Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study.

BACKGROUND: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). OBJECTIVE: We aimed to address the limited effectiveness research on JfA devices. METHODS: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. RESULTS: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. CONCLUSIONS: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. TRIAL REGISTRATION: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT0416846

Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure

<p>Abstract</p> <p>Background</p> <p>Monoclonal free light chains (FLCs) frequently cause rapidly progressive renal failure in patients with multiple myeloma. Immunoassays which provide quantitative measurement of FLCs in serum, have now been adopted into screening algorithms for multiple myeloma and other lymphoproliferative disorders. The assays indicate monoclonal FLC production by the presence of an abnormal κ to λ FLC ratio (reference range 0.26–1.65). Previous work, however, has demonstrated that in patients with renal failure the FLC ratio can be increased above normal with no other evidence of monoclonal proteins suggesting that in this population the range should be extended (reference range 0.37–3.1). This study evaluated the diagnostic sensitivity and specificity of the immunoassays in patients with severe renal failure.</p> <p>Methods</p> <p>Sera from 142 patients with new dialysis-dependent renal failure were assessed by serum protein electrophoresis (SPE), FLC immunoassays and immunofixation electrophoresis. The sensitivity and specificity of the FLC ratio's published reference range was compared with the modified renal reference range for identifying patients with multiple myeloma; by receiver operating characteristic curve analysis.</p> <p>Results</p> <p>Forty one patients had a clinical diagnosis of multiple myeloma; all of these patients had abnormal serum FLC ratios. The modified FLC ratio range increased the specificity of the assays (from 93% to 99%), with no loss of sensitivity. Monoclonal FLCs were identified in the urine from 23 of 24 patients assessed.</p> <p>Conclusion</p> <p>Measurement of serum FLC concentrations and calculation of the serum κ/λ ratio is a convenient, sensitive and specific method for identifying monoclonal FLC production in patients with multiple myeloma and acute renal failure. Rapid diagnosis in these patients will allow early initiation of disease specific treatment, such as chemotherapy plus or minus therapies for direct removal of FLCs.</p

Layer-by-layer functionalized nanotube arrays: A versatile microfluidic platform for biodetection

We demonstrate the layer-by-layer (LbL) assembly of polyelectrolyte multilayers (PEM) on three-dimensional nanofiber scaffolds. High porosity (99%) aligned carbon nanotube (CNT) arrays are photolithographically patterned into elements that act as textured scaffolds for the creation of functionally coated (nano)porous materials. Nanometer-scale bilayers of poly(allylamine hydrochloride)/poly(styrene sulfonate) (PAH/SPS) are formed conformally on the individual nanotubes by repeated deposition from aqueous solution in microfluidic channels. Computational and experimental results show that the LbL deposition is dominated by the diffusive transport of the polymeric constituents, and we use this understanding to demonstrate spatial tailoring on the patterned nanoporous elements. A proof-of-principle application, microfluidic bioparticle capture using N-hydroxysuccinimide-biotin binding for the isolation of prostate-specific antigen (PSA), is demonstrated.National Science Foundation (U.S.) (Award DMR-0819762

Detection of oligoclonal IgG kappa and IgG lambda bands in cerebrospinal fluid and serum with Hevylite™ antibodies. comparison with the free light chain oligoclonal pattern

<p>Abstract</p> <p>Background</p> <p>Oligoclonal IgG bands in cerebrospinal fluid that are absent in serum indicate intrathecal IgG synthesis and are a sensitive marker of CNS inflammatory diseases, in particular multiple sclerosis. It may be of interest to determine whether these bands are predominantly IgGκ or IgGλ.</p> <p>Methods</p> <p>We have used Hevylite™ antibodies and developed a technique for detection of oligoclonal IgGκ and IgGλ bands by means of isoelectric focusing followed by immunoblotting. The same technique was used for oligoclonal free κ and free λ detection. Among several techniques tested, affinity immunoblotting appears to be the most sensitive; it can detect less than 1 ng of IgGκ or IgGλ paraprotein. We compared oligoclonal IgG profiles with those of oligoclonal IgGκ and IgGλ. There was good agreement concerning the presence or absence of intrathecal synthesis. We observed the ratios between oligoclonal IgGκ and IgGλ bands, and they did not always match the ratios between free κ and free λ bands. We were also able to detect antigen-specific CSF-restricted oligoclonal IgGκ and IgGλ bands in neuroborreliosis. It remains to be determined subsequently by a clinically-oriented prospective study, whether predominant IgGκ/IgGλ or free κ/free λ can be observed more frequently in particular diseases with oligoclonal IgG synthesis.</p> <p>Discussion</p> <p>Very sensitive detection of oligoclonal IgGκ and IgGλ bands in cerebrospinal fluid with Hevylite antibodies is feasible; detection of antigen-specific IgGκ or IgGλ is possible as well. In particular situations, e.g. when difficulties arise in distinguishing between oligoclonal and monoclonal pattern, the test may be of considerable clinical value.</p

