‘’It just happens’. Care home residents’ experiences and expectations of accessing GP care.

Background: Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access. Methods: Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework. Findings: Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted. Conclusions: Care home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.Peer reviewedFinal Accepted Versio

Using Decision Analysis to Improve Malaria Control Policy Making

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases

Algorithms for Olfactory Search across Species

Localizing the sources of stimuli is essential. Most organisms cannot eat, mate, or escape without knowing where the relevant stimuli originate. For many, if not most, animals, olfaction plays an essential role in search. While microorganismal chemotaxis is relatively well understood, in larger animals the algorithms and mechanisms of olfactory search remain mysterious. In this symposium, we will present recent advances in our understanding of olfactory search in flies and rodents. Despite their different sizes and behaviors, both species must solve similar problems, including meeting the challenges of turbulent airflow, sampling the environment to optimize olfactory information, and incorporating odor information into broader navigational systems

Exposures to Carbon Monoxide in a Cookstove Intervention in Northern Ghana

Biomass burning for home energy use is a major environmental health concern. Improved cooking technologies could generate environmental health benefits, yet prior results regarding reduced personal exposure to air pollution are mixed. In this study, two improved stove types were distributed over four study groups in Northern Ghana. Participants wore real-time carbon monoxide (CO) monitors to measure the effect of the intervention on personal exposures. Relative to the control group (those using traditional stoves), there was a 30.3% reduction in CO exposures in the group given two Philips forced draft stoves (p = 0.08), 10.5% reduction in the group given two Gyapa stoves (locally made rocket stoves) (p = 0.62), and 10.2% reduction in the group given one of each (p = 0.61). Overall, CO exposure for participants was low given the prevalence of cooking over traditional three-stone fires, with 8.2% of daily samples exceeding WHO Tier-1 standards. We present quantification methods and performance of duplicate monitors. We analyzed the relationship between personal carbonaceous particulate matter less than 2.5 microns (PM2.5) and CO exposure for the dataset that included both measurements, finding a weak relationship likely due to the diversity of identified air pollution sources in the region and behavior variability.</p

Kitchen Area Air Quality Measurements in Northern Ghana: Evaluating the Performance of a Low-Cost Particulate Sensor within a Household Energy Study

Household air pollution from the combustion of solid fuels is a leading global health and human rights concern, affecting billions every day. Instrumentation to assess potential solutions to this problem faces challenges-especially related to cost. A low-cost ($159) particulate matter tool called the Household Air Pollution Exposure (HAPEx) Nano was evaluated in the field as part of the Prices, Peers, and Perceptions cookstove study in northern Ghana. Measurements of temperature, relative humidity, absolute humidity, and carbon dioxide and carbon monoxide concentrations made at 1-min temporal resolution were integrated with 1-min particulate matter less than 2.5 microns in diameter (PM2.5) measurements from the HAPEx, within 62 kitchens, across urban and rural households and four seasons totaling 71 48-h deployments. Gravimetric filter sampling was undertaken to ground-truth and evaluate the low-cost measurements. HAPEx baseline drift and relative humidity corrections were investigated and evaluated using signals from paired HAPEx, finding significant improvements. Resulting particle coefficients and integrated gravimetric PM2.5 concentrations were modeled to explore drivers of variability; urban/rural, season, kitchen characteristics, and dust (a major PM2.5 mass constituent) were significant predictors. The high correlation (R2 = 0.79) between 48-h mean HAPEx readings and gravimetric PM2.5 mass (including other covariates) indicates that the HAPEx can be a useful tool in household energy studies.</p

A glimpse into real-world kitchens: Improving our understanding of cookstove usage through in-field photo-observations and improved cooking event detection (CookED) analytics

The combustion of solid fuels in residential cookstoves is a global health and climate issue, and expanded use ofimproved cookstoves could have significant benefits locally and globally. Evaluating impacts of improved cookstove programs requires more accurately measuring stove use patterns. This work builds on and improves existing stove use monitoring methods. First, we introduce and describe a novel, in-field photo-observation sampling method designed to capture near-continuous, real-world, ground-truth stove usage information. These measurements are used to validate predictions made by electronic stove use monitors (SUMs). Second, we present Cooking Event Detector (CookED), a SUM algorithm that translates stove-temperature measurements into classifications of cooking or not-cooking. The predictive performance of the new algorithm is evaluated using results from the photo-observations and compared to existing algorithms. CookED demonstrates considerable improvement over some methods for all five types of improved and traditional stoves monitored in the study. Overall minute-level predictive accuracy of CookED ranges from 95.6% to 98.4%, depending on the stove type, while Matthews correlation coefficients range from 72.8% to 88.3%. Comparisons between predicted and observed average cooking event durations show high correlation (Pearson&rsquo;s r = 0.85). These methods can be applied in a wide variety of applications, including research studies linking behavior, technology, exposure, and human and environmental health, as well as operational programs that aim to scale up improved cookstove adoption and quantify benefits.</p

