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Enabling older people with mental health needs to engage with community social care: A scoping review to inform a theory of change
No full textDespite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, we undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they i) focused on older people (65+) living at home with social care needs; and ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long- term outcomes, preconditions, interventions, rationale & assumptions). All the included papers related to people with dementia. Four subgroups of papers were identified. The first highlight those external conditions that make it more likely an intervention will be successful; the second describe specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explore what services can do to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design
OUT OF DATE OR BEST BEFORE? A COMMENTARY ON THE RELEVANCE OF ECONOMIC EVALUATIONS OVER TIME
No full textThe impact of time on the applicability and relevance of historical economic evaluations can be considerable. Ignoring this may lead to the use of weak or invalid evidence to inform important research questions or resource allocation decisions, as historical economic evaluations may have reached different conclusions compared to if a similar study been conducted more recently. There are multiple factors that contribute towards evidence becoming outdated including changes to the relevant decision problem (e.g., comparators), changes to parameters (such as costs, utilities, and resource use) and methodological updates (e.g., recommendations on uncertainty analysis). Researchers reviewing economic evaluations need to consider whether changes over time would influence the study design and results if the evaluation were repeated, to the extent that it is no longer helpful or informative. In this paper we summarise these key issues and make recommendations about how and whether researchers can future-proof their economic evaluations
Can social groups be units of normative concern? Normative individualism, futurity, causality, social ontology
No full textHarvesting Devices’ Heterogeneous Energy Profiles and QoS Requirements in IoT: WPT-NOMA vs BAC-NOMA
No full textThe next generation Internet of Things (IoT) exhibits a unique feature that IoT devices have different energy profiles and quality of service (QoS) requirements. In this paper, two energy and spectrally efficient transmission strategies, namely wireless power transfer assisted non-orthogonal multiple access (WPT-NOMA) and backscatter communication (Back- Com) assisted NOMA (BAC-NOMA), are proposed by utilizing this feature of IoT and employing spectrum and energy cooperation among the devices. In particular, the use of NOMA ensures that the devices with different QoS requirements can share the same spectrum, and WPT and Back-Com are employed to utilize the cooperation among the devices with different energy profiles, which avoids the use of a dedicated power beacon. Furthermore, for the proposed WPT-NOMA scheme, the application of hybridsuccessive interference cancelation (SIC) decoding order is also considered, and analytical results are developed to demonstrate that WPT-NOMA can avoid outage probability error floors and realize the full diversity gain. Unlike WPT-NOMA, BAC-NOMA suffers from an outage probability error floor, and the asymptotic behaviour of this error floor is analyzed in the paper by applying the extreme value theory. In addition, the effect of a unique feature of BAC-NOMA, i.e., employing one device’s signal as the carrier signal for another device, is studied, and its impact on thediversity gain is revealed. Simulation results are also provided to compare the performance of the proposed strategies and verify the developed analytical results
Pathology of tumors associated with pathogenic germline variants in nine breast cancer susceptibility genes
No full textImportance: Rare germline genetic variants in several genes are associated with increased breast cancer (BC) risk, but their precise contribution to different disease subtypes are unclear. This information is relevant to guidelines for gene panel testing and risk prediction.Objective: To characterize tumors associated with BC susceptibility genes in large scale population- or hospital-based studies.Design: Case-control; BRIDGES studySetting: Multicenter, internationalParticipants: 42,680 cases and 46,387 controls, women aged 18-79 years, sampled independently of family history, from 38 studies.Exposures: Protein truncating variants (PTVs) and likely pathogenic missense variants (MSVs) in ATM, BARD1, BRCA1, BRCA2, CHEK2, PALB2, RAD51C, RAD51D, and TP53.Main Outcomes and Measures: BC ‘intrinsic-like’ subtypes as defined by ER, PR, HER2 status, and tumor grade; morphology; size; stage; lymph node involvement; subtype-specific odds ratios (ORs) for carrying PTVs and pathogenic MSVs in the nine BC susceptibility genes.Results: Mean ages at interview (controls) and