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Longstanding design and reproducibility challenges in inertial confinement fusion (ICF) capsule implosion experiments involve recognizing the need for appropriately characterized and modeled three-dimensional initial conditions and high-fidelity simulation capabilities to predict transitional flow approaching turbulence, material mixing characteristics, and late-time quantities of interest – for example, fusion yield. We build on previous coarse-graining (CG) simulations of the indirect-drive national ignition facility (NIF) cryogenic capsule N170601 experiment – a precursor of N221205 which resulted in net energy gain. We apply effectively combined initialization aspects and multiphysics coupling in conjunction with newly available hydrodynamics simulation methods, including directional unsplit algorithms and low Mach-number correction – key advances enabling high fidelity coarse-grained simulations of radiation-hydrodynamics driven transition.
Commentary of ‘Elemental psychopathology: distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5’ Vincent P. Martin 1, Régis Lopez 2,3, Jean-Arthur Micoulaud-Franchi 4,5, Christophe Gauld 4,6,*
The COVID-19 has had major direct (e.g., deaths) and indirect (e.g., social inequities) effects in the United States. While the public health response to the epidemic featured some important successes (e.g., universal masking ,and rapid development and approval of vaccines and therapeutics), there were systemic failures (e.g., inadequate public health infrastructure) that overshadowed these successes. Key deficiency in the U.S. response were shortages of personal protective equipment (PPE) and supply chain deficiencies. Recommendations are provided for mitigating supply shortages and supply chain failures in healthcare settings in future pandemics. Some key recommendations for preventing shortages of essential components of infection control and prevention include increasing the stockpile of PPE in the U.S. National Strategic Stockpile, increased transparency of the Stockpile, invoking the Defense Production Act at an early stage, and rapid review and authorization by FDA/EPA/OSHA of non-U.S. approved products. Recommendations are also provided for mitigating shortages of diagnostic testing, medications and medical equipment.
Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.1 HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP infections and associated work restrictions during isolation periods and the need to care for family members, particularly children, with COVID-19. Additionally, the detrimental physical and mental health impact of COVID-19 on HCP has led to attrition, which further exacerbates shortages.2 Demands increased in post-acute and long-term care (PALTC) settings, which already faced critical staffing challenges difficulty with recruitment, and high rates of turnover. Although individual healthcare organizations and state and federal governments have taken actions to mitigate recurring shortages, additional work and innovation are needed to develop longer-term solutions to improve healthcare workforce resiliency. The critical role of those with specialized training in infection prevention, including healthcare epidemiologists, was well-demonstrated in pandemic preparedness and response. The COVID-19 pandemic underscored the need to support growth in these fields.3 This commentary outlines the need to develop the US healthcare workforce in preparation for future pandemics.
Throughout history, pandemics and their aftereffects have spurred society to make substantial improvements in healthcare. After the Black Death in 14th century Europe, changes were made to elevate standards of care and nutrition that resulted in improved life expectancy.1 The 1918 influenza pandemic spurred a movement that emphasized public health surveillance and detection of future outbreaks and eventually led to the creation of the World Health Organization Global Influenza Surveillance Network.2 In the present, the COVID-19 pandemic exposed many of the pre-existing problems within the US healthcare system, which included (1) a lack of capacity to manage a large influx of contagious patients while simultaneously maintaining routine and emergency care to non-COVID patients; (2) a “just in time” supply network that led to shortages and competition among hospitals, nursing homes, and other care sites for essential supplies; and (3) longstanding inequities in the distribution of healthcare and the healthcare workforce. The decades-long shift from domestic manufacturing to a reliance on global supply chains has compounded ongoing gaps in preparedness for supplies such as personal protective equipment and ventilators. Inequities in racial and socioeconomic outcomes highlighted during the pandemic have accelerated the call to focus on diversity, equity, and inclusion (DEI) within our communities. The pandemic accelerated cooperation between government entities and the healthcare system, resulting in swift implementation of mitigation measures, new therapies and vaccinations at unprecedented speeds, despite our fragmented healthcare delivery system and political divisions. Still, widespread misinformation or disinformation and political divisions contributed to eroded trust in the public health system and prevented an even uptake of mitigation measures, vaccines and therapeutics, impeding our ability to contain the spread of the virus in this country.3 Ultimately, the lessons of COVID-19 illustrate the need to better prepare for the next pandemic. Rising microbial resistance, emerging and re-emerging pathogens, increased globalization, an aging population, and climate change are all factors that increase the likelihood of another pandemic.4
The Society for Healthcare Epidemiology in America (SHEA) strongly supports modernization of data collection processes and the creation of publicly available data repositories that include a wide variety of data elements and mechanisms for securely storing both cleaned and uncleaned data sets that can be curated as clinical and research needs arise. These elements can be used for clinical research and quality monitoring and to evaluate the impacts of different policies on different outcomes. Achieving these goals will require dedicated, sustained and long-term funding to support data science teams and the creation of central data repositories that include data sets that can be “linked” via a variety of different mechanisms and also data sets that include institutional and state and local policies and procedures. A team-based approach to data science is strongly encouraged and supported to achieve the goal of a sustainable, adaptable national shared data resource.
