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The widening inequality and discontent concern every economy irrespective of any measure of economic prosperity. The contest and debate centred around the notion of private property, assumes the premise that property is a legitimised unfettered accumulation with a right-based justification. On the contrary, the Gandhian conception of property, tries to reframe the premise that property is social and needs to be justified over its obligatory commitments. I argue that Gandhi’s engagement with property relations reflects the individual pursuit by socialising property. From problematising the individual property rights within the Anthropocene world, the article mapping a Gandhian theory of property identifies the normative structure of property. The individual as the custodian with normative obligatory commitments can foster pluralistic interest while anchoring the ethical foundations of property rights reflecting social justice.
Designers often rely on their self-evaluations – either independently or using design tools – to make concept selection decisions. When evaluating designs for sustainability, novice designers, given their lack of experience, could demonstrate psychological distance from sustainability-related issues, leading to faulty concept evaluations. We aim to investigate the accuracy of novice designers’ self-evaluations of the sustainability of their solutions and the moderating role of their (1) trait empathy and (2) their beliefs, attitudes and intentions toward sustainability on this accuracy. We conducted an experiment with first-year engineering students comprising a sustainable design activity. In the activity, participants evaluated the sustainability of their own designs, and these self-evaluations were compared against expert evaluations. We see that participants’ self-evaluations were consistent with the expert evaluations on the following sustainable design heuristics: (1) longevity and (2) finding wholesome alternatives. Second, trait empathy moderated the accuracy of self-evaluations, with lower levels of fantasy and perspective-taking relating to more accurate self-evaluations. Finally, beliefs, attitudes and intentions toward sustainability also moderated the accuracy of self-evaluations, and these effects vary based on the sustainable design heuristic. Taken together, these findings suggest that novice designers’ individual differences (e.g., trait empathy) could moderate the accuracy of the evaluation of their designs in the context of sustainability.
Aims: The King’s Fund have noted that the number of people waiting more than 12 hours after decision to admit to admission has increased significantly over the last ten years. With increasing demand for psychiatric inpatient beds, waiting times for mental health patient admissions are projected to similarly increase. This study aimed to investigate the length of stay for patients within a large inner city emergency department (ED) awaiting a mental health inpatient admission.
Methods: Time of decision to admit (DTA) and time of discharge were recorded and reviewed for all patients awaiting a psychiatric inpatient admission in August 2024.
Results: In total 101 patients were assessed for a psychiatric admission during this period. The average length of stay from arrival to discharge from the ED was 1 day and 7 hours, with the longest length of stay being 5 days and 5 hours. The average time from DTA to discharge from ED was 1 day and 16 minutes with 73.3% of all patients spending more than 12 hours waiting for their bed from DTA. It is noted, that out of the 101 patients initially assessed for admission, 14 were discharged to the community.
Conclusion: Emergency departments are less likely to be equipped with the resources, physical infrastructure and trained staff required for caring for patients with high acuity of mental illness for prolonged periods of time. This study provides information demonstrating the strain that services have in providing the right care in the right place. With the reduction in available inpatient psychiatric beds by 24% since 2010, ongoing consideration needs to be given on how appropriate care can be delivered to this cohort of vulnerable and unwell patients.
Human-centered design involves designing for users who may have social identities that are dissimilar from designers’ social identities. These differences could impact designers’ ability to understand users’ needs and integrate considerations of social identity into design decisions. Reflective interventions could encourage designers to actively consider social identity in design and our aim in this research is to explore this hypothesis through an experimental study. We tested the effects of completing a social identity-based reflection exercise on novice designers’ task clarification behavior. We also qualitatively examined the quality and content of the reflection responses. We find that participants who completed the intervention generated more social identity-focused design requirements, irrespective of the persona provided to them. Additionally, the content analysis revealed that designers who occupy minority identities (e.g., women and students of color) were more likely to provide deeper and higher-quality reflection responses. These findings suggest that reflective interventions could be an effective mechanism to promote inclusive design, leading to the design of products that users across social identities can use equitably. Furthermore, designers with different social identities may require different reflection cues (e.g., ones more focused on their personal experiences), to encourage deeper reflection on the effects of social identity in design.
