The role of the Intermediate Care Team in detecting and responding to loneliness in older clients

The Intermediate Care Team (ICT) supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how ICT professionals perceive, detect, or respond to loneliness in their clients. This study explores ICT professional’s attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight ICT professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data was analysed thematically using framework analysis, applying the Theory of Planned Behaviour as an interpretive framework. ICT professionals believed loneliness was a significant issue for many of their older clients but was a low priority for ICT services. Study participants believed that loneliness often goes undetected because it is an issue that is difficult to measure objectively. Barriers to managing loneliness included high work-load, unsatisfactory referral systems, and lack of close working with social-care and independent sector services. Introducing brief but reliable loneliness assessments into routine practice, receiving training on detecting and managing loneliness, and improving working relationships with social care and independent sector services were highlighted as strategies that could improve the detection and management of loneliness in ICT clients

Alternative causal inference methods in population health research: Evaluating tradeoffs and triangulating evidence.

Population health researchers from different fields often address similar substantive questions but rely on different study designs, reflecting their home disciplines. This is especially true in studies involving causal inference, for which semantic and substantive differences inhibit interdisciplinary dialogue and collaboration. In this paper, we group nonrandomized study designs into two categories: those that use confounder-control (such as regression adjustment or propensity score matching) and those that rely on an instrument (such as instrumental variables, regression discontinuity, or differences-in-differences approaches). Using the Shadish, Cook, and Campbell framework for evaluating threats to validity, we contrast the assumptions, strengths, and limitations of these two approaches and illustrate differences with examples from the literature on education and health. Across disciplines, all methods to test a hypothesized causal relationship involve unverifiable assumptions, and rarely is there clear justification for exclusive reliance on one method. Each method entails trade-offs between statistical power, internal validity, measurement quality, and generalizability. The choice between confounder-control and instrument-based methods should be guided by these tradeoffs and consideration of the most important limitations of previous work in the area. Our goals are to foster common understanding of the methods available for causal inference in population health research and the tradeoffs between them; to encourage researchers to objectively evaluate what can be learned from methods outside one's home discipline; and to facilitate the selection of methods that best answer the investigator's scientific questions

Reduction and reconstruction of stochastic differential equations via symmetries

An algorithmic method to exploit a general class of infinitesimal symmetries for reducing stochastic differential equations is presented and a natural definition of reconstruction, inspired by the classical reconstruction by quadratures, is proposed. As a side result the well-known solution formula for linear one-dimensional stochastic differential equations is obtained within this symmetry approach. The complete procedure is applied to several examples with both theoretical and applied relevance

Latitudinal extension of low-latitude scintillations measured with a network of GPS receivers

International audienceA latitudinal-distributed network of GPS receivers has been operating within Colombia, Peru and Chile with sufficient latitudinal span to measure the absolute total electron content (TEC) at both crests of the equatorial anomaly. The network also provides the latitudinal extension of GPS scintillations and TEC depletions. The GPS-based information has been supplemented with density profiles collected with the Jicamarca digisonde and JULIA power maps to investigate the background conditions of the nighttime ionosphere that prevail during the formation and the persistence of plasma depletions. This paper presents case-study events in which the latitudinal extension of GPS scintillations, the maximum latitude of TEC depletion detections, and the altitude extension of radar plumes are correlated with the location and extension of the equatorial anomaly. Then it shows the combined statistics of GPS scintillations, TEC depletions, TEC latitudinal profiles, and bottomside density profiles collected between September 2001 and June 2002. It is demonstrated that multiple sights of TEC depletions from different stations can be used to estimate the drift of the background plasma, the tilt of the plasma plumes, and in some cases even the approximate time and location of the depletion onset. This study corroborates the fact that TEC depletions and radar plumes coincide with intense levels of GPS scintillations. Bottomside radar traces do not seem to be associated with GPS scintillations. It is demonstrated that scintillations/depletions can occur when the TEC latitude profiles are symmetric, asymmetric or highly asymmetric; this is during the absence of one crest. Comparison of the location of the northern crest of the equatorial anomaly and the maximum latitude of scintillations reveals that for 90% of the days, scintillations are confined within the boundaries of the 50% decay limit of the anomaly crests. The crests of the anomaly are the regions where the most intense GPS scintillations and the deepest TEC depletions are encountered. In accord with early results, we observe that GPS scintillations/TEC depletions mainly occur when the altitude of the magnetic equator F-region is above 500km. Nevertheless, in many instances GPS scintillations and TEC depletions are observed to exist when the F-layer is well below 500km or to persist when the F-layer undergoes its typical nighttime descent. Close inspection of the TEC profiles during scintillations/depletions events that occur when the equatorial F-layer peak is below 500km altitude reveals that on these occasions the ratio of the crest-to-equator TEC is above 2, and the crests are displaced 10° or more from the magnetic equator. When the equatorial F-layer is above 500km, neither of the two requirements is needed, as the flux tube seems to be inherently unstable. We discuss these findings in terms of the Rayleigh-Taylor instability (RTI) mechanism for flux-tube integrated quantities. We advance the idea that the seeming control that the reverse fountain effect exerts on inhibiting or suppressing GPS scintillations may be related to the redistribution of the density and plasma transport from the crests of the anomaly toward the equatorial region and then to much lower altitudes, and the simultaneous decrease of the F-region altitude. These two effects originate a decrease in the crest/trough ratio and a reduction of the crests separation, making the whole flux tube more stable to the RTI. The correspondence between crest separation, altitude of the equatorial F-region, the onset of depletions, and the altitude (latitude) extension of plumes (GPS scintillations) can be used to track the fate of the density structures