Gadfly petrels Pterodroma spp. are among the most threatened bird taxa. Conservation interventions have been successfully developed and applied for some gadfly petrel species, but a substantial gap remains in conservation science for this group in the tropical Pacific Ocean. The Vanuatu Petrel Pterodroma [cervicalis] occulta is an ideal exemplar to develop a pipeline for conservation science in tropical Pacific gadfly petrels as it is subject to many of the challenges facing other gadfly petrel taxa in the region. We review over 40 pelagic Vanuatu Petrel records and five research expeditions to the only known colony on the island of Vanua Lava, Vanuatu. These records provide a baseline from which to recommend conservation research actions for the taxon. The population status, taxonomy, distribution, and threat profile of the taxon are all poorly known, and these areas are high priorities for future research.
A 3D verification and validation suite of test problems is presented and used to evaluate hydrodynamic methods within a radiation hydrodynamics code, xRAGE. These test problems exercise different levels of complexity, building towards ICF problems which in addition to hydrodynamics also include three temperature plasma physics, thermal conduction, and radiation diffusion. Among the problems in the test suite are the Kidder ball problem, the Verney shell problem, and a 5-material compression problem, which exercise different purely hydrodynamic methods implemented within xRAGE. There is excellent agreement between 2D and 3D XRAGE simulation results and between the xRAGE results and the benchmark solutions. Two 3D ICF test problems are also presented, based on an OMEGA direct drive capsule experiment and on a NIF indirect drive capsule experiment. It is demonstrated that the newer unsplit hydrodynamic method in xRAGE produces more vorticity relative to the older default method. For the indirect drive capsule, the 3D simulations are in reasonable agreement with the experimental values of ion temperature and neutron production.
Functional connectivity of the default mode network (DMN) during rest has been shown to be different among adults with Mild Cognitive Impairment (MCI) relative to aged-matched individuals without MCI and is predictive of transition to dementia. Post-traumatic stress disorder (PTSD) is also associated with aberrant connectivity of the DMN. Prior work from this group has demonstrated a higher rate of MCI and PTSD among World Trade Center (WTC) responders relative to the general population. The current study sought to investigate the main and interactive effects of MCI and PTSD on DMN functioning. Based on prior work, we hypothesized that MCI, but not PTSD, would predict aberrant connectivity in the DMN.
Participants and Methods:
99 WTC responders aged 44–65 stratified by MCI status (yes/no) and PTSD status (yes/no) and matched for age in years, sex (male vs. female), race (white, black, and other), and educational attainment (high school or less, some college / technical school, and university degree), and occupation on September 11, 2001 (law enforcement vs. other) underwent fMRI using a 3T Siemens Biograph MR scanner. A single 10-minute continuous functional MR sequence was acquired while participants were at rest with their eyes open. Group-level analyses were conducted using SPM-12, with correction for multiple comparisons using AFNI's 3dClustSim. Based on this threshold, the number of comparisons in our imaging volume, and the smoothness of our imaging data as measured by 3dFWHMx-acf, a minimum cluster size of 1134 voxels was required to have a corrected p . .05 with 2-sided thresholding. Spherical 3 mm seeds were placed in the dorsal (4, -50, 26) and ventral (4, -60, 46) posterior cingulate cortex (PCC).
