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Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.
Objective:
The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.
Methods:
We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.
Results:
Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.
Conclusions:
Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.
We used Cerner Real-World Data™, representing hospital admission records from 2020, to examine patients with co-occurring sickle cell disease and COVID-19 by discharge disposition grouped as death/hospice versus transfers to other facilities, returned home, or left against medical advice. Among the death/hospice group, we found older age and higher rates of congestive heart failure and diabetes. There were also significant differences in tachypnea, mechanical ventilation, minimum O2 saturation, and length of stay with higher rates in the death/hospice group. Awareness of such factors and associated mortality risks for this population may aid in patient care.
To examine the impact of SARS-CoV-2 infection on CLABSI rate and characterize the patients who developed a CLABSI. We also examined the impact of a CLABSI-reduction quality-improvement project in patients with and without COVID-19.
Design:
Retrospective cohort analysis.
Setting:
Academic 889-bed tertiary-care teaching hospital in urban Los Angeles.
Patients or participants:
Inpatients 18 years and older with CLABSI as defined by the National Healthcare Safety Network (NHSN).
Intervention(s):
CLABSI rate and patient characteristics were analyzed for 2 cohorts during the pandemic era (March 2020–August 2021): COVID-19 CLABSI patients and non–COVID-19 CLABSI patients, based on diagnosis of COVID-19 during admission. Secondary analyses were non–COVID-19 CLABSI rate versus a historical control period (2019), ICU CLABSI rate in COVID-19 versus non–COVID-19 patients, and CLABSI rates before and after a quality- improvement initiative.
Results:
The rate of COVID-19 CLABSI was significantly higher than non–COVID-19 CLABSI. We did not detect a difference between the non–COVID-19 CLABSI rate and the historical control. COVID-19 CLABSIs occurred predominantly in the ICU, and the ICU COVID-19 CLABSI rate was significantly higher than the ICU non–COVID-19 CLABSI rate. A hospital-wide quality-improvement initiative reduced the rate of non–COVID-19 CLABSI but not COVID-19 CLABSI.
Conclusions:
Patients hospitalized for COVID-19 have a significantly higher CLABSI rate, particularly in the ICU setting. Reasons for this increase are likely multifactorial, including both patient-specific and process-related issues. Focused quality-improvement efforts were effective in reducing CLABSI rates in non–COVID-19 patients but were less effective in COVID-19 patients.
Cement references were reviewed and whole pattern methods were developed for the quantitative phase analysis (QPA) of Type I Portland Cements. A set of control references were established for phase identification and quantitative analysis using laboratory diffractometers. Both RIR and Rietveld whole pattern fitting methods were used in the analyses. A block refined, parameter restricted, Rietveld method produced the best QPA results by comparison with known mixtures. Similar to prior literature findings, care has to be taken because of the severe peak overlap of the major calcium silicate and calcium aluminate phases in Portland cement and the complexity of the chemistry and structures involved. Two of the four major phases identified are doped supercells and the major C3S phase is also disordered.
Healthcare personnel (HCP) with unprotected exposures to aerosol-generating procedures (AGPs) on patients with coronavirus disease 2019 (COVID-19) are at risk of infection with severe acute respiratory coronavirus virus 2 (SARS-CoV-2). A retrospective review at an academic medical center demonstrated an infection rate of <1% among HCP involved in AGPs without a respirator and/or eye protection.
It is increasingly recognized that existing diagnostic approaches do not capture the underlying heterogeneity and complexity of psychiatric disorders such as depression. This study uses a data-driven approach to define fluid depressive states and explore how patients transition between these states in response to cognitive behavioural therapy (CBT).
Methods
Item-level Patient Health Questionnaire (PHQ-9) data were collected from 9891 patients with a diagnosis of depression, at each CBT treatment session. Latent Markov modelling was used on these data to define depressive states and explore transition probabilities between states. Clinical outcomes and patient demographics were compared between patients starting at different depressive states.