Ice marginal dynamics of the last British-Irish Ice Sheet in the southern North Sea: Ice limits, timing and the influence of the Dogger Bank

The southern North Sea is a particularly important area for understanding the behaviour of the British-Irish Ice Sheet (BIIS) during the last glacial cycle. It preserves a record of the maximum extent of the eastern sector of the BIIS as well as evidence for multiple different ice flow phases and the dynamic re-organisation of the BIIS. However, to date, the known ice sheet history and geochronology of this region is predominantly derived from onshore geological evidence, and the offshore imprint and dynamic history of the last ice sheet remain largely unknown. Using new data collected by the BRITICE-CHRONO project this paper explores the origin and age of the Dogger Bank; re-assesses the extent and age of the glaciogenic deposits across the shallow areas of the North Sea between the Dogger Bank and the north Norfolk coast and; re-examines the dynamic behaviour of the BIIS in the southern North Sea between 31.6 and 21.5 ka. This paper shows the core of the Dogger Bank to be composed glaciolacustrine sediment deposited between 31.6 and 25.8 ka. Following its formation the western end of the Dogger lake was overridden with ice reaching ∼54°N where the ice margin is co-incident with the southerly extent of subglacial tills previously mapped as Bolders Bank Fm. This initial ice override and retreat northwards back across the Dogger lake was complete by 23.1 ka, but resulted in widespread compressive glaciotectonism of the lake sediments and the formation of thrust moraine complexes. Along the northern edge of the bank moraines are on-lapped by later phase glaciolacustrine and marine sediments but do not show evidence of subsequent ice override. The shallow seafloor to the west and southwest of the Dogger Bank records several later phases of ice advance and retreat as the North Sea Lobe flowed between the Dogger Bank and the Yorkshire/Lincolnshire coasts and reached North Norfolk. New optically stimulated luminescence (OSL) ages from Garrett Hill on outwash limit the arrival of the BIIS on the Norfolk coast to 22.8–21.5 ka. Multiple till sheets and chains of moraines on the seafloor north of Norfolk mark dynamic oscillation of the North Sea Lobe margin as it retreated northwards. This pattern of behaviour is broadly synchronous with the terrestrial record of deposition of subglacial, glaciofluvial and glaciolacustrine sediments along the Yorkshire coast which relate to post Dimlington Stadial ice marginal oscillations after 21.5 ka. With respect to forcing mechanisms it is likely that during the early phases of the last glacial maximum (∼30-23ka) the interaction between the southern margin of the BIIS and the Dogger Lake was critical in influencing flow instability and rapid ice advance and retreat. However, during the latter part of the last glacial maximum (22–21 ka) late-phase ice advance in the southern North Sea became restricted to the western side of the Dogger Bank which was a substantial topographic feature by this time. This topographic confinement, in addition to decoupling of the BIIS and the Fennoscandian Ice Sheet (FIS) further north, enabled ice to reach the north Norfolk coast, overprinting the seabed with late-phase tills of the Bolders Bank Fm

Retreat dynamics of the eastern sector of the British–Irish Ice Sheet during the last glaciation

