Conversations with Art Faculty: Visualizing a Polytechnic “Aesthetic Toolbox” for Hands-On, Community- Based Education

An interview with art faculty at Cal Poly Humboldt

An exploration and evaluation of mechanisms to aid recognition of acute deterioration in people with learning disabilities: "What do I need to know?"

Executive summaryBackgroundMany people require help with everyday life and the management of their healthcare. One such group is people with learning disabilities. They may be cared for in their own homes, in care‐homes or nursing homes. They are not ill, though they often have chronic health problems, but are as susceptible to acute conditions, such as Covid-19 and sepsis, as the rest of the population. It is known that persons with Learning Disability have worse outcomes from acute illness than average. This was highlighted recently by their worse outcomes from Covid-19 infection than other population groups. Most adults, when they develop an acute illness can make clear that they are feeling unwell and are able to communicate their symptoms. They can trigger the healthcare system to provide the support, investigation, and treatment appropriate to their condition. Children, elderly people with cognitive decline, and people with learning disabilities are less able to do this. When they become ill, they are more dependent upon those around them recognising that there is a problem, and this can often be difficult as their behavioural and emotional responses are sometimes understandable only to those who are familiar with their ‘usual’.In acute care settings Early Warning Scores (EWS) are used to identify the signs of deterioration. These use a score derived from the usual monitoring information that is recorded routinely. Recently EWS has been introduced in community settings where people do not normally have their vital signs monitored. Some EWS require monitoring of the patients’ vital signs (Pulse, Blood Pressure, Oxygen Saturation, Respiratory Rate and Conscious Level) whereas others depend on small changes in behaviour and do not require the use of any equipment. Study aims and designAim: 1. To investigate and evaluate the current use, the potential for future use and the impact of routine use of Early Warning Systems to identify acute deterioration in people with a learning disability. Design: A qualitative approach to explore and evidence the lived experiences and knowledge of paid and unpaid carers with respect to the following topics:• Their ability to recognise the early signs of illness and deterioration in the condition of adults with a learning disability • Their experiences of escalating their concerns to get timely help and treatment• Their thoughts and opinions about the usefulness of such tools and education2. To review the variety of EWS being used outside of acute care in England.3. To identify the range of soft signs recognised by the participating carers.The SampleDuring the development stage of the project, we were also asked to evaluate an NHS England project to teach the use of Restore2 Mini to carers for people with learning difficulties. This review became the source of the sample of carers interviewed for the overall study. This decision was partly a response to the difficulties presented by the onset of the pandemic that complicated the use of a general sample of carers. Thirty-three participants were recruited from the training sessions: 10 family carers (unpaid); 10 paid staff members working for care provider organisations (paid carers); 4 Shared Lives carers (paid carers). Nine participants were recruited from super-trainer sessions. Semi-structured interviews with the carers were transcribed and analysed for significant themes.ResultsThe carers’ concerns• Health professionals do not value the knowledge and skills the carers possess in their role and disregard their contributions. Carers report that this sometimes results in unnecessary clinical complications.• Carers themselves accept that they do not have the necessary technical language for communicating with health professionals.• Primary and secondary care ‘gatekeepers’ often lack the knowledge to recognise the urgency of an issue raised by carers. This can lead to delay in securing appropriate treatment.• Some patients do not have their learning disability registered with their GP. This complicates issues of access and entitlement to services.• Carers lack confidence in their capacity to undertake clinical tasks – such as making vital signs observations.Training for Restore2Mini• Those carers who had attended training sessions in the use of Restore2 Mini liked the format of the training and found the content useful.• Carers who attended training for Restore2 Mini were subsequently more confident in making assessments• Carers endorsed the Restore2 Mini as providing them with appropriate language to describe acute illness.• Carers endorsed the use of an early warning score that included vital signs, where it provided baseline values that were useful in the interpretation of subsequent episodes of deterioration.• Carers believe that without Learning Disability awareness training for acute sector medical professionals the potential benefits of Restore2 Mini will not be realised.• Carers believe that if those managerial and administrative staff who control access to primary and secondary care gatekeepers do not have training in the use and language of Restore2 Mini its potential benefits will not be realised.Scoping review of tools in use in EnglandA wide range of EWS tools were identified. Carers favour those that do not require the use of equipment for measuring the individual’s vital signs. The reasons for this were that the high rate of staff turnover and the heterogenicity of background of carers makes the more complex training for making physiological measurements difficult, that many people with learning disabilities find procedures such as blood pressure measurement frightening, and that the use of soft signs indicators endorses and augments the carers intuitive evaluation of their clients.Soft signsSoft signs are changes from an individual’s usual behaviour that indicate that an individual may be becoming unwell. This study identified a wide range of types of soft signs that those caring for people with a learning disability have encountered. Soft signs are highly variable and, in the case of those with learning difficulty, sometimes unusual; thus, it can take time and personal knowledge of the individual for carers to become experienced in their recognition

