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Protocol for a meta-review of interventions to prevent and manage ICU delirium
Get PDFIntroduction
Intensive care unit (ICU) delirium is an acute brain dysfunction that affects up to 7 out of 10 patients admitted to ICUs. Patients who develop ICU delirium cannot think clearly, have trouble paying attention, do not understand what is happening around them and may see or hear things that are not there. ICU delirium increases the time patients spend in ICUs and hospitals and therefore healthcare costs. ICU delirium is also associated with increased mortality and dementia in the longer term. ICU delirium prevention and management strategies are likely to include both pharmacological and non-pharmacological components as part of a complex intervention, but it is unclear which components should be included. The objective of this meta-review is to systematically map the quantity and certainty of the available evidence from reviews and meta-analyses of randomised controlled trials (RCTs) of pharmacological and non-pharmacological interventions, which will be used to design a multicomponent intervention to prevent and manage ICU delirium.
Methods and analysis
A systematic search strategy was performed in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and Web of Science (from inception to 26 September 2023), as well as Epistemonikos (from inception to 19 July 2023). We will include all critically ill adults (aged≥18 years) and any ICU delirium prevention or management intervention (pharmacological or non-pharmacological). For pharmacological interventions, we will include reviews of RCTs. For non-pharmacological interventions, we will consider reviews of RCTs, quasi-experimental and cohort studies. We will use the International Consensus Study (Del-COrS) core outcome set for research evaluating interventions to prevent or manage ICU delirium and synthesise our findings using quantitative data description methods. We will involve our Patient and Public Involvement group of people who experienced ICU delirium to develop and comment on such aspects as the research question, methodology and which outcomes are most important.
Ethics and dissemination
No ethical approval is required for this study. The results of this meta-review will be disseminated through peer-reviewed publications and conferences. They will also form part of an evidence map and logic model for the prevention and management of ICU delirium.
PROSPERO registration number
CRD4202347326
Preparing for the worst: the irrationality of emotionally recalcitrant reasoning
Get PDFThe question of what exactly is irrational about recalcitrant emotions—those that occur in tension or conflict with our beliefs—has been widely debated. Sabine Döring claims that such irrationality only emerges if we act on our recalcitrant emotion or engage in emotion-relevant reasoning in light of it. I here provide an account that acts as an extension to the latter part of this claim by considering in more depth the question of what is irrational about that reasoning, i.e., emotionally recalcitrant reasoning. In doing so, I offer a somewhat alternative explanation to Döring's as to the form of irrationality involved. Where Döring argues that emotionally recalcitrant reasoning involves epistemic irrationality by way of conflicting judgments that are involved, I argue that our engagement in this reasoning is, in fact, practically irrational. This is because, I claim, it involves us “accepting”—treating as true—propositions that we do not believe to be true, in the absence of the kind of reasons that would usually rationalize doing so. Doing so constitutes a form of practical, rather than epistemic, irrationality. This is a conclusion I arrive at through a consideration of the nature of the reasoning our emotions in general tend to motivate
Wolf reintroduction to Scotland could support substantial native woodland expansion and associated carbon sequestration
Get PDF1. Large carnivores, including the grey wolf (Canis lupus), play an important role in the carbon cycle through modifying the behaviour and population of wild herbivores. Large carnivores have been eradicated from much of their former range and are now absent from the UK, contributing to increased herbivore populations, which can prevent natural regeneration of trees and woodland. A reintroduction of wolves to the UK could reduce deer populations and associated browsing of tree saplings, but the potential impacts on woodland expansion and carbon sequestration have not been assessed.
2. Here we estimate the impact of a wolf reintroduction in the Scottish Highlands on red deer populations, native woodland colonisation and carbon sequestration. We use a Markov predator–prey model to estimate that a reintroduction would lead to a population of 167 ± 23 wolves, sufficient to reduce red deer populations below 4 deer km−2, the threshold at which we assume browsing to be sufficiently suppressed to enable natural colonisation of trees.
3. Using a model of potential new native woodlands we estimate the subsequent expansion of native woodland would result in an average annual carbon sequestration of 1.0 ± 0.1 Mt CO2, with each wolf contributing an annual carbon sequestration of 6080 t CO2.
