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Objectives: People with dementia live with unmet needs due to dementia and other conditions. The EMBED-Care Framework is a co-designed app-delivered intervention involving holistic assessment, evidence-based decision- support tools and resources to support its use. Its intention is to empower people with dementia, family and practitioners to assess, monitor and manage needs. We aimed to explore the feasibility and acceptability of the EMBED-Care Framework and develop its underpinning programme theory.
Methods: A six-month single arm mixed-Methods feasibility and process evaluation, underpinned by an initial programme theory which was iteratively developed from previous studies. The settings were two community teams and two long term care facilities (LTCFs). People with dementia and family were recruited to receive the intervention for 12 weeks. Practitioners were recruited to deliver the intervention for six months. Quantitative data included candidate process and outcome measures. Qualitative data comprised interviews, focus groups and observations with people with dementia, family and practitioners. Qualitative and quantitative data were analysed separately and triangulated at the interpretation phase.
Results: Twenty-six people with dementia, 25 family members and 40 practitioners were recruited. Practitioners in both settings recognized the potential benefit for improving care and outcomes for people with dementia, and to themselves in supporting care provision. Family in both settings perceived a role in informing assessment and decisions about care. Family was integral to the intervention in community teams but had limited involvement in LTCFs. In both settings, embedding the intervention into routine care processes was essential to support its use. In community teams, this required aligning app functionality with care processes, establishing processes to monitor alerts, and clarifying team responsibilities. In LTCFs, duplication of care processes and limited time to integrate the intervention into routine care processes, affected its acceptability.
Conclusions: A theoretically informed co-designed digital intervention has potential to improve care processes and outcomes for people with dementia and family, and is acceptable to practitioners in community teams. Further work is required to strengthen the intervention in LTCFs to support integration into care processes and support family involvement. The programme theory detailing key mechanisms and likely outcomes of the EMBED-Care Framework is presented.
Background: Most individuals with dementia in the UK die in care homes. 70% of these are residential, relying on external healthcare professionals to manage the complex needs. eHealth can help facilitate the delivery of holistic care in care homes, yet adoption has traditionally been faced with resistance. Innovative approaches employing Methods from implementation science are required to promote the uptake of eHealth in care homes.
Aim: To evaluate the feasibility of a theoretically-informed co-designed implementation plan for an eHealth intervention to support holistic assessment and decision making for people with dementia in care homes and their family carers, and to identify opportunities to strengthen it.
Methods: An embedded mixed-Methods study conducted in two residential care homes. Qualitative data comprised non-participant observations of the intervention in use, focus groups and semi-structured interviews with care home staff. Data was analysed using a codebook thematic analysis underpinned by the Normalistion Process Theory. Quantitative data included app usage data and two implementation measures, analysed using descriptive statistics. Patient and public involvement informed development and conduct of the study.
Results: 20 care home staff across two care homes used the intervention with 26 residents. Whilst there was some evidence of adoption, reach within the care home and feasibility of its implementation, usage data indicated that the intervention was largely not utilised as intended. Whilst there was sufficient coherence around the intervention, staff faced barriers related to collective action including workload and incompatibility with practice. Reflexive monitoring was therefore low as individuals could not appraise its impact, which compromised staff cognitive participation. Revisions to the plan related to strategies to provide further staff support, including encouraging family involvement and a more tailored approach to training.
Conclusions: Evaluating feasibility of the implementation plan of the intervention was a vital step in its development. Rapid evaluation and iterative response to barriers to use informed learning and allowed for real- time adjustments to implementation strategies, and a set of updated recommendations for use. Further collaboration on the revised strategies with people living with dementia and their family carers is required.
