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Person-centred medicine in the care home setting: feasibility testing of a complex intervention
No full textBackground
Person-centred medicine in older patients requires medication decisions to be aligned with individual preferences, needs, and values. However, involvement of care home residents and their relatives in such decisions remains limited due to professional preferences and perceived barriers. This study investigates the feasibility of a newly developed intervention aiming to facilitate person-centred medicine through resident and relative involvement and interprofessional communication support.
Methods
The feasibility testing was conducted in two care homes from April to October 2022 in an urban Danish Municipality. The intervention consisted of two components: the PREparation of Patients for Active Involvement in medication Review for Care Home (PREPAIR-CH) and a medication communication template for healthcare professionals. A flexible three-stage workflow and a multifaceted implementation strategy facilitated implementation. Data was collected through observations and interviews with healthcare professionals (care home staff, GPs), residents, and relatives. Data analysis was guided by Normalization Process Theory.
Results
Ten residents participated in the intervention (four in the presence of relatives) and were subsequently interviewed. Additionally, five interviews with healthcare professionals were conducted. The intervention purpose was deemed relevant by residents, relatives, and healthcare professionals and aligned with individual values. The implementation strategy followed the intended delivery. Flexibility, coordination, and collaboration within the local team were key to facilitating intervention implementation. Challenges included selection of residents, involvement of relatives, and management of competing priorities. The intervention offered a structure for involvement and provided valuable insights for healthcare professionals into the patient perspective, thereby fostering reflection and dialogue and enhancing the residents’ and relatives’ perceived involvement. The medication communication template was considered relevant by staff, whereas GPs found it unnecessary.
Conclusions
The PREPAIR-CH was found acceptable and feasible by residents, relatives, and healthcare professionals, but care home staff and GPs disagreed on the relevance of the medication communication template. The findings suggest that the intervention may enhance resident and relative involvement to support person-centred medicine. Some uncertainties must be explored before a large-scale evaluation, including the applicability to different types of residents and how to support interprofessional communication about medicines, as the needs appear to differ between care home staff and GPs
System states and disturbance estimation using adaptive integral terminal sliding mode observer for U‐tube steam generator model in nuclear power plant
Get PDFDesigning water level control for a U-tube steam generator (UTSG) in nuclear power plants (NPP) remains a challenge, especially at low power demand due to unreliable steam flow measurements. This paper addresses the steam flow rate as a disturbance to the plant, treating it as an inaccessible variable. To estimate the disturbance (steam flow rate) and system states, an adaptive integral terminal sliding mode observer is developed. These estimated values can be utilized in the water level control design to enhance the reliability and performance of the control system. An adaptive observer is developed such that the augmented systems formed by the error dynamical systems and the designed adaptive laws are globally uniformly ultimately bounded. This technique is applied to a non-minimum phase system model representing the UTSG system to improve water level control and prevent possible serious consequences. Various disturbance signal forms with different amplitudes are simulated to demonstrate the reliability of the proposed technique. The simulation results show the effectiveness of the method proposed in this paper
A photometric comparison of B and Be stars using Gaia DR3
Get PDFPrevious studies have observed significant photometric differences between non-emission B-type and classical Be stars, however the precise mechanism responsible for these differences is unclear. This study combines the Bright Star Catalogue with Tycho and Gaia photometry to create a homogeneous sample of 1015 of the closest and brightest B and Be-type field stars with 90 per cent of objects at distances
500 pc. Due to their proximity, the extinction towards these objects is very low, ensuring we minimize any obfuscation in the reddening correction and final photometry. We present our findings in both Tycho and Gaia photometry through colour magnitude diagrams and present intrinsic colours and absolute magnitudes for each spectral type. We find Be stars are on average
0.5 mag brighter in both Gaia G and Tycho V
compared to non-emission B stars of the same spectral type. Additionally, we find tentative evidence that Be stars are redder in Gaia B
R
, particularly for the earlier types, but have similar Tycho B
V
colours. We test the effects of gravitational darkening due to rapid rotation and binarity on the photometry of our sample and find both to be insufficient to explain the observed photometric differences between B and Be stars. We conclude that the most likely mechanism responsible for the observed photometric differences is the combined effect of the circumstellar disc and stellar evolution up the main sequence, with the disc dominating early-types and evolution dominating late type stars
Environmentally friendly pretreatment of chitin using relatively low concentration KOH/urea mixture for enhanced nanofiber preparation
Get PDFTraditional methods to prepare chitin nanofibers require circular chemical treatment to further purify the chitin from the seller and the morphology of the prepared nanofibers is commonly rod-like one. This study introduces an approach utilizing low-temperature freeze pretreatment of chitin in a relatively low concentration KOH/urea mixture. The crystallinity of β-chitin reduced as the concentration of KOH increased in the pretreatment solvent. The concentration of urea had little effect on the crystallinity of chitin. The pretreated chitin was then oxidized in a 2,2,6,6-Tetramethylpiperidine-1-oxyl (TEMPO)/NaBr/NaClO system to prepare nanofibers. The morphologies of the nanofibers can be regulated by oxidizing the chitin pretreated with different concentration of KOH. The nanofibers obtained by oxidizing chitin pretreated by 3 wt% KOH/ 1 wt% urea mixture showed rod-like morphologies with length about 150 nm. The carboxyl content of nanofibers prepared with KOH/urea mixture freeze treated chitin increased compared to that of nanofibers prepared with solely freeze treated chitin. In addition, the pretreatment solvent can be used to treat α-chitin and can be reused. The freeze KOH/urea mixture pretreatment methods can be extended to treat other biomasses for nanofiberization
