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Bereavement practices within older adult care homes in Scotland: a focus group study
Get PDFObjective: To describe how care home staff experience bereavement and their perspectives on providing bereavement care within care home settings.
Design: Qualitative descriptive study using focus groups analysed with the Framework Method.
Setting: Seven residential and nursing care homes for older adults in Scotland.
Participants: 37 care home staff were recruited through the Enabling Research In Care Homes (ENRICH) Scotland research network. Participants included registered nurses, care workers, senior care workers, managers and ancillary workers with experience of resident death and bereavement practice.
Results: Bereavement was woven through everyday care home life, understood as a tapestry of experiences, relationships and practices that involved staff, residents and their relatives. Three themes that connected to the tapestry metaphor were identified: Warps: structural threads grounding bereavement within the culture of homely living, where close bonds normalise death and dying, and pragmatic acceptance. Wefts: strengthening practices nurturing resilience, including relational trust, mutual support, rituals and follow-up with relatives. Moths: disruptions undermining bereavement practice include family secrecy, hospital deaths with withheld information, difficulty supporting residents with advanced dementia and dissatisfaction with online training.
Conclusions: Bereavement in care homes is collective, relational and embedded in routine practice. Organisational recognition of grief improved interservice communication. Tailored reflective support for staff is needed to sustain compassionate care. Further research should explore how residents experience repeated exposure to death and bereavement within communal living environments
Viscoelasticity drives EMT in pancreatic intraepithelial neoplasia
Get PDFPancreatic intraepithelial neoplasia (PanIN) is a precursor of pancreatic adenocarcinoma (PDAC) and therefore critical to understand for identifying early-stage diagnostic and therapeutic targets. During PanIN, epithelial-to-mesenchymal transition (EMT) of pancreatic epithelial cancer cells is a crucial event which promotes invasion and early dissemination of cells into circulation before the full development of PDAC tumours. Changes in tissue mechanics are apparent during progression from PanIN to PDAC and increased local and global elasticity has been mathematically modelled in PanIN tissue as a predictive tool for diagnostics and development of personalized therapies. Aside from elasticity, viscoelasticity is emerging as a key feature of cancer which affects tissue mechanics through a combination of elastic and viscous components. Viscoelasticity has recently been shown to drive mechanosensitive cell behaviour and is known to change dramatically in PDAC progression. Hydrogels, as water-swollen polymer networks, are effective extracellular matrix (ECM) models that can recapitulate the viscoelastic properties of natural tissue. Despite this, hydrogels developed for studying cell behaviour in PanIN use purely elastic materials or have neglected the viscous component. Here, using PDAC mouse models, we show that viscoelasticity dynamically alters between healthy and PanIN-bearing tissue and have decoupled the role of elasticity and viscosity during EMT of pancreatic epithelial cancer cells using two-dimensional (2D) polyacrylamide (PAAm) hydrogels. Our work shows viscosity is critical in driving phenotypic changes associated with EMT in a pancreatic epithelial cancer cell line. These findings identify viscosity as an integral component of cell mechanosensing as PanIN develops, which may contribute to initial metastatic events via dissemination from the developing primary tumour. This should be explored further to potentially reveal novel diagnostic and therapeutic targets
Public-private mix in health systems and repercussions for health inequalities in Latin American countries: A scoping review protocol
No full textIntroduction: Health system models in Latin American countries express differences in the state’s role in regulating, financing and providing health services, as well as in the coexistence of different care arrangements involving public and private entities. This scoping review will seek to identify evidence on how the different public-private configurations of health systems influence health inequalities in Latin America. Methods and analysis: This protocol will be guided by the scoping review methodology developed by the Joanna Briggs Institute. The results will be presented according to the PRISMA-ScR protocol. Searches will be carried out on the Scielo, Lilacs, Embase, Pubmed, Web of Science and Scopus databases. The inclusion criteria will be publications whose central theme is the public-private mix of health systems in Latin America between January 2000 and March 2024. Exclusion criteria will be clinical trials, incomplete studies or in the design phase, duplicate publications, pre-print studies and gray literature (interim reports, unpublished texts, dissertations, and theses. The steps for carrying out the scope review will: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results. Two independent reviewers will select the articles. The results will be described, analyzed, and categorized through narrative synthesis, correlating with the research objectives and questions. Expected results: It is hoped that this scoping protocol will provide a comprehensive framework for investigating the gaps in the current literature on the public-private mix in Latin America and the effects on health inequalities
