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Interoceptive and exteroceptive pregnant bodily experiences and postnatal well‐being: A network analysis
Get PDFObjectives: Pregnancy involves rapid physical and physiological changes that may affect feelings towards the bodily experience. This experience, including body dissatisfaction and interoceptive sensibility, is linked to antenatal attachment and maternal mental health. However, the long‐term relationships between pregnant bodily experiences and postnatal outcomes remain unknown. This study aimed to explore the complex relationships between the perinatal bodily experience and postnatal variables. Design: Longitudinal observational study using online surveys at three time points. Methods: Longitudinal data were collected at three time points, during pregnancy (N = 253), and 3 (N = 137) and 6 (N = 107) months postpartum. Pregnancy‐validated measures assessed body dissatisfaction and interoception, alongside measures of postnatal bonding, maternal anxiety and depression, breastfeeding behaviours, and infant birth weight and development. A partial correlation graphical lasso network analysis was used to explore the relationships between the bodily experience and these postnatal variables. Results: Antenatal bodily experiences linked to postnatal anxiety, body dissatisfaction and interoceptive trust, with poorer postnatal experiences going on to correlate with higher anxiety, depression and breastfeeding rates at 3 months. Antenatal body weight dissatisfaction was linked to increased breastfeeding and depression, less trust in bodily signals and a lower quality mother‐infant bond at 6 months postpartum. Conclusions: The findings underscore the importance of pregnant bodily experiences for maternal postnatal health and mother‐infant bonding, helping to identify mothers at risk of poorer postnatal outcomes
Community health worker interventions for healthy ageing in community for older people in the United States and globally: a scoping review
Get PDFBackground and objectives: Healthy ageing allows older people to experience well-being; community health workers (CHW) may have a role in supporting healthy ageing in community. Understanding what is known, and where gaps in knowledge exist, is important for advancing research on this topic.
Methods: A scoping review was undertaken to explore the question - What community health worker interventions in any community setting (urban, suburban, and rural) with a focus on older people’s (adults over age 65) well-being have been evaluated globally that include information about health outcomes, healthy equity, social connection, or health and social care service delivery? Six databases (PubMed, Cochrane, Policy Commons, CINAHL, ASSIA, Embase, Global Index Medicus) and grey literature were searched for relevant sources. References were screened by two researchers to identify if they met inclusion criteria. Data were summarised as narratives, figures, and in tables.
Results: Thirteen papers met criteria for inclusion; eleven were primary studies with varied research designs and disparate diseases, conditions, and health and social needs studied. Ten of the studies were conducted in high-income countries worldwide with varied activities and assessments performed. Results suggest CHWs may have capacity to support healthy ageing in community for older people.
Conclusion: CHWs represent a promising practice for supporting healthy ageing. The review identified several potential roles for CHWs, and the evidence available may provide guidance on where CHWs can facilitate and promote healthy ageing in the community – and enable older people to not only meet their basic daily needs but also contribute to their communities. The author did not perform quality assessments on included papers so the credibility and reliability of the findings is unknown. Further, the overall findings were developed on domains where an effect was reported but did not establish where an effect was not observed
Stretch-induced microstructural evolution of electrospun polycaprolactone microfibers for biomedical applications
Get PDFThe performance and degradation of polymeric medical yarns depend strongly on their microstructure, which can evolve significantly during fabrication. This work investigates and models how the microstructure of microfibrous electrospun (ES) filaments change during the critical post-processing step of uniaxial stretching. Specifically, we studied filaments designed for use in a knee ligament regeneration implant, made from biodegradable, semicrystalline polycaprolactone (PCL). Structural changes were characterized at both the fiber and molecular scales. Stretching led to fiber alignment, thinning, and coalescence, as revealed by micro-computed tomography (µCT) and scanning electron microscopy (SEM). At the molecular scale, the crystalline microarchitecture transformed profoundly, as shown by differential scanning calorimetry (DSC), 1D and 2D X-ray diffraction (XRD), and dynamic mechanical thermal analysis (DMTA). Based on these findings, we propose a conceptual model for stretch-induced microstructural evolution: at low strains, chain-folded crystals (CFC) fragment while amorphous chains extend; at higher strains, CFC unfold and recrystallize with extended chains into more thermodynamically stable chain-extended crystals (CEC) aligned with the stretch axis. This mechanism clarifies how uniaxial strain reorganizes semicrystalline domains in PCL, with important implications for thermomechanical and degradative properties relevant to implant performance. Understanding how microstructure responds to stretching enables the future development of more accurate simulations of complex fibrous materials under physiological conditions and informs the optimization of fabrication and design parameters for next-generation medical yarns
Digitally Enabled Care in Diverse Environments (DECIDE): protocol for a programme of rapid evaluation of technology-enabled remote monitoring in health and social care
Get PDFBackground
There is considerable interest in technology-enabled remote monitoring in the UK. The aim is to respond to system pressures and improve access, experience and quality of care. There is an urgent need for process, outcome and impact evaluations of interventions at various stages of development and implementation to address evidence gaps around adoption, spread, sustainability and inequalities.
