Setting priorities to inform assessment of care homes’ readiness to participate in healthcare innovation: a systematic mapping review and consensus process

© 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedOrganisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.Peer reviewe

Signal-to-Noise Eigenmode Analysis of the Two-Year COBE Maps

To test a theory of cosmic microwave background fluctuations, it is natural to expand an anisotropy map in an uncorrelated basis of linear combinations of pixel amplitudes --- statistically-independent for both the noise and the signal. These $S/N$-eigenmodes are indispensible for rapid Bayesian analyses of anisotropy experiments, applied here to the recently-released two-year COBE {\it dmr} maps and the {\it firs} map. A 2-parameter model with an overall band-power and a spectral tilt $\nu_{\Delta T}$ describes well inflation-based theories. The band-powers for {\it all} the {\it dmr} $53,90,31$ $a$+$b$ GHz and {\it firs} 170 GHz maps agree, $\{(1.1\pm 0.1)\times 10^{-5}\}^{1/2}$, and are largely independent of tilt and degree of (sharp) $S/N$-filtering. Further, after optimal $S/N$-filtering, the {\it dmr} maps reveal the same tilt-independent large scale features and correlation function. The unfiltered {\it dmr} $53$ $a$+$b$ index $\nu_{\Delta T}+1$ is $1.4\pm 0.4$; increasing the $S/N$-filtering gives a broad region at (1.0--1.2)$\pm$0.5, a jump to (1.4--1.6)$\pm$0.5, then a drop to 0.8, the higher values clearly seen to be driven by $S/N$-power spectrum data points that do not fit single-tilt models. These indices are nicely compatible with inflation values ($\sim$0.8--1.2), but not overwhelmingly so.Comment: submitted to Phys.Rev.Letters, 4 pages, uuencoded compressed PostScript; also bdmr2.ps.Z, via anonymous ftp to ftp.cita.utoronto.ca, cd to /pub/dick/yukawa; CITA-94-2

Systematic Errors in Cosmic Microwave Background Interferometry

Cosmic microwave background (CMB) polarization observations will require superb control of systematic errors in order to achieve their full scientific potential, particularly in the case of attempts to detect the B modes that may provide a window on inflation. Interferometry may be a promising way to achieve these goals. This paper presents a formalism for characterizing the effects of a variety of systematic errors on interferometric CMB polarization observations, with particular emphasis on estimates of the B-mode power spectrum. The most severe errors are those that couple the temperature anisotropy signal to polarization; such errors include cross-talk within detectors, misalignment of polarizers, and cross-polarization. In a B mode experiment, the next most serious category of errors are those that mix E and B modes, such as gain fluctuations, pointing errors, and beam shape errors. The paper also indicates which sources of error may cause circular polarization (e.g., from foregrounds) to contaminate the cosmologically interesting linear polarization channels, and conversely whether monitoring of the circular polarization channels may yield useful information about the errors themselves. For all the sources of error considered, estimates of the level of control that will be required for both E and B mode experiments are provided. Both experiments that interfere linear polarizations and those that interfere circular polarizations are considered. The fact that circular experiments simultaneously measure both linear polarization Stokes parameters in each baseline mitigates some sources of error.Comment: 19 pages, 9 figures, submitted to Phys. Rev.

Observational constraints on the spectral index of the cosmological curvature perturbation

We evaluate the observational constraints on the spectral index $n$, in the context of the $\Lambda$CDM hypothesis which represents the simplest viable cosmology. We first take $n$ to be practically scale-independent. Ignoring reionization, we find at a nominal 2-$\sigma$ level $n\simeq 1.0 \pm 0.1$. If we make the more realisitic assumption that reionization occurs when a fraction $f\sim 10^{-5}$ to 1 of the matter has collapsed, the 2-$\sigma$ lower bound is unchanged while the 1-$\sigma$ bound rises slightly. These constraints are compared with the prediction of various inflation models. Then we investigate the two-parameter scale-dependent spectral index, predicted by running-mass inflation models, and find that present data allow significant scale-dependence of $n$, which occurs in a physically reasonable regime of parameter space.Comment: ReVTeX, 15 pages, 5 figures and 3 tables, uses epsf.sty Improved treatment of reionization and small bug fixed in the constant n case; more convenient parameterization and better treatment of the n dependence in the CMB anisotropy for the running mass case; conclusions basically unchanged; references adde

Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review

© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe

Three flavor neutrino oscillation analysis of the Superkamiokande atmospheric neutrino data

Superkamiokande atmospheric neutrino data for 535 days are analyzed in the framework of three flavor oscillations with mass hierarchy. It is shown that the best fit point is very close to the pure maximal $\nu_\mu\leftrightarrow\nu_\tau$ case and $\Delta m^2 \simeq 7\times10^{-3}$ eV$^2$. The allowed region at 90 %CL is given and the implications to the long baseline experiments are briefly discussed.Comment: 8 pages + 1 Table + 28 PostScript figures updated using 535 day dat

Measuring life events and their association with clinical disorder: a protocol for development of an online approach

Background: Severe life events are acknowledged as important aetiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared to checklist questionnaire methods and arguments for interview approaches have resurfaced as choice of assessment tool has been implicated in gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objectives: (i) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (ii) To review life events measures and key findings related to disorder, exemplifying depression. (iii) To describe an ongoing study with a new online measure, to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods: The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule (LEDS) interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties and utilise calendar-based timing, to improve upon checklist approaches. The phases of the study are outlined in terms of its samples of midlife cases with depression, unaffected controls and students, testing of the psychometric properties of CLEAR, as well as proposed investigations of its association with disorder and educational outcomes. Conclusions: There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life event data whilst combatting the limitations of interviews (e.g. time consuming and costly) and life event checklists (e.g. inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice and interventions are discussed

Mapping the 3-D Dark Matter potential with weak shear

We investigate the practical implementation of Taylor's (2002) 3-dimensional gravitational potential reconstruction method using weak gravitational lensing, together with the requisite reconstruction of the lensing potential. This methodology calculates the 3-D gravitational potential given a knowledge of shear estimates and redshifts for a set of galaxies. We analytically estimate the noise expected in the reconstructed gravitational field, taking into account the uncertainties associated with a finite survey, photometric redshift uncertainty, redshift-space distortions, and multiple scattering events. In order to implement this approach for future data analysis, we simulate the lensing distortion fields due to various mass distributions. We create catalogues of galaxies sampling this distortion in three dimensions, with realistic spatial distribution and intrinsic ellipticity for both ground-based and space-based surveys. Using the resulting catalogues of galaxy position and shear, we demonstrate that it is possible to reconstruct the lensing and gravitational potentials with our method. For example, we demonstrate that a typical ground-based shear survey with redshift limit z=1 and photometric redshifts with error Delta z=0.05 is directly able to measure the 3-D gravitational potential for mass concentrations >10^14 M_\odot between 0.1<z<0.5, and can statistically measure the potential at much lower mass limits. The intrinsic ellipticity of objects is found to be a serious source of noise for the gravitational potential, which can be overcome by Wiener filtering or examining the potential statistically over many fields. We examine the use of the 3-D lensing potential to measure mass and position of clusters in 3-D, and to detect clusters behind clusters.Comment: 21 pages, including 24 figures, submitted to MNRA