139 research outputs found
Disentangling the roles of late Miocene palaeogeography and vegetation:Implications for climate sensitivity
Making the most of what we have: application of extrapolation approaches in wildlife transfer models
A collaborative hackathon to investigate climate change and extreme weather impacts in justice and insurance settings
By bringing together a large group of participants with diverse skillsets, hackathons aim to make good headway into a particular research topic over a short period of time. This collaborative approach supports relationship building, cross team working and the development of technical skills across different areas
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The BRIDGE HadCM3 family of climate models: HadCM3@Bristol v1.0
Understanding natural and anthropogenic climate change processes involves using computational models that represent the main components of the Earth system: the atmosphere, ocean, sea ice, and land surface. These models have become increasingly computationally expensive as resolution is increased and more complex process representations are included. However, to gain robust insight into how climate may respond to a given forcing, and to meaningfully quantify the associated uncertainty, it is often required to use either or both ensemble approaches and very long integrations. For this reason, more computationally efficient models can be very valuable tools. Here we provide a comprehensive overview of the suite of climate models based around the HadCM3 coupled general circulation model. This model was developed at the UK Met Office and has been heavily used during the last 15 years for a range of future (and past) climate change studies, but has now been largely superseded for many scientific studies by more recently developed models. However, it continues to be extensively used by various institutions, including the BRIDGE (Bristol Research Initiative for the Dynamic Global Environment) research group at the University of Bristol, who have made modest adaptations to the base HadCM3 model over time. These adaptations mean that the original documentation is not entirely representative, and several other relatively undocumented configurations are in use. We therefore describe the key features of a number of configurations of the HadCM3 climate model family, which together make up HadCM3@Bristol version 1.0. In order to differentiate variants that have undergone development at BRIDGE, we have introduced the letter B into the model nomenclature. We include descriptions of the atmosphere-only model (HadAM3B), the coupled model with a low-resolution ocean (HadCM3BL), the high-resolution atmosphere-only model (HadAM3BH), and the regional model (HadRM3B). These also include three versions of the land surface scheme. By comparing with observational datasets, we show that these models produce a good representation of many aspects of the climate system, including the land and sea surface temperatures, precipitation, ocean circulation, and vegetation. This evaluation, combined with the relatively fast computational speed (up to 1000 times faster than some CMIP6 models), motivates continued development and scientific use of the HadCM3B family of coupled climate models, predominantly for quantifying uncertainty and for long multi-millennial-scale simulations
Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit
Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the ‘person-centred’ dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.
Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being ‘confused’. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.
Trial Registration number: ClinicalTrials.gov: NCT0113614
Exploring the Contextual Assumptions, Interventions, and Outcomes of Digital Advance Care Planning Systems: A Theory of Change Approach to Understand Implementation and Evaluation
Background: Digital advance care planning systems are used internationally to document and share
patients’ wishes and preferences to inform care delivery. However, their use is impeded by a limited
understanding of factors influencing implementation and evaluation.
Aim: To develop mid-range programme theory to account for technological, infrastructure and human
factor influences on digital advance care planning systems.
Design: Exploratory qualitative research design incorporating Theory of Change workshops that
explored contextual assumptions affecting digital advance care planning in practice. A mid-range
programme theory was developed through thematic framework analysis using the Non-adoption,
Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, generating a conceptual
model depicting contextual assumptions, interventions and outcomes influencing implementation.
Participants: 38 participants (16 from London, 14 from West Yorkshire, and eight online) including
patients, carers, and health and care professionals (including those with commissioning
responsibilities).
Results: A conceptual model was generated depicting five distinct components relating to digital
advance care planning system use: (sociocultural, technical, and structural prerequisites; recognition
of the clinical need for conversation; having conversations and documenting decisions; accessing,
actioning, and amending; and using data to support evaluation, use, and implementation). There were
differences and uncertainty relating to what digital advance care planning systems are, who they are
for, and how they should be evaluated.