Models for slow flow of dense granular materials often treat the medium as incompressible, thereby neglecting the role of Reynolds dilatancy. However, recent particle simulations have demonstrated the presence of a significant coupling between the volume fraction and velocity fields. The model of Dsouza & Nott (J. Fluid Mech., vol. 888, 2020, R3) incorporates dilatancy and captures the coupling, but it has thus far lacked experimental validation. In this paper, we provide the first experimental demonstration of dilatancy and its coupling to the kinematics in a two-dimensional cylindrical Couette cell. We find a shear layer near the inner cylinder within which there is significant dilation. Within the shear layer, the azimuthal velocity decays roughly exponentially and the volume fraction rises with radial distance from the inner cylinder. The predictions of the model of Dsouza & Nott (2020) are in good agreement with the experimental data for a variety of roughness features of the outer cylinder. Moreover, by comparing the steady states resulting from different initial volume fraction profiles (but having the same average), we show the inter-dependence of the velocity and volume fraction fields, as predicted by the model. Our results establish the importance of shear dilatancy even in systems of constant volume.
Nursing home (NH) residents have an elevated risk of coronavirus disease 2019 (COVID-19) infection and severe outcomes. However, literature regarding outbreak outcomes at the facility level is limited.
Methods:
NH outbreaks beginning between March 1, 2020, and February 22, 2022, at facilities under Los Angeles County jurisdiction were assigned to 1 of 6 time periods defined by dominant variants, surges in community transmission, and vaccination levels. Outbreaks were defined as 1 or more NH resident cases with lab-confirmed COVID-19 infection and no periods of 14 or more days between successive COVID-19 resident cases. Outbreak size and duration were the number of NH resident cases and the number of days between the index case(s) and 14 days after the last resident case(s). Rates of severe outcomes were measured per 100 licensed beds among all outbreaks per time period.
Results:
44,279 cases were analyzed from 1,587 outbreaks. Median outbreak duration peaked during the first winter surge (39 days; time period 3); median outbreak size per 100 licensed beds peaked in time period 6 (17), after widespread vaccination - during the second winter surge. Hospitalizations and deaths per 100 resident cases fell from 31 and 24 prior to widespread vaccination to 11 and 7, respectively, after.
Conclusions:
NH COVID-19 outbreaks may have been affected by vaccine uptake and community transmission levels. Because outbreak size and duration peaked during peak community transmission but severe outcome rates did not, the latter may be preferable to outbreak size and duration as outbreak metrics.
An aberrant right subclavian artery represents the most common aortic arch vascular anomaly. Conventional wisdom states that these anomalies do not result in dysphagia, but rather serve as “red herrings”. Clearly, in the vast majority of cases, this holds true. Nonetheless, one should never say never.
Methods:
Herein, we present a cohort of four children with debilitating dysphagia resulting from an aberrant right subclavian artery. Subclavian reimplantation via a right posterolateral thoracotomy was performed successfully in all cases.
Results:
Dysphagia resolved postoperatively, and all patients were able to advance to a normal diet. They were able to gain appropriate weight postoperatively and continue to do well at most recent clinical follow-up.
Conclusions:
This case series suggests that aberrant right subclavian artery anatomy should be considered a potential aetiology of dysphagia, albeit rarely. Surgical intervention for select patients can provide dramatic resolution of symptoms.
This study describes the illness burden in the first year of life for children with single-ventricle heart disease, using the metric of days alive and out of hospital to characterize morbidity and mortality.
