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Why did you do this work?Our tertiary paediatric service provides complex care for multi-national patients. To promote holistic patient-centred care we hold weekly psychosocial multidisciplinary meetings. As a team, we envisaged that a quality improvement project could develop our processes.The overall aim was to improve the effectiveness of our psychosocial meetings.The objectives were to: identify and implement strategies during psychosocial meetings to ensure most effective use of time, enhance inter-disciplinary communications and promote a holistic approach to care.What did you do?Anonymous qualitative survey was conducted to understand staff experiences of the meetings. Quantitative measures were also set up to provide a baseline of meeting effectiveness criteria. This alongside listening events supported further idea generation and multidisciplinary working. Ideas were implemented through iterative test cycles. In chronological order, these included: the creation of an online shared patient list, a newly appointed psychologist who also acquired the role of chairing the meetings, a move from virtual to hybrid format, consistent minuting, and encouraging broad multidisciplinary team (MDT) attendance. To evaluate the impact a second survey was conducted one year later, after the changes were implemented.What did you find?The number of respondents increased from 11 to 19 between the two time points. Staff perceived that representation from MDT professions was initially only 27%; this increased to 90%. Staff satisfaction with the meetings improved from 36% to 68%. Initially 18% of respondents reported that the meetings were effective; this improved to 71%. 71% reported that the implemented changes were effective, with 65% reporting that they had positively influenced patient care.Many highlighted the importance of having dedicated time and space to come together, share insights, and ensure a holistic approach is integrated alongside medical management. Respondents reported that the introduction of a new and embedded psychologist, who now chairs the meetings, has fostered more family-centred discussions and encouraged consideration of broader systemic factors.It was suggested that functional enhancement of the electronic record system could lead to more effective meetings. Respondents expressed mixed feelings about the hybrid format due to unreliable audio-visual technology.What does it mean?This project highlighted the benefits of having effective psychosocial meetings. It demonstrated that implementing changes in response to feedback results in an improved staff experience of psychosocial meetings, better inter-professional communication and, in turn, perceived patient care. This study was for a single service, but learning could be transferred to similar contexts. It would be beneficial to complete a further quality improvement cycle around use of technology to better support the meetings.

Why did you do this work?Our tertiary paediatric service provides complex care for multi-national patients. To promote holistic patient-centred care we hold weekly psychosocial multidisciplinary meetings. As a team, we envisaged that a quality improvement project could develop our processes.The overall aim was to improve the effectiveness of our psychosocial meetings.The objectives were to: identify and implement strategies during psychosocial meetings to ensure most effective use of time, enhance inter-disciplinary communications and promote a holistic approach to care.What did you do?Anonymous qualitative survey was conducted to understand staff experiences of the meetings. Quantitative measures were also set up to provide a baseline of meeting effectiveness criteria. This alongside listening events supported further idea generation and multidisciplinary working. Ideas were implemented through iterative test cycles. In chronological order, these included: the creation of an online shared patient list, a newly appointed psychologist who also acquired the role of chairing the meetings, a move from virtual to hybrid format, consistent minuting, and encouraging broad multidisciplinary team (MDT) attendance. To evaluate the impact a second survey was conducted one year later, after the changes were implemented.What did you find?The number of respondents increased from 11 to 19 between the two time points. Staff perceived that representation from MDT professions was initially only 27%; this increased to 90%. Staff satisfaction with the meetings improved from 36% to 68%. Initially 18% of respondents reported that the meetings were effective; this improved to 71%. 71% reported that the implemented changes were effective, with 65% reporting that they had positively influenced patient care.Many highlighted the importance of having dedicated time and space to come together, share insights, and ensure a holistic approach is integrated alongside medical management. Respondents reported that the introduction of a new and embedded psychologist, who now chairs the meetings, has fostered more family-centred discussions and encouraged consideration of broader systemic factors.It was suggested that functional enhancement of the electronic record system could lead to more effective meetings. Respondents expressed mixed feelings about the hybrid format due to unreliable audio-visual technology.What does it mean?This project highlighted the benefits of having effective psychosocial meetings. It demonstrated that implementing changes in response to feedback results in an improved staff experience of psychosocial meetings, better inter-professional communication and, in turn, perceived patient care. This study was for a single service, but learning could be transferred to similar contexts. It would be beneficial to complete a further quality improvement cycle around use of technology to better support the meetings.