Results
A model with seven depressive states emerged as the best compromise between optimal fit and interpretability. States loading preferentially on cognitive/affective v. somatic symptoms of depression were identified. Analysis of transition probabilities revealed that patients in cognitive/affective states do not typically transition towards somatic states and vice-versa. Post-hoc analyses also showed that patients who start in a somatic depressive state are less likely to engage with or improve with therapy. These patients are also more likely to be female, suffer from a comorbid long-term physical condition and be taking psychotropic medication.
Conclusions
This study presents a novel approach for depression sub-typing, defining fluid depressive states and exploring transitions between states in response to CBT. Understanding how different symptom profiles respond to therapy will inform the development and delivery of stratified treatment protocols, improving clinical outcomes and cost-effectiveness of psychological therapies for patients with depression.
We provide an update on diagnostic methods for the detection of urogenital schistosomiasis (UGS) in men and highlight that satisfactory urine-antigen diagnostics for UGS lag much behind that for intestinal schistosomiasis, where application of a urine-based point-of-care strip assay, the circulating cathodic antigen (CCA) test, is now advocated. Making specific reference to male genital schistosomiasis (MGS), we place greater emphasis on parasitological detection methods and clinical assessment of internal genitalia with ultrasonography. Unlike the advances made in defining a clinical standard protocol for female genital schistosomiasis, MGS remains inadequately defined. Whilst urine filtration with microscopic examination for ova of Schistosoma haematobium is a convenient but error-prone proxy of MGS, we describe a novel low-cost sampling and direct visualization method for the enumeration of ova in semen. Using exemplar clinical cases of MGS from our longitudinal cohort study among fishermen along the shoreline of Lake Malawi, the portfolio of diagnostic needs is appraised including: the use of symptomatology questionnaires, urine analysis (egg count and CCA measurement), semen analysis (egg count, circulating anodic antigen measurement and real-time polymerase chain reaction analysis) alongside clinical assessment with portable ultrasonography.
Background: The NIH Toolbox - Cognition Battery (NIHTB-CB) is a computerized cognitive assessment designed for clinical research that is administered in-person. Here, we explored the feasibility and validity of a novel video-conference protocol for administering the NIHTB-CB. Since our protocol required repeated assessments, we further explored the NIHTB-CB’s practice effect. Methods: Twenty-five healthy participants completed the NIHTB-CB under two separate conditions four weeks apart. The standard condition followed the recommended administration protocol, whereas the video-conference condition had the examiner and participant in separate rooms but able to communicate over video-conference. A linear mixed-model analysis was performed to explore the fixed effect of testing condition and time on NIHTB-CB performance. Results: Across all three NIHTB-CB composite scores (total, fluid and crystallized cognition) no significant fixed effect of administration condition was found. A significant practice effect was observed for the fluid and total cognition composite scores over a 29.0 (± 2.1) day test-retest interval. Conclusions: Our novel video-conference protocol for the NIHTB-CB is equivalent to the standard protocol in healthy participants, and may provide a solution for researchers seeking to engage study participants at remote sites. If the NIHTB-CB is used longitudinally to monitor patients, corrections for repeated measures may be required.
Current understanding of climate change impacts, adaptation and vulnerability among Inuit in the Arctic is relatively static, rooted in the community and time that case studies were conducted. This paper captures the dynamism of Inuit–climate relationships by applying a longitudinal approach to assessing vulnerability to climate change among Inuit in Ulukhaktok, Northwest Territories, Canada. Data were collected in 2005 and 2016 following a consistent methodology and analytical framework. Findings from the studies are analysed comparatively together with longitudinal datasets. The data reveal that many of the climatic changes recorded in 2005 that adversely affected hunting activities have been observed to be persisting or progressing, such as decreasing sea ice thickness and extent, and stronger and more consistent summer winds. Inuit are responding by altering travel routes and equipment, taking greater pre-trip precautions, and concentrating their efforts on more efficient and accessible hunts. Increasing living and subsistence costs and time-constraints, changes in the generation and transmission of environmental knowledge and land skills, and the concentration of country food sharing networks were identified as key constraints to adaptation. The findings indicate that the connections between subsistence activities and the wage economy are central to understanding how Inuit experience and respond to climate change.