Harpetid and trinucleid trilobites share a similar and unusual morphology, the most striking feature of which is a wide, flattened cephalic brim with many pits or holes. This similarity was once interpreted as a sign that these two groups of trilobites were closely related, but in recent years it has instead been assumed that the ‘harpiform’ brim arose in both groups independently. However, relatedness and similarity can be difficult to disentangle in fossil taxa without close living relatives, and this assumption about the harpiform brim has never been explicitly tested. Our study re-evaluates the relationship between Harpetida and Trinucleioidea in order to test a longstanding assumption about trilobite relationships and as a case study in evaluating different kinds of morphological similarity in extinct groups. We inferred a new phylogenetic tree using parsimony methods and discrete morphological character data from a broad sampling of harpetids, trinucleids, and their relatives. Despite their gross morphological similarities, we found that harpetids and trinucleids were readily distinguished in our analyses, a result consistent with a hypothesis of multiple origins for the harpiform brim. By mapping brim-related characters across our new phylogeny, we identified a sequence of morphological innovations that arose in parallel in both groups and led ultimately in each case to the evolution of the harpiform brim. These results indicate that harpiform brims are a prime example of parallel evolution—the similar development of a morphological trait in distantly related taxa that nevertheless share a similar original morphology. In addition, our phylogeny supports the idea that trinucleids are specialized, harpiform asaphids, rather than an independent order of trilobites. We also provide new information on the relationships of the putative ‘basal-most’ members of Trinucleioidea, the Liostracinidae, and confirm recent assessments that this family is more distantly related to trinucleids.
Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for asymptomatic bacteriuria in older adults. Understanding these barriers is an important step toward implementing age-friendly stewardship interventions.
The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.
Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]).
Results:
For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms.
Conclusion:
Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.
Drawn from the concept of the powered air purifying respirator (PAPR), the AerosolVE helmet creates a personal negative pressure space to contain aerosolized infectious particles produced by patients, making the cabin of an EMS vehicle safer for providers. The helmet was developed initially for use in hospitals and could be of significant use in the prehospital setting. The objective of this study was to determine the efficacy and safety of the helmet in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, a medical helicopter, and a medical jet. Sodium chloride particles were used to simulate infectious particles, and particle counts were obtained in numerous locations close to the helmet and around the patient compartment. Counts near the helmet were compared to ambient air with and without use of AGPs (non-rebreather mask [NRB], continuous positive airway pressure mask [CPAP], and high-flow nasal cannula [HFNC]).
Results:
Without the helmet fan on, the particle generator alone and with all AGPs produced particle counts inside the helmet significantly higher than ambient particle counts. With the fan on, there was no significant difference in particle counts around the helmet compared to baseline ambient particle counts. Particle counts at the filter exit averaged less than one despite markedly higher particle counts inside the helmet.
Conclusion:
Given the risk to EMS providers by communicable respiratory diseases, development of devices to improve safety while still enabling use of respiratory therapies is of paramount importance. The AerosolVE helmet demonstrated efficacy in creating a negative pressure environment and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
The fossil record is notoriously imperfect and biased in representation, hindering our ability to place fossil specimens into an evolutionary context. For groups with fossil records mostly consisting of disarticulated parts (e.g., vertebrates, echinoderms, plants), the limited morphological information preserved sparks concerns about whether fossils retain reliable evidence of phylogenetic relationships and lends uncertainty to analyses of diversification, paleobiogeography, and biostratigraphy in Earth's history. To address whether a fragmentary past can be trusted, we need to assess whether incompleteness affects the quality of phylogenetic information contained in fossil data. Herein, we characterize skeletal incompleteness bias in a large dataset (6585 specimens; 14,417 skeletal elements) of fossil squamates (lizards, snakes, amphisbaenians, and mosasaurs). We show that jaws + palatal bones, vertebrae, and ribs appear more frequently in the fossil record than other parts of the skeleton. This incomplete anatomical representation in the fossil record is biased against regions of the skeleton that contain the majority of morphological phylogenetic characters used to assess squamate evolutionary relationships. Despite this bias, parsimony- and model-based comparative analyses indicate that the most frequently occurring parts of the skeleton in the fossil record retain similar levels of phylogenetic signal as parts of the skeleton that are rarer. These results demonstrate that the biased squamate fossil record contains reliable phylogenetic information and support our ability to place incomplete fossils in the tree of life.
