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Responsible and adaptive robots in care home settings: an implementation framework analysis of a workshop with public and professionals
Get PDFAs populations grow, research looks to emerging adaptive technologies for the urgent challenge in providing suitable care for older adults. Drawing on implementation science, we conducted a holistic examination looking at broader, contextual factors relating to the acceptability of robotics and sensor technologies in care homes. We held a workshop that brought together members of the public and researchers with experience in care home, to try such technologies and discuss their application in different care home scenarios. Using the NASSS framework, we examine acceptability through the angles of technology, condition, adopters, value proposition, organisation, wider context, and sustainability. While both groups of participants share concerns about the negative impacts of robotics on the quality of care, we also uncovered additional areas of further consideration relating to tensions between stakeholders and constraints around material resources, culture, processes and regulatory considerations
Enhancing care coordination for neurofibromatosis type 1 in primary care: insights and applications for rare diseases
Get PDFPatients with rare diseases often encounter significant challenges, including poor coordination of healthcare services. The UK Rare Disease Framework emphasizes key priorities such as faster diagnoses, greater awareness among healthcare professionals, improved care coordination, and better access to specialist care. This National Health Service (NHS) project, based in the North East and Yorkshire Genomic Medicine Service (GMS), aimed to improve care coordination for patients with rare genetic diseases in primary care. The project focused on developing a generic clinical pathway to improve care coordination and transitions of care that could be applied to a range of rare diseases. Additionally, it sought to strengthen the integration between genomic services and primary care, fostering a more cohesive approach to patient management. The project mapped clinical care pathways for two exemplar rare genetic diseases, Achondroplasia and Neurofibromatosis type 1 (NF1), this paper describes the NF1 pathway and broader learning from this project. The pathways focussed on identifying common clinical touchpoints with primary care and transitions between primary and specialty care. Key findings included the identification of gaps in care coordination, particularly during the transition from paediatric to adult services, and the development of a set of principles and a template for mapping other rare diseases. Feedback from a wide range of stakeholders, including clinicians across specialties and patient representatives, informed the refinement of the pathways. This project illustrates a systematic approach to enhancing care coordination for patients with rare genetic diseases through the mapping of clinical pathways and the development of primary care resources. The principles and template created can be adapted for other rare diseases, enabling the development of concise, disease-specific pathways. By prioritizing care coordination and transitions, and engaging a wide range of stakeholders in the process, this approach offers significant potential to improve the management of rare disease patients, especially during the critical transition from paediatric to adult care
Maternal, childhood and adolescent influences on Leydig cell functional capacity and circulating INSL3 concentration in young adults: Importance of childhood infections and body mass index
Get PDFBackgroundThe constitutive Leydig cell hormone insulin-like peptide 3 (INSL3) is considered a good estimate of the adult Leydig cell functional capacity and appears to remain relatively consistent throughout adult male life, only gradually declining into old age. Importantly, in younger men it appears to predict hypogonadism and hence later health and morbidity.ObjectivesHere, we have used the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort of boys and young men to assess those factors during pregnancy, infancy, childhood, and adolescence, when the adult-type Leydig cell population is being established, which by association might influence the final circulating INSL3 concentration in young adulthood.MethodsA wide range of clinical, anthropometric and lifestyle parameters were assessed from up to 2000 boys and young men based on direct medical measurement and/or by targeted questionnaires. Scalar variables used bivariate correlation analysis, whereas comparative statistics, such as t-tests, were applied to categorical variables.ResultsMaternal parameters, such as maternal smoking, gestational age, or being small for gestational age (SGA) appeared to have no association with adult