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Implementation of the Cognitive Daisy (COG-D) for improving care planning and delivery for residents with dementia in care homes: results of a feasibility randomised controlled trial
Get PDFBackground: Many residents in care homes for older adults live with dementia. Understanding the unique profiles of cognitive impairments for each resident is important for person-centred care, yet information about specific cognitive problems is limited, and knowledge varies. This study explored the feasibility of implementing the Cognitive Daisy (COG-D) intervention, which provide a visual summary in the shape of a 15-petal flower derived from the scores on a neuropsychological assessment battery, in care homes for older adults. Methods: A parallel-group feasibility cluster randomised controlled trial (cRCT) was conducted over 24 months. Eight care homes were randomised in a 1:1 ratio to either usual care plus the Cognitive Daisy intervention (COG-D) or usual care (control). Care staff were trained on how to use Cognitive Daisies and/or on how to conduct the COG-D assessments with residents. Cognitive Daisies were displayed in residents’ rooms and included in care plans. COG-D assessments were repeated after 6 months. The primary objective was to explore areas of uncertainty for a future large-scale trial including recruitment rates and intervention implementation and adherence. Secondary objectives were to explore signals of effects in candidate outcome measures for residents and staff, obtained at baseline and 6- and 9-month post-randomisation. A process evaluation explored barriers and facilitators to intervention implementation through care-plan audits (to explore recommendations in response to COG-D assessments), interviews and focus groups with staff, residents and relatives. Results: Resident recruitment (n = 115) and staff recruitment (n = 99) in 8 care homes exceeded targets (100 and 50, respectively, in 8–10 care homes). Staff training was perceived positively with high completion rates (77.1% and 83.3% for basic and advanced training, respectively). Completion rates were also high for COG-D assessments (75.5% for assessment 1, and 72.5% of these residents completed assessment 2), and COG-D scores remained stable across the two assessment points. No clear signals of effects were found for candidate outcome measures. Number of recommendations in care plans varied across care homes, and interviews/focus groups highlighted several barriers to staff’s use of the Cognitive Daisies in daily practice. Conclusion: Findings indicate trial delivery was feasible. However, the COG-D requires modification if it is to be feasibly implemented in care home settings. Trial registration: This trial was registered on (date) (ISRCTN15208844)
Behaviours of pyroclastic and analogue materials, in dry and wet environments, for use in experimental modelling of pyroclastic density currents
Get PDFModelling pyroclastic density currents (PDCs) is a challenging yet essential element of hazard assessment. PDCs are unpredictable and internal processes are often difficult to measure directly. Analogue experiments have been an important tool for investigating internal PDC dynamics. Typically, analogue experiments have removed moisture from experimental materials to limit cohesion. However, this does not represent natural systems well, where moisture can be introduced into a PDC through a variety of processes. In this study, we characterise pyroclastic and analogue materials in dynamic (i.e. flowing), static (i.e. stationary), wet and dry experiments to explore fundamental frictional and fluidisation behaviours. The addition of moisture can lead to changes in material properties resulting in significant impacts on geomechanical behaviours (size, density, shear strength), fluidisation and flowability. This work highlights the importance of validating the material choice used in modelling experiments, especially in wet conditions
Cryogenic Separation Techniques for Hydrogen Recovery
No full textThis chapter examines the diverse range of cryogenic techniques employed in hydrogen recovery from gas mixtures. It also provides a comprehensive analysis of process design schemes, highlighting the configurations that have gained widespread adoption in commercial applications. Although its progress has been relatively slow, the field of cryogenic hydrogen recovery is witnessing active research efforts aimed at reducing its high energy demand by enhancing refrigeration efficiency and integrating cryogenic methods with other hydrogen recovery technologies
The Elgar Encyclopedia of Food and Society
No full textFeaturing over 120 entries from international experts, this Encyclopedia provides a comprehensive overview of the activities, ideas, issues and challenges that shape relationships between food systems and society. Each entry includes an accessible and informative introduction to its topic, along with specific examples, recommended further reading and references to other sources
