143174 research outputs found
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Leveraging monaural exposures to reveal early effects of noise: evidence from police radio ear-piece use
No full textResearch into the long-term effects of noise on hearing is often confounded by health and lifestyle differences between individuals. UK police radio ear-pieces are capable of emitting high sound levels and, crucially, are worn in one ear, allowing between-ear comparisons which control for individual-level confounding factors. Low volume-control settings are recommended to reduce risk to police hearing, yet actual usage patterns and auditory effects remain unexamined. This study used a large-scale survey (N = 4,498) to assess ear-piece noise exposure and the associated hearing health. Most participants reported using high volume-control settings and 45.2% reported experiencing signs of temporary threshold shift (TTS) in the exposed ear. Estimated weekly-averaged noise exposures frequently exceeded the UK's 85 dBA Upper Exposure Action Value. Ear-piece use was associated with 73% (95% confidence interval [CI] 46–106%) increased risk of persistent tinnitus, which on mediation analysis appeared to be driven by a subset of users who experienced signs of TTS. Importantly, tinnitus location was associated with the side of exposure, suggesting tinnitus related to device use rather than to other factors. In contrast, Digits-In-Noise thresholds showed no relation with noise exposure; potential explanations include compensatory auditory training effects, but limitations of Digits-In-Noise data must also be considered. Findings highlight a need for further investigation into hearing risks in police personnel, including in-person auditory testing. Risk mitigation strategies might involve improved device design, training on safe use, and expanded hearing health surveillance. Given the potential for cumulative auditory damage, TTS may serve as an early warning sign, warranting attention in broader noise-exposed populations
Pendant-bearing detergents: strategies and membrane protein stabilization
No full textMembrane proteins (MPs) are vital to many biological processes, making their atomic-level structures essential for drug discovery. Detergent micelles are commonly used in MP research, from extraction, purification, and structure determination. Recently, detergents featuring small pendant groups positioned at the hydrophilic–hydrophobic interface of the micelle have emerged as promising membrane mimetics. This review highlights recent developments in pendant-bearing detergents and explores the roles of pendant groups in MP stabilization. Hydrophobic or hydrophilic pendants enhance alkyl chain packing within micelle interiors through distinct mechanisms. Additionally, reactive pendants enable in situ structural modification of detergents. Pendant-bearing detergents represent valuable tools for MP structural studies and their rational design would pave the way for next-generation detergents to advance MP research
Shared decision-making with older people on TReatment Escalation planning for Acute deterioration in the emergency Medical Setting - Observed (STREAMS-O): an ethnographic study
No full textBackground
Shared decision-making is increasingly expected in healthcare. Treatment escalation planning is a contingency for medical intervention in the event of acute deterioration in hospital. Treatment escalation planning guidelines in the United Kingdom reference shared decision-making but it is not clear to what extent this is feasible.
Aim
To understand how shared decision-making takes place during conversations about treatment escalation planning between clinicians and patients in the acute medical setting for older patients with mental capacity to participate in decisions about treatment escalation plans.
Methods
This was a focussed ethnography following a constructivist approach, conducted by a single researcher who is a medical doctor and qualitative researcher with input from a wider research team. Fieldwork took place April-July 2024 in an urban teaching hospital emergency department and acute medical unit. Data was collected as fieldnotes via participant observation, ad-hoc unstructured interviews, documentary analysis and case study analysis. Reflexive thematic analysis was conducted according to Braun and Clarke.
Results
There were five themes, which, collectively, illustrated and explained challenges for shared decision-making with older patients in treatment escalation planning in the acute medical setting: ‘A cog in the hospital machine’, ‘One of many good decisions’, ‘A reluctant conversation’, ‘Gatekeeping the decision’, and ‘Unconstructive conversations’.