INSL3 levels. Of all the parameters assessed, those with greatest impact on young adult Leydig cell status appeared to be childhood and adolescent body mass index (BMI) and early childhood infectious disease. Particularly, chickenpox in infancy had a marked and significant negative association with INSL3 (reduced by 10%-14%) at both 17 and 24 years. Being overweight (> 85th percentile) at 13 years was associated with a 20% reduction in young adult INSL3. In contrast, childhood and adolescent inflammatory factors and cigarette exposure appeared to have no long-lasting impact on adult Leydig cell status.LimitationsThis retrospective cohort study is limited by relatively small numbers and by its correlative analysis. The hypotheses generated will need to be validated in more extensive, in-depth studies.Lay summaryThe testis hormone INSL3 is considered a good estimate of the gonadal capacity to make testosterone. It is relatively constant throughout adult male life, only gradually declining into old age. Importantly, in younger men reduced INSL3 appears to predict hypogonadism and hence later health and morbidity. Whilst showing low within-individual variation, between individuals INSL3 can vary more than 10- up to 100-fold. The source of this variance is unknown but is believed to have its origin during childhood and adolescence. Analysis of data from the ALSPAC cohort implies that of various parameters assessed, only childhood and adolescent BMI as well as early infectious disease, in particular chickenpox, have any influence on young adult INSL3 concentration, respectively reducing circulating levels each by 10%-20%. More research is needed to understand the mechanisms how these factors influence testis function, what can be done as mitigation, and what other factors may be involved
Bipolar Seesaw of Atmospheric CO2 Between North Pacific and Southern Ocean at Millennial Timescales
Get PDFThe interhemispheric relation of deep-water ventilation and surface-ocean productivity may have played a prominent role in past atmospheric CO2 regulation. However, how these processes vary on orbital-millennial timescales remains poorly understood. Here, we present high-resolution proxy data and model simulations on the variability of biological productivity and deep water circulation for the abyssal northwestern Pacific Ocean spanning 20–60 kyr. We found that enhanced surface productivity increased during Heinrich Stadials (HS) and long term, caused by intensified westerly winds and associated dust fertilization, implying CO2 extraction from the atmosphere and increased nutrient supply to the euphotic zone. A similar increase in productivity for the Southern Ocean during Heinrich events implies enhanced upwelling and exhalation of CO2 to the atmosphere, indicative for an interhemispheric carbon cycle seesaw on millennial time scales. However, the longer-term global cooling demonstrates that deep ocean carbon storage and degassing was predominantly modulated by the North Pacific Ocean
Psychiatric Comorbidity in Intellectual Developmental Disorders: A Systematic Review
Get PDFAims/Background Intellectual developmental disorders (IDD) are characterized by significant limitations in intellectual functioning and adaptive behavior, affecting conceptual, social, and practical skills. They impact 1% of the global population, with mild cases being more common. Major causes include prenatal, perinatal, and postnatal factors, although a clear cause is often not identified. This study aims to evaluate the comorbidity of psychological disorders in individuals diagnosed with IDD.Methods Following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) statement, studies from 2014 to 2024 were considered using the databases Web of Science, PsycInfo, and PubMed. Articles focusing on psychopathology in individuals with IDD from birth were selected, excluding studies involving individuals under 16 years old and cases of severe and profound IDD.Results Of the 2895 articles retrieved, 11 were included. These studies showed heterogeneity in comorbidities such as schizophrenia spectrum and other psychotic disorders, mood disorders, anxiety disorders, developmental disorders, personality disorders, substance use disorders, and adjustment and stress reaction disorders.Conclusion Individuals with IDD are more vulnerable to mental health conditions, underscoring the need for comprehensive assessments and multidisciplinary treatments to improve their quality of life and optimize public resources. Future research should develop validated diagnostic tools for IDD and conduct longitudinal studies on their impact on quality of life. It should also explore gender differences and address specific needs in disadvantaged contexts with tailored interventions
The ActiveText@T2D text messaging behavioural intervention to increase physical activity in adults with type 2 diabetes: A prospective single-arm feasibility trial