Azithromycin and oesophageal motility in chronic respiratory disease: a feasibility study
Get PDFBACKGROUND: The role of the gut-lung axis in respiratory disease is increasingly recognised. Much emphasis has been placed on gastro-oesophageal reflux disease; however, oesophageal dysmotility may also play a significant role. Azithromycin, a known prokinetic, has been shown to be of major benefit in a number of respiratory diseases, but the relationship between oesophageal function and the lung has not been examined. OBJECTIVES: We assessed the feasibility of performing continuous cough monitoring and repeated high-resolution oesophageal manometry (HROM) in patients with chronic respiratory disease. DESIGN: We conducted an open-label, single-arm, feasibility trial. METHODS: Azithromycin 250 mg once daily was given to patients with chronic respiratory disease who reported a chronic cough. All participants were monitored continually for at least 1 week prior to and 4 weeks after azithromycin with the Hyfe Cough Tracker. Participants also had HROM performed at two time-points, immediately before and 4 weeks after initiation of azithromycin. Feasibility outcomes pertaining to recruitment, data quality, and acceptability of trial processes were assessed. Exploratory outcome data for metrics of oesophageal function were also analysed. RESULTS: A total of 30 participants (57% female, mean age 65.2 (SD = 11.3)) were recruited over a 10-month period, giving a recruitment rate of three patients per month in a single centre. A total of 87% (n = 26) of participants completed all three study visits. All pre-specified data quality outcomes met their 'green' traffic light stop-go criteria. HROM demonstrated that the majority (52%) of participants had abnormal oesophageal function, as defined by the Chicago Classification, at baseline. Changes in oesophageal function were not significantly associated with changes in objective or subjective cough measures, except for a weakly negative correlation with the Hull Airway Reflux Questionnaire score. CONCLUSION: A large-scale trial examining the effect of azithromycin on the relationship between oesophageal function and cough in respiratory disease is feasible and acceptable to patients. TRIAL REGISTRATION: This trial was prospectively registered ClinicalTrials.gov ID: NCT05469555
Social context prevents heat hormetic effects against mutagens during fish development
Get PDFSince stress can be transmitted to congeners via social metabolites, it is paramount to understand how the social context of abiotic stress influences aquatic organisms' responses to global changes. Here, we integrated the transcriptomic and phenotypic responses of zebrafish embryos to a UV damage/repair assay following scenarios of heat stress, its social context and their combination. Heat stress preceding UV exposure had a hormetic effect through the cellular stress response and DNA repair, rescuing and/or protecting embryos from UV damage. However, experiencing heat stress within a social context negated this molecular hormetic effect and lowered larval fitness. We discuss the molecular basis of interindividual chemical transmission within animal groups as another layer of complexity to organisms' responses to environmental stressors
Can Passive Cough Monitoring Predict COPD Exacerbations?
Get PDFPurpose: Validation of an alert mechanism for COPD exacerbations based on coughing detected by a stationary unobtrusive nighttime monitor. Methods: This prospective double-blind longitudinal study of cough monitoring included 40 chronic obstructive pulmonary disease (COPD) patients. Participants underwent cough monitoring and completed a daily questionnaire for 12 weeks. If no exacerbation occurred within that period patients were asked to continue being monitored for a further 12 weeks. The automated system identified deteriorating trends in cough based on a personalized cough classifier and the alerts were compared with patient reported exacerbation onsets. Results: Thirty-eight patients [median age 72 (range 57–84)], median FEV-1% predicted 43% (range 20–106%) completed the study and had 41 exacerbations over a total of 3981 days. For 32 patients, the cough monitor data allowed classifier personalization, trend analysis, and alert generation. Based on the trend data, it is estimated that ∼30% of exacerbations are not associated with an increase in cough. The alert mechanism flagged 59% of the exacerbations. For the cases with alerts preceding the onset, the associated lead time was 4 days or more. Conclusion: Though based on a single variable only, the cough-based alert system captured more than half of the exacerbations in a passive, free-living scenario. No adherence issues were reported, and patients confirmed the unobtrusive and hassle-free nature of the approach