Past-year prevalence of prescription opioid misuse among those 11 to 30

AbstractBackgroundThere are high levels of prescription and consumption of prescription opioids in the US. Misuse of prescription opioids has been shown to be highly correlated with prescription opioid-related morbidity and mortality including fatal and non-fatal overdose. We characterized the past-year prevalence of prescription opioid misuse among those 11–30years of age in the US.MethodsA systematic review and meta-analysis were carried out following a published protocol and PRISMA guidelines. We searched electronic databases; reports were eligible if they were published between 1/1/1990–5/30/2014, and included data on individuals 11–30years of age from the US. Study quality was assessed using the Newcastle-Ottawa Scale.ResultsA total of 3211 abstracts were reviewed for inclusion; after discarding duplicates and identifying non-eligible reports, a total of 19 unique reports, providing 34 estimates, were included in the final systematic review and meta-analysis. The range of past-year prescription opioid misuse prevalence the reports was 0.7%–16.3%. An increase in prevalence of 0.4% was observed over the years of data collection.ConclusionsThis systematic review and meta-analysis found a high prevalence of past-year prescription opioid misuse among individuals 11–30years of age. Importantly, we identified an increase in past-year prevalence 1990–2014. Misuse of prescription opioids has played an important role in national increases of fatal and non-fatal drug overdose, heroin use and injection, and HIV and HCV infection among young people. The observed high and increasing prevalence of prescription opioid misuse is an urgent public health issue

When are active Brownian particles and run-and-tumble particles equivalent? Consequences for motility-induced phase separation

Active Brownian particles (ABPs, such as self-phoretic colloids) swim at fixed speed $v$ along a body-axis ${\bf u}$ that rotates by slow angular diffusion. Run-and-tumble particles (RTPs, such as motile bacteria) swim with constant \u until a random tumble event suddenly decorrelates the orientation. We show that when the motility parameters depend on density $\rho$ but not on ${\bf u}$, the coarse-grained fluctuating hydrodynamics of interacting ABPs and RTPs can be mapped onto each other and are thus strictly equivalent. In both cases, a steeply enough decreasing $v(\rho)$ causes phase separation in dimensions $d=2,3$, even when no attractive forces act between the particles. This points to a generic role for motility-induced phase separation in active matter. However, we show that the ABP/RTP equivalence does not automatically extend to the more general case of \u-dependent motilities

Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data

Background: Globally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea. Methods: Data for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression. Results: The results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and those whose partners had secondary/higher level of education (AOR=1.46, CI=1.22-1.75), women in the richest wealth quintile (AOR=5.09, CI=3.70-7.00), those with planned pregnancies (AOR=1.50, CI=1.23-1.81), Muslim women (AOR=1.65, CI=1.38-2.12), those who take healthcare decisions alone (AOR=1.53, CI=1.24-1.89), and those who listened to radio less than once a week (AOR= 1.30, CI=1.10-1.53) had higher odds of antenatal care uptake. Also, women with secondary/higher level of education (AOR=1.83, CI=1.25-2.68), those whose partners had secondary/higher level of education (AOR=1.40, CI=1.11-1.76), those in the richest wealth quintile (AOR=10.79, CI=6.64-17.51), those with planned pregnancies (AOR=1.25, CI=1.03-1.52), Christian women (AOR=4.13, CI=3.17-5.39), those living in urban areas (AOR=3.00, CI=2.29-3.94), women with one birth (AOR= 1.58, CI=1.20-2.06), those who take healthcare decisions alone (AOR=1.87, CI=1.46-2.39), those who read newspaper at least once a week (AOR= 1.19, CI=1.01-1.40), those who watched television at least once week (AOR=1.69, CI=1.30-2.19), and those in female-headed households (AOR=1.52, CI=1.20-1.92) were more likely to utilize the services of skilled birth attendants. Conclusion: The study proved that various socio-economic and contextual factors influence antenatal care and skilled birth attendance in Guinea. These findings suggest the need to design community-based interventions (e.g., miniature local ANC clinics, early screening services) that prioritize women’s education and vocational training, media accessibility, especially among the poor, and those residing in rural settings. Such interventions should not ignore the influence of other socio-cultural norms that hinder the utilization of antenatal care and skilled birth attendance services in Guinea