Evidence for a Shallow Evolution in the Volume Densities of Massive Galaxies at z=4z=4 to 88 from CEERS

We analyze the evolution of massive (log$_{10}$ [$M_\star/M_\odot$] $>10$) galaxies at $z \sim$ 4--8 selected from the JWST Cosmic Evolution Early Release Science (CEERS) survey. We infer the physical properties of all galaxies in the CEERS NIRCam imaging through spectral energy distribution (SED) fitting with dense basis to select a sample of high redshift massive galaxies. Where available we include constraints from additional CEERS observing modes, including 18 sources with MIRI photometric coverage, and 28 sources with spectroscopic confirmations from NIRSpec or NIRCam wide-field slitless spectroscopy. We sample the recovered posteriors in stellar mass from SED fitting to infer the volume densities of massive galaxies across cosmic time, taking into consideration the potential for sample contamination by active galactic nuclei (AGN). We find that the evolving abundance of massive galaxies tracks expectations based on a constant baryon conversion efficiency in dark matter halos for $z \sim$ 1--4. At higher redshifts, we observe an excess abundance of massive galaxies relative to this simple model. These higher abundances can be explained by modest changes to star formation physics and/or the efficiencies with which star formation occurs in massive dark matter halos, and are not in tension with modern cosmology.Comment: 20 pages, 10 figure

Spectroscopic verification of very luminous galaxy candidates in the early universe

During the first 500 million years of cosmic history, the first stars and galaxies formed and seeded the cosmos with heavy elements. These early galaxies illuminated the transition from the cosmic "dark ages" to the reionization of the intergalactic medium. This transitional period has been largely inaccessible to direct observation until the recent commissioning of JWST, which has extended our observational reach into that epoch. Excitingly, the first JWST science observations uncovered a surprisingly high abundance of early star-forming galaxies. However, the distances (redshifts) of these galaxies were, by necessity, estimated from multi-band photometry. Photometric redshifts, while generally robust, can suffer from uncertainties and/or degeneracies. Spectroscopic measurements of the precise redshifts are required to validate these sources and to reliably quantify their space densities, stellar masses, and star formation rates, which provide powerful constraints on galaxy formation models and cosmology. Here we present the results of JWST follow-up spectroscopy of a small sample of galaxies suspected to be amongst the most distant yet observed. We confirm redshifts z > 10 for two galaxies, including one of the first bright JWST-discovered candidates with z = 11.4, and show that another galaxy with suggested z ~ 16 instead has z = 4.9, with strong emission lines that mimic the expected colors of more distant objects. These results reinforce the evidence for the rapid production of luminous galaxies in the very young Universe, while also highlighting the necessity of spectroscopic verification for remarkable candidates.Comment: Submitted to Natur

CEERS Spectroscopic Confirmation of NIRCam-Selected z > 8 Galaxy Candidates with JWST/NIRSpec: Initial Characterization of their Properties

We present JWST NIRSpec spectroscopy for 11 galaxy candidates with photometric redshifts of $z\simeq9-13$ and $M_{\rm\,UV} \in[-21,-18]$ newly identified in NIRCam images in the Cosmic Evolution Early Release Science (CEERS) Survey. We confirm emission line redshifts for 7 galaxies at $z=7.762-8.998$ using spectra at $\sim1-5\mu$m either with the NIRSpec prism or its three medium resolution gratings. For $z\simeq9$ photometric candidates, we achieve a high confirmation rate of $\simeq$90\%, which validates the classical dropout selection from NIRCam photometry. No robust emission lines are identified in three galaxy candidates at $z>10$, where the strong [OIII] and H$\beta$ lines would be redshifted beyond the wavelength range observed by NIRSpec, and the Lyman-$\alpha$ continuum break is not detected with the current sensitivity. Compared with HST-selected bright galaxies ($M_{\rm\,UV}\simeq-22$) that are similarly spectroscopically confirmed at $z\gtrsim8$, these NIRCam-selected galaxies are characterized by lower star formation rates (SFR$\simeq4\,M_{\odot}$~yr$^{-1}$) and lower stellar masses ($\simeq10^{8}\,M_{\odot}$), but with higher [OIII]+H$\beta$ equivalent widths ($\simeq$1100$\r{A}$), and elevated production efficiency of ionizing photons ($\log(\xi_{\rm\,ion}/{\rm\,Hz\,erg}^{-1})\simeq25.8$) induced by young stellar populations ($<10$~Myrs) accounting for $\simeq20\%$ of the galaxy mass, highlighting the key contribution of faint galaxies to cosmic reionization. Taking advantage of the homogeneous selection and sensitivity, we also investigate metallicity and ISM conditions with empirical calibrations using the [OIII]/H$\beta$ ratio. We find that galaxies at $z\sim8-9$ have higher SFRs and lower metallicities than galaxies at similar stellar masses at $z\sim2-6$, which is generally consistent with the current galaxy formation and evolution models.Comment: 21 pages, 11 figures, 2 tables. Submitted to ApJL Focus Issu