Microfluidic 3D tissue culture systems are attractive for in vitro drug testing applications due to the ability of these platforms to generate 3D tissue models and perform drug testing at a very small scale. However, the minute cell number and liquid volume impose significant technical challenges to perform quantitative cell viability measurements using conventional colorimetric or fluorometric assays, such as MTS or Alamar Blue. Similarly, live-dead staining approaches often utilize metabolic dyes that typically label the cytoplasm of live cells, which makes it difficult to segment and count individual cells in compact 3D tissue cultures. In this paper, we present a quantitative image-based cell viability (QuantICV) assay technique that circumvents current challenges of performing the quantitative cell viability assay in microfluidic 3D tissue cultures. A pair of cell-impermeant nuclear dyes (EthD-1 and DAPI) were used to sequentially label the nuclei of necrotic and total cell populations, respectively. Confocal microscopy and image processing algorithms were employed to visualize and quantify the cell nuclei in the 3D tissue volume. The QuantICV assay was validated and showed good concordance with the conventional bulk MTS assay in static 2D and 3D tumor cell cultures. Finally, the QuantICV assay was employed as an on-chip readout to determine the differential dose responses of parental and metastatic 3D oral squamous cell carcinoma (OSCC) to Gefitinib in a microfluidic 3D culture device. This proposed technique can be useful in microfluidic cell cultures as well as in a situation where conventional cell viability assays are not available.

BackgroundWalker Warburg dystroglycanopathy is the most severe subtype of congenital muscular dystrophies. It is characterised by four consistent features -cobble stone lissencephaly, cerebellar malformation ,retinal abnormalities and muscular dystrophy. The incidence is estimated at 1.2 per 100,000 live births and the life-span in these children is around 3 years. There are more than fifteen causative genes and transmission is autosomal recessive.CaseWe describe a boy, born in Kuwait to parents of a consanguineous marriage ,premature at 34 weeks gestation with hypotonia, antenatal hydrocephalus and severe eye abnormalities. An MRI brain done at the referring hospital showed cobblestone lissencephaly and severe ventricular dilatation. He was transferred to our centre at corrected age 38 weeks for neurosurgical and medical management. Clinical examination showed central hypotonia with a lack of purposeful movements, macrocephaly from hydrocephalus, left eye buphthalmos and congenital glaucoma, a blind microphthalmic right eye, hearing impairment and bilateral medullary nephrocalcinosis. The creatinine kinase was elevated at 3996U/l. A genetic panel for muscular dystrophy done here detected a homozygous ISPD c.1186G>T p. (Gly396Ter) pathogenic sequence variant, confirming ISPD-related congenital muscular dystrophy. Complications included cerebrospinal fluid leak post ventriculoperitoneal (VP) shunt insertion, recurrent aspiration pneumonia and urinary tract infections.Of note, he developed hypothermia as a side effect from Timolol eye drops as part of his treatment for glaucoma. He underwent a fundoplication gastrostomy ;slowly tolerating feeds with anti-reflux medications, breathing comfortably in air and cooing in response to parents’ handling. Within a comprehensive multidisciplinary team effort , lung protective strategies, regular occupational and physiotherapy, he made a good recovery. He was successfully repatriated home with good parental care at corrected age 7 monthsConclusionPrognosis may be poor in WWS, however it is most ethical to provide holistic care, optimise the quality of life and direct genetic counselling.

While world leaders gather to step up the transition towards net-zero carbon emissions at COP26 in Glasgow, the nations they represent are locked in an unprecedented race to secure their supplies of fossil fuels for winter in the Northern Hemisphere. Without a properly planned and well-executed transition away from fossil fuels, renewable energy targets could go up in smoke. [...]while high fossil fuel prices should drive investment in renewables over the long-term, in the short term they simply make the dirtiest fuels even more profitable and drive up costs across the supply chain — including for solar components.

This study aimed to investigate the effect of intramuscular injection of testosterone undecanoate on overall quality of life （QoL） in men with testosterone deficiency syndrome （TDS）. A randomized controlled trial over a 12-month period was carried out in 2009. One hundred and twenty men aged 40 years and above with a diagnosis of TDS （serum total testosterone 〈12 nmol 1-1 and total Aging Male Symptom （AMS） scores ≥ 27） were invited to participate. Interventions comprised intramuscular injection of either placebo or 1000 mg testosterone undecanoate, given at weeks O, 6, 18, 30 and 42. This paper presents the secondary analysis of QoL changes measured in the scores of Short-Form-12 （SF-12） scale at baseline, weeks 30 and 48 after the first injection. A total of 56/60 and 58/60 men from the active treatment and placebo group, respectively, completed the study. At week 48, before adjusting for baseline differences, the QoL of men in the treatment group improved significantly in five out of the eight domains on SF-12. The physical health composite scores improved 4.0 points from a baseline of 41.9±7.0 in the treatment group compared to 0.8 point from a baseline of 43.7--7.1 in the placebo group （F=3.652, P=0.027）. The mental health composite scores improved 4.4 points from a baseline of 37.1±9.0 in the treatment group compared to 1.0 points from a baseline of 37.6±7.9 in the placebo group （F=4.514, P=-0.018）. After adjusting for baseline differences, significant improvement was observed in mental health composite scores, but not in physical health composite scores. LQng-acting testosterone undecanoate significanUy improved the mental health component of QoL in men with TDS.

