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Objectives/Goals: Evaluate the effectiveness of ChatGPT as a complementary tool for addressing the mental health needs of Hispanic LGBTTQI+ young adult patients. We will also explore the experience of clinical healthcare providers with the integration of ChatGPT as a complementary tool in psychotherapy with Hispanic LGBTTQI+ young adults. Methods/Study Population: In this mixed-method study, we will create hypothetical clinical cases that reflect common mental health challenges experienced by LGBTTQI+ Hispanic population. These cases will be presented to three groups: 1) ChatGPT app, 2) clinical mental health care providers, and 3) clinical mental health care providers collaborating with ChatGPT. Each group will provide a diagnosis and a treatment plan based on the case information. A panel of experts will evaluate each plan using a standardized rubric to provide a score on clinical accuracy and on the ability to address specific needs of Hispanic LGBTTQI+ patients. Statistical analysis will be used to evaluate the differences in the scores of each domain and qualitative content analysis to evaluate the experience of clinical mental health care providers using ChatGPT. Results/Anticipated Results: The results will provide evidence of the effectiveness of ChatGPT as a supportive tool in mental health care. We anticipated that the combination of a clinical mental health care provider and ChatGPT to develop a diagnosis and treatment plan would produce better outcomes than either ChatGPT or the clinical mental health care provider working independently. We will also expect to find a positive attitude toward the integration of ChatGPT applications, viewing them as useful tools that complement traditional psychological interventions for Hispanic LGBTTQI+ young adults. The study will provide evidence of the effectiveness of ChatGPT to complementing clinical practice involving Hispanic LGBTTQI+ young adults. Those results in a preclinical phase are preconditions to a more applied intervention. Discussion/Significance of Impact: We aim to improve the quality of life for LGBTTQI+ Hispanics by developing innovative psychological treatments enhanced by AI apps. By developing innovative treatments, we are addressing and mitigating health disparities within the LGBTTQI+ Hispanic community in Puerto Rico and contributing to a broader effort of inclusivity and health equity.
People with advanced cancer express the need for support to balance everyday activities to experience quality of life. The Balance, Activity and Quality of Life Intervention was developed to address this need using a resource- and activity-oriented approach that integrates rehabilitation into palliative care. To inform a future full-scale evaluation, the objective of this feasibility study was to test if the selected outcome measures of health-related quality of life, including physical function and fatigue, and occupational balance could capture any possible changes of the Balance, Activity and Quality of Life Intervention in people with advanced cancer.
Methods
Repeated-measurement feasibility study without a control group (ClinicalTrials.gov NCT04772690). Twenty-two home-living adults with advanced cancer participated in the study. The intervention was delivered at the research clinic of REPHA, The Danish Knowledge Centre for Rehabilitation and Palliative Care. Data regarding health-related quality of life, including physical function and fatigue, and occupational balance were collected with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and the Occupational Balance Questionnaire at baseline, after a 5-day intervention stay and at 6- and 12-week follow-up.
Results
The outcome measure of health-related quality of life captured a statistically significant improvement (p = 0.0046) after the 5-day intervention stay, with 64% of the participants experiencing clinically relevant improvements. No other statistically significant changes were found. Missing data were minor.
Significance of results
Health-related quality of life is a promising outcome measure to capture the possible changes of the Balance, Activity and Quality of Life Intervention. The results indicate that a resource- and activity-oriented approach may be helpful when integrating rehabilitation into palliative care.
People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health.
Aims
To evaluate the feasibility of an intervention where volunteer ‘Health Champions’ support people with SMI in managing their physical health.
Method
A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done.
Results
We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant.
Conclusions
The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.
