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The COVID-19 pandemic has catalyzed a move from face-to-face to online delivery of services by hospitals and primary care providers, but little is known about the impact of digital transformation in organizations supporting unpaid caregivers. The value of care provided by informal caregivers since the start of the COVID-19 pandemic has been estimated at EUR111 billion in England.
Methods
The study assessed the impact of digital transformation in an English caregivers’ support organization covering a population of 0.98 million. A retrospective mixed method study was conducted of digital and non-digital support service utilization among caregivers in city and rural geographical areas from January 2019 to June 2021. Organizational performance and service quality indicators were compared for two financial years: 2019-2020 and 2020-2021. A survey of users was conducted to evaluate barriers to and facilitators of digital service uptake, computer proficiency among caregivers, and preferences for future digital service provision.
Results
The number of caregivers registered with the organization rose by 36 percent to 20,237 in 2021. Monthly contacts rose by 225 percent to 6,500, with remote contacts rising from 65 to 85 percent. Observed behavior patterns differed between city and rural caregivers. Overall, one-to-one contacts increased by 89 percent and caregiver assessments by 21 percent, with no expansion in staffing. User-reported service quality improved in five out of eight indicators (p<0.05). The demographic characteristics of survey respondents (152 caregivers) were similar to all registered caregivers. The mean short form Computer Proficiency Questionnaire score of 25.61 indicated a relatively high computer proficiency. Qualitative analysis confirmed a preference for face-to-face and online options. The most highly rated online services were peer support groups and wellbeing assessment and support needs checks.
Conclusions
Considering the economic importance of unpaid caregivers, more attention should be paid to the organizations supporting them and the potential for technology to enhance caregivers’ access to and benefit from such services. This initial assessment of digital transformation in one such organization demonstrates the potential for cost-effective service transition. Further research is required to inform sustainable future solutions.
Comparative transcriptomics can be used to translate an understanding of gene regulatory networks from model systems to less studied species. Here, we use RNA-Seq to determine and compare gene expression dynamics through the floral transition in the model species Arabidopsis thaliana and the closely related crop Brassica rapa. We find that different curve registration functions are required for different genes, indicating that there is no single common ‘developmental time’ between Arabidopsis and B. rapa. A detailed comparison between Arabidopsis and B. rapa and between two B. rapa accessions reveals different modes of regulation of the key floral integrator SOC1, and that the floral transition in the B. rapa accessions is triggered by different pathways. Our study adds to the mechanistic understanding of the regulatory network of flowering time in rapid cycling B. rapa and highlights the importance of registration methods for the comparison of developmental gene expression data.
It is increasingly common for models of shallow-layer overland flows to include equations for the evolution of the underlying bed (morphodynamics) and the motion of an associated sedimentary phase. We investigate the linear stability properties of these systems in considerable generality. Naive formulations of the morphodynamics, featuring exchange of sediment between a well-mixed suspended load and the bed, lead to mathematically ill-posed governing equations. This is traced to a singularity in the linearised system at Froude number ${\textit {Fr}} = 1$ that causes unbounded unstable growth of short-wavelength disturbances. The inclusion of neglected physical processes can restore well posedness. Turbulent momentum diffusion (eddy viscosity) and a suitably parametrised bed load sediment transport are shown separately to be sufficient in this regard. However, we demonstrate that such models typically inherit an associated instability that is absent from non-morphodynamic settings. Implications of our analyses are considered for simple generic closures, including a drag law that switches between fluid and granular behaviour, depending on the sediment concentration. Steady morphodynamic flows bifurcate into two states: dilute flows, which are stable at low ${\textit {Fr}}$, and concentrated flows which are always unstable to disturbances in concentration. By computing the growth rates of linear modes across a wide region of parameter space, we examine in detail the effects of specific model parameters including the choices of sediment erodibility, eddy viscosity and bed load flux. These analyses may be used to inform the ongoing development of operational models in engineering and geosciences.