Fall applications of pronamide [3,5-dichloro(N-1,1-dimethyl-2-propynyl)benzamide] control or suppress quackgrass [Agropyron repens (L.) Beauv.] in established alfalfa (Medicago sativa L.). Studies were initiated to evaluate benefits of pronamide usage in areas where quackgrass is a problem. Alfalfa swards severely infested with quackgrass were treated with pronamide. Forage quality of first cutting alfalfa was significantly improved with pronamide usage, but second and third cutting forage quality was not greatly affected. First cutting hay from pronamide-treated and untreated areas was fed to goats and dairy cows in feeding trials. Animal intake of total forage dry matter, digestible dry matter, and digestible crude protein was increased with pronamide usage. A reduction in need for supplemental protein, an increase in efficiency in dry matter conversion into milk, and a 20% increase in milk production resulted from controlling quackgrass in alfalfa with pronamide.
Trifluralin was evaluated at 1.1, 2.2, and 4.5 kg/ha in 1983 and 1984 at two locations in Iowa for residue carryover injury to corn the following seasons. Three methods of seedbed preparation (no-till, moldboard, and chisel plowing) for corn planting were also examined. There was no effect on corn growth at the 1.1 kg/ha rate of trifluralin. Averaged over the four experiments, reductions in corn height of 8 and 24% were observed 5 weeks after planting at 2.2 and 4.5 kg/ha, respectively. The relative degree of stunting due to trifluralin decreased as the growing season progressed. Early-season carryover injury was more severe in reduced tillage than in moldboard plow treatments in the 1983-84 Nashua experiment. Moldboard and chisel plowing reduced the concentration of trifluralin in the 0- to 7.5-cm zone of the soil profile by 62 and 31%, respectively, when compared to no-till. No yield reductions were observed at the 1.1 or 2.2 kg/ha rate of trifluralin. In 1984, grain yields were reduced by 8 and 16% at Ames and Nashua, respectively, by the 4.5 kg/ha trifluralin rate.
The degree and longevity of quackgrass [Agropyron repens (L.) Beauv.] control provided by autumn applications of pronamide [3,5-dichloro(N-1,1-dimethyl-2-propynyl)benzamide] was influenced greatly by alfalfa (Medicago sativa L.) stand density, as well as by rate of application and soil type. When applications were made to a field with a sparse alfalfa stand (10 to 20 crowns/m2), quackgrass yields were reduced the year following pronamide application, but quackgrass reinfested the plots the second year after treatment. Quackgrass yields one and two seasons following autumn treatment with 2.2 kg/ha pronamide were 1480 and 3890 kg/ha compared to 4480 and 4870 kg/ha for control plots. Annual applications of pronamide were necessary to maintain quackgrass control in the sparse alfalfa stand. Pronamide application to a vigorous, dense alfalfa stand (40 to 50 crowns/m2) provided quackgrass control which persisted into the second year after treatment. Quackgrass control ratings one and two seasons after application of 1.1 kg/ha pronamide were 100 and 90%. Pronamide treatments reduced first cutting quackgrass yields, and increased first cutting alfalfa yields. Treatment of the sparse alfalfa stand with 2.2 kg/ha pronamide resulted in first cutting alfalfa and quackgrass yields of 2420 and 990 kg/ha compared to 1430 and 3940 kg/ha for controls. Treatment of a dense alfalfa stand with 1.1 kg/ha pronamide resulted in first cutting alfalfa and quackgrass yields of 3850 and 300 kg/ha compared to 1710 and 1660 kg/ha for controls. Total herbage yields from all cuttings were either slightly decreased when fields with sparse alfalfa stands were treated or remained constant or slightly increased when more dense alfalfa stands were treated. Pronamide applied with potash as the carrier was as effective as when applied in water. Pronamide treatment resulted in increased crude protein concentration in first cutting herbage at all locations in all years. Crude protein concentration in first cutting control herbage ranged from 13.3 to 16.1%. Crude protein concentration in first cutting herbage from plots treated with 1.1 kg/ha pronamide ranged from 17.7 to 20.6%, depending on year and location. In vitro digestible dry matter (IVDDM) concentrations were increased by most rates of pronamide in first, second, and third cutting herbage. IVDDM for first cutting control herbage was 51.4% compared to 61.3% for herbage treated with 2.2 kg/ha pronamide. Acid detergent fiber concentration in first cutting herbage was not affected by pronamide.
