Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement

Aim: To investigate registered hospital and nursing home nurses' experiences of coordination and communication within and between care settings when older persons are transferred from nursing homes to hospital and vice versa. Background: It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon. Design: A descriptive study design with a qualitative approach was used. Methods: In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n = 20). Data were analysed using content analysis. Results: Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursing home registered nurses suggested increased collaboration to understand each other's work situation better. Conclusion: Communication and coordination among hospital and nursing home registered nurses need to be furthered improved. Registered nurses' coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursing care and unnecessary transfer and admission to hospital.måsjekke

NoiseGrad: enhancing explanations by introducing stochasticity to model weights

Many efforts have been made for revealing the decision-making process of black-box learning machines such as deep neural networks, resulting in useful local and global explanation methods. For local explanation, stochasticity is known to help: a simple method, called SmoothGrad, has improved the visual quality of gradient-based attribution by adding noise in the input space and taking the average over the noise. In this paper, we extend this idea and propose NoiseGrad that enhances both local and global explanation methods. Specifically, NoiseGrad introduces stochasticity in the weight parameter space, such that the decision boundary is perturbed. NoiseGrad is expected to enhance the local explanation, similarly to SmoothGrad, due to the dual relationship between the input perturbation and the decision boundary perturbation. Furthermore, NoiseGrad can be used to enhance global explanations. We evaluate NoiseGrad and its fusion with SmoothGrad -- FusionGrad -- qualitatively and quantitatively with several evaluation criteria, and show that our novel approach significantly outperforms the baseline methods. Both NoiseGrad and FusionGrad are method-agnostic and as handy as SmoothGrad using simple heuristics for the choice of hyperparameter setting without the need of fine-tuning.Comment: 19 pages, 16 figure

Overexpression of the scaffold WD40 protein WRAP53β enhances the repair of and cell survival from DNA double-strand breaks

Altered expression of the multifunctional protein WRAP53β (WD40 encoding RNA Antisense to p53), which targets repair factors to DNA double-strand breaks and factors involved in telomere elongation to Cajal bodies, is linked to carcinogenesis. While loss of WRAP53β function has been shown to disrupt processes regulated by this protein, the consequences of its overexpression remain unclear. Here we demonstrate that overexpression of WRAP53β disrupts the formation of and impairs the localization of coilin to Cajal bodies. At the same time, the function of this protein in the repair of DNA double-strand breaks is enhanced. Following irradiation, cells overexpressing WRAP53β exhibit more rapid clearance of phospho-histone H2AX (γH2AX), and more efficient homologous recombination and non-homologous end-joining, in association with fewer DNA breaks. Moreover, in these cells the ubiquitylation of damaged chromatin, which is known to facilitate the recruitment of repair factors and subsequent repair, is elevated. Knockdown of the ubiquitin ligase involved, ring-finger protein 8 (RNF8), which is recruited to DNA breaks by WRAP53β, attenuated this effect, suggesting that overexpression of WRAP53β leads to more rapid repair, as well as improved cell survival, by enhancing RNF8-mediated ubiquitylation at DNA breaks. Our present findings indicate that WRAP53β and RNF8 are rate-limiting factors in the repair of DNA double-strand breaks and raise the possibility that upregulation of WRAP53β may contribute to genomic stability in and survival of cancer cells

The Meta-Evaluation Problem in Explainable AI: Identifying Reliable Estimators with MetaQuantus

Explainable AI (XAI) is a rapidly evolving field that aims to improve transparency and trustworthiness of AI systems to humans. One of the unsolved challenges in XAI is estimating the performance of these explanation methods for neural networks, which has resulted in numerous competing metrics with little to no indication of which one is to be preferred. In this paper, to identify the most reliable evaluation method in a given explainability context, we propose MetaQuantus -- a simple yet powerful framework that meta-evaluates two complementary performance characteristics of an evaluation method: its resilience to noise and reactivity to randomness. We demonstrate the effectiveness of our framework through a series of experiments, targeting various open questions in XAI, such as the selection of explanation methods and optimisation of hyperparameters of a given metric. We release our work under an open-source license to serve as a development tool for XAI researchers and Machine Learning (ML) practitioners to verify and benchmark newly constructed metrics (i.e., ``estimators'' of explanation quality). With this work, we provide clear and theoretically-grounded guidance for building reliable evaluation methods, thus facilitating standardisation and reproducibility in the field of XAI.Comment: 30 pages, 12 figures, 3 table

Mendelian randomization shows a causal effect of low vitamin D on multiple sclerosis risk.