Several techniques have been developed for the quantitative microchemical analysis of thin foils. These procedures require that in an alloy AB the measured intensity ratio, IA/IB frora the foil be independent of foil thickness. Cliff and Lorimer find that this condition is met in all cases they have examined whereas Jacobs and Baborovska show data where absorption of longer wavelength X-rays was apparent.
The present study was undertaken to evaluate these procedures for the combination of a scanning transmission electron microscope (JEOL JSEM 200) and an energy dispersive analyzer (Ortec).
Leighton’s graph covering theorem states that a pair of finite graphs with isomorphic universal covers have a common finite cover. We provide a new proof of Leighton’s theorem that allows generalisations; we prove the corresponding result for graphs with fins. As a corollary we obtain pattern rigidity for free groups with line patterns, building on the work of Cashen–Macura and Hagen–Touikan. To illustrate the potential for future applications, we give a quasi-isometric rigidity result for a family of cyclic doubles of free groups.
A tubular group G is a finite graph of groups with ℤ2 vertex groups and ℤ edge groups. We characterize residually finite tubular groups: G is residually finite if and only if its edge groups are separable. Methods are provided to determine if G is residually finite. When G has a single vertex group an algorithm is given to determine residual finiteness.
The unsteady ascent of a buoyant, turbulent line plume through a quiescent, uniform environment is modelled in terms of the width-averaged vertical velocity and density deficit. It is demonstrated that for a well-posed, linearly stable model, account must be made for the horizontal variation of the velocity and the density deficit; in particular the variance of the velocity field and the covariance of the density deficit and velocity fields, represented through shape factors, must exceed threshold values, and that models based upon ‘top-hat’ distributions in which the dependent fields are piecewise constant are ill-posed. Numerical solutions of the nonlinear governing equations are computed to reveal that the transient response of the system to an instantaneous change in buoyancy flux at the source may be captured through new similarity solutions, the form of which depend upon both the ratio of the old to new buoyancy fluxes and the shape factors.
Introduction: Intra-articular steroid injection (IASI) is commonly used in the emergency department for management of osteoarthritis (OA) symptoms. Hip IASI carries risks, such as avascular necrosis, and there is currently no reliable way to predict long-term response of a patient’s OA to IASI. Ultrasound (US) conveniently assesses for active arthropathy by detecting effusion-synovitis, and x-ray (XR) is useful for visualizing bone-related changes. We investigated the extent that a response to hip IASI could be predicted from baseline OA patient clinical and physical features alongside US and XR imaging features. Methods: 97 consenting patients with symptomatic hip OA presenting for hip IASI were evaluated at baseline (XR and US) and again 8-weeks after IASI (US only). Self-reported pain (WOMAC), hip range of motion (ROM) were measured at baseline and follow up. On US images we quantified joint effusion and synovial thickening, i.e., “effusion-synovitis”, by the bone-capsule distance (BCD) at the apex of the femoral head from outer femoral cortex to outer synovium. On XR, we measured minimum joint space width (cm) and Kellgren-Lawrence (K-L) Grade for osteophytes and sclerotic changes. Results: In our 97 patients (43 female) aged 28-87 years (mean 59+/-13 years, K-L grades averaged 2.5+/-1.5, and US BCD averaged 5.9+/-2.0 mm. We performed multiple linear regression using age, sex, BMI, ROM of hip flexion, US BCD, radiographic joint space width and K-L grade against the dependent variable, change in WOMAC pain subscore (R=0.587, P=0.002). We compared the response predicted by this model to the actual change in WOMAC pain. At a threshold value of -20% for minimal clinically important difference, 35/97 patients were responders, and a 2x2 table gave 67% overall model predictive accuracy, 61% sensitivity, and 71% specificity. Likelihood ratio for a positive response (LR+) was 2.13. Conclusion: Combining radiographic information on structural damage, US information on active arthropathy, and demographics correctly predicted about two-thirds of the patients that would benefit from IASI after 8 weeks. A patient with hip OA that met our model criteria was more than twice as likely to respond to IASI. With further model refinement, effective, personalized evidence-based management of symptomatic hip OA is possible using XR and hip US, which could both be performed during an ER visit.
Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of “what works for whom” in attachment intervention.
We show that certain graphs of groups with cyclic edge groups are aTmenable. In particular, this holds when each vertex group is either virtually special or acts properly and semisimply on ℍn.
Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear.
Method
We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments.
Results
Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72–0.82] and positive predictive value of 0.76 (95% CI 0.70–0.80), the specificity of 0.29 (95% CI 0.20–0.38) and negative predictive value of 0.36 (95% CI 0.22–0.40) were low. Thus, 64% of those who scored below the AQ cut-off were ‘false negatives’ who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may ‘mimic’ ASD and inflate AQ scores, leading to false positives.
Conclusions
The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.
We model the unsteady evolution of turbulent buoyant plumes following temporal changes to the source conditions. The integral model is derived from radial integration of the governing equations expressing the evolution of mass, axial momentum and buoyancy in the plume. The non-uniform radial profiles of the axial velocity and density deficit in the plume are explicitly captured by shape factors in the integral equations; the commonly assumed top-hat profiles lead to shape factors equal to unity. The resultant model for unsteady plumes is hyperbolic when the momentum shape factor, determined from the radial profile of the mean axial velocity in the plume, differs from unity. The solutions of the model when source conditions are maintained at constant values are shown to retain the form of the well-established steady plume solutions. We demonstrate through a linear stability analysis of these steady solutions that the inclusion of a momentum shape factor in the governing equations that differs from unity leads to a well-posed integral model. Therefore, our model does not exhibit the mathematical pathologies that appear in previously proposed unsteady integral models of turbulent plumes. A stability threshold for the value of the shape factor is also identified, resulting in a range of its values where the amplitudes of small perturbations to the steady solutions decay with distance from the source. The hyperbolic character of the system of equations allows the formation of discontinuities in the fields describing the plume properties during the unsteady evolution, and we compute numerical solutions to illustrate the transient development of a plume following an abrupt change in the source conditions. The adjustment of the plume to the new source conditions occurs through the propagation of a pulse of fluid through the plume. The dynamics of this pulse is described by a similarity solution and, through the construction of this new similarity solution, we identify three regimes in which the evolution of the transient pulse following adjustment of the source qualitatively differs.
Volcanic eruptions commonly produce buoyant ash-laden plumes that rise through the stratified atmosphere. On reaching their level of neutral buoyancy, these plumes cease rising and transition to horizontally spreading intrusions. Such intrusions occur widely in density-stratified fluid environments, and in this paper we develop a shallow-layer model that governs their motion. We couple this dynamical model to a model for particle transport and sedimentation, to predict both the time-dependent distribution of ash within volcanic intrusions and the flux of ash that falls towards the ground. In an otherwise quiescent atmosphere, the intrusions spread axisymmetrically. We find that the buoyancy-inertial scalings previously identified for continuously supplied axisymmetric intrusions are not realised by solutions of the governing equations. By calculating asymptotic solutions to our model we show that the flow is not self-similar, but is instead time-dependent only in a narrow region at the front of the intrusion. This non-self-similar behaviour results in the radius of the intrusion growing with time $t$ as $t^{3/4}$, rather than $t^{2/3}$ as suggested previously.We also identify a transition to drag-dominated flow, which is described by a similarity solution with radial growth now proportional to $t^{5/9}$. In the presence of an ambient wind, intrusions are not axisymmetric. Instead, they are predominantly advected downstream, while at the same time spreading laterally and thinning vertically due to persistent buoyancy forces. We show that close to the source, this lateral spreading is in a buoyancy-inertial regime, whereas far downwind, the horizontal buoyancy forces that drive the spreading are balanced by drag. Our results emphasise the important role of buoyancy-driven spreading, even at large distances from the source, in the formation of the flowing thin horizontally extensive layers of ash that form in the atmosphere as a result of volcanic eruptions.