Get PDFPhysical activity is a core aspect of type 2 diabetes (T2DM) self-management, but most Saudi adults do not meet physical activity recommendations and there are no culturally tailored interventions to promote physical activity in Saudi adults with T2DM. This study is a prospective single-centre, single-arm feasibility study of a mobile SMS text messaging intervention with a nested qualitative study. The aim was to explore the feasibility and acceptability of ActiveText@T2D, a 6-week theory-based mobile text messaging intervention to promote physical activity in people with T2DM in Saudi Arabia. Intervention development was informed by the Behaviour Change Wheel (BCW) framework and COM-B model. ActiveText@T2D consisted of 2 one-way SMS text messages per week, for 6 weeks. All participants were offered the intervention and assessed at baseline (T0) and 3-month follow-up (Time 1: T1). Data collection included feasibility outcomes (recruitment and retention), clinical outcomes (body mass index and glycaemic control from clinic records at T0), and self-reported outcomes (self-efficacy, physical activity, and barriers to exercise at T0, T1). Qualitative interview data (n=19) were collected at T1 with 11 patients (7 male, 4 female, mean age 54.5 years) and 8 female nurses (mean age 31.8 years). Quantitative data were analysed descriptively, qualitative data were analysed thematically. Of 98 participants approached, 62 were eligible, and 52 consented (84% participation rate; 23 women, 29 men; mean age 54.82 years), 44 (85%) completed baseline measures and received the intervention. Thirty-nine participants completed follow-up measures (75% retention to T1). All outcome measures were sensitive to change: The Arabic version of the CDC Barriers to Being Active Quiz (BBAQ), The Arabic version of Exercise Self-Efficacy scale (ESE-A), The Arabic International Physical Activity Questionnaire (A-IPAQ). Patients and healthcare professionals perceived the intervention to be broadly acceptable. Qualitative findings identified three overarching themes: “use of text messaging as a health intervention”, “engagement with physical activity” and “instilling knowledge about physical activity and diabetes control”. This study demonstrates the feasibility and acceptability of ActiveText@T2D, a theory-based culturally tailored SMS text messaging intervention, to Saudi adult patients with T2DM and healthcare professionals involved in their care. The next step would be a full-scale definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of ActiveText@T2D
‘Falling from a cliff-face’ into the necropolitical abyss: experiences of those with sexual convictions leaving prison
Get PDFWe reconceptualise the experience of people with sexual convictions leaving prison, as being in, but not of, the community. Release from prison can be characterised as falling into a necropolitical abyss, which entails extreme social exclusion. Via our interview data we extend current understanding on this transition, as we newly theorise the severity of the cliff-face drop, the post-prison precarity and the deathworld experience. Escape from the deathworld is attempted through performance, via what we term a life mask. Embracing the work of Agamben, Butler, Mbembe and Goffman we explore this substitute stigmatised identity performance. We evaluate the ontological (in)security for persons with sexual convictions. Novelty also lies in the form of positivity ascribed to imprisonment as, although prison is recognised as a terrible place, it nonetheless does facilitate security and a social life
Development of Adamantane-based hydrophobic tags targeting anaplastic lymphoma kinase with enhanced antitumor activities
No full textAnaplastic lymphoma kinase (ALK) has emerged as a critical molecular target for therapeutic intervention in various malignancies, with a particular focus on non-small cell lung cancer (NSCLC) and anaplastic large-cell lymphomas (ALCLs). In this work, we utilized the hydrophobic tagging (HyT) strategy to design and synthesize a series of novel ALK-targeting degraders, which were constructed by linking the derivative A3 based on ALK inhibitor alectinib to a HyT fragment adamantane via various customized linkers. The most promising compound, H7, demonstrated potent ALK degradation activity both in vitro and in vivo, along with potent anti-proliferative effects in ALK-dependent cell lines, while showing minimal cytotoxicity in cells lacking ALK fusion proteins. Furthermore, it was found that the degradation process mediated by compound H7 occurred via the ubiquitin-proteasome system, with chaperones playing a vital role in the process. These findings offer promising insights for the development of effective degraders targeting ALK, potentially advancing therapeutic strategies in ALK-related diseases
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