Methods:
This is a retrospective single-centre study of single-ventricle patients born between 2005 and 2021 who had their initial operation performed at our institution. Patient demographics, anatomical details, and hospitalizations were extracted from our institutional single-ventricle database. Days alive and out of hospital were calculated by subtracting the number of days hospitalized from number of days alive during the first year of life. A multivariable linear regression with stepwise variable selection was used to determine independent risk factors associated with fewer days alive and out of hospital.
Results:
In total, 437 patients were included. Overall median number of days alive and out of hospital in the first year of life for single-ventricle patients was 278 days (interquartile range 157–319 days). In a multivariable analysis, low birth weight (<2.5kg) (b = −37.55, p = 0.01), presence of a dominant right ventricle (b = −31.05, p = 0.01), moderate-severe dominant atrioventricular valve regurgitation at birth (b = −37.65, p < 0.05), index hybrid Norwood operation (b = −138.73, p < 0.01), or index heart transplant (b = −158.41, p < 0.01) were all independently associated with fewer days alive and out of hospital.
Conclusions:
Children with single-ventricle heart defects have significant illness burden in the first year of life. Identifying risk factors associated with fewer days alive and out of hospital may aid in counselling families regarding expectations and patient prognosis.
A fundamental open problem in the mechanics of granular media is the determination of the stress in the static state. It is known that the static stress depends strongly on how the grain assembly is created and the nature of confining boundaries. Non-trivial spatial variations have been observed even in simple geometries, posing long-standing challenges to continuum modelling. In this paper, we create gravity-deposited grain packings computationally and devise a method to visualise the paths of load transmission, which we call force lines. We show that the force lines reflect the flow during deposition, thereby encoding preparation history. We then show that the force lines coincide with ensemble averaged biased random walks in the particle contact network; this identification yields a closure relation for the stress, which together with the static momentum balances fully determines the stress field. The model makes accurate predictions for the stress in piles and silos, even for unusual deposition methods, thereby showing promise for more general scenarios.
To develop and validate an English and Kannada version of the questionnaire to assess awareness and knowledge of advance care planning (ACP) among end-stage kidney disease (ESKD) patients, caregivers, and healthcare providers.
Methods
The questionnaire was developed from the published literature on ACP use in ESKD setting after a literature search. An expert panel consisting of nephrologists, palliative medicine physicians, ESKD patients, and their family caregivers participated in the content validity of the questionnaire using the Delphi process. The study was conducted between August 2021 and July 2022 at a tertiary care hospital in India. A validated questionnaire was administered to eligible 30 ESKD patients, 30 caregivers, and 10 health care professionals. A retest was carried out 1 week after the first administration.
Results
The content validity ratio of patient, caregiver, and health care professions questions ranged from 0.6 to 1 and Cronbach’s α value was 0.737 to 0.925. The intraclass correlation coefficient values for the test–retest of all three sections of this questionnaire varied from 0.879 to 0.972.
Significance of results
The developed questionnaire is a reliable and valid method for assessing the preference and knowledge of ACP in ESKD patients, family caregivers, and kidney care providers both in English and Kannada.
Functional cognitive disorders (FCDs) refer to conditions where patients present with persistent problematic subjective memory complaints that are not consistent with their observed level of cognitive functioning. The demonstrated symptoms are also not in keeping with a recognized psychiatric or neurodegenerative process. FCD is likely to be underdiagnosed in clinical practice with the place-holder label of mild cognitive impairment being used in some cases due to lack of clarity about its symptomatology. In this paper, we describe two cases whose presentations were suggestive of FCDs.
Methods
Mrs X, 53 years old female not previously known to mental health services referred for increasing difficulties with her memory over 2 years which she believed was impacting her activities of daily living. She has a history of ischaemic heart disease, fibromyalgia, Insulin-dependent diabetes mellitus, depression, and polycystic ovarian syndrome. On assessment MOCA = 15/30, and MMSE = 25/30.
Mr Y, 57 years old male not known to mental health services. Although, has been treated for anxiety and depression by GP. He presented with a 3-year history of struggling with his memory. He reported being forgetful of appointments and he has to paste sticky papers on the fridge for reminders. Similarly, he has a diagnosis of Fibromyalgia and essential hypertension. On Assessment MOCA – 19/30 and MMSE – 25/30.