ObjectiveWe sought to estimate the causal effect of low serum 25(OH)D on multiple sclerosis (MS) susceptibility that is not confounded by environmental or lifestyle factors or subject to reverse causality.MethodsWe conducted mendelian randomization (MR) analyses using an instrumental variable (IV) comprising 3 single nucleotide polymorphisms found to be associated with serum 25(OH)D levels at genome-wide significance. We analyzed the effect of the IV on MS risk and both age at onset and disease severity in 2 separate populations using logistic regression models that controlled for sex, year of birth, smoking, education, genetic ancestry, body mass index at age 18-20 years or in 20s, a weighted genetic risk score for 110 known MS-associated variants, and the presence of one or more HLA-DRB1*15:01 alleles.ResultsFindings from MR analyses using the IV showed increasing levels of 25(OH)D are associated with a decreased risk of MS in both populations. In white, non-Hispanic members of Kaiser Permanente Northern California (1,056 MS cases and 9,015 controls), the odds ratio (OR) was 0.79 (p = 0.04, 95% confidence interval (CI): 0.64-0.99). In members of a Swedish population from the Epidemiological Investigation of Multiple Sclerosis and Genes and Environment in Multiple Sclerosis MS case-control studies (6,335 cases and 5,762 controls), the OR was 0.86 (p = 0.03, 95% CI: 0.76-0.98). A meta-analysis of the 2 populations gave a combined OR of 0.85 (p = 0.003, 95% CI: 0.76-0.94). No association was observed for age at onset or disease severity.ConclusionsThese results provide strong evidence that low serum 25(OH)D concentration is a cause of MS, independent of established risk factors

A dynamic and multifunctional account of middle‐range theories

This article develops a novel account of middle‐range theories for combining theoretical and empirical analysis in explanatory sociology. I first revisit Robert K. Merton’s original ideas on middle‐range theories and identify a tension between his developmental approach to middle‐range theorizing that recognizes multiple functions of theories in sociological research and his static definition of the concept of middle‐range theory that focuses only on empirical testing of theories. Drawing on Merton's ideas on theorizing and recent discussions on mechanism‐based explanations, I argue that this tension can be resolved by decomposing a middle‐range theory into three interrelated and evolving components that perform different functions in sociological research: (i) a conceptual framework about social phenomena that is a set of interrelated concepts that evolve in close connection with empirical analysis; (ii) a mechanism schema that is an abstract and incomplete description of a social mechanism; and (iii) a cluster of all mechanism‐based explanations of social phenomena that are based on the particular mechanism schema. I show how these components develop over time and how they serve different functions in sociological theorizing and research. Finally, I illustrate these ideas by discussing Merton’s theory of the Matthew effect in science and its more recent applications in sociology.This article develops a novel account of middle‐range theories for combining theoretical and empirical analysis in explanatory sociology. I first revisit Robert K. Merton’s original ideas on middle‐range theories and identify a tension between his developmental approach to middle‐range theorizing that recognizes multiple functions of theories in sociological research and his static definition of the concept of middle‐range theory that focuses only on empirical testing of theories. Drawing on Merton's ideas on theorizing and recent discussions on mechanism‐based explanations, I argue that this tension can be resolved by decomposing a middle‐range theory into three interrelated and evolving components that perform different functions in sociological research: (i) a conceptual framework about social phenomena that is a set of interrelated concepts that evolve in close connection with empirical analysis; (ii) a mechanism schema that is an abstract and incomplete description of a social mechanism; and (iii) a cluster of all mechanism‐based explanations of social phenomena that are based on the particular mechanism schema. I show how these components develop over time and how they serve different functions in sociological theorizing and research. Finally, I illustrate these ideas by discussing Merton’s theory of the Matthew effect in science and its more recent applications in sociology.Peer reviewe

Impact of the degradation leachate of the polyacrylonitrile-based material UP2W on the retention of Ni(II), Eu(III) and Pu(IV) by cement

The uptake of $^{63}$Ni(II), $^{152}$Eu(III) and $^{242}$Pu(IV) by hardened cement paste (HCP, CEM I) in the degradation stage II (pH ≈ 12.5, [Ca] ≈ 0.02 M) was investigated in the presence of a degradation leachate of UP2W, a polyacrylonitrile-based (PAN) material used as a filter aid in nuclear power plants. The degradation leachate with a concentration of dissolved organic carbon of ∼40 ppm was obtained from the degradation of UP2W in portlandite-buffered solutions for ca. 1100 days. Redox conditions in the Pu systems were buffered with hydroquinone, which defines mildly reducing conditions (pe + pH ≈ 10) where Pu(IV) is the predominant oxidation state. The degradation leachate investigated in this work is moderately sorbed by cement, with distribution ratios (R$_d$) of (0.35 ± 0.15) m$^3$ kg$^{−1}$. These values are 30 to 100 times greater than distribution ratios previously reported for proxy ligands of PAN degradation products, i.e., glutaric acid, α-hydroxyisobutyric acid and 3-hydroxybutyric acid. The presence of the degradation leachate induces a moderate decrease in the uptake of $^{63}$Ni(II), $^{152}$Eu(III) and $^{242}$Pu(IV) by cement, as compared to the sorption in the presence of the proxy ligands. Nevertheless, retention in the presence of the degradation leachate remains high for all investigated radionuclides, with Rd($^{63}$Ni(II)) ≈ 2 m$^3$ kg$^{−1}$, Rd($^{152}$Eu(III)) ≈ 100 m$^3$ kg$^{−1}$ and Rd($^{242}$Pu(IV)) ≈ 30 m$^3$ kg$^{−1}$. These observations possibly reflect that the multiple functionalities (–COOH, –OH, amide groups) expected in the macromolecules (10–15 kDa) present in the degradation leachate, can offer further binding/chelating capabilities compared to the small organic proxy ligands with at most bidentate binding