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Interventions to mitigate the risks of COVID-19 for people experiencing homelessness and their effectiveness:a systematic review
Get PDFOBJECTIVES: People experiencing homelessness also experience poorer clinical outcomes of COVID-19. Various interventions were implemented for people experiencing homelessness in 2020-2022 in different countries in response to varied national guidance to limit the impact of COVID-19. It is important to understand what was done and the effectiveness of such interventions. This systematic review aims to describe interventions to mitigate the risks of COVID-19 in people experiencing homelessness and their effectiveness.METHODS: A protocol was developed and registered in PROSPERO. Nine databases were searched for studies on interventions to mitigate the impact of COVID-19 on people experiencing homelessness. Included studies were summarised with narrative synthesis.RESULTS: From 8,233 references retrieved from the database searches and handsearching, 15 were included. There was a variety of interventions, including early identification of potential COVID-19 infections, provision of isolation space, healthcare support, and urgent provision of housing regardless of COVID-19 infection.CONCLUSION: The strategies identified were generally found to be effective, feasible, and transferable. This review must be interpreted with caution due to the low volume of eligible studies and the low quality of the evidence available.</p
Implementation of Oxygen Enhanced Magnetic Resonance Imaging (OE-MRI) and a Pilot Genomic Study of Hypoxia in Bladder Cancer Xenografts
Get PDFBACKGROUND/AIM: Patients with hypoxic bladder cancer benefit from hypoxia modification added to radiotherapy, but no biomarkers exist to identify patients with hypoxic tumours. We, herein, aimed to implement oxygen-enhanced MRI (OE-MRI) in xenografts derived from muscle-invasive bladder cancer (MIBC) for future hypoxia biomarker discovery work; and generate gene expression data for future biomarker discovery.MATERIALS AND METHODS: The flanks of female CD-1 nude mice inoculated with HT1376 MIBC cells. Mice with small (300 mm 3) or large (700 mm 3) tumours were imaged, breathing air then 100% O 2, 1 h post injection with pimonidazole in an Agilant 7T 16cm bore magnet interfaced to a Bruker Avance III console with a T2-TurboRARE sequence using a dynamic MPRAGE acquisition. Dynamic Spoiled Gradient Recalled Echo images were acquired for 5 min, with 0.1mmol/kg Gd-DOTA (Dotarem, Guerbet, UK) injected after 60 s (1 ml/min). Voxel size and field of view of dynamic contrast enhanced (DCE)-MRI and OE-MRI scans were matched. The voxels considered as perfused with significant post-contrast enhancement (p<0.05) in DCE-MRI scans and tissue were further split into pOxyE (normoxic) and pOxyR (hypoxic) regions. Tumours harvested in liquid N 2, sectioned, RNA was extracted and transcriptomes analysed using Clariom S microarrays. RESULTS: Imaged hypoxic regions were greater in the larger versus smaller tumour. Expression of known hypoxia-inducible genes and a 24 gene bladder cancer hypoxia score were higher in pimonidazole-high versus -low regions: CA9 (p=0.012) and SLC2A1 (p=0.012) demonstrating expected transcriptomic behaviour.CONCLUSION: OE-MRI was successfully implemented in MIBC-derived xenografts. Transcriptomic data derived from hypoxic and non-hypoxic xenograft regions will be useful for future studies.</p
The amphibians and reptiles of Cusuco National Park, Northwest Honduras: updates from a long-term conservation programme
Get PDFMesoamerican cloud forests support a rich and unique biodiversity but face severe threats from increasing habitat degradation and climate change. Here, we present an updated overview of the amphibians and reptiles of Cusuco National Park (CNP), an isolated cloud forest in the Sierra de Omoa, Northwest Honduras. Based on surveys conducted over a 17-year period, we report the presence of 105 confirmed species of amphibians (30) and reptiles (75) within the reserve. This includes numerous threatened and regionally endemic amphibian species, as well as several reptile species previously unrecorded within the park. Given that it harbours approximately 26% of all recorded Honduran herpetofauna, our study highlights CNP as the most diverse forest region in Honduras with respect to the reptile and amphibian diversity documented to date. Our findings reinforce the plea to actively protect CNP as a globally valuable biodiversity hotspot and a centre of herpetofaunal endemicity. Furthermore, in the face of rapid deforestation across Mesoamerica, our findings highlight the need for expanded biodiversity studies across extant forest regions in Honduras to refine species distribution ranges and facilitate timely and effective conservation measures
Rational inattention: A new theory of neurodivergent information seeking