Results
FCDs can be quite challenging because the clinical picture overlaps with other neurodegenerative conditions. Typically, patients report issues around memory function in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and observations at assessment. Regarding our cases, the primary presenting issues were increasing difficulties with memory, and forgetfulness. Other noteworthy observations were a mismatch between their scores in the MOCA, MMSE, their level of functioning, and reported memory problems. Neurological examinations and neuroimaging were not suggestive of any neurodegenerative disorders. A differential diagnosis of functional cognitive disorder was considered due to the discrepancies between symptoms reported, the level of their functioning, observations at assessments as well as absence of relevant neuropathology on imaging.
Conclusion
FCD is a condition that is common in clinical practice but underdiagnosed. Hence, it is imperative that clinicians keep this diagnosis in mind when patients present with memory difficulties that do not meet the diagnostic criteria for dementia and is not due to a recognized medical or psychiatric condition. Correctly identifying and diagnosing FCD can positively impact patient outcomes.
This clinical audit is aimed at assessing the knowledge, attitude and practices of team members towards compliance regarding information sharing and consenting service users and to create awareness about existing Trust policies and national guidelines, importance of gaining consent for Information Sharing. Consent to share information should be recorded on the appropriate clinical record keeping system and/or paper. Service users also have the right to request that information is not shared – and staff must record these decisions in the clinical record. Team members work with other agencies and at times need to share patient information. Hence, there should be discussion about who information is going to be shared with, and why. A recorded consent is useful in instances when patient data may need to be shared in court.
Methods
The 1st cycle of the audit was conducted from 15th of December 2022 to 4th of January 2023. Clients that met the inclusion criteria were checked to see if the form was filled in by the relevant practitioner/ ever filled in. This was done for both the Community Mental Health Team (CMHT) and Memory assessment Services (MAS). A survey with 7 questions was sent out to team members to assess their knowledge of the Trust policy as well as national guidelines on consent on information sharing.
Results
A total of 238 service user records were assessed. 119 each under CMHT and MAS. Combined results of 37% of the 238 services users had consent documented while 63% did not have consent documented. 27% of services users under MAS had consent obtained and documented. 56% of service users under CMHT had consent obtained. 100% of team members that responded to the survey knew to discuss personal and confidential information sharing with patients. 91% of staff knew that the discussion on consent and information sharing should be documented. 23.5% of staff were not aware of trainings on information sharing and 35.3% of staff were unaware of where to document the consent.
Conclusion
Although rare, unrecorded discussion/consent on Information sharing can cause serious implications. This audit highlights the need to create awareness about the importance of recording Information Sharing consent. Possible reasons for results include team members not being aware of where to document in client records, Trust has not properly educated staff on Information sharing and the way to record it in electronic health records and the Concept of implied consent.
Designers are experiencing greater mental demands given the complexity of design tools, necessitating the study of cognitive load in design. Researchers have identified task- and designer-related factors that affect cognitive load; however, these studies primarily use self-reported measures that could be inaccurate and incomplete. Little research has tested the accuracy and completeness of self-reported measures and we aim to explore this gap. Towards this aim, we seek to answer the question: How does cognitive load vary based on the different design representations used, and do these differences depend on the measure of cognitive load? From our results, we see that the design representations vary in the range of cognitive load experienced by designers when using them. Moreover, this role of the range of cognitive load variance was observed given our use of pupil diameter. These findings call for the use of a multi-modal approach for measuring cognitive load with the combined use of subjective (e.g., self-report) and objective measures (e.g., physiological measures), as well as the use of both retrospective (e.g., self-report) and concurrent measures (e.g., physiological measures).