A framework for developing children’s legal capability
No full textIn this paper we introduce a framework for developing children’s legal capability. This is the outcome of an extended period of interdisciplinary research, reflection, and discussion to explore the question of ‘what does a legally capable child look like?’. Initially this question was explored within the context of adult-focused legal capability literature, and we explain how the framework we propose in this paper has been informed by this scholarship. However, we go on to demonstrate how our work breaks new ground not only because of its focus on children, but because we radically reconceptualise legal capability, drawing on a range of interdisciplinary theories. Within the framework we introduce the concept of ‘baseline’ legal capability, and we argue that this addresses the conundrum we identify in the literature, where legal capability is conceptualised as something which those most in need of effective public legal education can never achieve. More generally, we demonstrate how the framework turns traditional ideas about legal education upside down as we ‘decentre’ the law and legal institutions, and instead place the learner at its core
“We’ll always go back for more”? Probation, precariousness, and professional identity
Get PDFOver the last few decades, the environment in which the Probation Service in England and Wales operates has become both more punitive and managerial, dominated by the logic of risk. A challenge to the tenets on which probation’s professional project was founded, such as its (social work) knowledge base and autonomy to work with individuals under supervision, has accompanied this changed landscape. Indeed, probation’s relative powerlessness to mobilise against governmental impositions has resulted in four top-down organisational restructurings since the turn of the millennium. This paper, therefore, considers the impact of such change on professional identity in probation. Against the backdrop of the most recent organisational reform–the “unification” of services, in June 2021 which brought to an end a failed seven-year experiment in part-privatisation–it explores how punitive, managerial, and marketising reforms have contributed to a crisis of identity that has been decades in the making. The paper argues that, while an appeal to an ideology of service centred on helping clients remains significant among staff, the nature and extent of the challenges probation faces has rendered professional identity more precarious
Editorial for “MRI assessment of lung water density in individuals previously infected with COVID‐19: a cross‐sectional study”
No full textYoung migrants on the move: Ethics and methods of conducting qualitative research ‘in the moment’
Get PDFQualitative forms of enquiry offer valuable opportunities to generate rich data that deepens our understandings of contemporary social issues, such as migration. Qualitative methods are often championed for enabling the engagement of so-called hard-to-reach or vulnerable groups in research and through using techniques that support the building of research relationships and rapport with participants. However, possibilities for building rapport can be problematic in contexts of flux and precarity. In this paper, we reflect on (and problematise) our decision-making in relation to the ethics and methods of a qualitative study exploring the livelihoods of young African migrants in Ghana. Our reflections highlight the challenges of investigating youth mobilities, including how frequent movements influence the generation of in-depth data with young people occupying precarious circumstances. Capturing data ‘in the moment’ challenged us to rethink our approaches, offering alternative ways to conduct a qualitative enquiry with young people frequently on the move
The neutron veto of the XENONnT experiment: results with demineralized water
Get PDFRadiogenic neutrons emitted by detector materials are one of the most challenging backgrounds for the direct search of dark matter in the form of weakly interacting massive particles (WIMPs). To mitigate this background, the XENONnT experiment is equipped with a novel gadolinium-doped water Cherenkov detector, which encloses the xenon dual-phase time projection chamber (TPC). The neutron veto (NV) can tag neutrons via their capture on gadoliniumorhydrogen,whichreleaseγ-raysthataresubsequently detected as Cherenkov light. In this work, we present the first results of the XENONnT NV when operated with demineralized water only, before the insertion of gadolinium. Its efficiency for detecting neutrons is (82 ± 1)%,the highest neutron detection efficiency achieved in a water Cherenkov detector. This enables a high efficiency of (53 ± 3)% for the tagging of WIMP-like neutron signals, inside a tagging time window of 250µs between TPC and NV, leading to a live time loss of 1.6% during the first science run of XENONnT
Cardiac MRI-derived mean right atrial pressure and its prognostic importance
Get PDFBackground
Right atrial pressure (RAP) is a key variable that cardiac MRI (CMR) cannot currently measure. We aimed to develop a model to estimate mean RAP (mRAP) using CMR and assess the prognostic value of CMR-derived mRAP in an independent patient cohort.
Methods
The derivation cohort consisted of patients investigated for heart failure symptoms with right heart catheterisation and CMR. Right atrial and ventricular CMR measurements were correlated with invasive mRAP to inform multivariable linear regression models incorporating patient characteristics. CMR-derived mRAP was tested as a predictor for clinical outcomes (lower-limb oedema, heart failure hospitalisation and all-cause mortality) on an independent cohort of patients receiving CMR. Both cohorts were derived from hospital registries.
Results
In the derivation cohort (n=672), invasive mRAP was >8 mm Hg in 56% of patients. Right atrial end-systolic volume (RAESV) had the strongest correlation with invasive mRAP (Pearson’s coefficient 0.58, p0.05). CMR-derived mRAP ≥10 mm Hg was better associated with outcomes than mRAP ≥8 mm Hg in the clinical cohort (n=101) with diagnostic power for peripheral oedema (area under the curve (AUC) 0.75, p=0.02) and heart failure hospitalisation (AUC 0.93, p<0.01). Kaplan-Meier analysis demonstrated elevated CMR-derived mRAP (≥10 mm Hg) was associated with reduced survival compared with mRAP <10 mm Hg (χ2=5, p=0.02) over a mean follow-up of 6.8 years.
Conclusion
mRAP can be estimated by CMR. Raised CMR-derived mRAP is predictive of lower-limb oedema, heart failure hospitalisation and all-cause mortality
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