4. Practical Implication. Our analysis demonstrates the ecosystem benefit that wolves can provide through control of red deer numbers, leading to native woodland expansion. Large-scale expansion of woodlands, facilitated through the return of wolves, can contribute to national climate targets and could provide potential economic benefits to landowners and communities through carbon finance
Inclusive Futures: Harnessing Virtual Reality for Dementia Care
Get PDFDementia care, on both national and global scales, faces mounting pressures as incidence increases, effective treatments remain elusive, and existing support systems struggle to provide personalised, enriching experiences for those in moderate-to-advanced stages of the condition. Simultaneously, virtual reality (VR) technology has advanced rapidly in both capability and accessibility, offering potentially new ways to deliver immersive experiences to spark reminiscence, social connection, and improve emotional wellbeing. In this report, we explore how these two trajectories—heightened demand for person-centred dementia care and the maturation of immersive technologies—could converge to shape a more inclusive future for people living with dementia. Through four complementary streams of inquiry, we explore the depth and breadth of VR’s potential in dementia support. We report on two studies led by the Centre for Immersive Technologies: (i) surveying experts working in healthcare and/or with XR technologies; and (ii) a focus group with the underserved South Asian community. The results of this work show that interventions must reflect personal histories and linguistic preferences if they are to be truly meaningful. We highlight the results of a Yorkshire-based VR company, Recreo VR, who conducted a feasibility trial with 101 participants in community and care-home settings. Their personalised, low-flow 360° videos successfully engaged up to 97% of users, eliciting recollections of treasured life events and facilitating valuable conversations that might otherwise have remained dormant. Finally, a pilot project at Bradford District Care Trust demonstrated that even in the most challenging environment of inpatient wards, VR shows potential for reducing agitation, promoting calmness, and allowing patients who cannot leave the ward to access virtual nature or travel scenes. Collectively, these studies demonstrate the significant potential for VR interventions to be integrated into diverse care pathways, whether as reminiscence sessions in care homes, family-oriented activities in community centres, or therapeutic tools in acute hospital settings. They also underscore that a one-size-fits-all approach will not suffice: content must be culturally relevant, co-designed with people who have dementia, and supported by clear training and guidelines for caregivers. Larger-scale trials, rigorous evaluation of clinical outcomes, and engagement with policy makers will be critical in transforming these promising pilots into standard practice. By bridging empathy, technological innovation, and cultural awareness, VR may be able to offer deeply personal, uplifting moments for people with dementia, pointing toward a future where immersive care is as inclusive as it is transformative
Speaker embedding informed audiovisual active speaker detection for egocentric recordings
Get PDFAudiovisual active speaker detection (ASD) addresses the task of determining the speech activity of a candidate speaker given acoustic and visual data. Typically, systems model the temporal correspondence of audiovisual cues, such as the synchronisation between speech and lip movement. Recent work has explored extending this paradigm by additionally leveraging speaker embeddings extracted from candidate speaker reference speech. This paper proposes the speaker comparison auxiliary network (SCAN) which uses speaker-specific information from both reference speech and the candidate audio signal to disambiguate challenging scenes when the visual signal is unresolvable. Furthermore, an improved method for enrolling face-speaker libraries is developed, which implements a self-supervised approach to video-based face recognition. Fitting with the recent proliferation of wearable devices, this work focuses on improving speaker-embedding-informed ASD in the context of egocentric recordings, which can be characterised by acoustic noise and highly dynamic scenes. SCAN is implemented with two well-established baselines, namely TalkNet and Light-ASD; yielding a relative improvement in mAP of 14.5% and 10.3% on the Ego4D benchmark, respectively
The Sedative and Haemodynamic effects Of Continuous Ketamine infusions on Intensive Care Unit patients (SHOCK-ICU): Investigating key outcomes, resource utilisation and staff decision-making: Clinical feasibility study protocol
No full textBackground:
Between April 2022 and March 2023, 43.8% (88,259) patients admitted to Intensive Care Units (ICU) in the United Kingdom (UK) required breathing support through a ventilator, the majority require sedation. Unfortunately, mechanical ventilation is associated with high mortality and morbidity, and sedative agents currently used have significant side effects including hypotension and delirium. They are also implicated in long-term psychological sequelae such as major depression and posttraumatic stress disorder. Ketamine has been utilised in anaesthesia for over 50 years and has an excellent safety profile. The diverse properties of ketamine are the focus of much research currently, including its properties as a potent antidepressant. Ketamine has not been fully investigated in the context of ICU, and there are gaps in the evidence that warrant further investigation through a large randomised controlled trial. Preparatory work for such a study includes refining study designs, identifying key clinical and patient centred outcomes and exploring barriers to implementation, which is the focus of this work.
Methods:
SHOCK-ICU is a single centre, non-randomised, feasibility study assessing the feasibility of continuous ketamine infusions for the provision of sedation for 30 patients undergoing mechanical ventilation on the ICU.
Data will be collected at baseline, daily until >48 h without mechanical ventilation, ICU discharge, and 90-days from enrolment. Data collection will include trial aspects such as expected recruitment, refusal, and follow-up rates, ability to collect data, and exploratory assessment of clinical efficacy markers.