Parkinson’s disease (PD) is the most common movement disorder with motor and nonmotor signs. The current therapeutic regimen for PD is mainly symptomatic as the etio-pathophysiology has not been fully elucidated. A variety of animal models has been generated to study different aspects of the disease for understanding the pathogenesis and therapeutic development. The disease model can be generated through neurotoxin-based or genetic-based approaches in a wide range of animals such as non-human primates (NHP), rodents, zebrafish, Caenorhabditis (C.) elegans, and drosophila. Cellular-based disease model is frequently used because of the ease of manipulation and suitability for large-screen assays. In neurotoxin-induced models, chemicals such as 6-hydroxydopamine (6-OHDA), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), rotenone, and paraquat are used to recapitulate the disease. Genetic manipulation of PD-related genes, such as α-Synuclein(SNCA), Leucine-rich repeat kinase 2 (LRRK2), Pten-Induced Kinase 1 (PINK1), Parkin(PRKN), and Protein deglycase (DJ-1) Are used in the transgenic models. An emerging model that combines both genetic- and neurotoxin-based methods has been generated to study the role of the immune system in the pathogenesis of PD. Here, we discuss the advantages and limitations of the different PD models and their utility for different research purposes.

Inaccurate risk perceptions of diabetes complications are responsible for the inertia among patients to engage in protective health behaviours. One potential approach to changing risk perceptions is to use social comparison of their diabetes to other people of similar clinicodemographic profiles. This study examined the perspectives of primary care physicians (PCPs) in ambulatory care on the utility of a patient similarity-based digital tool for risk communication to patients with type 2 diabetes mellitus (T2DM). A qualitative study design using direct observation and in-depth interviews was conducted on 11 PCP participants. Participants had at least 6 months of clinical experience in ambulatory primary care. Participants went through three hypothetical case scenarios using the digital tool under direct observation and shared their perspectives on its utility during an in-depth interview. Data were coded and analysed using thematic analysis. PCPs perceived the digital tool to be useful in educating patients with newly diagnosed or uncontrolled T2DM and to motivate them to achieve better glycated haemoglobin (HBA1c) levels. Patients who do not practise social comparison would refrain from HBA1c comparison and prefer to know the absolute state of their diabetes. PCPs were also concerned about patients' potential for false reassurance or negative reactions instead of correctly understanding the risk message intended for them. The patient similarity-based digital tool requires further work to support PCPs in risk communication to patients with T2DM. Usage should be targeted at patient subgroups with newly diagnosed or uncontrolled T2DM and who practise social comparison. Strategies to maximise benefit include identifying patients who practise social comparison and training PCPs to be adept at framing and communicating risk information in a person-centric manner to mitigate the possibility of false reassurance or negative reactions from their patients.

The inertia to adopt protective health behaviours by patients with diabetes is contributed by underestimation of their risks of diabetes complications. Risk communication, using social comparison of glycaemic control and disease trajectory to other patients of similar clinicodemographic profiles, has potential to increase patients' risk perceptions and motivate protective health behaviours. A digital tool named PERDICT.AI was designed to support primary care physicians (PCPs) in patient similarity-based risk communication to patients with type 2 diabetes mellitus (T2DM). This study explored the perspectives of patients with uncontrolled T2DM on how their diabetes-related risks were communicated to them by a PCP using PERDICT.AI. A qualitative design was used. Eighteen participants aged 40-79 with T2DM with ≥1 HBA1c reading ≥8.0% within the last 6 months were recruited from a primary care clinic in Singapore. Each participant went through the risk communication session followed by an in-depth interview. The transcripts were coded and analysed to identify emerging themes. Five themes emerged representing participants' risk perceptions post-session and social comparison tendencies. These are: 1) 'I am myself', 2) motivation to be like the majority, 3) avoiding similar negative outcomes, 4) low risk does not equate to zero risk, and 5) motivation to replicate how others achieve positive outcomes. Themes 1 and 4 were concurrently represented among some participants; zero risk tolerance for diabetes complications was expressed despite not being motivated by their HBA1c cohort ranking. This study provided insights into the acceptability of using a social comparison approach in communicating risk to patients with uncontrolled T2DM. It highlights the importance of identifying and selecting patients who are receptive to social comparison, clarifying patients' perceptions of risks, including zero risk, and providing tailored and socially comparable strategies to mitigate these risks.