Inducing metamorphosis in the irukandji jellyfish Carukia barnesi

Here we utilize chemical ecology as a tool to manipulate the biological system of a small, but highly venomous to humans, cubozoan jellyfish, Carukia barnesi. We trialled a range of chemical reagents including indole compounds, 9-cis-retinoic acid and lugols solution to induce metamorphosis between the polyp and medusa life stages. An optimum method was determined resulting in a 90% metamorphosis rate to healthy medusa by exposing the polyps to 1 μM of 5-methoxy-2-methylindole for 24 h. Of note is that chemical exposure time significantly impacts health and metamorphosis rates in this species. We also present a theoretical mechanism for the chemical/biological interactions occurring during metamorphosis. This is a significant methodological advancement which now enables rearing of this animal en mass in aquaria-a world first for this species-which will subsequently supply and facilitate venom research into this understudied jellyfish.

Potential of electric fields to reduce bycatch of highly threatened sawfishes

Sawfishes are among the most threatened families of marine fishes and are susceptible to incidental capture in net fisheries. Since bycatch reduction devices currently used in trawl fisheries are not effective at reducing sawfish catches, new methods to minimise sawfish bycatch are needed. Ideally, these should affect sawfish behaviour and prevent contact with the fishing gear. We tested the effects of electric fields on sawfish behaviour to assess the potential of electric pulses in mitigating sawfish bycatch. Experiments were conducted in a tank where 2 electrodes were suspended in the water column, connected to a pulse generator, and placed across the swimming path of sawfish. Two largetooth sawfish Pristis pristis were tested in control conditions, in the presence of a baseline pulse, and of 5 variations of that pulse where 1 parameter (polarity, voltage, frequency, pulse shape, pulse duration) was altered at a time. Conditional inference trees were used to identify the effects of various parameters (e.g. treatment, individual) on reaction type, reaction distance, twitching presence and duration, and inter-approach times. Sawfish reacted to electric fields, but reaction distances were small (typically <1.2 m), and no field tested consistently led to reactions conducive to escaping from moving nets. The following parameters induced the most response in both individuals: bipolar current, rectangular shaped, 5-10 Hz, ~1500 µs duration, and 100 V. We recommend further research focussing on moving nets, testing a V-shaped electric array preceding the net mouth by at least 5 m, and testing a setup similar to electrotrawling.

Trained facilitators' experiences with structured advance care planning conversations in oncology: an international focus group study within the ACTION trial

BACKGROUND

In oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation.

METHODS

A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes.

RESULTS

Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script.

CONCLUSIONS

Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients' preferences while staying attuned to patients' needs.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number registry 63110516 ( ISRCTN63110516 ) per 10/3/2014.

Severe Cardiac Failure Associated with Presumed Jellyfish Sting. Irukandji Syndrome?

We present a retrospective review of twelve cases of Irukandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland.

Patients presented with significant and ongoing pain, tachycardia and hypertension. Half the patients became hypotensive requiring inotropic support. Cardiac echocardiography revealed significant cardiac dysfunction. Six patients required ventilatory support. There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage.

We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.

Advance care planning: A systematic review about experiences of patients with a life-threatening or life-limiting illness

BACKGROUND

Advance care planning is seen as an important strategy to improve end-of-life communication and the quality of life of patients and their relatives. However, the frequency of advance care planning conversations in practice remains low. In-depth understanding of patients' experiences with advance care planning might provide clues to optimise its value to patients and improve implementation.

AIM

To synthesise and describe the research findings on the experiences with advance care planning of patients with a life-threatening or life-limiting illness.

DESIGN

A systematic literature review, using an iterative search strategy. A thematic synthesis was conducted and was supported by NVivo 11.

DATA SOURCES

The search was performed in MEDLINE, Embase, PsycINFO and CINAHL on 7 November 2016.

RESULTS

Of the 3555 articles found, 20 were included. We identified three themes in patients' experiences with advance care planning. 'Ambivalence' refers to patients simultaneously experiencing benefits from advance care planning as well as unpleasant feelings. 'Readiness' for advance care planning is a necessary prerequisite for taking up its benefits but can also be promoted by the process of advance care planning itself. 'Openness' refers to patients' need to feel comfortable in being open about their preferences for future care towards relevant others.

CONCLUSION

Although participation in advance care planning can be accompanied by unpleasant feelings, many patients reported benefits of advance care planning as well. This suggests a need for advance care planning to be personalised in a form which is both feasible and relevant at moments suitable for the individual patient.

Efficient assembly of multi-color fiberless optoelectrodes with on-board light sources for neural stimulation and recording

Fiberless optoelectrodes are an emerging tool to enable brain circuit mapping by providing precise optical modulation and electrical monitoring of many neurons. While optoelectrodes having an on-board light source offer compact and optically efficient device solutions, many of them fail to provide robust thermal and electrical design to fully exploit the recording capabilities of the device. In this work, we present a novel fiberless multicolor optoelectrode solution, which meets the optical and thermal design requirements of an in vivo neural optoelectrode and offers potential for low-noise neural recording. The total optical loss measured for 405 nm and 635 nm wavelengths through the waveguide is 11.7±1.1 dB and 9.9±0.7 dB, corresponding to respective irradiances of 1928 mW/mm2 and 2905 mW/mm2 at the waveguide tip from 6 mW laser diode chips. The efficient thermal packaging enables continuous device operation for up to 190 seconds at 10% duty cycle. We validated the fully packaged device in the intact brain of anesthetized mice co-expressing Channelrhodopsin-2 and Archaerhodopsin in the hippocampal CA1 region and achieved activation and silencing of the same neurons. We discuss improvements made to reduce the stimulation artifact induced by applying currents to the laser diode chips.

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Background

Improving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.

Aims

(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.

Design

A mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.

Results

Of the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.

Conclusions

Patients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.