Primary outcome:
The primary outcome is study feasibility; this will be assessed using pre-defined progression criteria that will aid design of future ketamine sedation studies
Kinetics of the Reaction Between the Criegee Intermediate CH2OO and NO2: Experimental Measurements and Comparison with Theory
Get PDFKinetics of the gas phase reaction between the stabilized Criegee intermediate formaldehyde oxide (CH2OO) and nitrogen dioxide (NO2) have been measured using laser flash photolysis of CH2I2/O2/N2/NO2 mixtures coupled with time-resolved broadband ultraviolet absorption spectroscopy. Experiments were performed in N2 under pseudo-first-order conditions at temperatures between 242 and 353 K and pressures in the range 25 to 300 Torr. The kinetics of CH2OO + NO2 are independent of pressure, with a mean rate coefficient of k1 = (1.24 ± 0.22) × 10-12 cm3 s-1 at 298 K, where the uncertainty represents a combination of the 1σ statistical error and the systematic errors resulting from uncertainties in gas flow rates and in the concentration of NO2. Measurements indicate upper limits of <5% for production of NO3 and <5% for production of NO, and further studies of product yields are warranted. In contrast to expectations from theory, the kinetics of CH2OO + NO2 display a negative temperature dependence that can be described by k1 = (1.07 ± 0.02) × 10-12 × (T/298)-(2.9±0.2) cm3 s-1. Analysis using the Master Equation Solver for Multi-Energy well Reactions is able to reproduce a negative temperature dependence for the reaction if significant changes to barrier heights are made, but the overall agreement between the experiment and theory remains poor. This work highlights the challenges associated with calculations for systems with significant multi-reference character
Media publiczne w erze streamingu: Praktyki wydawnicze w przestrzeni cyfrowej
Get PDFMedia publiczne podlegają nieustannie zmianom kulturowym i technologicznym. W ostatnich latach stanęły jednak przed zupełnie nowymi zadaniami, wynikającymi szczególnie z procesu transformacji cyfrowej tradycyjnych nadawców (Public Broadcasting Service, PBS) w platformy multimedialne (Public Service Media, PSM). Radykalne zmiany w sposobie korzystania z mediów i personalizacja, będące skutkiem pojawienie się mediów strumieniowych i streamingu, a w szerszym kontekście dominacji na rynku globalnych firm technologicznych (Big Tech) – są wyzwaniem dla mediów publicznych zarówno jako instytucji konkurującej o dostęp do użytkowników (niegdyś zwanych odbiorcami), ale także jako usługi publicznej mającej na celu dotarcie do świadomych i dobrze poinformowanych obywateli. Wszystko to wpływa również na samych nadawców, obligując ich do przekształcenia się w cyfrowe organizacje, co z kolei narzuca konieczność przeprowadzenia zmian struktury i kultury organizacyjnej.
Mając na uwadze ten wielowymiarowy kontekst, przedstawiamy wyniki badań międzynarodowego projektu badawczego nt. „Public Service Media in the Age of Platforms (PSM-AP)”. W raporcie przedstawiamy szereg ustaleń i zaleceń dotyczących praktyk publikacji i personalizacji oferty mediów publicznych w oparciu o analizę wewnętrznych usług wideo na żądanie (VoD) i głównych kanałów linearnych. Wyniki badań dotyczą następujących rynków medialnych: Belgia (Flandria i Walonia), Dania, Kanada, Polska, Włochy i Wielka Brytania
New rites, local lives:Strontium isotope analysis of cremated human remains from the Late Iron Age cemetery at Westhampnett, West Sussex, UK
Get PDFSynthetic β-d-Glucuronides:Substrates for Exploring Glucuronide Degradation by Human Gut Bacteria
Get PDFThe human gut microbiota (HGM) is a complex ecosystem subtly dependent on the interplay between hundreds of bacterial species and numerous metabolites. Dietary phenols, whether ingested (e.g., plant-derived guaiacol, mequinol, or resveratrol) or products of bacterial fermentation (e.g., p-cresol), have been attributed with influencing bacterial growth and host health. They are cleared by phase II metabolism, one form utilizing β-d-glucuronidation, but encounter bacterially derived glucuronidases capable of hydrolyzing them to release their phenolic and glucuronic acid moieties with potential effects on host cells or the surrounding bacterial population. Tools to enable the detailed study of their activity are currently lacking. Syntheses of β-d-glucuronides from methyl 1,2,3,4 tetra-acetyl β-d-glucopyranosyluronate by direct glycosylation with 2-, 3-, or 4-methoxy- and 4-fluorophenol acceptors employing trimethylsilyl triflate catalysis are reported. Yields (methoxy series) were modest. An improved route from methyl 1,2,3,4-tetra-acetyl β-d-glucopyranosyluronate via selective anomeric deprotection (N-methyl piperazine) and conversion to an α-trichloroacetimidate glycosyl donor was employed. Coupling with 2- and 3-methoxyphenol acceptors and deprotection provided 2- and 3-methoxyphenyl β-d-glucuronides in 2-fold improved overall yield. These naturally occurring methoxyphenyl glucuronides augment available model substrates of dietary glucuronides, which include 3- and 4'-linked resveratrol. The use of model glucuronides as substrates was illustrated in studies of β-d-glucuronidase activity employing cell lysates of 9 species of HGM (Bacteroidetes), revealing distinct outcomes. Contrasting effects on bacterial growth were also observed between the free phenolic components, their respective glucuronides, and glucuronic acid. The glucuronide of 4-fluorophenol provided sensitive and background-free detection of β-glucuronidase activity using 19F NMR
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