Get PDFAbstractThis paper presents rational inattention as a new, transdiagnostic theory of information seeking in neurodevelopmental conditions that have uneven cognitive and socio‐emotional profiles, including developmental language disorder (DLD), dyslexia, dyscalculia and autism. Rational inattention holds that the optimal solution to minimizing epistemic uncertainty is to avoid imprecise information sources. The key theoretical contribution of this report is to endogenize imprecision, making it a function of the primary neurocognitive difficulties that have been invoked to explain neurodivergent phenotypes, including deficits in auditory perception, working memory, procedural learning and the social brain network. We argue that disengagement with information sources with low endogenous precision (e.g. speech in DLD, orthography‐phonology mappings in dyslexia, numeric stimuli in dyscalculia and social signals in autism) constitutes resource‐rational behaviour. We demonstrate the strength of this account in a series of computational simulations. In experiment 1, we simulate information seeking in artificial agents mimicking an array of neurodivergent phenotypes, which optimally explore a complex learning environment containing speech, text, numeric stimuli and social cues. In experiment 2, we simulate optimal information seeking in a cross‐modal dual‐task paradigm and qualitatively replicate empirical data from children with and without DLD. Across experiments, simulated agents’ only aim was to maximally reduce epistemic uncertainty, with no difference in reward across information sources. We show that rational inattention emerges naturally in specific neurodivergent phenotypes as a function of low endogenous precision. For instance, an agent mimicking the DLD phenotype disengages with speech (and preferentially engages with alternative precise information sources) because endogenous imprecision renders speech not conducive to information gain. Because engagement is necessary for learning, simulation demonstrates how optimal information seeking may paradoxically contribute negatively to an already delayed learning trajectory in neurodivergent children.Research Highlights We present the first comprehensive theory of information seeking in neurodivergent children to date, centred on the notion of rational inattention. We demonstrate the strength of this account in a series of computational simulations involving artificial agents mimicking specific neurodivergent phenotypes that optimally explore a complex learning environment containing speech, text, numeric stimuli, and social cues. We show how optimal information seeking may, paradoxically, contribute negatively to an already delayed learning trajectory in neurodivergent children. This report advances our understanding of the factors shaping short‐term decision making and long‐term learning in neurodivergent children
The Contribution of Difficulty of an Irrelevant Task to Task Conflict
Get PDFIn the standard color-word Stroop task, participants are presented with color words and required to respond to their color while ignoring their meaning. Two types of conflict might occur in such experiments: information conflict and task conflict. Information conflict reflects the processing of two contradicting pieces of information and is indicated by shorter reaction times (RTs) in congruent compared to incongruent trials. Task conflict reflects the additional effort associated with performing two tasks, as opposed to one, and is indicated by shorter RTs in neutral trials compared to congruent trials (termed reverse facilitation). While information conflict is commonly seen in Stroop-like tasks, task conflict is rarely observed. In the present study, participants were presented with colored segments that, by applying Gestalt principles, could be perceived as color words. We found that incongruent trials were slower than congruent trials, suggesting that participants successfully perceived the color words, which led to involuntary reading. In addition, reversed facilitation was found so that neutral trials (i.e., trials that only consist of one task) were faster than congruent trials (as well as incongruent trials; both consist of two tasks). The presence of both interference from the incongruent trials and reverse facilitation suggests that involuntary reading could also occur in scenarios requiring cognitive effort
Improving well-being and reducing deforestation in Indonesia's protected areas
Get PDFAbstractProtected areas (PAs) are central to sustainability targets, yet few evaluations explore outcomes for both conservation and development, or the trade‐offs involved. We applied counterfactual analyses to assess the extent to which PAs maintained forest cover and influenced well‐being across >31,000 villages in Sumatra and Kalimantan, Indonesia. We examined multidimensional aspects of well‐being, tracking education, health, living standards, infrastructure, environment, and social cohesion in treatment and control villages between 2005 and 2018. Overall, PAs were effective at maintaining forest cover compared to matched controls and were not detrimental to well‐being. However, impacts were highly heterogeneous, varying by island and strictness of protection. While health, living standards, and infrastructure aspects of well‐being improved, education access, environmental conditions, and social cohesion declined. Our analysis reveals the contexts through which individual PAs succeed or fail in delivering multiple benefits and provides insights into where further on‐ground support is needed to achieve conservation and development objectives
Mechanisms underpinning sympathoexcitation in hypoxia