This paper presents a fault detection and diagnosis (FDD) algorithm for various faults in the primary air data sensors (PADS) of an aircraft in the presence of external disturbances such as atmospheric turbulence. Rapid wind variations due to turbulence induce excessive error in the externally fitted air data probe measurements, which may lead to loss of control and misinterpretations by the flight crew. In adverse environmental conditions, the FDD of air data prefers robust and adaptive air data estimates that use an analytical redundancy approach with fewer computations. The proposed method considers the kinematics of the aircraft instead of the dynamics used in the state-of-the-art algorithms. The advantage of using kinematics is that it can reduce modeling errors significantly, avoiding high false alarm rates in the FDD process. For the estimation of stable and accurate air data under external disturbance, the inertial navigation system and global positioning system (INS/GPS) output are considered instead of actual air data probe or sensor measurements. The proposed algorithm uses estimates of air data using an exponentially weighted adaptive extended Kalman filter (EW-AEKF) to detect and diagnose PADS faults, which can perform well even in the presence of uncertain noise due to atmospheric turbulence experienced during flight. The simulation was carried out to validate the algorithm with flight data obtained from the X-Plane flight simulator under moderate atmospheric turbulence. The simulation experiments were carried out using the MATLAB programming platform. The results show that the proposed method achieves satisfactory FDD performance with lower root mean square error (RMSE) and computation time than traditional EKF-based algorithms.
Healthcare workers’ (HCWs) safety and availability to care for patients are critical during a pandemic such as the one caused by severe acute respiratory syndrome coronavirus 2. Among providers of different specialities, it is critical to protect those working in hospital settings with a high risk of infection. Using an agent-based simulation model, various staffing policies were developed and simulated for 90 days using data from the largest health systems in South Carolina. The model considers staffing policies that include geographic segregation, interpersonal contact limits, and a combination of factors, including the patient census, transmission rates, vaccination status of providers, hospital capacity, incubation time, quarantine period, and interactions between patients and providers. Comparing the existing practices to various risk-adjusted staffing policies, model predictions show that restricted teaming and rotating schedules significantly (p-value <0.01) reduced weekly HCW unavailability and the number of infected HCWs by 22% and 38%, respectively, when the vaccination rates among HCWs were lower (<75%). However, as the vaccination rate increases, the benefits of risk-adjusted policies diminish; and when 90% of HCWs were vaccinated, there were no significant (p-value = 0.09) benefits. Although these simulated outcomes are specific to one health system, our findings can be generalised to other health systems with multiple locations.
“Harlequin effect” may be observed in the watershed region of a patient with pulmonary dysfunction, receiving peripheral veno-arterial extracorporeal membrane oxygenation via the femoral vessels. In such cases, retrograde oxygenated blood from the peripheral inflow cannula converges with the antegrade deoxygenated blood ejected from the left ventricle. This occurs when the left ventricle is ejecting significantly but the recovery of pulmonary function lags behind. Herein, we describe the occurrence of “Harlequin effect” in the setting of central veno-arterial extracorporeal membrane oxygenation that ensues due to the persistence of right ventricular dysfunction in the presence of an interatrial communication. This results in right to left shunting at the atrial level while weaning the patient from extracorporeal life support.
Risk and reward are negatively correlated in a wide variety of environments, and in many cases this trade off approximates a fair bet. Pleskac and Hertwig (2014) recently proposed that people have internalized this relationship and use it as the basis for probability estimation and subsequent choice under conditions of uncertainty. Specifically, they showed that risky options with high-value outcomes are inferred to have lower probability than options offering a less valuable reward. We report two experiments that test a simple corollary of this idea. In both studies, participants estimated the magnitude of prizes offered by lotteries with known win-probabilities. The relationship between estimates and probabilities followed the power relationship predicted by the risk-reward heuristic, albeit with a tendency to overestimate outcome magnitude. In addition, people’s estimates predicted their willingness to take the gamble. Our results provide further evidence that people have internalized the ecological relationship between risk and reward in financial lotteries, and we suggest that this relationship exerts a wide-ranging influence on decision-making.