diagnosis (cases) were 55.1 and 55.8 years respectively. There was substantial heterogeneity in the distribution of intrinsic subtypes by gene. RAD51C, RAD51D and BARD1 variants were associated mainly with triple-negative disease: OR=6.19(95%CI:3.17-12.12), OR=6.19(95%CI:2.99-12.79) and OR=10.05(95%CI:5.27-19.19), respectively. CHEK2 variants were associated with all subtypes (with ORs ranging from 2.21-3.17) except for triple-negative disease. For ATM variants, the association was strongest for the hormone receptor (HR)+HER2─highgrade subtype (OR=4.99, 95%CI:3.68-6.76). BRCA1 was associated with increased risk of all subtypes, but ORs varied widely, being highest for triple-negative disease (OR=55.32, 95%CI:40.51-75.55). BRCA2 and PALB2 variants were also associated with triple-negative disease. TP53 variants were most strongly associated with HR+HER2+, and HR─HER2+subtypes. Tumors occurring in pathogenic variant carriers were of higher grade. For most genes and subtypes a decline in OR was observed with increasing age. Together the nine genes contributed to 27.3% of all triple-negative tumors in women age 40 years. Conclusions and Relevance: Variants in the nine BC risk genes differ substantially in their associated pathology but are generally associated with triple-negative and/or high-grade disease. Knowing the age and tumor subtype distributions associated with individual BC genes can aid guidelines for gene panel testing, risk prediction, and variant classification and guide targeted screening strategies
Genetics of Childhood Hearing Loss
No full textCompelling evidence indicates that some newborns harboring genetic variants associated with deafness/hard-of-hearing (DHH) may not be identified by current physiologic NBHS rendering current NBHS suboptimal. Incorporating GS into NBHS would improve clinical diagnosis and decrease time to early intervention efforts
Correlations of Shocks and Stresses with Distribution Network Outages
No full textDistribution network outages have significant socioeconomic impacts, and potentially pose a threat to life when critical infrastructures are affected. Shocks and stresses, such as climate change, extreme weather or intentional attacks, in combination with an expected rise in electricity demand, pose an increasing risk to power network reliability. Detailed data on distribution network outages can be used for further research in prevention and mitigation of such outages. This paper presents and describes a unique and comprehensive dataset of UK distribution network outages. The dataset for 2020 is analyzed to identify correlations with shocks and stresses, such as demand, extreme weather, and COVID-19 lockdown. The results justifyfurther research in prevention and mitigation of distribution network outages, support the industry in future planning of distribution networks, and can feed into models for operational planning in face of upcoming shocks and stresses
Biogeochemical Cycling of 99Tc in Alkaline Sediments
No full text99Tc will be present in significant quantities in radioactive wastes including intermediate level wastes (ILW). The internationally favoured concept for disposing of ILW is via deep geological disposal in an underground engineered facility located approximately 200 – 1000 m deep. Typically, in the deep geological disposal environment the subsurface will be saturated, cement will be used extensively as an engineering material, and iron will be ubiquitous. This means that understanding Tc biogeochemistry in high pH, cementitious environments is important to underpin safety case development. Here, alkaline sediment microcosms (pH 10) were incubated under anoxic conditions under no added Fe(III) and with added Fe(III) conditions (added as ferrihydrite) at three Tc concentrations (10-11, 10-6, and 10-4 mol L-1). In the 10-6 mol L-1 Tc experiments with ‘no added Fe(III)’, approximately 35% Tc(VII) removal occurred during bioreduction. Solvent extraction of the residual solution phase indicated that approximately 75% of Tc was present as Tc(IV), potentially as colloids. In both biologically active and sterile control experiments ‘with added Fe(III)’, Fe(II) formed during bioreduction and greater than 90% Tc was removed from the solution, most likely due to abiotic reduction mediated by Fe(II). X-ray absorption spectroscopy (XAS) showed that in bioreduced sediments, Tc was present as hydrous TcO2-like phases, with some evidence for an Fe association. When reduced sediments with added Fe(III) were air oxidised, there was a significant loss of Fe(II) over 1 month (approximately 50%), yet this was coupled to only modest Tc remobilisation (approximately 25%). Here, XAS analysis suggested with air oxidation, partial incorporation of Tc(IV) into newly forming Fe oxyhydr(oxide) minerals may be occurring. These data suggest that in Fe-rich, alkaline environments, biologically mediated processes may limit Tc mobility
Demand vs supply-side approaches to mitigation: What final energy demand assumptions are made to meet 1.5 and 2°C targets?
