Digital Advance Care Planning with Severe Mental Illness:A retrospective observational cohort analysis of the use of an electronic palliative care coordination system

Abstract Background People living with severe mental illness (SMI) face significant health inequalities, including in palliative care. Advance Care Planning (ACP) is widely recommended by palliative care experts and could reduce inequalities. However, implementing ACP with this group is challenging. Electronic Palliative Care Coordination Systems such as Coordinate my Care (CMC) have been introduced to support documentation and sharing of ACP records with relevant healthcare providers. This study explores the use of CMC amongst those with SMI and aims to describe how those with a primary diagnosis of SMI who have used CMC for ACP, and makes recommendations for future research and policy. Method A retrospective observational cohort analysis was completed of CMC records created 01/01/2010–31/09/2021 where the service user had a primary diagnosis of SMI, with no exclusions based on comorbidities. Descriptive statistics were used to report on characteristics including: age, diagnosis, individual prognosis and resuscitation status. Thematic analysis was used to report on the content of patients’ statements of preference. Results 1826 records were identified. Of this sample most (60.1%) had capacity to make treatment decisions, 47.8% were aged under 70, 86.7% were given a prognosis of ‘years’ and most (63.1%) remained for full cardio-pulmonary resuscitation in the event of cardio-pulmonary arrest. Records with completed statements of preferences (20.3%) contained information about preferences for physical and mental health treatment care as well as information about patient presentation and capacity, although most were brief and lacked expression of patient voice. Discussion Compared to usual CMC users, the cohort of interest are relatively able, younger people using CMC to make long-term plans for active physical and mental health treatment. ADM is a service user-driven process, and so it was expected that authentic patient voice would be expressed within statements of preference, however this was mostly not achieved. Conclusions This digital tool is being used by people with SMI but to plan for more than palliative care. This cohort and supporting professionals have used CMC to plan for longer term physical and mental healthcare. Future research and policy should focus on development of tailored digital tools for people with SMI to plan for palliative, physical and mental healthcare and support expression of patient voice

Prehospital intravenous access and fluid resuscitation in severe sepsis: An observational cohort study

Introduction: Prompt treatment of severe sepsis in the Emergency Department reduces deaths, but the role of prehospital fluid resuscitation is unknown. We sought to determine the risk-adjusted association between prehospital fluid administration and hospital mortality among emergency medical services (EMS) patients admitted with severe sepsis. Methods: We performed a prospective, observational study of patients hospitalized with severe sepsis on admission among 45,394 adult EMS encounters taken to 15 hospitals from 11/2009 to 12/2010 by a two-tier EMS system in King County, Washington. The region mandated recording of prehospital intravenous catheter and fluid administration in prehospital records, along with detailed demographic, incident, physiologic, and hospital adjustment variables. We determined the effect of prehospital intravenous catheter or fluid versus no catheter or fluid on all-cause mortality using multivariable logistic regression. Results: Of all encounters, 1,350 met criteria for severe sepsis on admission, of whom 205 (15%) died by hospital discharge, 312 (23%) received prehospital intravenous fluid, 90 (7%) received a prehospital catheter alone and 948 (70%) did not receive catheter or fluid. EMS administered a median prehospital fluid volume of 500 mL (interquartile range (IQR): 200, 1000 mL). In adjusted models, the administration of any prehospital fluid was associated with reduced hospital mortality (Odds ratio =0.46; 95% Confidence interval: 0.23, 0.88; P =0.02) compared to no prehospital fluid. The odds of hospital mortality were also lower among severe sepsis patients treated with prehospital intravenous catheter alone (Odds ratio =0.3; 95% Confidence interval: 0.17 to 0.57; P <0.01). Conclusions: In a population-based study, the administration of prehospital fluid and placement of intravenous access were associated with decreased odds of hospital mortality compared with no prehospital catheter or fluid