Peru has the second-highest diversity of birds in the world, but little is known about the interactions between birds and plastic waste. To fill this knowledge gap, we searched the scientific literature, collected information from social networks such as Facebook and databases such as Macaulay Library and iNaturalist and solicited records through messaging with researchers and bird enthusiasts. We found 119 bird interactions with plastic debris involving 39 species from 20 families, with the red-legged cormorant Phalacrocorax gaimardi and the neotropical cormorant Phalacrocorax brasilianus being the most affected species. By type of interaction category, plastic waste in nests was the most abundant, followed by entanglement, capture and handling and ingestion. Ropes, nets and soft plastics such as bags were the most frequently reported types of waste. As our methodology has limitations, it is probable that other species that also interact with plastic waste have not been reported, so we recommend further study.
The hawksbill sea turtle Eretmochelys imbricata is categorized as Critically Endangered on the IUCN Red List and its population has declined by over 80% in the last century. The Eastern Pacific population is one of the most threatened hawksbill populations globally. Western Mexico is the northern distribution limit for hawksbill sea turtles in the Eastern Pacific and recent research indicates that the Mexican Pacific portion of the population is a separate management unit because of the restricted movements of these turtles. Here we use the most complete database of sighting records in the north-west Pacific of Mexico to identify sites where hawksbill turtles are present. We also develop a conservation index to determine the conservation status of hawksbill turtle sites. Our results demonstrate the importance of this region for juveniles and the relevance of rocky reefs and mangrove estuaries as habitats for hawksbill turtles. We identified 52 sites with records of hawksbill turtles. Most of these sites (71%) are not protected; however, sites with high conservation value included islands and coastal sites along the Baja California peninsula that are established as marine protected areas. Reefs and mangrove estuaries relevant for hawksbill turtles are probably also significant fish nursery areas that are important for local fishing communities, creating opportunities for conservation strategies that combine science, local engagement and policy to benefit both local fishing communities and hawksbill sea turtle conservation.
To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.
Design:
Prospective cohort study with historical controls.
Participants:
Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.
Methods:
The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.
Results:
We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001).
Conclusions:
Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.
Molybdenum sulfide hydrotreating catalysts promoted with nickel over tridimensional mesoporous silica (KIT-6 post synthesis modified with alumina) were prepared with three different chelating agents. Citric acid and EDTA (ethylenediaminetetraacetic acid) were used as typical chelates and the new suggestion, polyacrylic acid as a polymeric agent. The catalysts were synthesized by the incipient wetness impregnation method, and two different activation methods were applied to determine the correlation between the chelating agent and activation conditions. The beneficial use of chelating agents was evaluated in their performance on HDS (hydrodesulfurization) of DBT (dibenzothiophene). To determine the properties of catalysts, nitrogen physisorption, X-ray diffraction, HRTEM (high-resolution transmission electron microscopy), and TGA (thermogravimetric analysis) were used. The beneficial effect of chelating Ni during impregnation to avoid NiSx formation and thus promoting NiMoS arrangement was clearly observed in the catalytic HDS performance, and the TGA analysis of Ni-chelate complexes also confirms this theory. The catalyst with the best performance in the HDS reaction of DBT was the synthesized with citric acid and a slow rate temperature sulfidation.
As a measure to manage the climate impact of aviation, significant enhancements to aviation technologies and operations are necessary. When assessing these enhancements and their respective impacts on the climate, it is important that we also quantify the associated uncertainties. This is important to support an effective decision and policymaking process. However, such quantification of uncertainty is challenging, especially in a complex system that comprises multiple interacting components. The uncertainty quantification task can quickly become computationally intractable and cumbersome for one individual or group to manage. Recognizing the challenge of quantifying uncertainty in multicomponent systems, we utilize a divide-and-conquer approach, inspired by the decomposition-based approaches used in multidisciplinary analysis and optimization. Specifically, we perform uncertainty analysis and global sensitivity analysis of our multicomponent aviation system in a decomposition-based manner. In this work, we demonstrate how to handle a high-dimensional multicomponent interface using sensitivity-based dimension reduction and a novel importance sampling method. Our results demonstrate that the decomposition-based uncertainty quantification approach can effectively quantify the uncertainty of a feed-forward multicomponent system for which the component models are housed in different locations and owned by different groups.