Conclusion
Medical rather than shared decision-making was an inevitability in this context due to a complex set of interlinking factors, whilst patients assumed autonomy over their treatment escalation plan. This study questions the prevailing discourse that shared decision-making is always an optimal and achievable approach. Strategies to enhance shared decision-making in treatment escalation plans might include public education and encouraging clinicians and healthcare organisations to review treatment escalation plan decision-making practice. However, deliberation is required at policy level to determine expectations for different stakeholders’ authority over treatment escalation plans
The impact of individual head-related transfer function augmentation on spatial release from masking
No full textBinaural hearing underpins effective communication in complex acoustic environments by increasing listeners’ abilities to segregate concurrent sound sources. In certain conditions, interaural magnification of binaural cues has been shown to improve speech intelligibility in competing target masker scenarios, yet existing methods primarily comprise hearing aid algorithms, which, due to processing constraints, cause unwanted artefacts. Moreover, the perceptual effects of applying interaural magnification directly to a person’s own head-related transfer function (HRTF) remain unclear.
We revisit a previous method for magnifying interaural cues, apply it to individual HRTFs, and propose a modified version designed to reduce spatial distortions. We evaluate both approaches using auditory models and listening tests involving speech-on-speech masking with a midline target and symmetrical maskers. Behavioural results show that although magnifying interaural phase and level differences improves overall speech intelligibility compared to unmodified HRTFs, it does not significantly enhance spatial release from masking (SRM). Meanwhile, auditory model predictions suggest greater SRM gains than those observed behaviourally, suggesting an influence of listener familiarity with their individual spatial cues. Finally, interaural magnification benefits diminish for listeners who already exhibit strong SRM with their own HRTFs
Building an international precision medicine platform trial for the acute respiratory distress syndrome (ARDS): an expert consensus project report
No full textBackground
Almost all large-scale trials of disease-modifying therapeutic agents in critical care have failed to show benefit for patients, which may be explained in part by the clinical and biological heterogeneity inherent in virtually all critical illness syndromes. Enrichment strategies have been developed to separate responders from non-responders and better target treatments. In patients with the acute respiratory distress syndrome, a critical illness syndrome involving severe lung inflammation, latent class analysis and other clustering approaches have led to the discovery of subgroups (phenotypes) that appear to respond differently to treatment based on retrospective analyses of published clinical trials and observational cohorts. The next step is to test these phenotypes in a prospective trial. Rapid, point-of-care analytical methods have now made such a trial possible. There is a need to advance treatment for patients with acute respiratory distress syndrome and other critical illness syndromes by incorporating a phenotype-based approach into prospective trial design. The hyperinflammatory and hypoinflammatory phenotypes, that have been identified in acute respiratory distress syndrome, will be the first to be included in such a trial, with scope for further phenotypes to be studied over time.
Future work
This Efficacy and Mechanism Evaluation report, through expert consensus, describes a new Phase II, multiarm, adaptive platform randomised controlled trial design that tests multiple pharmacological therapies in a population of patients with acute respiratory distress syndrome stratified by baseline inflammatory phenotype. This report also reviews issues to be considered in developing precision medicine trials in critical care, which are designed with newly developed clinical phenotypes in mind. This work has been used to develop the Precision medicine Adaptive Network platform Trial in Hypoxaemic acutE respiratory failuRe precision medicine trial in acute respiratory distress syndrome, which has been funded and will begin recruitment in June 2025.
Limitations
This report is the result of expert consensus review, rather than utilising strict review methodologies (e.g. Delphi consensus process). However, expert consensus has been found to generate similar results to consensus processes when a high degree of agreement is reached and > 70% agreement was reached for all included recommendations.