Get PDFSympathoexcitation is a hallmark of hypoxic exposure, occurring acutely, as well as persisting in acclimatised lowland populations and with generational exposure in highland native populations of the Andean and Tibetan plateaus. The mechanisms mediating altitude sympathoexcitation are multifactorial, involving alterations in both peripheral autonomic reflexes and central neural pathways, and are dependent on the duration of exposure. Initially, hypoxia-induced sympathoexcitation appears to be an adaptive response, primarily mediated by regulatory reflex mechanisms concerned with preserving systemic and cerebral tissue O delivery and maintaining arterial blood pressure. However, as exposure continues, sympathoexcitation is further augmented above that observed with acute exposure, despite acclimatisation processes that restore arterial oxygen content ( ). Under these conditions, sympathoexcitation may become maladaptive, giving rise to reduced vascular reactivity and mildly elevated blood pressure. Importantly, current evidence indicates the peripheral chemoreflex does not play a significant role in the augmentation of sympathoexcitation during altitude acclimatisation, although methodological limitations may underestimate its true contribution. Instead, processes that provide no obvious survival benefit in hypoxia appear to contribute, including elevated pulmonary arterial pressure. Nocturnal periodic breathing is also a potential mechanism contributing to altitude sympathoexcitation, although experimental studies are required. Despite recent advancements within the field, several areas remain unexplored, including the mechanisms responsible for the apparent normalisation of muscle sympathetic nerve activity during intermediate hypoxic exposures, the mechanisms accounting for persistent sympathoexcitation following descent from altitude and consideration of whether there are sex-based differences in sympathetic regulation at altitude. [Abstract copyright: © 2024 The Authors. The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.
Service users' preferences and feasibility – which alternative care pathway for adult ambulance users achieves the optimal balance? Workshops for the COLLABORATE project
Get PDFAdults presenting to the ambulance service for diagnosed epilepsy are often transported to emergency departments (EDs) despite no clinical need. An alternative care pathway (CP) could allow paramedics to divert them from ED and instigate ambulatory care improvements. To identify the most promising CP configuration for subsequent testing, the COLLABORATE project surveyed people with epilepsy and family/friends who had recently used the English ambulance service to elicit preferences for 288 CP configurations for different seizures. This allowed CPs to be ranked according to alignment with service users' preferences. However, as well as being acceptable to users, a CP must be feasible. We thus engaged with paramedics, epilepsy specialists and commissioners to identify the optimal configuration. Three Knowledge Exchange workshops completed. Participants considered COLLABORATE's evidence on service users' preferences for the different configurations. Nominal group techniques elicited views on the feasibility of users' preferences according to APEASE criteria. Workshop groups specified the configuration/s considered optimum. Qualitative data was analysed thematically. Utility to users of the specified CP configurations estimated using the COLLABORATE preference survey data. Twenty-seven participants found service users' preferences broadly feasible and outlined delivery recommendations. They identified enough commonality in preferences for different seizures to propose a single CP. Its configuration comprised: 1) patients staying where they were; 2) paramedics having access to medical records; 3) care episodes lastin
Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project
Get PDFTo identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Interlaboratory study of the operational stability of automated sorption balances.
Get PDFAutomated sorption balances are widely used for characterizing the interaction of water vapor with hygroscopic materials. These instruments provide an efficient way to collect sorption isotherm data and kinetic data. A typical method for defining equilibrium after a step change in relative humidity (RH) is using a particular threshold value for the rate of change in mass with time. Recent studies indicate that commonly used threshold values yield substantial errors and that further measurements are needed at extended hold times as a basis to assess the accuracy of abbreviated equilibration criteria. However, the mass measurement accuracy at extended times depends on the operational stability of the instrument. Published data on the stability of automated sorption balances are rare. An interlaboratory study was undertaken to investigate equilibration criteria for automated sorption balances. This paper focuses on the mass, temperature, and RH stability and includes data from 25 laboratories throughout the world. An initial target for instrument mass stability was met on the first attempt in many cases, but several instruments were found to have unexpectedly large instabilities. The sources of these instabilities were investigated and greatly reduced. This paper highlights the importance of verifying operational mass stability of automated sorption balances, gives a method to perform stability checks, and provides guidance on identifying and correcting common sources of mass instability