Aim
DECIDE (Digitally Enabled Care in Diverse Environments) is a centre for rapid evaluation of technology-enabled remote monitoring funded by the National Institute for Health and Care Research (2023 to 2026). It aims to support service users, service commissioners and providers of remote monitoring services, to enable high quality care. Example questions include: Is the technology-enabled remote monitoring innovation needed and, if so, for whom? How are technology-enabled care pathways implemented, and what are associated outcomes and impacts? What are the opportunities and challenges for sustainability, scale-up and spread?
Methods
A range of qualitative, quantitative and economic methods will be used. Exact methods and questions will be dependent on the focus, scope and scale of each evaluation. Evaluations will be informed by relevant theory, including the Non-Adoption, Abandonment and the challenges to Spread, Scale-up and Sustainability of technological innovation in health and care (NASSS) framework.
A User Advisory Group and External Steering Committee, both with diverse voices, will help shape evaluation design, implementation and dissemination. Project-led dissemination will ensure timely sharing of insights and support impact.
Conclusion
Evaluations will advance understanding of when and for whom technology-enabled remote monitoring innovation is needed; how it works and how factors related to the intervention, implementation process and wider context influence adoption; associated outcomes and impacts, whether and how these tackle inequalities; and potential challenges to scale and spread. We aim to inform decision-making by policymakers, commissioners, providers, patients/service users and researchers
Bayesian optimisation with unknown hyperparameters: regret bounds logarithmically closer to optimal
Get PDFBayesian Optimization (BO) is widely used for optimising black-box functions but requires us to specify the length scale hyperparameter, which defines the smoothness of the functions the optimizer will consider. Most current BO algorithms choose this hyperparameter by maximizing the marginal likelihood of the observed data, albeit risking misspecification if the objective function is less smooth in regions we have not yet explored. The only prior solution addressing this problem with theoretical guarantees was A-GP-UCB, proposed by Berkenkamp et al. (2019). This algorithm progressively decreases the length scale, expanding the class of functions considered by the optimizer. However, A-GP-UCB lacks a stopping mechanism, leading to over-exploration and slow convergence. To overcome this, we introduce Length scale Balancing (LB)-a novel approach, aggregating multiple base surrogate models with varying length scales. LB intermittently adds smaller length scale candidate values while retaining longer scales, balancing exploration and exploitation. We formally derive a cumulative regret bound of LB and compare it with the regret of an oracle BO algorithm using the optimal length scale. Denoting the factor by which the regret bound of A-GP-UCB was away from oracle as g(T), we show that LB is only log g(T) away from oracle regret. We also empirically evaluate our algorithm on synthetic and real-world benchmarks and show it outperforms A-GP-UCB, maximum likelihood estimation and MCMC
Development of image analysis tool to evaluate Langerhans cell migration after exposure to isothiazolinones
Get PDFIncidence of allergic contact dermatitis (ACD) is rising worldwide as a consequence of raising chemical exposure, especially from biocides present in common water-based products such as cosmetics and household products. Understanding the biological processes involved in skin sensitization is crucial to mitigating ACD. Migration of Langerhans cells to the basal lamina of the skin is a key step in sensitization. Animal testing for sensitization has been largely replaced by alternative in vitro methods due to ethical concerns. This study presents an open-source program using QuPath software enhanced with machine learning to analyze Langerhans cells migration in immunostained human skin samples. We validated scripts for automated detection of skin layers and