In this study, we investigate the process of generating single-sentence representations for the purpose of Dialogue Act (DA) classification, including several aspects of text pre-processing and input representation which are often overlooked or underreported within the literature, for example, the number of words to keep in the vocabulary or input sequences. We assess each of these with respect to two DA-labelled corpora, using a range of supervised models, which represent those most frequently applied to the task. Additionally, we compare context-free word embedding models with that of transfer learning via pre-trained language models, including several based on the transformer architecture, such as Bidirectional Encoder Representations from Transformers (BERT) and XLNET, which have thus far not been widely explored for the DA classification task. Our findings indicate that these text pre-processing considerations do have a statistically significant effect on classification accuracy. Notably, we found that viable input sequence lengths, and vocabulary sizes, can be much smaller than is typically used in DA classification experiments, yielding no significant improvements beyond certain thresholds. We also show that in some cases the contextual sentence representations generated by language models do not reliably outperform supervised methods. Though BERT, and its derivative models, do represent a significant improvement over supervised approaches, and much of the previous work on DA classification.
The availability of finance is a key requirement for action to mitigate and adapt to climate change. Several studies show that companies responding to ESG (environement, sustainability and governance) principles generally outperform others financially. There is strong growth of the sustainable finance sub-sector but off a low base. Fiduciary duty now is generally understood to include the need to take into account climate chage in decision-making and the exposure of company directors is growing exponentially. With falling prices, renewables are now being adopted by many leading companies for their own energy requirements. Green bonds and other climate-friendly financial instruments are in growing demand but large global financial institutions continue to direct a larger proportion of funds to fossil fuels than to ESG-rated investments including renewables. The present rate of growth of sustainable finance is not sufficient to meet climate goals for limiting emissions. The chapter recommends actions by governments to change this situation.
To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery.
Methods:
Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children’s hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score.
Results:
Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3 mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87).
Conclusions:
We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.
Recent models of psychopathology suggest the presence of a general factor capturing the shared variance among all symptoms along with specific psychopathology factors (e.g., internalizing and externalizing). However, few studies have examined predictors that may serve as transdiagnostic risk factors for general psychopathology from early development. In the current study we examine, for the first time, whether observed and parent-reported infant temperament dimensions prospectively predict general psychopathology as well as specific psychopathology dimensions (e.g., internalizing and externalizing) across childhood. In a longitudinal cohort (N = 291), temperament dimensions were assessed at 4 months of age. Psychopathology symptoms were assessed at 7, 9, and 12 years of age. A bifactor model was used to estimate general, internalizing, and externalizing psychopathology factors. Across behavioral observations and parent-reports, higher motor activity in infancy significantly predicted greater general psychopathology in mid to late childhood. Moreover, low positive affect was predictive of the internalizing-specific factor. Other temperament dimensions were not related with any of the psychopathology factors after accounting for the general psychopathology factor. The results of this study suggest that infant motor activity may act as an early indicator of transdiagnostic risk. Our findings inform the etiology of general psychopathology and have implications for the early identification for children at risk for psychopathology.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
The ability to understand others’ actions and intentions is at the core of human social competence. Action understanding, what it means and how it develops, has received much attention in developmental research because it is viewed as one of the most fundamental abilities in early social-cognitive development. For example, there is a growing body of evidence linking early action understanding with later theory of mind (Brooks & Meltzoff, 2015; Charman et al., 2000; Wellman, Phillips, Dunphy-Lelii, & LaLonde, 2004), and to the development of communicative skills (e.g., Brooks & Meltzoff, 2008). Increasing evidence suggests that the mirror neuron system (MNS) is a key neural correlate of action understanding. In this chapter, we discuss the role the MNS is thought to play in the development of social cognitive skills in infancy. We also discuss the current challenges of measuring the MNS that are unique to work with infants, what such studies have found in both typical and atypical populations, and how this work can impact our understanding of development.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