Strongly magnetized pulsars: explosive events and evolution

Well before the radio discovery of pulsars offered the first observational confirmation for their existence (Hewish et al., 1968), it had been suggested that neutron stars might be endowed with very strong magnetic fields of $10^{10}$-$10^{14}$G (Hoyle et al., 1964; Pacini, 1967). It is because of their magnetic fields that these otherwise small ed inert, cooling dead stars emit radio pulses and shine in various part of the electromagnetic spectrum. But the presence of a strong magnetic field has more subtle and sometimes dramatic consequences: In the last decades of observations indeed, evidence mounted that it is likely the magnetic field that makes of an isolated neutron star what it is among the different observational manifestations in which they come. The contribution of the magnetic field to the energy budget of the neutron star can be comparable or even exceed the available kinetic energy. The most magnetised neutron stars in particular, the magnetars, exhibit an amazing assortment of explosive events, underlining the importance of their magnetic field in their lives. In this chapter we review the recent observational and theoretical achievements, which not only confirmed the importance of the magnetic field in the evolution of neutron stars, but also provide a promising unification scheme for the different observational manifestations in which they appear. We focus on the role of their magnetic field as an energy source behind their persistent emission, but also its critical role in explosive events.Comment: Review commissioned for publication in the White Book of "NewCompStar" European COST Action MP1304, 43 pages, 8 figure

In pursuit of thermal comfort: an exploration of Smart Heating in everyday life

Smart Home Heating Technologies (SHHT) have been designed to improve demand flexibility and energy conservation. SHHT rely on rational theories of energy use postulating that people will use less energy when the energy cost is higher. The inclusion of AI within SHHT is poised to optimise energy use in the future as the introduction of lower carbon energy sources place new demands on the grid. When SHHT is introduced in the home, however, they become situated in temporal heating practices that are shaped by an interplay of materiality, meanings, and competencies. We report findings from a mixed methods field study involving eleven households utilising an AI-enabled SHHT probe ‘Squid’. Taking a temporal focus throughout, our study contributes a new lens as to why households may not fully engage with SHHT’s rational design, given that energy conversation is already embedded in their ongoing socio-material practices with heating. Focusing on the AI-human relation, we articulate the necessity for human agency where heating is involved, whilst also advancing an understanding of the new forms of hidden labour that households incur before they can engage with the AI. Crucially, our research informs the ongoing HCI concern over how humans understand AI, raising the question of who is responsible to assess the appropriateness of AI when the effects of human-AI performance remain opaque. Our findings contribute a new theoretical perspective into the intricate relationship between individuals and AI in the home and raise several new design implications for SHHT

Factors influencing the selection of delay analysis methodologies

This is the post-print version of the final paper published in International Journal of Project Management. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2007 Elsevier B.V.Delays and disruption to contractors’ progress are a major source of claims and disputes in the construction industry. Often at the heart of the matter in dispute is the question of the extent of each contracting party’s responsibility for the project delay. Various delay analysis methodologies have been developed over the years as aids to answering this question. This paper reports on a study into the factors that influence analysts’ selection from these methodologies. Eighteen factors were identified through literature review and pilot surveys and then ranked on their relative importance based on data collected in a nation-wide survey of UK construction organisations. Factor analysis was used to reduce the factors into 6 group factors: project characteristics, contractual requirements, characteristics of baseline programme, cost proportionality, timing of the analysis and record availability

Protective Microbiota: From Localized to Long-Reaching Co-Immunity

Resident microbiota do not just shape host immunity, they can also contribute to host protection against pathogens and infectious diseases. Previous reviews of the protective roles of the microbiota have focused exclusively on colonization resistance localized within a microenvironment. This review shows that the protection against pathogens also involves the mitigation of pathogenic impact without eliminating the pathogens (i.e., “disease tolerance”) and the containment of microorganisms to prevent pathogenic spread. Protective microorganisms can have an impact beyond their niche, interfering with the entry, establishment, growth, and spread of pathogenic microorganisms. More fundamentally, we propose a series of conceptual clarifications in support of the idea of a “co-immunity,” where an organism is protected by both its own immune system and components of its microbiota