No full textToday’s climate policies will shape the future trajectory of emissions. Consumption is the main driver behind recent increases in global greenhouse gas emissions, outpacing savings through improved technologies, and therefore its representation in the evidence base will impact on the success of policy interventions. The IPCC’s Special Report on Global Warming of 1.5°C (SR1.5) summarises global evidence on pathways for meeting below-2°C targets, underpinned by a suite of scenarios from integrated assessment models (IAMs). We explore how final energy demand is framed within these, with the aim to making demand-related assumptions more transparent, and evaluating their significance, feasibility, and use or underutilisation as a mitigation lever. We investigate how the integrated assessment models compensate for higher and lower levels of final energy demand across scenarios, and how this varies when mitigating for 2°C and 1.5°C temperature targets through an analysis of (1) final energy demand projections, (2) energy-economy relationships and (3) differences between energy system decarbonisation and carbon dioxide removal in the highest and lowest energy demand pathways. We look across the full suite of mitigation pathways and assess the consequences of achieving different global carbon budgets. We find that energy demand in 2100 in the highest energy demand scenarios is approximately three to four times higher than the lowest demand pathways, but we do not find strong evidence that 1.5°C-consistent pathways cluster on the lower end of demand levels, particularly when they allow for overshoot. The majority of demand reductions happen pre-2040, which assumes absolute decoupling from economic growth in the near-term; thereafter final energy demand levels generally grow to 2100. Lower energy demand pathway moderately result in lower renewable energy supply and lower energy system investment, but do not necessarily reduce reliance on carbon dioxide removal. In this sense, there is more scope for IAMs to implement energy demand reduction as a longer-term mitigation lever and to reduce reliance on negative emissions technologies. We demonstrate the need for integrated assessments to play closer attention to how final energy demand interacts with, relates to, and can potentially offset supply-side characteristics, alongside a more diverse evidence base
Venous cerebral blood flow quantification and cognition in patients with sickle cell anemia
No full textPrior studies have described high venous signal qualitatively using arterial spin labelling (ASL) in patients with sickle cell anemia (SCA), consistent with arteriovenous shunting. We aimed to quantify the effect and explored cross-sectional associations with arterial oxygen content (CaO2), disease-modifying treatments, silent cerebral infarction (SCI), and cognitive performance. 94 patients with SCA and 42 controls underwent cognitive assessment and MRI with single- and multi- inflow time (TI) ASL sequences. Cerebral blood flow (CBF) and bolus arrival time (BAT) were examined across gray and white matter and high-signal regions of the sagittal sinus. Across gray and white matter, increases in CBF and reductions in BAT were observed in association with reduced CaO2 in patients, irrespective of sequence. Across highsignal sagittal sinus regions, CBF was also increased in association with reduced CaO2 using both sequences. However, BAT was increased rather than reduced in patients across these regions, with no association with CaO2. Using the multiTI sequence in patients, increases in CBF across white matter and high-signal sagittal sinus regions were associated with poorer cognitive performance. These novel findings highlight the utility of multiTI ASL in illuminating, and identifying objectively quantifiable and functionally significant markers of, regional hemodynamic stress in patients with SCA.Keywords: Cerebrovascular disease, Hematology, Hemodynamics, Cognition, MRI Venous CBF quantification in sickle cell anemi