Results:
Individuals with PTSD demonstrated significantly less connectivity of the dorsal posterior cingulate cortex (PCC) with medial insula (T = 5.21), subthalamic nucleus (T = 4.66), and postcentral gyrus (T = 3.81). There was no difference found in this study for connectivity between groups stratified by MCI status. There were no significant results for the ventral PCC seed.
Conclusions:
Contrary to hypotheses that were driven by a study of cortical thickness in WTC responders, the impact of PTSD appears to outweigh the impact of MCI on dorsal DMN connectivity among WTC responders stratified by PTSD and MCI status. This study is limited by several issues, including low number of female and minority participants, relatively small group cell sizes (n = 23–27 per cell), a brief resting state sequence (10 minutes), and lack of a non-WTC control group. Importantly, responders are a unique population so generalizability to other populations may be limited. Individuals in the current study are now being followed longitudinally to relate baseline resting state functional connectivity with cognitive changes and changes in connectivity over a four-year period.
The advent of neuroimaging techniques has driven advances in how we understand where in the brain different aspects of cognition are instantiated, and how this neural activity relates to behaviour. While the translation of this approach to study neuropsychiatric disorders has had some successes, it could be argued that it fails to capture what the brain is doing. Computational models serve as a bridge from brain to behaviour (see Figure 5.7.1), permitting the formulation of mechanistic hypotheses about neural computations and how they might be different in clinical conditions. Most applications of computational models to psychiatric disorders concern altered learning about the world. While many formal models of learning exist, two have had widespread success in their application to psychiatry: reinforcement learning and Bayesian models. Both models are concerned with how we learn from past experiences to form expectations about the world around us.
In this paper, we consider absorbing Markov chains $X_n$ admitting a quasi-stationary measure $\mu $ on M where the transition kernel ${\mathcal P}$ admits an eigenfunction $0\leq \eta \in L^1(M,\mu )$. We find conditions on the transition densities of ${\mathcal P}$ with respect to $\mu $ which ensure that $\eta (x) \mu (\mathrm {d} x)$ is a quasi-ergodic measure for $X_n$ and that the Yaglom limit converges to the quasi-stationary measure $\mu $-almost surely. We apply this result to the random logistic map $X_{n+1} = \omega _n X_n (1-X_n)$ absorbed at ${\mathbb R} \setminus [0,1],$ where $\omega _n$ is an independent and identically distributed sequence of random variables uniformly distributed in $[a,b],$ for $1\leq a <4$ and $b>4.$
Cultural competence training plays an effective role in improving cultural competence for healthcare professionals, but cultural competence training was found to be insufficient in Hong Kong.
Aim:
This study aims to explore receptivity and readiness of Hong Kong healthcare professionals (nurses, occupational therapists (OTs), and physiotherapists (PTs)) towards cultural competence training.
Methods:
Twenty-three semi-structured interviews were conducted with 7 educators/trainers from tertiary institutions, 2 representatives of professional groups, and 14 managerial and frontline workers. Data were analysed using theoretical thematic analysis.
Findings:
Results show that nurses and PTs have lower levels of cultural competence than OTs owing to insufficient in-depth training and the nature of professional practice, and they expressed lower willingness to receive the training than OTs. However, the staff in these three professions encounter various challenges in serving ethnoculturally diverse groups. Therefore, barriers in receiving cultural competence training and best practice for providing cultural competence training were identified and discussed for these three professions.