Langerhans cells position, enabling accurate, reproducible analysis. An ex vivo human skin organo-culture model was used to test Langerhans cells migration after 24-h exposure to four different isothiazolinones diluted in water at different concentrations. The initial results show that the water vehicle has an impact on Langerhans cells migration. We also observed a different Langerhans cells migration pattern for methylisothiazolinone and benzothiazolinone exposed skin compared to octylisothiazolinone. The results suggest that only octylisothiazolinone can induce Langerhans cells migration to the basal lamina of the epidermis as described for sensitizers. This automated approach represents a advancement in ACD risk assessment by minimizing the subjectivity and labor involved in Langerhans cells analysis, providing a valuable tool for future research
Some aspects of the regulation of respiration in man
Get PDFThe work described in this thesis was undertaken to study the effects of inspiratory flow-resistive loading on gas exchange and breathing pattern in healthy man. The increased oxygen demand of the respiratory muscles accompanying the imposition of loading may lead to problems of "power-sharing" between the respiratory and non-respiratory working muscles, as the supply of oxygen may not be sufficient to meet the demands of both muscle groups and this may lead to the development of fatigue.
The responses of a total of 11 healthy young subjects were studied over a range of ventilations from resting to about 80 L.min-1, induced by incremental work tests on a bicycle ergometer or by incremental steps of inspired C02. Eight of the subjects were studied during both types of tests. Initially, three different severities of loading were employed, one of which (the most severe) was chosen for the main experiments, this added a resistance of 76 mmH20 at a flow of 60 L.min-1.
The oxygen cost of breathing was significantly increased by loading, during exercise this was evident as a significant increase in total oxygen uptake. However, surprisingly, total oxygen uptake at the highest work levels was little or unaffected by loading. In a separate series of 5 experiments, plasma lactate concentrations were measured during incremental work tests. Above the anaercbic threshold, plasma lactate levels were higher during loading in the subjects in whom oxygen uptake was little or unaffected, indicating an additional energy source.
The breathing pattern responses to hypercapnia and exercise were very similar during both control experiments and those in the presence of loading. Loading was associated with a significant fall in ventilation and CO2 retention, the result of a significant increase in inspiratory time and reduced mean inspiratory flow, while expiratory time and mean expiratory flow were unaffected. This suggests that the centrally mechanisms governing expiratory flow are unaffected by imposed changes in inspiratory flow and duration. Loading at the highest levels of ventilation was associated with a different pattern of breathing to that at lower ventilations, inspiratory and expiratory durations not being significantly different from those seen in the unloaded condition.
End-expiratory volume decreased significantly with exercise or hypercapnia and was further decreased by loading.
Increased respiratory drive was associated with a progressive squaring of the flow profile, especially the expiratory portion, evident as a significantly greater initial rate of rise of flow and mean/peak flow ratio
Once more, without feeling
Get PDFI argue for a pluralist theory of moral standing, on which both welfare subjectivity and autonomy can confer moral status. I argue that autonomy does not entail welfare subjectivity, but can ground moral standing in its absence. Although I highlight the existence of plausible views on which autonomy entails phenomenal consciousness, I primarily emphasize the need for philosophical debates about the relationship between phenomenal consciousness and moral standing to engage with neglected questions about the nature of autonomy and its possible links to consciousness, especially if we are to face up to the ethical challenges future AI systems may pose