${\sim}60\%$
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Background: Endovascular thrombectomy (EVT) has shown efficacy in acute ischemic stroke (AIS) patients with infective endocarditis (IE). The possibility to undertake advanced histopathological clot analysis following EVT offers a new avenue to establish the etiological basis of the stroke – which is often labelled “cryptogenic.” In this paper, we present our findings from four consecutive patients with IE who underwent EVT following an AIS at our tertiary referral comprehensive stroke centre. Methods: Comprehensive histopathological analysis of clot retrieved after EVT, including morphology, was undertaken. Results: The consistent observation was the presence of dense paucicellular fibrinoid material mixed/interspersed with clusters of bacterial cocci. This clot morphology may be specific to septic embolus due to IE unlike incidental bacteraemia and could possibly explain the refractoriness of such clots to systemic thrombolysis. Conclusion: Detailed morphological and histopathological analysis of EVT-retrieved clots including Gram staining can assist in etiological classification of the clot. Understanding the composition of the clot may be of clinical value in early diagnostics and mapping treatment planning in IE.
An animal egg such as amphibian, mammalian or sea urchin egg receives only a single sperm at fertilisation. After binding of the first sperm, the egg is prevented from allowing the entry of additional sperm. In fact, polyspermy results in aborted development of the zygote. It has been generally accepted that a molecule(s) released from cortical granules participates in the block to polyspermy. As one such molecule, a cortical granule lectin has been isolated from unfertilised Xenopus eggs (Xenopus cortical granule lectin; XCGL). XCGL is released into the perivitelline space after fertilisation, and forms a complex with J1 jelly molecules to form an F layer, resulting in a block to additional sperm penetration.
A lectin molecule has also been purified from the eggs of several species of fish. The fish egg lectin is located in the cortical alveoli and is released from them after fertilisation. However, its biological function is unclear. We isolated cortical alveolar lectin from unfertilised eggs of Chinook salmon through affinity column chromatography (salmon egg lectin; SEL). The lectin activity was estimated by haemagglutination. The activity of the purified SEL was most strongly inhibited by L-rhamnose and D-galactose, but not by EDTA. Further analysis by C4 reverse-phase column chromatography using HPLC revealed that the lectin was composed of three subunit proteins: 24K, 26Ka and 26Kb proteins. In addition, we cloned cDNAs for them by RT-PCR. The deduced amino acid sequence of the 26Ka protein was homologous with that of the 26Kb protein (identity, 96.4%). Identities of the 24K with the 26Ka and the 26Kb proteins were 55.9% and 66.7%, respectively. A database search revealed that a lectin molecule similar to the SEL had been identified in Anthocidaris crassispina egg (sea urchin egg lectin; SUEL). The SUEL is composed of 105 amino acids, and is similar to both amino-terminal and carboxyl-terminal halves of the SELs. Thus, the SEL molecule is composed of two repeats of such SUEL-like domains, suggesting that the SEL gene was produced by gene duplication.
The availability of lidar datasets has led to several advances in archaeology, notably in the process of site prospection. Some remote sensing practitioners have aimed to create automated feature extraction (AFE) techniques that increase the efficiency and efficacy of identification and analysis. While these advances have been successful, many archaeological professionals who might have an interest in lidar-derived products do not have the technical experience to modify or create AFE techniques for particular regions or environments. Additionally, some features are not appropriate for AFE. Instead, the most widely used technique is still likely to be visually based manual feature identification. Using authors of different experience levels, we seek to evaluate the use of manual techniques for feature identification and subsequent analysis by implementing a publicly available lidar-derived digital elevation model (DEM). We demonstrate that manual feature extraction (MFE) can be accurate when more than one researcher is involved in a sort of “checks and balances” process. We also show that the use of confidence ratings can be an important part of this process if those ratings have some systematic and clearly defined underpinning. Finally, we argue, using a case study from American Samoa, that manually identified features can be analytically important as part of larger landscape studies.