Conclusions: Digital advance care planning lacks shared beliefs and practices, despite these being
essential for complex technology implementation. Our mid-range programme theory can guide their
further development and application by considering technological, infrastructure and human factor
influences to optimise their implementation
Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
OBJECTIVE:To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury.DESIGN:Multicentre, pragmatic, observer-blinded, randomized controlled trial in England.SETTING:Community.PARTICIPANTS:People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent.INTERVENTIONS:A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control).MAIN MEASURES:The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization.RESULTS:We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised.CONCLUSION:This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions
Rehabilitation of memory following brain injury (ReMemBrIn): study protocol for a randomised controlled trial
Background
Impairments of memory are commonly reported by people with traumatic brain injuries (TBI). Such deficits are persistent, debilitating, and can severely impact quality of life. Currently, many do not routinely receive follow-up appointments for residual memory problems following discharge.
Methods/Design
This is a multi-centre, randomised controlled trial investigating the clinical and cost-effectiveness of a group-based memory rehabilitation programme. Three hundred and twelve people with a traumatic brain injury will be randomised from four centres. Participants will be eligible if they had a traumatic brain injury more than 3 months prior to recruitment, have memory problems, are 18 to 69 years of age, are able to travel to one of our centres and attend group sessions, and are able to give informed consent. Participants will be randomised in clusters of 4 to 6 to the group rehabilitation intervention or to usual care. Intervention groups will receive 10 weekly sessions of a manualised memory rehabilitation programme, which has been developed in previous pilot studies. The intervention will include restitution strategies to retrain impaired memory functions and compensation strategies to enable participants to cope with their memory problems. All participants will receive a follow-up postal questionnaire and an assessment by a research assistant at 6 and 12 months post-randomisation. The primary outcome is the Everyday Memory Questionnaire at 6 months. Secondary outcomes include the Rivermead Behavioural Memory Test-3, General Health Questionnaire-30, health related quality of life, cost-effectiveness analysis determined by the EQ-5D and a service use questionnaire, individual goal attainment, European Brain Injury Questionnaire (patient and relative versions), and the Everyday Memory Questionnaire-relative version. The primary analysis will be based on intention to treat. A mixed-model regression analysis of the Everyday Memory Questionnaire at 6 months will be used to estimate the effect of the group memory rehabilitation programme.
Discussion
The study will hopefully provide robust evidence regarding the clinical and cost-effectiveness of a group-based memory rehabilitation intervention for civilians and military personnel following TBI. We discuss our decision-making regarding choice of outcome measures and control group, and the unique challenges to recruiting people with memory problems to trials
Visual laterality in dolphins: importance of the familiarity of stimuli
<p>Abstract</p> <p>Background</p> <p>Many studies of cerebral asymmetries in different species lead, on the one hand, to a better understanding of the functions of each cerebral hemisphere and, on the other hand, to develop an evolutionary history of hemispheric laterality. Our animal model is particularly interesting because of its original evolutionary path, i.e. return to aquatic life after a terrestrial phase. The rare reports concerning visual laterality of marine mammals investigated mainly discrimination processes. As dolphins are migrant species they are confronted to a changing environment. Being able to categorize new versus familiar objects would allow dolphins a rapid adaptation to novel environments. Visual laterality could be a prerequisite to this adaptability. To date, no study, to our knowledge, has analyzed the environmental factors that could influence their visual laterality.</p> <p>Results</p> <p>We investigated visual laterality expressed spontaneously at the water surface by a group of five common bottlenose dolphins (<it>Tursiops truncatus</it>) in response to various stimuli. The stimuli presented ranged from very familiar objects (known and manipulated previously) to familiar objects (known but never manipulated) to unfamiliar objects (unknown, never seen previously). At the group level, dolphins used their left eye to observe very familiar objects and their right eye to observe unfamiliar objects. However, eyes are used indifferently to observe familiar objects with intermediate valence.</p> <p>Conclusion</p> <p>Our results suggest different visual cerebral processes based either on the global shape of well-known objects or on local details of unknown objects. Moreover, the manipulation of an object appears necessary for these dolphins to construct a global representation of an object enabling its immediate categorization for subsequent use. Our experimental results pointed out some cognitive capacities of dolphins which might be crucial for their wild life given their fission-fusion social system and migratory behaviour.</p
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