Funding
This article presents independent research funded by the (NIHR) Efficacy and Mechanism Evaluation programme as award number NIHR154493
Community-based monitoring of river health and biodiversity
No full textThis practical guide supports Indigenous peoples and local communities to monitor the health of their rivers and the biodiversity they support. It links traditional and local knowledge with simple, low-cost scientific methods for assessing river condition. The guide covers visual and sensory assessment of river health, monitoring of small river animals as indicators of water quality, affordable approaches to testing water chemistry and contamination (including nutrients, heavy metals and microbes), and participatory methods for tracking fish health and abundance using catch-per-unit-effort. It also provides questions and tools for documenting traditional and local knowledge, understanding governance of rivers, and interpreting changes over time. Designed for use by community monitors, Indigenous organisations and supporting practitioners, the guide aims to strengthen community-led stewardship, citizen science and rights-based river conservation
A systematic review of Indigenous peoples’ participation in dominant systems of water governance
No full textIndigenous peoples’ rights and responsibilities to water are routinely undermined by dominant or colonial water governance systems. Although the importance of engaging Indigenous peoples in water governance
is recognized, few studies have assessed the extent or nature of their participation. Here we present a systematic review of peer-reviewed literature on Indigenous participation in dominant water governance, analysing 226 journal articles and 183 case studies. Case studies span 15 countries, with the majority (77%) from Western settler-colonial countries. Forms of participation differ across regions, and some decision-making scales are better studied than others. Few participatory processes give consideration to Indigenous values and knowledge, and even fewer evaluate Indigenous participation, making it difficult to determine if it was meaningful. Participation in international water governance processes is evident but remains underexamined in the literature. Crucially, Indigenous peoples are influencing and reshaping dominant water governance at all levels
The overlapping global distribution of dengue, chikungunya, Zika and yellow fever
No full textArboviruses transmitted mainly by Aedes (Stegomyia) aegypti and Ae. albopictus, including dengue, chikungunya, and Zika viruses, and yellow fever virus in urban settings, pose an escalating global threat. Existing risk maps, often hampered by surveillance biases, may underestimate or misrepresent the true distribution of these diseases and do not incorporate epidemiological similarities despite shared vector species. We address this by generating new global environmental suitability maps for Aedes-borne arboviruses using a multi-disease ecological niche model with a nested surveillance model fit to a dataset of over 21,000 occurrence points. This reveals a convergence in suitability around a common global distribution with recent spread of chikungunya and Zika closely aligning with areas suitable for dengue. We estimate that 5.66 (95% confidence interval 5.64-5.68) billion people live in areas suitable for dengue, chikungunya and Zika and 1.54 (1.53-1.54) billion people for yellow fever. We find large national and subnational differences in surveillance capabilities with higher income more accessible areas more likely to detect, diagnose and report viral diseases, which may have led to overestimation of risk in the United States and Europe. When combined with estimates of uncertainty, these suitability maps can be used by ministries of health to target limited surveillance and intervention resources in new strategies against these emerging threats
Investigating a systematic and widespread misidentification in the metabolic profiling literature: phenylacetylglutamine and phenylacetylglycine signal misassignment in proton NMR spectra of human and rodent urine
No full textAccurate assignment of endogenous and exogenous constituents within complex biological matrices remains a central challenge in metabolomics. Phenylacetylglutamine (PAGln) and phenylacetylglycine (PAGly) are terminal metabolites of the host-microbial co metabolism of phenylalanine, predominantly observed in humans and rodents, respectively. Motivated by a pervasive misidentification within the literature, we demonstrate that PAGln in human urine has been erroneously identified as PAGly in 82 of 166 NMR-based studies, yielding an estimated misannotation rate of 49%. Herein, we provide definitive assignments for both PAGly and PAGln, and present a comprehensive statistical evaluation of the NMR resonances attributed to both species, alongside their quantitative determination via targeted line-fitting approaches in extensive human and rodent urine samples obtained from the INTERSALT cohort (N = 1589) and the historical COMET study (N = 4399) respectively. In agreement with canonical hepatic metabolic pathways, PAGln was found to be exclusively present in human urine, whereas PAGly was restricted to rodent (i.e., rat and mouse) urine. These findings underscore the need for systematic re-evaluation of prior metabolomic annotations involving these structurally related yet biochemically distinct metabolites
Temperature-dependent optical properties of ice crystals in the far-infrared regime
No full textA database of temperature-dependent hexagonal ice aggregate optical properties in the far-infrared (FIR) spectrum is developed to support FIR missions, particularly the current Polar Radiant Energy in the Far InfraRed Experiment and the upcoming Far-infrared-Outgoing-Radiation Understanding and Monitoring. Based on this data set, simulations of the brightness temperatures (BTs) in the 100–667 cm−1 FIR region are conducted for an anvil-like ice cloud in a tropical atmosphere. The results show nonnegligible impact of ice cloud temperature on simulated BTs, which can be as large as 3 K due to the difference between fixed 160 or 270 K cloud temperature and the benchmark counterpart, varying in accordance with the ambient temperature profile for a cloud residing between 249.6 and 199.6 K. To enhance the accuracy of FIR radiative transfer modeling, it is recommended to incorporate temperature-dependent optical properties of ice clouds