines the decision of the Grand Chamber.

Background. Adherence is a major problem facing HIV-seropositive patients. Low adherence has been associated with faster disease progression as well as development of drug-resistant strains of HIV. Thus it is critical to understand factors associated with treatment compliance. This study examined the independent contributions of disease severity, age, gender, household income, homelessness, ethnicity, and sexual orientation on appointment adherence. Methods. Participants ( n = 671) scheduled for appointments in an outpatient county treatment facility for HIV-related medical care completed demographic questionnaires and clinic staff collected appointment attendance data. Results. Multiple regression analyses indicated that patients diagnosed with AIDS, older in age, and receiving a higher income were more likely to keep medical appointments. Additionally, African American ethnicity and identifying as heterosexual were associated with missing scheduled medical appointments. Conclusions. These data suggest that cultural and sociodemographic characteristics influence patients' adherence to outpatient services. Implications for interventions aimed at increasing medical adherence are discussed.

People with a colostomy often have many questions relating to managing their colostomy when out at work, shopping or away on holiday as they try to move forward and return to living their normal lives. While travelling in particular may be a daunting prospect, with encouragement, reassurance and pre-planning, these fears can be overcome. Even those who are expert at living with a colostomy may require travel advice from their stoma care nurse specialists or from patient associations.

Previous efforts to characterize conservation between the human and mouse genomes focused largely on sequence comparisons. These studies are inherently limited because they don’t account for gene structure differences, which may exist despite genomic sequence conservation. Recent high-throughput transcriptome studies have revealed widespread and extensive overlaps between genes, and transcripts, encoded on both strands of the genomic sequence. This overlapping gene organization, which produces sense-antisense gene pairs, is capable of effecting regulatory cascades through established mechanisms. We present an evolutionary conservation assessment of sense-antisense pairs, on three levels: genomic, transcriptomic, and structural. From a genome-wide dataset of human sense-antisense pairs, we first identified orthologous loci in the mouse genome, then assessed their transcription in the mouse, and finally compared the genomic structures of sense-antisense pairs expressed in both species. We found that approximately half of human sense-antisense loci have single orthologous locations in the mouse genome; however, only half of those orthologous locations have sense-antisense transcriptional activity in the mouse. This suggests that high human-mouse gene conservation overlooks widespread distinctions in sense-antisense pair incidence and expression. We compared gene structures at orthologous sense-antisense loci, finding frequent differences in gene structure between human and orthologous mouse sense-antisense pair members. Our categorization of human sense-antisense pairs with respect to mouse conservation of expression as well as structure points to limitations of mouse models. Gene structure differences, including at sense-antisense loci, may account for some of the phenotypic distinctions between primates and rodents. Genes in non-conserved sense-antisense pairs may contribute to evolutionary lineage-specific regulatory outcomes.

This essay brings together George Eliot's well‐known familiarity with scientific theories and her writing of The Lifted Veil. Few Eliot scholars have paid more than cursory attention to this strange tale. Where it has been discussed, it has been primarily in the context of Eliot's early interest in phrenology and mesmerism. It is my argument that, far from being the “slight story” which Eliot described, The Lifted Veil raises important questions about the way in which disciplines of knowledge such as science and literature become gendered and hierarchised as their specific systems of meaning are deployed across the wider spectrum of cultural organisation. Drawing upon contemporary medical theories and ideas of masculinity, Eliot, I argue, challenges assumptions about the division of knowledge and experience into gendered categories where “masculine”, rational, objective science is opposed to “feminine”, instinctual, subjective vision.

Forty-three patients with the primary complaint of vulval pruritus were recruited to take part in this prospective patch-testing study. A detailed questionnaire was administered to each and patch testing to an extended battery of allergens was undertaken. This included the European standard series, preservatives, corticosteroids and a battery of common over-the-counter topical vulval treatments. Analysis of demographic data and prior treatments used, and various other parameters, were studied in the context of patch-test results. This prospective study reports a very high rate of contact sensitivity in patients presenting with vulval pruritus, with 81.4% of those tested having at least one contact allergen detected. One or more clinically relevant allergens were found in 44% of the subjects patch tested. The variables found to predict a greater likelihood of a contact allergy were a biopsy diagnosis of vulval dermatitis, the use of multiple topical treatments, sexual inactivity and patients with severe pruritus on a self-reported scale. Most importantly, many clinically relevant allergens these patients reacted to were outside the European standard series. This highlights the need for an extended series in this patient population.

The development of a family clinic for later life families within an Old Age Psychiatry service is briefly described. An extended life cycle model has been found useful in understanding and working with such families and is also described, together with two cases which illustrate the practical application of the model.

The authors have used a modified surgical technique for repair of the distal end of the biceps brachii in three patients who presented with chronic rupture, all more than 6 weeks old. All patients were males; two lesions were on the dominant right side and one was on the non-dominant left side. An anterior incision was made over the cubital fossa, a hole was drilled over the radial tuberosity and a simple pull-through technique with an Ethibond suture was used to attach the tendon to an endobutton over the posterior surface of the radius. All patients returned to their employment and preinjury activity levels by six months. There were no postoperative complications and clinically all repairs remained intact. The patients regained their normal range of movements in 3 months; all but one regained the endurance and strength of their bicep in 6 months as assessed by Cybex testing. Surgical repair of the distal end of the biceps using the technique reported has given excellent results in these three patients.