The findings of BRITICE‐CHRONO Transect 2 through the North Sea Basin and eastern England are reported. We define ice‐sheet marginal oscillation between ~31 and 16 ka, with seven distinctive former ice‐sheet limits (L1–7) constrained by Bayesian statistical analysis. The southernmost limit of the North Sea Lobe is recorded by the Bolders Bank Formation (L1; 25.8–24.6 ka). L2 represents ice‐sheet oscillation and early retreat to the northern edge of the Dogger Bank (23.5–22.2 ka), with the Garret Hill Moraine in north Norfolk recording a significant regional readvance to L3 at 21.5–20.8 ka. Ice‐marginal oscillations at ~26–21 ka resulted in L1, L2 and L3 being partially to totally overprinted. Ice‐dammed lakes related to L1–3, including Lake Humber, are dated at 24.1–22.3 ka. Ice‐sheet oscillation and retreat from L4 to L5 occurred between 19.7 and 17.3 ka, with grounding zone wedges marking an important transition from terrestrial to marine tidewater conditions, triggered by the opening of the Dogger Lake spillway between 19.9 and 17.5 ka. L6 relates to ice retreat under glacimarine conditions and final ice retreat into the Firth of Forth by 15.8 ka. L7 (~15 ka) represents an ice retreat from Bosies Bank into the Moray Firth

Seabed geomorphology: a two-part classification system

The BGS has developed a two- part classification system (‘Morphology’ and ‘Geomorphology’) to facilitate work on a new ‘S eabed Geomorphology’ mapping initia tive, and this classification system is the focus of this report. As stated in the Foreword, the rationale and the basic framework of the classification system were conceived and es tablished within BGS, but recent collaboration within the MAREANO -Norway, INFOMAR -Ireland, and MAREMAP -UK (MIM) partnership has led to significant improvement of the classifi cation system, and this report. To further support this effort, existing BGS GIS tools (SIGMA) ha ve been adapted to apply this two-part classification system for more efficient geom orphological mapping in the marine environment. This report: provides a brief background on seabed mapping and characterisation, as well as how this science has been addressed historically within BGS; describes the current motiva tion to conduct seabed geom orphological mapping, and the requirement for a new set of t ools to facilitate this work; describes the logical framework that underpins the classification system; outlines the attributes of the classification system, how it can be applied, and discusses the advantages and limitations of the approach. It is anticipated that through testing and usage, the classification syst em will be revised and improved over time, with updated versions released through MIM partnershi p. It is also planned that a further ‘user guide’ report will be produced for the classifi cation system and the GIS tools, including thematic details (e.g. background information on ‘coastal’ or ‘glacial’ features) and a feature glossary

Effect of losartan on performance and physiological responses to exercise at high altitude (5035 m)

Objective: Altitude-related and exercise-related elevations in blood pressure (BP) increase the likelihood of developing pulmonary hypertension and high-altitude illness during high-altitude sojourn. This study examined the antihypertensive effect and potential exercise benefit of the angiotensin II receptor antagonist losartan when taken at altitude. Methods: Twenty participants, paired for age and ACE genotype status, completed a double-blinded, randomised study, where participants took either losartan (100 mg/day) or placebo for 21 days prior to arrival at 5035 m (Whymper Hut, Mt Chimborazo, Ecuador). Participants completed a maximal exercise test on a supine cycle ergometer at sea level (4 weeks prior) and within 48 hours of arrival to 5035 m (10-day ascent). Power output, beat-to-beat BP, oxygen saturation (SpO2) and heart rate (HR) were recorded during exercise, with resting BP collected from daily medicals during ascent. Before and immediately following exercise at 5035 m, extravascular lung water prevalence was assessed with ultrasound (quantified via B-line count). Results: At altitude, peak power was reduced relative to sea level (p<0.01) in both groups (losartan vs placebo: down 100±29 vs 91±28 W, p=0.55), while SpO2 (70±6 vs 70±5%, p=0.96) and HR (146±21 vs 149±24 bpm, p=0.78) were similar between groups at peak power, as was the increase in systolic BP from rest to peak power (up 80±37 vs 69±33 mm Hg, p=0.56). Exercise increased B-line count (p<0.05), but not differently between groups (up 5±5 vs 8±10, p=0.44). Conclusion: Losartan had no observable effect on resting or exercising BP, exercise-induced symptomology of pulmonary hypertension or performance at 5035 m

Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study

Background Understanding and assessing patients’ body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. Objective The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. Methods We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed “Up &amp; Go,” Berg Balance Test, ankle range of motion, shoulder range of motion) as the “challenge” for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers’ family members and clinical experience. Results Kubi, which allowed the clinician to remotely control the patient’s device, was useful for repositioning the tablet camera to gain a better view of the patient’s body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. Conclusions Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient’s clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement. </jats:sec