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Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68–100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research.

Although being recognized by the World Health Organization as an essential domain of palliative care, spiritual care is still one of the most neglected component of the healthcare system. In this editorial, we set the context and invite contributions for a  BMC Palliative Care  Collection of articles titled ‘Spirituality in Palliative Care’.

Concern for climate change is one of the drivers of new, transitional energy policies oriented towards economic growth and energy security, along with reduced greenhouse gas (GHG) emissions and preservation of biodiversity. Since 2010, the Climate Policy Initiative (CPI) has been publishing annual Global Landscape of Climate Finance reports. According to these reports, US$3660 billion has been spent on global climate change projects over the period 2011–2018. Fifty-five percent of this expenditure has gone to wind and solar energy. According to world energy reports, the contribution of wind and solar to world energy consumption has increased from 0.5% to 3% over this period. Meanwhile, coal, oil, and gas continue to supply 85% of the world’s energy consumption, with hydroelectricity and nuclear providing most of the remainder. With this in mind, we consider the potential engineering challenges and environmental and socioeconomic impacts of the main energy sources (old and new). We find that the literature raises many concerns about the engineering feasibility as well as environmental impacts of wind and solar. However, none of the current or proposed energy sources is a “panacea”. Rather, each technology has pros and cons, and policy-makers should be aware of the cons as well as the pros when making energy policy decisions. We urge policy-makers to identify which priorities are most important to them, and which priorities they are prepared to compromise on.

Child maltreatment often has a negative impact on the development of social behavior and health. The biobehavioral mechanisms through which these adverse outcomes emerge, however, are not clear. To better understand the ways in which early life adversity affects subsequent social behavior, changes in the neuropeptide oxytocin (OT) in children (n = 73) aged 8.1–11.5 years following a laboratory stressor were examined. Girls with histories of physical abuse have higher levels of urinary OT and lower levels of salivary cortisol following the stressor when compared to controls. Abused and control boys, however, do not differ in their hormonal responses. These data suggest that early adversity may disrupt the development of the stress regulation system in girls by middle childhood.

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

The design and synthesis of protein-like polymers is a fundamental challenge in materials science. A biomimetic approach is to explore the impact of monomer sequence on non-natural polymer structure and function. We present the aqueous self-assembly of two peptoid polymers into extremely thin two-dimensional (2D) crystalline sheets directed by periodic amphiphilicity, electrostatic recognition and aromatic interactions. Peptoids are sequence-specific, oligo- N -substituted glycine polymers designed to mimic the structure and functionality of proteins. Mixing a 1:1 ratio of two oppositely charged peptoid 36mers of a specific sequence in aqueous solution results in the formation of giant, free-floating sheets with only 2.7 nm thickness. Direct visualization of aligned individual peptoid chains in the sheet structure was achieved using aberration-corrected transmission electron microscopy. Specific binding of a protein to ligand-functionalized sheets was also demonstrated. The synthetic flexibility and biocompatibility of peptoids provide a flexible and robust platform for integrating functionality into defined 2D nanostructures. Peptoids are synthetic polymers designed to mimic the structure and functionality of proteins. When a one-to-one blend of two oppositely charged peptoids is mixed in solution, giant, 2.7-nm-thick free-floating sheets are formed. The sheets can specifically bind a corresponding protein, and offer potential for producing functional two-dimensional nanostructures in the future.

ObjectivesThe objective was to explore how the voice of the nurse in paediatric intensive care units (PICU) is portrayed in the literature.DesignScoping review using the six-step scoping review framework outlined by Arksey and O’Malley.Data sourcesPubMed, Nursing (OVID), Medline (OVID), CINHAL (EBSCO), SCOPUS and Web of Science online databases. The initial search was conducted in June 2020 and was repeated in January 2023.Eligibility criteriaThe review included publications in English; published since 2010 in peer-reviewed journals; papers identified nurses in the population studied and conducted in PICU.Data extraction and synthesisThe papers were screened by abstract and subsequently by reading the full text by two independent reviewers. The literature was imported into the software program NVivo V.12 for thematic analysis.ResultsThe scoping review identified 53 articles for inclusion. While the value of seeking the voice of the nurse has been identified explicitly in other healthcare contexts, it has only been identified indirectly in PICU. Four main themes emerged from the data: the voice of the nurse in the organisation of PICU, caring for children in PICU, as a healthcare professional, and communication in PICU.ConclusionWhile this literature suggests many facets of the complex role of the nurse, including partnership with families and advocating for patients, the limited literature on care delivery reduces the capacity to fully understand the voice of the nurse at key junctions of care. Further research is needed on the voice of the nurse in PICU to illuminate the barriers and enablers for nurses using their voices during decision-making.