Combinations of rotary hoeing, cultivation, and band- or broadcast-applied herbicides were compared for weed management in corn at 64 locations in Iowa from 1987 to 1991. Cultivation alone resulted in denser weed populations than herbicide treatments at 41% of the locations; however, corn yields were reduced at only 22% of the locations when weeds were controlled mechanically rather than with herbicides. Compared with broadcast applications, herbicides applied in a band resulted in increased weed populations at 8% of the locations; however, corn yields were reduced at only 1% of the locations.
Developments in X-ray analysis, and advances in scientific research, have dramatically influenced the types of data now considered suitable for inclusion in the Powder Diffraction FileTM (PDF®). Initially, the PDF was geared towards the identification of unknown crystalline materials by comparison of d-spacings and peak intensities. Today, the International Centre for Diffraction Data (ICDD) maintains and continuously enhances the quality and content of the PDF database to better provide customers and scientists with a comprehensive reference source that supports their needs, and interests. The events that initially led to the inclusion of crystalline polymer data to the PDF have recently been amended to also encompass semi-crystalline and amorphous polymeric materials as well. This paper discusses the resultant updates being made to the PDF in support of this new data form, and also highlights several features and benefits of providing this data to PDF users.
With the explosive growth in the number of highly automated powder diffraction systems, many types of analyses which were previously considered a specialty analysis are now performed on a routine basis. Algorithms have been developed for measuring peak profiles from which crystallite sizes, residual microstrain, and X-ray crystal structure (Rietveld techniques for example) can be determined. However, these techniques require an instrumental peak profile calibration standard to correct the experimental data for instrumental broadening due to the system optics.
Significant problems are encountered when laboratories try to cross-correlate or reproduce published data due to the lack of a common reference material for instrumental calibration. This is particularly distressing in microstrain and crystallite size calculations which can be dramatically affected by a poor choice of standard materials. Microstrain and crystallite size measurement are becoming increasingly important for the characterization of advanced materials and catalysts.
The aim of any diffraction experiment is to obtain reproducible data of high accuracy and precision so that the data can be correctly interpreted and analyzed. Various methods of sample preparation have been devised so that reproducibility, precision and accuracy can be obtained. The success of a diffraction experiment will often depend on the correct choice of preparation method for the sample being analyzed and for the instrument being used in the analysis.
A diffraction pattern contains three types of useful information: the positions of the diffraction maxima, the peak intensities, and the intensity distribution as a function of diffraction angle. This information can be used to identify and quantify the contents of the sample, as well as to calculate the material's crystallite size and distribution, crystallinity, and stress and strain. The ideal preparation for a given experiment depends largely on information desired.
An experimental X-ray powder diffraction pattern was produced and analyzed for alpha-polymorphic tegafur, also called Ftorafur (an antineoplastic agent). The indexed data matched the powder patterns in the ICDD PDF-4/Organics database calculated from the reported single-crystal X-ray diffraction data in the Cambridge Structural Database. Alpha tegafur has a triclinic crystal system, with reduced cell parameters of a=16.720(6) Å, b=9.021(5) Å, c=5.995(3) Å, α=93.66(4)°, β=93.15(8)°, γ=100.14(4)°. There are four formula units contained in one unit cell. The cell volume and space group were determined to be 886.27 Å3 and P-1, respectively.