Obese individuals are at an increased risk of developing CVD, hypertension, type 2 diabetes, and bacterial and viral infections when compared with the normal-weight population. In a 9-week randomised, double-blind, cross-over study, twenty-four obese subjects aged between 20 and 60 years and with a BMI between 30 and 45 kg/m2 were fed grape or placebo powder for 3-week intervals to determine the effects of dietary grapes on blood lipid profiles, plasma inflammatory marker concentrations and immune cell function. Blood samples were collected on days 1 and 8 for obtaining baseline information and at weeks 3, 4, 8 and 9. Comprehensive chemistry panels, lipid profile analyses by NMR, measurement of plasma inflammatory marker concentrations, and analyses of cytokine production by activated T lymphocytes and monocytes were performed for each blood draw. Dietary grape powder reduced the plasma concentrations of large LDL-cholesterol and large LDL particles compared with the placebo powder (P< 0·05). The concentrations of interferon-γ, TNF-α, IL-4 and IL-10 were measured in supernatants from peripheral blood mononuclear cells (PBMC) activated with anti-CD3/CD28 antibodies and those of TNF-α, IL-1β, IL-6 and IL-8 were measured in supernatants from PBMC activated with lipopolysaccharide (LPS). No difference in the production of T-cell cytokines was observed between the two intervention groups. The production of IL-1β and IL-6 was increased in supernatants from LPS-activated PBMC in the grape powder group compared with the placebo powder group (P< 0·05). These data suggest that dietary grapes may decrease atherogenic lipid fractions in obese individuals and increase the sensitivity of monocytes in a population at a greater risk of developing infections.
Biofortification of cassava with the provitamin A carotenoid β-carotene is a potential mechanism for alleviating vitamin A deficiency. Cassava is a staple food in the African diet, but data regarding the human bioavailability of β-carotene from this food are scarce. The objective of the present study was to evaluate provitamin A-enhanced cassava as a source of β-carotene and vitamin A for healthy adult women. The study was a randomised, cross-over trial of ten American women. The subjects consumed three different porridges separated by 2 week washout periods. Treatment meals (containing 100 g cassava) included: biofortified cassava (2 mg β-carotene) porridge with added oil (15 ml peanut or rapeseed oil, 20 g total fat); biofortified cassava porridge without added oil (6 g total fat); unfortified white cassava porridge with a 0·3 mg retinyl palmitate reference dose and added oil (20 g total fat). Blood was collected six times from − 0·5 to 9·5 h post-feeding. TAG-rich lipoprotein (TRL) plasma was separated by ultracentrifugation and analysed using HPLC with coulometric array electrochemical detection. The AUC for retinyl palmitate increased after the biofortified cassava meals were fed (P< 0·05). Vitamin A conversion was 4·2 (sd 3·1) and 4·5 (sd 3·1) μg β-carotene:1 μg retinol, with and without added oil, respectively. These results show that biofortified cassava increases β-carotene and retinyl palmitate TRL plasma concentrations in healthy well-nourished adult women, suggesting that it is a viable intervention food for preventing vitamin A deficiency.