Detection of carbon monoxide's 4.6 micron fundamental band structure in WASP-39b's atmosphere with JWST NIRSpec G395H

Carbon monoxide (CO) is predicted to be the dominant carbon-bearing molecule in giant planet atmospheres and, along with water, is important for discerning the oxygen and therefore carbon-to-oxygen ratio of these planets. The fundamental absorption mode of CO has a broad, double-branched structure composed of many individual absorption lines from 4.3 to 5.1 μm, which can now be spectroscopically measured with JWST. Here we present a technique for detecting the rotational sub-band structure of CO at medium resolution with the NIRSpec G395H instrument. We use a single transit observation of the hot Jupiter WASP-39b from the JWST Transiting Exoplanet Community Early Release Science (JTEC ERS) program at the native resolution of the instrument (R ~ 2700) to resolve the CO absorption structure. We robustly detect absorption by CO, with an increase in transit depth of 264 ± 68 ppm, in agreement with the predicted CO contribution from the best-fit model at low resolution. This detection confirms our theoretical expectations that CO is the dominant carbon-bearing molecule in WASP-39b's atmosphere and further supports the conclusions of low C/O and supersolar metallicities presented in the JTEC ERS papers for WASP-39b

Photochemically-produced SO2_2 in the atmosphere of WASP-39b

Photochemistry is a fundamental process of planetary atmospheres that regulates the atmospheric composition and stability. However, no unambiguous photochemical products have been detected in exoplanet atmospheres to date. Recent observations from the JWST Transiting Exoplanet Early Release Science Program found a spectral absorption feature at 4.05 $\mu$m arising from SO$_2$ in the atmosphere of WASP-39b. WASP-39b is a 1.27-Jupiter-radii, Saturn-mass (0.28 M$_J$) gas giant exoplanet orbiting a Sun-like star with an equilibrium temperature of $\sim$1100 K. The most plausible way of generating SO$_2$ in such an atmosphere is through photochemical processes. Here we show that the SO$_2$ distribution computed by a suite of photochemical models robustly explains the 4.05 $\mu$m spectral feature identified by JWST transmission observations with NIRSpec PRISM (2.7$\sigma$) and G395H (4.5$\sigma$). SO$_2$ is produced by successive oxidation of sulphur radicals freed when hydrogen sulphide (H$_2$S) is destroyed. The sensitivity of the SO$_2$ feature to the enrichment of the atmosphere by heavy elements (metallicity) suggests that it can be used as a tracer of atmospheric properties, with WASP-39b exhibiting an inferred metallicity of $\sim$10$\times$ solar. We further point out that SO$_2$ also shows observable features at ultraviolet and thermal infrared wavelengths not available from the existing observations.Comment: 39 pages, 14 figures, accepted to be published in Natur

Early Release Science of the Exoplanet WASP-39b with JWST NIRSpec G395H

Measuring the abundances of carbon and oxygen in exoplanet atmospheres is considered a crucial avenue for unlocking the formation and evolution of exoplanetary systems. Access to an exoplanet's chemical inventory requires high-precision observations, often inferred from individual molecular detections with low-resolution space-based and high-resolution ground-based facilities. Here we report the medium-resolution (R$\sim$600) transmission spectrum of an exoplanet atmosphere between 3-5 $\mu$m covering multiple absorption features for the Saturn-mass exoplanet WASP-39b, obtained with JWST NIRSpec G395H. Our observations achieve 1.46x photon precision, providing an average transit depth uncertainty of 221 ppm per spectroscopic bin, and present minimal impacts from systematic effects. We detect significant absorption from CO$_2$ (28.5$\sigma$) and H$_2$O (21.5$\sigma$), and identify SO$_2$ as the source of absorption at 4.1 $\mu$m (4.8$\sigma$). Best-fit atmospheric models range between 3 and 10x solar metallicity, with sub-solar to solar C/O ratios. These results, including the detection of SO$_2$, underscore the importance of characterising the chemistry in exoplanet atmospheres, and showcase NIRSpec G395H as an excellent mode for time series observations over this critical wavelength range.Comment: 44 pages, 11 figures, 3 tables. Resubmitted after revision to Natur

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research