Foramina of bones are beginning to yield more information about metabolic rates and activity levels of living and extinct species. This study investigates the relationship between estimated blood flow rate to the femur and body mass among cursorial birds extending back to the Late Cretaceous. Data from fossil foramina are compared with those of extant species, revealing similar scaling relationships for all cursorial birds and supporting crown bird–like terrestrial locomotor activity. Because the perfusion rate in long bones of birds is related to the metabolic cost of microfracture repair due to stresses applied during locomotion, as it is in mammals, this study estimates absolute blood flow rates from sizes of nutrient foramina located on the femur shafts. After differences in body mass and locomotor behaviors are accounted for, femoral bone blood flow rates in extinct species are similar to those of extant cursorial birds. Femoral robustness is generally greater in aquatic flightless birds than in terrestrial flightless and ground-dwelling flighted birds, suggesting that the morphology is shaped by life-history demands. Femoral robustness also increases in larger cursorial bird taxa, probably associated with their weight redistribution following evolutionary loss of the tail, which purportedly constrains femur length, aligns it more horizontally, and necessitates increased robustness in larger species.
Quantifying and managing the cumulative effects of human activities on coastal and marine environments is among the foremost challenges in enabling sustainable development in the twenty-first century. As the speed with which these environments are changing increases, there is greater impetus to resolve the evident problems facing governance systems responsible for managing cumulative impacts. Policymakers and regulators recognise the need to assess and manage cumulative effects, as evidenced by widespread legislation requiring cumulative effects assessment (CEA). Yet there is ample evidence that we are not turning the tide in terms of balancing good environmental health with increasing demands of already degraded coastal and marine spaces that are increasingly impacted by climate change. This paper reviews the current state of knowledge regarding scientific and practical advances in CEA, assesses whether these advances are being applied in decision-making and identifies where challenges to implementation exist. Priority research questions are formulated to accelerate the inclusion of effective CEA in marine and coastal planning and management.
Patient safety problems stemming from healthcare represent a significant cause of morbidity and mortality globally. The evidence base on safety in mental healthcare, particularly regarding community-based mental health services, has long fallen behind that of physical healthcare, with fewer research publications, developed primarily in isolation from the wider improvement science discipline. This disconnect both yields, and stems from, conceptual and practical challenges which must be surmounted in order to advance the science and improvement of safety in mental healthcare.
Objectives
The objectives of this research were to conduct a narrative review to provide an overview of conceptual issues in this area, their origins, and implications for patient safety science and clinical care. We also sought to identify approaches to overcoming these issues.
Methods
We examined theoretical and empirical evidence from the fields of patient safety, mental health, and improvement science to address this knowledge gap.
Results
We identified challenges with defining safety in the context of community mental healthcare, ascertaining what constitutes a ‘preventable’ safety problem requiring intervention, and in finding relevant research evidence. The research indicated that risk management has taken precedence over proactive safety promotion in mental healthcare. This positions service users as the origin of safety risks, with iatrogenic harm and latent system hazards associated with mental healthcare widely overlooked.
Conclusions
We propose a broader conceptualisation of safety to advance the field and outline potential next steps for the integration and uptake of different sources of ‘safety intelligence’ within community mental health services.
Disclosure
NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.
There is limited existing research about patient safety issues in mental healthcare. A lack of evidence is particularly pronounced in relation to safety in community-based mental health services, where the majority of care is provided. To date, reviews of mental health patient safety literature have focused primarily on inpatient care settings.
Objectives
This systematic scoping review will aim to identify and synthesise literature about the types of patient safety problems in adult community-based mental health settings, the causes of these problems, and evaluated safety interventions in this care context.
Methods
A systematic search was conducted on 19th June 2020 and refreshed on 23rd October 2021, across five databases: Medline, Embase, PsycINFO, Health Management Information Consortium, and Cumulative Index to Nursing and Allied Health Literature. The search strategy focused on three key elements: ‘mental health’, ‘patient safety’ and ‘community-based mental health services’. Retrieved articles were screened at title, abstract and subject heading level, followed by full-text screen of longlisted articles.
Results
In this presentation, the findings of this systematic scoping review will be described, based on synthesised literature about safety incidents, broader care delivery problems, their causes, and evaluated patient safety interventions to address these issues.
Conclusions
This study will offer learning opportunities about the safety problems, contributory factors, and safety interventions in adult community-based mental health services, as described in the evidence base. Review findings will also help to ascertain gaps in existing research, which should be addressed in future studies.
Disclosure
NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.