Particle-size segregation can have a significant feedback on the bulk motion of granular avalanches when the larger grains experience greater resistance to motion than the fine grains. When such segregation-mobility feedback effects occur the flow may form digitate lobate fingers or spontaneously self-channelize to form lateral levees that enhance run-out distance. This is particularly important in geophysical mass flows, such as pyroclastic currents, snow avalanches and debris flows, where run-out distance is of crucial importance in hazards assessment. A model for finger formation in a bidisperse granular avalanche is developed by coupling a depth-averaged description of the preferential transport of large particles towards the front with an established avalanche model. The coupling is achieved through a concentration-dependent friction coefficient, which results in a system of non-strictly hyperbolic equations. We compute numerical solutions to the flow of a bidisperse mixture of small mobile particles and larger more resistive grains down an inclined chute. The numerical results demonstrate that our model is able to describe the formation of a front rich in large particles, the instability of this front and the subsequent evolution of elongated fingers bounded by large-rich lateral levees, as observed in small-scale laboratory experiments. However, our numerical results are grid dependent, with the number of fingers increasing as the numerical resolution is increased. We investigate this pathology by examining the linear stability of a steady uniform flow, which shows that arbitrarily small wavelength perturbations grow exponentially quickly. Furthermore, we find that on a curve in parameter space the growth rate is unbounded above as the wavelength of perturbations is decreased and so the system of equations on this curve is ill-posed. This indicates that the model captures the physical mechanisms that drive the instability, but additional dissipation mechanisms, such as those considered in the realm of flow rheology, are required to set the length scale of the fingers that develop.
During the lifetime of a nuclear facility, radioactive material may become deposited onto process and structural material surfaces. Due to their high corrosion resistance, steels comprise the largest class of metal-based materials encountered on nuclear sites. A greater understanding of the mechanisms of how contaminant radionuclides interact with and attach to process steels in nuclear plant environments is required in order to enable informed decisions to be made about the design and effective application of decontamination techniques, reducing secondary wastes.
There is limited literature relating to radionuclide sorption mechanisms on steels. Key studies have found that sorbed contamination is almost entirely located in the outermost oxide layers formed at steel surfaces. Thus, a molecular level investigation of contaminant uptake during induced oxide formation would be beneficial in developing steel decontamination strategies.
Stainless steel 316L is commonly employed in the nuclear industry in process streams and pipework. Thus, we describe work carried out on electrochemically accelerated oxide growth on 316L and SS2343 (a 316L analog) in nitric acid media and its characterisation using combined voltammetric and microgravimetric measurements. These allow identification of active, passive, high voltage passive, transpassive and secondary passivation regimes in the associated current voltage curves. EQCM on SS2343 coated quartz crystal piezoelectrodes, combined with potentiodynamic polarisation data have allowed us to determine that fastest net growth of surface oxide occurs in the low voltage passive regime. Further, we have directly measured the growth of that layer by using in situ microgravimetry for the first time. We will be shortly using the methods described above and radionuclide surrogates for the study of contaminant uptake during oxide formation and uptake onto preformed oxide layers. XPS will be used to determine layer composition and mode of contaminant uptake.
Obesity is a strong risk factor for the development of CVD, hypertension and type 2 diabetes. The overall goal of the present pilot study was to feed strawberries, in the form of freeze-dried powder, to obese subjects to determine whether dietary strawberries beneficially altered lipid profiles and reduced blood markers of inflammation compared with a control intervention. A total of twenty healthy subjects (thirteen females and seven males) aged between 20 and 50 years with a BMI between 30 and 40 kg/m2 completed the present 7-week double-blind, randomised, cross-over trial. Each subject received a prepared diet 7 d/week for 7 weeks consisting of approximately 35 % of energy from fat, 20 % protein, 45 % carbohydrate and 14 g fibre. Blood was collected on days 1 and 8 for baseline information. After the first week, subjects were randomly assigned to the strawberry powder (equivalent to four servings of frozen strawberries) or control (strawberry-flavoured) intervention for 3 weeks. For the remaining 3 weeks, subjects crossed over to the opposite intervention. Blood was collected again at the end of weeks 3, 4, 6 and 7. A comprehensive chemistry panel, lipid profile analyses and measurement of inflammatory mediators were performed for each blood draw. A 3-week dietary intervention with strawberry powder reduced plasma concentrations of cholesterol and small HDL-cholesterol particles, and increased LDL particle size in obese subjects (P < 0·05). Dietary strawberry powder reduced risk factors for CVD, stroke and diabetes in obese volunteers, suggesting a potential role for strawberries as a dietary means to decrease obesity-related disease.