Because polarization encodes geometrical information about unresolved scattering regions, it provides a unique tool for analyzing the 3-D structures of supernovae (SNe) and their surroundings. SNe of all types exhibit time-dependent spectropolarimetric signatures produced primarily by electron scattering. These signatures reveal physical phenomena such as complex velocity structures, changing illumination patterns, and asymmetric morphologies within the ejecta and surrounding material. Interpreting changes in polarization over time yields unprecedentedly detailed information about supernovae, their progenitors, and their evolution.
Begun in 2012, the SNSPOL Project continues to amass the largest database of time-dependent spectropolarimetric data on SNe. I present an overview of the project and its recent results. In the future, combining such data with interpretive radiative transfer models will further constrain explosion mechanisms and processes that shape SN ejecta, uncover new relationships among SN types, and probe the properties of progenitor winds and circumstellar material.
η Carinae, the most extreme luminous blue variable in our Galaxy, underwent a Great Eruption in the 1800s and ejected significant mass into the well-known bipolar Homunculus. But η Car's outer ejecta, a spread of dense, nitrogen-rich knots outside the Homunculus, have led to suspicion that the Great Eruption was not this star's first major mass-loss event. We have measured proper motions for nearly 800 distinct features in the outer ejecta using 21 years of HST WFPC2 and ACS imaging. With motions measured across sixteen baselines, we find that the outer ejecta are expanding ballistically and belong to three age groups: one dating to the mid-1200s, another to the mid-1500s, and a third to the early 1800s, associated with but perhaps predating the peak of the Great Eruption. These three age groups are separated in space and radial velocity. There is no evidence for interaction between the dense ejecta that could be powering η Car's soft X-ray shell, which is instead likely driven by fast, rarefied ejecta from the Great Eruption striking the older dense ejecta. The thirteenth-century event was strikingly asymmetric, ejecting mass almost entirely to one side of the star. The sixteenth-century event displays bipolar symmetry, but along a different axis than the current Homunculus. These observations provide constraints on theoretical models of η Car's behavior, as viable models must explain the repetition, timescale, and asymmetry of these major mass-loss events. For more details, see Kiminki, Reiter, & Smith (2016, MNRAS, 463, 845).
During the Cretaceous and Paleogene, the Indian subcontinent was isolated as it migrated north from the east coast of Africa to collide with Asia. As it passed over the Reunion hotspot in the late Maastrichtian–early Danian, a series of lava flows extruded, known as the Deccan Traps. Also during this interval, there was a major mass-extinction event at the Cretaceous–Paleogene boundary, punctuated by a meteorite impact at Chicxulub, Mexico. What were the biological implications of these changes in paleogeography and the extensive volcanism in terms of biodiversity, evolution, and biogeography? By combining chronostratigraphic, paleosol, and paleobotanical data, an understanding of how the ecosystems and climates changed and the relative contributions of the Chicxulub impact, Deccan Traps volcanism, and paleogeographic isolation can be gained. Understanding relative ages of paleobotanical localities is crucial to determining floristic changes, and is challenging because different methods (e.g., magnetostratigraphy, radiometric dating, vertebrate and microfossil biostratigraphy) sometimes give conflicting answers, or have not been done for paleobotanical localities. Climatic data can be obtained quantitatively by studying paleosol geochemistry, as well as qualitatively by examining functional traits and nearest living relatives of fossil plants. An additional challenge is revising macrofossil data, which includes some confidently identified taxa and others with uncertain affinities. This is important for understanding ecosystem composition both spatially and temporally, as well as the biogeographic implications of an isolated India.