Behind claims to bring about fair educational policy or, indeed, budget cuts that are as fair as possible lie a mass of contradictory meanings. These contradictions are rarely made explicit. However, we argue that it is crucial to do so if it is going to be possible to debate what a fair education system might mean, and to find whether fairness in education is indeed possible. This chapter looks at the ideas of fairness underlying particular current national and local educational policy and practice and tries to assess implications for a fair education system. The context of this chapter is English education policy with examples from the city of Newcastle upon Tyne. However, similar policies are found in many international contexts.
The approach we take is to look at current educational policy and practice and identify the key ideas of fairness that seem to be portrayed. We first look at the accessibility and attractiveness of the concept of fairness and explore why it seems to be in vogue. Next we consider the focus in flagship educational policy on fairness as equality of opportunity as expressed in the targeting of resources on those deemed disadvantaged. We then consider additional aspects of fairness, which are not central to policy, but which are important to broaden current conceptions beyond distributive justice notions around ‘closing the gap’ in attainment between rich and poor, and beyond a marketised framework for organising schools. We assert the need for a focus in policy on many aspects of relational justice and suggest our seven principles of educational fairness as a way to operationalise both distributional and relational justice.
Understanding fairness
The idea that something is deemed either fair or unfair is one that is, pretty much, accessible to the general public. Young children have a keen sense of when something is unfair, and are often ready to declare this to those around them. In general parlance, fair is understood as good. Politicians, to indicate policies that will bring about a better life, use fairness as a key concept.
It is not difficult to find evidence for the need to improve – or indeed ensure – fairness. The view that inequalities in society in a number of key areas are not good for anyone is becoming an idea of our time, with the success of the book The Spirit Level (Wilkinson and Pickett, 2012).
Analysis of dental calculus is increasingly important in archaeology, although the focus has hitherto been on dietary reconstruction. Non-edible material has, however, recently been extracted from the dental calculus of a Neanderthal population from the 49 000-year-old site of El Sidrón, Spain, in the form of fibre and chemical compounds that indicate conifer wood. Associated dental wear confirms that the teeth were being used for non-dietary activities. These results highlight the importance of dental calculus as a source of wider biographical information, and demonstrate the need to include associated data within research, in particular tooth wear, to maximise this valuable resource.
National Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a ‘traffic light’ system for risk and a clinical management pathway.
Objectives
To evaluate this care pathway.
Methods
The care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained.
Results
The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (<50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC>250 mcg/g and were diagnosed by ‘straight to test’ colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%).
Conclusions
A care pathway for the use of FC that incorporates a higher cut-off value, a ‘traffic light’ system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.
The photodegradation of polypropylene (PP)/ZnO composites at different concentrations was evaluated under solar simulated exposure of respective nanocomposite films. Nanocomposites were prepared by solid mixing using a cryogenic mill, and then films were prepared by compression molding. All films showed a good dispersion of ZnO nanoparticles without affect considerably the optical properties of the films. The films were exposed in a solar simulation chamber under three xenon arc lamps with a 340nm filter. Degradation of PP/ZnO nanocomposite films was monitored by formation of oxidative groups and changes on surface microstructure. FTIR results showed that oxidation groups in nanocomposites films increased by using cuasi-spherical ZnO nanoparticles.
We describe the investigation and control of a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae outbreak in a 20-bed surgical intensive care unit during the period from January 1, 2009 through January 1, 2010. Nine patients were either colonized or infected with a monoclonal strain of K. pneumoniae. The implementation of a bundle of interventions on July 2009 successfully controlled the further horizontal spread of this organism.
This article reports mean scores on the Bayley Scales of Infant and Toddler Development (Version III) for 211 randomly selected healthy term (≥ 37 weeks gestation) Australian infants at one year of age. Mean scores were significantly different from standardised norms in all subscales except fine motor. Australian infants scored higher on cognitive and receptive language (p < .01) and lower on expressive language and gross motor (ps < .01) subscales. These findings raise questions regarding the validity of this test in the Australian population and suggest that the test be re-normed on Australian children for valid interpretation of scores in this cultural context.