A geostatistical approach to surface flux estimation of atmospheric trace gases

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94944/1/jgrd11176.pd

Application of a Mathematical Model to Describe the Effects of Chlorpyrifos on Caenorhabditis elegans Development

The nematode Caenorhabditis elegans is being assessed as an alternative model organism as part of an interagency effort to develop better means to test potentially toxic substances. As part of this effort, assays that use the COPAS Biosort flow sorting technology to record optical measurements (time of flight (TOF) and extinction (EXT)) of individual nematodes under various chemical exposure conditions are being developed. A mathematical model has been created that uses Biosort data to quantitatively and qualitatively describe C. elegans growth, and link changes in growth rates to biological events. Chlorpyrifos, an organophosphate pesticide known to cause developmental delays and malformations in mammals, was used as a model toxicant to test the applicability of the growth model for in vivo toxicological testing.L1 larval nematodes were exposed to a range of sub-lethal chlorpyrifos concentrations (0-75 microM) and measured every 12 h. In the absence of toxicant, C. elegans matured from L1s to gravid adults by 60 h. A mathematical model was used to estimate nematode size distributions at various times. Mathematical modeling of the distributions allowed the number of measured nematodes and log(EXT) and log(TOF) growth rates to be estimated. The model revealed three distinct growth phases. The points at which estimated growth rates changed (change points) were constant across the ten chlorpyrifos concentrations. Concentration response curves with respect to several model-estimated quantities (numbers of measured nematodes, mean log(TOF) and log(EXT), growth rates, and time to reach change points) showed a significant decrease in C. elegans growth with increasing chlorpyrifos concentration.Effects of chlorpyrifos on C. elegans growth and development were mathematically modeled. Statistical tests confirmed a significant concentration effect on several model endpoints. This confirmed that chlorpyrifos affects C. elegans development in a concentration dependent manner. The most noticeable effect on growth occurred during early larval stages: L2 and L3. This study supports the utility of the C. elegans growth assay and mathematical modeling in determining the effects of potentially toxic substances in an alternative model organism using high-throughput technologies

Crustal types and Tertiary tectonic evolution of the Alborán sea, western Mediterranean

Multichannel seismic reflection images across the transition between the east Alborán and the Algero-Balearic basins show how crustal thickness decreases from about 5 s two-way traveltime (TWTT, ∼15 km thick) in the west (east Alborán basin) to ∼2 s TWTT typical of oceanic crust (∼6 km thick) in the east (Algero-Balearic basin). We have differentiated three different crustal domains in this transition, mainly on the basis of crustal thickness and seismic signature. Boundaries between the three crustal domains are transitional and lack evidence for major faults. Tilted blocks related to extension are very scarce and all sampled basement outcrops are volcanic, suggesting a strong relationship between magmatism and crustal structure. Stratigraphic correlation of lithoseismic units with sedimentary units of southeastern Betic basins indicates that sediments onlap igneous basement approximately at 12 Ma in the eastern area and at 8 Ma in the western area. Linking seismic crustal structure with magmatic geochemical evidence suggests that the three differentiated crustal domains may represent, from west to east, thin continental crust modified by arc magmatism, magmatic-arc crust, and oceanic crust. Middle to late Miocene arc and oceanic crust formation in the east Alborán and Algero-Balearic basins, respectively, occurred during westward migration of the Gibraltar accretionary wedge and shortening in the Betic-Rif foreland basins. Arc magmatism and associated backarc oceanic crust formation were related to early to middle Miocene subduction and rollback of the Flysch Trough oceanic basement. Subduction of this narrow slab beneath the Alborán basin was coeval with collision of the Alborán domain with the Iberian and African passive margins and subsequent subcontinental-lithosphere edge delamination along the Betic-Rif margins