Stokes and skyrmion tensors and their application to structured light
No full textWe replace the familiar Stokes vector by a tensor. This allows us to introduce, for example, polar-coordinate components of the Stokes vector. From the tensor, we can derive the skyrmion field for mapping the polarization in structured light beams. These ideas have wider application in optics and in electromagnetic theory. We illustrate this with an example from non-paraxial optics and for the Poynting vector
Reconstruction and ³⁶Cl based geochronology of the deglaciation of central Ireland
Get PDFThis paper presents geomorphological and geochronological evidence for ice sheet oscillations during the deglaciation of the last Irish Ice Sheet. Cosmogenic exposure age results (³⁶Cl ages; n = 18) demonstrate that the ice margin had retreated into central Ireland by c. 19 ka, with ice restricted to the uplands west of the River Shannon by c. 16.7 ka. These dates are consistent with dated ice margins on the east coast of Ireland. The geomorphological evidence points to streaming ice draining eastward within the Irish interior and a transition from streaming to surging ice dynamics during recession, as the ice sheet split into separate lobes. Up to four substantial, non-synchronous readvances of individual lobes over several kilometres are observed. These were in part caused by surging behaviour in the ice sheet, indicating the role of internal disequilibria in local to regional-scale advances. Despite the existence of an extensive proglacial ice-contact lake, Palaeolake Riada, which formed at the ice margin during retreat into the Shannon drainage basin, cosmogenic exposure age results demonstrate that water submersion did not affect surface exposure ages obtained from glacial boulders, indicating that the ice contact lake existed for too short a time span to have had an effect on boulder exposure ages. A key finding is that the ice retreat into central Ireland was earlier than in some parts of Britain, such as eastern Scotland, and highlights the complexity of the glacial record across Great Britain and Ireland
Extending a scalable satellite-based vegetation edge detection framework to diverse tropical coasts
Get PDFMonitoring vegetation edges in dynamic coastal zones is essential for understanding long-term shoreline change and supporting effective coastal management, particularly as climate change accelerates erosion, sea-level rise, and ecosystem shifts. This study provides the first validation of VedgeSat, an automated Vegetation Edge (VE) detection toolkit, in contrasting tropical coastal environments, with relevance for coastal monitoring worldwide. In Sumatra, Indonesia, fifteen sites were assessed, encompassing diverse vegetation and sediment types, a range of water clarity, and varying wave exposures in both open and sheltered coastal settings. Vegetation edge detection was conducted with high-resolution PlanetScope imagery and differential Global Positioning System (dGPS) field surveys. VedgeSat performed reliably in areas with dense vegetation, regardless of the type of vegetation or sediment, and water clarity achieving sub-pixel root mean square errors (RMSE) of less than 7 m, R2 values up to 0.89 and minimal positional bias. Performance declined in areas with sparse and patchy vegetation, such as pioneer mangroves and grasses in sandy environments, resulting in higher RMSE and reduced R2 values. A sensitivity analysis demonstrated that tuning the threshold of Normalized Difference Vegetation Index (NDVI) values can optimize edge detection across diverse vegetation types and environments. Overall, the results confirm the robustness of VedgeSat for scalable monitoring of vegetated coasts without retraining, while also identifying limitations in sparsely vegetated settings. This study provides the f irst benchmark for automated vegetation edge detection in tropical systems and demonstrates the potential of satellite-based approaches to enable large-scale, repeatable, and cost-effective coastal monitoring in data-scarce regions
Do we need exercise echocardiography to diagnose HFpEF? Not at all
No full textAttaining a robust diagnosis of heart failure with preserved ejection fraction (HFpEF) can often be complex. A hallmark of heart failure is an increase in left ventricular (LV) filling pressure, but this may be absent at rest. Exercise may provoke increases in filling pressure, but does this suffice to make a diagnosis of HFpEF and is exercise echocardiography a reliable tool for measuring pressures in this context? Given the diversity of views and opinions, and the relevance of the topic, we and others1 felt that presenting two contrasting perspectives on the role of exercise echocardiography in guiding management for patients with suspected HFpEF was timely and necessary to stimulate further debate and guide research
A Type 2 Diabetes Policy Model that predicts remaining life expectancy, quality adjusted life expectancy and healthcare costs for use in economic evaluation, incorporating equity concerns
Get PDFAims:
To illustrate a T2DM policy model incorporating socio-economic status.
