Climate change scenarios for the California region

To investigate possible future climate changes in California, a set of climate change model simulations was selected and evaluated. From the IPCC Fourth Assessment, simulations of twenty-first century climates under a B1 (low emissions) and an A2 (a medium-high emissions) emissions scenarios were evaluated, along with occasional comparisons to the A1fi (high emissions) scenario. The climate models whose simulations were the focus of the present study were from the Parallel Climate Model (PCM1) from NCAR and DOE, and the NOAA Geophysical Fluid Dynamics Laboratory CM2.1 model (GFDL). These emission scenarios and attendant climate simulations are not “predictions,” but rather are a purposely diverse set of examples from among the many plausible climate sequences that might affect California in the next century. Temperatures over California warm significantly during the twenty-first century in each simulation, with end-of-century temperature increases from approximately +1.5°C under the lower emissions B1 scenario in the less responsive PCM1 to +4.5°C in the higher emissions A2 scenario within the more responsive GFDL model. Three of the simulations (all except the B1 scenario in PCM1) exhibit more warming in summer than in winter. In all of the simulations, most precipitation continues to occur in winter. Relatively small (less than ~10%) changes in overall precipitation are projected. The California landscape is complex and requires that model information be parsed out onto finer scales than GCMs presently offer. When downscaled to its mountainous terrain, warming has a profound influence on California snow accumulations, with snow losses that increase with warming. Consequently, snow losses are most severe in projections by the more responsive model in response to the highest emissions

The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review

OBJECTIVES: To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN: A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING: Community-based interventions. PARTICIPANTS: Patients with multimorbidity. MAIN OUTCOME MEASURES: Unplanned healthcare usage. RESULTS: Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS: Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics

Improving multidisciplinary team working to support integrated care for people with frailty amidst the COVID-19 pandemic

Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings

The programming of sequences of saccades

Saccadic eye movements move the high-resolution fovea to point at regions of interest. Saccades can only be generated serially (i.e., one at a time). However, what remains unclear is the extent to which saccades are programmed in parallel (i.e., a series of such moments can be planned together) and how far ahead such planning occurs. In the current experiment, we investigate this issue with a saccade contingent preview paradigm. Participants were asked to execute saccadic eye movements in response to seven small circles presented on a screen. The extent to which participants were given prior information about target locations was varied on a trial-by-trial basis: participants were aware of the location of the next target only, the next three, five, or all seven targets. The addition of new targets to the display was made during the saccade to the next target in the sequence. The overall time taken to complete the sequence was decreased as more targets were available up to all seven targets. This was a result of a reduction in the number of saccades being executed and a reduction in their saccade latencies. Surprisingly, these results suggest that, when faced with a demand to saccade to a large number of target locations, saccade preparation about all target locations is carried out in paralle

Development of a Virtual Laboratory for the Study of Complex Human Behavior

The study of human perception has evolved from examining simple tasks executed in reduced laboratory conditions to the examination of complex, real-world behaviors. Virtual environments represent the next evolutionary step by allowing full stimulus control and repeatability for human subjects, and a testbed for evaluating models of human behavior. Visual resolution varies dramatically across the visual field, dropping orders of magnitude from central to peripheral vision. Humans move their gaze about a scene several times every second, projecting taskcritical areas of the scene onto the central retina. These eye movements are made even when the immediate task does not require high spatial resolution. Such “attentionally-driven” eye movements are important because they provide an externally observable marker of the way subjects deploy their attention while performing complex, real-world tasks. Tracking subjects’ eye movements while they perform complex tasks in virtual environments provides a window into perception. In addition to the ability to track subjects’ eyes in virtual environments, concurrent EEG recording provides a further indicator of cognitive state. We have developed a virtual reality laboratory in which head-mounted displays (HMDs) are instrumented with infrared video-based eyetrackers to monitor subjects’ eye movements while they perform a range of complex tasks such as driving, and manual tasks requiring careful eye-hand coordination. A go-kart mounted on a 6DOF motion platform provides kinesthetic feedback to subjects as they drive through a virtual town; a dual-haptic interface consisting of two SensAble Phantom extended range devices allows free motion and realistic force-feedback within a 1^3 m volume (Refer to PDF file for exact formulas)

Chapter 15: Potential Surprises: Compound Extremes and Tipping Elements

The Earth system is made up of many components that interact in complex ways across a broad range of temporal and spatial scales. As a result of these interactions the behavior of the system cannot be predicted by looking at individual components in isolation. Negative feedbacks, or self-stabilizing cycles, within and between components of the Earth system can dampen changes (Ch. 2: Physical Drivers of Climate Change). However, their stabilizing effects render such feedbacks of less concern from a risk perspective than positive feedbacks, or self-reinforcing cycles. Positive feedbacks magnify both natural and anthropogenic changes. Some Earth system components, such as arctic sea ice and the polar ice sheets, may exhibit thresholds beyond which these self-reinforcing cycles can drive the component, or the entire system, into a radically different state. Although the probabilities of these state shifts may be difficult to assess, their consequences could be high, potentially exceeding anything anticipated by climate model projections for the coming century

Reassessing China’s Higher Education Development: A Focus on Academic Culture

During the past three and a half decades, China has been progressing in higher education in a surprisingly dramatic manner, evidenced especially by scientific publications and sheer numbers of graduates. Such a fact has national, regional and global implications. China’s higher education development and its future directions are now placed highly on the research agendas of many from various parts of the world. Unlike the general acknowledgment of China’s achievements, assessment of the future development of China’s higher education is wide open to question. To some, Chinese universities are on a trajectory to become “world-class” and China’s high-fliers challenge Western supremacy. To others, China’s notion of “world-class” status has been largely imitative. Pumping resources into universities will only lead to diminishing returns as Chinese culture and practices will act as a brake to the pursuit of academic excellence. An increasing deal of attention has been paid to where China will be located in a global higher education landscape and in what shape. Based on the author’s long-standing professional observation and recent empirical studies, this article assesses China’s higher education development, with a particular focus on the challenges brought forward by academic culture. It interrogates China’s pride of the idea that Chinese universities are not willing to assume that Western models define excellence, and asks how far Chinese universities could move within their current development model.postprin

Depression and unplanned secondary healthcare use in patients with multimorbidity: a systematic review

Background: Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable. Aim: To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity. Methods: We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced. Results: Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities. Conclusion: Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings