Exploring the impact of care home environments and culture on supporting residents to “wander” safely

Background Up to 60% of people with dementia living in care homes will ‘wander’ at some point, which has typically been seen by staff as a problematic behaviour. A range of non-pharmacological interventions have been tested to either support or prevent wandering. However, even recent innovative practice continues to maintain a focus on reducing or preventing wandering. This study aimed to identify, for the first time, care home staff perspectives on home level factors that facilitate or hinder them supporting residents to wander safely. Methods Semi-structured qualitative interviews were conducted with 19 care home staff, working in the North of England. Framework analysis was used to analyse the data. Results A range of environmental considerations were identified by staff. Care home design influenced how residents were able to move safely around, and inclusion of points of interest encouraged walking to different locations, such as a garden. Staff worried about managing access to other residents’ rooms by people who wander. Within the care home culture, prioritising safe staffing levels, training and awareness, involving external healthcare professionals where required and mentorship from experienced staff members, all contributed towards safe wandering. Staff support for positive risk-taking within the care home was key to promote person-centred care, alongside careful oversight and management of relationships between residents. Conclusions We identified a range of cultural and environmental factors that contribute towards safe wandering. A positive approach to risk-taking by staff is required to support residents to engage in wandering as an enjoyable activity, whilst acknowledging that there are inherent risks associated with this

Time-of-arrival distributions from position-momentum and energy-time joint measurements

The position-momentum quasi-distribution obtained from an Arthurs and Kelly joint measurement model is used to obtain indirectly an ``operational'' time-of-arrival (TOA) distribution following a quantization procedure proposed by Kocha\'nski and W\'odkiewicz [Phys. Rev. A 60, 2689 (1999)]. This TOA distribution is not time covariant. The procedure is generalized by using other phase-space quasi-distributions, and sufficient conditions are provided for time covariance that limit the possible phase-space quasi-distributions essentially to the Wigner function, which, however, provides a non-positive TOA quasi-distribution. These problems are remedied with a different quantization procedure which, on the other hand, does not guarantee normalization. Finally an Arthurs and Kelly measurement model for TOA and energy (valid also for arbitrary conjugate variables when one of the variables is bounded from below) is worked out. The marginal TOA distribution so obtained, a distorted version of Kijowski's distribution, is time covariant, positive, and normalized

Effects of coastal urbanization on salt-marsh faunal assemblages in the northern Gulf of Mexico

Author Posting. © American Fisheries Society, 2014. This article is posted here by permission of American Fisheries Society for personal use, not for redistribution. The definitive version was published in Marine and Coastal Fisheries: Dynamics, Management, and Ecosystem Science 6 (2014): 89-107, doi:10.1080/19425120.2014.893467.Coastal landscapes in the northern Gulf of Mexico, specifically the Mississippi coast, have undergone rapid urbanization that may impact the suitability of salt-marsh ecosystems for maintaining and regulating estuarine faunal communities. We used a landscape ecology approach to quantify the composition and configuration of salt-marsh habitats and developed surfaces at multiple spatial scales surrounding three small, first-order salt-marsh tidal creeks arrayed along a gradient of urbanization in two river-dominated estuaries. From May 3 to June 4, 2010, nekton and macroinfauna were collected weekly at all six sites. Due to the greater abundance of grass shrimp Palaemonetes spp., brown shrimp Farfantepenaeus aztecus, blue crab Callinectes sapidus, Gulf Menhaden Brevoortia patronus, and Spot Leiostomus xanthurus, tidal creeks in intact natural (IN) salt-marsh landscapes supported a nekton assemblage that was significantly different from those in partially urbanized (PU) or completely urbanized (CU) salt-marsh landscapes. However, PU landscapes still supported an abundant nekton assemblage. In addition, the results illustrated a linkage between life history traits and landscape characteristics. Resident and transient nekton species that have specific habitat requirements are more likely to be impacted in urbanized landscapes than more mobile species that are able to exploit multiple habitats. Patterns were less clear for macroinfaunal assemblages, although they were comparatively less abundant in CU salt-marsh landscapes than in either IN or PU landscapes. The low abundance or absence of several macroinfaunal taxa in CU landscapes may be viewed as an additional indicator of poor habitat quality for nekton. The observed patterns also suggested that benthic sediments in the CU salt-marsh landscapes were altered in comparison with IN or PU landscapes. The amount of developed shoreline and various metrics related to salt marsh fragmentation were important drivers of observed patterns in nekton and macroinfaunal assemblages

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Biochemical attack on concrete in wastewater applications : a state of the art review

The costs associated with the provision and maintenance of drinking water and wastewater infrastructure represents a significant financial demand worldwide. Maintenance costs are disproportionately high, indicating a lack of adequate durability. There remains a lack of consensus on degradation mechanisms, the performance of various cement types, the role of bacteria in the corrosion process associated with wastewater applications and testing methodologies. This paper presents a review of the literature, outlining the various research approaches undertaken in an effort to address this problem. The findings of these varying approaches are compared, and the different strategies employed are compiled and discussed. It is proposed that a key step in advancing the understanding of the associated deterioration mechanism is a combined approach that considers the interaction between biological and chemical processes. If this can be achieved then steps can be taken to establishing a performance-based approach for specifying concrete in these harsh service conditions.Other funderEnterprise IrelandEcocem Ireland LtdRecord must link to the DOI version - http://dx.doi.org/10.1016/j.cemconcomp.2010.05.001. DG 09/07/10 ti SB. 20/7/1