Materials and Methods:
Using the Scottish Diabetes Research Network (SDRN) national diabetes cohort, we identified individuals newly diagnosed with T2DM between 1 January 2004 and 31 December 2020 and followed from diagnosis until death or end of follow-up. Covariates included sex, Scottish Index of Multiple Deprivation (SIMD) quintiles, ethnicity, HbA1c, systolic blood pressure (SBP), eGFR, total cholesterol, high-density lipoprotein, BMI, smoking status and cardiovascular disease history. Remaining life expectancy was modelled using Gompertz regression, stratified by sex and SIMD. Probabilities of complications were estimated using repeated measure logistic regression, and healthcare costs were modelled using repeated measure linear regression. A parameterised Kaplan–Meier sample-average estimator was used to obtain life expectancy, quality-adjusted life years (QALYs) and costs.
Results:
We identified 269 759 people newly diagnosed with T2DM. The mean age at diagnosis was 63 years, 56% were male and 24% lived in the most deprived areas. Total follow-up was 2 090 108 patient-years (median 7 years per patient). Approximately one in four patients died during follow-up. The most common T2DM-related complications were coronary heart disease and heart failure. For a man diagnosed at age 50 in the most deprived quintile, with all other covariates at average values, the model predicted a remaining life expectancy of 26.7 years, 21.1 QALYs and healthcare costs of £273 k (undiscounted). For the same profile, the incremental cost-effectiveness ratio for a hypothetical intervention reducing HbA1c by 1% was £7832 per QALY.
Conclusions:
We developed a T2DM policy model incorporating socio-economic deprivation, providing estimates of life expectancy, QALYs and healthcare costs to inform health technology assessment
Over-the-Air Magnitude-Based RF Gesture Recognition Using a Single Printed, Stretchable Antenna-Sensor
No full textThis paper presents a novel over-the-air (OTA) gesture recognition system using a single antenna, 3D-printed using liquid metals infills, and utilizing magnitude-only RF transmission data, unlike previous approaches that rely on phase or complex-valued data. The antenna is fabricated via stereolithographic additive manufacturing with liquid metal microchannels, enabling a wearable and deformable sensing platform. Gestureinduced variations in antenna gain are detected in the farfield through received power measurements, eliminating the need for multiple antennas or phase calibration. The antenna's |S21| response was measured at -45 dB at 3.64 m and a frequency bandwidth in the MHz range, with gesture capture performed using a vector network analyzer (VNA) over a bandwidth of 150−300MHz. A dataset of 10 British Sign Language gestures was collected at a distance exceeding 3.5 m and classified using machine learning (ML) techniques. The results show a high accuracy of 92%, validating magnitude-based OTA sensing relying on uncalibrated S-parameter magnitude
The promise of building a distinct AI ecosystem
No full textIndia is democratising hardware access. But it needs to overcome chip geopolitics, power costs and data security issue
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