Background This qualitative study was undertaken to obtain feedback from informal carers about their experiences of involvement in a cluster randomised trial of clinically-assisted hydration in the last days of life (“CHELsea II trial”). Methods Informal carers that had taken part in the trial post-bereavement postal survey, and had expressed an interest in taking part in further research, were approached about this post-bereavement qualitative study. Interviews were conducted remotely, using a semi-structured interview schedule that asked about the impact of the research on patient / their end-of-life care, the impact of the research on the informal carer, and the informal carers views on research at the end-of-life. The interview transcripts were thematically analysed. Results Fifteen informal carers took part in the study prior to thematic saturation. Invariably informal carers reported that there was no negative impact on the patient or themselves, and were positive about taking part in future end-of-life research (if the situation occurred). The analysis generated three themes: (a) Purpose, helping, and no disruption; (b) Preparing for what was to come; and (c) Timing of research at the end-of-life. Conclusions This study confirms that research can be undertaken in patients at the end-of-life without negatively impacting the experience. Moreover, patients and their informal carers want to take part in such research, as it provides them with purpose during this time, and gives them the chance of helping future patients. Trial registration ISRCT Registry (registry number - ISRCTN65858561) – registered 14/09/2021.

A major challenge in coronavirus vaccination and treatment is to counteract rapid viral evolution and mutations. Here we demonstrate that CRISPR-Cas13d offers a broad-spectrum antiviral (BSA) to inhibit many SARS-CoV-2 variants and diverse human coronavirus strains with >99% reduction of the viral titer. We show that Cas13d-mediated coronavirus inhibition is dependent on the crRNA cellular spatial colocalization with Cas13d and target viral RNA. Cas13d can significantly enhance the therapeutic effects of diverse small molecule drugs against coronaviruses for prophylaxis or treatment purposes, and the best combination reduced viral titer by over four orders of magnitude. Using lipid nanoparticle-mediated RNA delivery, we demonstrate that the Cas13d system can effectively treat infection from multiple variants of coronavirus, including Omicron SARS-CoV-2, in human primary airway epithelium air-liquid interface (ALI) cultures. Our study establishes CRISPR-Cas13 as a BSA which is highly complementary to existing vaccination and antiviral treatment strategies. A major challenge in coronavirus vaccination and treatment is to counteract rapid viral evolution and mutations. Here the authors show that CRISPR-Cas13d can be used as a broad-spectrum antiviral to inhibit human coronaviruses, including new SARS-CoV-2 variants, combined with small molecule drugs for an enhanced antiviral effect in human primary cells.

Background Adult specialist palliative care professionals have played a key role in the care of children with palliative care needs in the community. However, there is little known on their perceived level of preparedness or training in providing children’s palliative care in the community setting. The aim of this scoping review is to appraise the current literature and identify any existing gaps in knowledge on the level of preparedness and training of adult specialist palliative care professionals caring for children in the community. The review question asks: “Do adult specialist palliative care professionals feel sufficiently prepared to deliver their services to children in the community?”. Methods In order to address the review question, a scoping review was conducted. This was guided by the framework of Arksey and O’Malley and further enhanced by the methodology of the Joanna Brigg’s Institute in order to report the findings. Results Twenty studies were identified from the database searches. Common areas identified from the literature were that adult specialist palliative care professionals perceived that they had a lack of training or experience in children’s palliative care, lack of knowledge or preparedness, and that they faced barriers preventing them from providing effective children’s palliative care. Conclusion This review highlights the lack of empirical research on adult specialist palliative care professionals providing children’s palliative care in the community. While the available literature demonstrates both their limited training, experience and preparedness in caring for children.