Azithromycin, Oesophageal Function, and Cough in Chronic Respiratory Disease
Get PDFChronic cough is a disabling feature of many chronic respiratory diseases and is now recognised as a distinct disease. Despite being amongst the commonest causes for healthcare contact, there are no licenced treatments for chronic cough in the UK. The role of the gut-lung axis in respiratory disease is increasingly recognised. However, much of the current research has been centred around gastro-oesophageal reflux disease, with little research on the potential co-existence of oesophageal dysfunction in chronic respiratory conditions. The macrolide antibiotic azithromycin is used to prevent exacerbations in various respiratory diseases; however, its mechanism of action remains unclear. It is known that azithromycin improves gastrointestinal motility through agonism of motilin receptors. We hypothesise that this mechanism may contribute to the beneficial effects of azithromycin.In this thesis we aimed to explore different elements of this hypothesis through multiple methodologies. First, we establish the prevalence of oesophageal dysmotility in respiratory disease through a retrospective analysis of high-resolution oesophageal manometry (HROM) studies in patients with persistent respiratory symptoms. We then perform a systematic review and meta-analysis to examine the effect of azithromycin on objective and subjective measures of cough in patients with chronic respiratory disease. Using the established methodology of a feasibility study, we evaluate the practicability of performing repeated HROM measures and continuous cough monitoring in patients with chronic respiratory disease. Finally, we perform an exploratory analysis of the effect of azithromycin on continuously recorded objective cough frequency using both traditional and novel methods of cough analysis.We have addressed multiple aspects of our hypothesis with the studies conducted in this thesis. We have highlighted the high prevalence of oesophageal dysmotility in those with chronic cough and shown that azithromycin has shown early promise as a potential antitussive agent. Moreover, we demonstrate that using both HROM and continuous cough monitoring is feasible and acceptable to patients. This study provides rationale for a large-scale, randomised controlled trial using mixed methodologies to investigate azithromycin's potential as a treatment for chronic cough
Navigating Student Incivility and the Role of Zero Tolerance Policies in Higher Education Institutes
No full textSedimentary environment controls on critical metals enrichment in late Permian coal measures in western Guizhou, China
Get PDFCritical metals are, as the name suggests, critical to modern society and understanding how and where they form is essential for targeted exploration for new resources. In the late Permian, the input of alkaline volcanic ash from the Emeishan Large Igneous Province (ELIP) led to the formation of multiple Nb–Zr–REY (rare earth elements and Y)–Ga-enriched coal seams (called metalliferous coals) within the coal measures (middle-lower Longtan Formation) in western Guizhou, which exhibiting exceptionally high natural gamma-ray log (GR) positive anomalies. Ore beds are characterized by GR values > 2.0 pA/kg in rock layers and > 1.6 pA/kg in adjacent coal seams. The sedimentary environment of deposition controls both the formation of ore beds and the enrichment of critical metals within them. Ore beds are distributed across four facies: floodplain paleosols, freshwater peat mires, marine-influenced peat mires, and lagoons, with four corresponding lithological associations: tonstein–coal, paleosol–coal, coal, and carbonaceous mudstone. The highest concentrations of critical metals are found in tonstein–coals that formed in marine–influenced peat mire environments. Leaching by acid rain and meteoric water, adsorption effects of peat and clay minerals, the presence of acidic and reducing environments, seawater incursion, and the effects of plant growth all play a role in enhancing critical metals enrichment. The coal ash from metalliferous coals contains average concentrations of Nb, Zr, REY, and Ga of 813.80 μg/g, 5,178.58 μg/g, 1,255.21 μg/g, and 117.01 μg/g, respectively. The number of minable seams is one or two, with an average thickness of 1.98 m. The critical metals reserves in minable metalliferous coal ash are estimated at 7.81 × 105 t (Nb), 4.97 × 106 t (Zr), 1.21 × 106 t (REY), and 1.12 × 105 t (Ga). However, the coal ash is enriched not only with critical metals but also with elements harmful to health such as Pb, Cr, Th, and U, along with abundant nano–scale quartz particles, posing substantial threats to human health. Our findings represent a valuable contribution to exploration for critical metals in sedimentary successions and furthermore demonstrate potential for efficient and clean utilization of coal ash as a metal resource in an increasingly circular economy