Oldest-old partner’s experiences of providing end-of-life care: a narrative study

Background Population ageing has rapidly increased the number of people requiring end-of-life care across the globe. Governments have responded by promoting end-of-life in the community. Partly as a consequence, older partners are frequently providing for their partner’s end-of-life care at home, despite potentially facing their own health issues. Little is known about people aged 75 and over who are providing end-of-life care. In order to prepare our health and social care systems for rapidly ageing populations, we need to understand more about this group’s experiences of end-of-life care. Aim To explore the experiences of oldest-old partners looking after their partner approaching end-of-life care. Method First, I conducted a systematic review of the extant literature published since 1985 on the topic. Second, I conducted a longitudinal narrative interview study with 17 couples (19 participants in total). Findings A systematic review of the literature identified a small and only medium quality evidence-base with important empirical and theoretical gaps that require further research. Drawing on interview data, the first key finding was that older partners navigated the carer identity in relation to external and internal factors with not all subsequently embracing the carer identity for themselves. A second key finding is that older partners are actively engaged in integrating care in their capacity as home- keepers, networkers and vigilant visitors. A third key finding highlights the creative ways in which older partners engaged with a pill organizer called a dosette box to make their daily end-of-life caring and medical management bearable. Conclusions The overarching contributions of this thesis challenge notions of the fourth age as merely comprising “decline, passivity and frailty” by emphasizing the activity and creativity of older partners providing end-of-life care. Second, by thinking about oldest-old partners needs and experiences as interconnected, I suggest that policy-makers and health and social care providers will be able to more effectively design services that meet the needs of both oldest-old partners.Woolf Fisher Doctoral Scholarshi

Gender and palliative care: a call to arms.

There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice

Sterility and C2C12 Cell Growth Potential of Polycarbonate

The current data collection method of cell growth and death in a simulated space environment using a rotary cell culture system involves the use of disposable polystyrene. Polystyrene generates large amounts of waste and is limited by the sizes determined by manufacturers. A novel rotary cell culture system at USU required a material that could be custom machined for the purposes of the simulation. Polycarbonate is a durable material that is capable of being shaped, but little is known of its biocompatibility. The sterilization treatments of dry heat, autoclaving, ethanol, and UV radiation were used and compared to unsterilized polycarbonate to determine the effectiveness of each method of sterilization on cell viability of C2C12 cells. Upon 10 days of growth, the samples of polycarbonate were removed from growth media, cleaned with ethanol to kill remaining cells, and observed for structural defects and cytotoxicity. Dry heat and wet heat were found to be acceptable processes to sterilize the polycarbonate and encourage cell growth. Polycarbonate was proven non-cytotoxic by itself, as it did not cause cell death upon contact with attached C2C12 cells

Exploring the experiences of living with Lewy body dementia: An integrative review.

AIM: Lewy body dementia is a common neurodegenerative dementia with unique challenges in managing day-to-day life. A more in-depth multifaceted picture of the Lewy body dementia lived experience will enable identification of best practice and future research direction. The review aim was to explore experiences of people living with Lewy body dementia and their family carers. DESIGN: Integrative review method informed by Whittemore and Knafl, supported by the information retrieval framework PALETTE. A convergent integrated approach enabled synthesis of key findings and theme identification. DATA SOURCES: Medline, CINAHL, PsycINFO, AMED, and ALOIS databases were systematically searched to find studies published between 1995 and 2020. REVIEW METHODS: Twenty-six articles from twenty studies were synthesized (from 1583 retrieved). Quality and relevance were appraised using the Mixed-Methods Appraisal Tool and Gough's 'Weight of Evidence' framework. Data management was supported by ATLAS.ti 8 and COVIDENCE software. RESULTS: Four themes were identified: living with an uncertain diagnosis and prognosis; fear of the now - worry for the future; living with behavioural and psychiatric symptoms; and maintaining a social and emotional life. People reported difficulty finding information and support around diagnosis, disease progression and managing complex symptoms. The result is increased caregiver burden, grief and stress and reduced quality of life. CONCLUSION: Delayed diagnosis and complex symptom burden means people are not getting the timely support and information they need to live and die well. Current evidence is largely quantitative, with a focus on family caregiver burden and unmet need. The challenge remains in how to capture a more holistic picture of the lived experience for people living with Lewy body dementia and those who care for them. IMPACT: This review highlighted current knowledge and identified gaps in exploring the lived experience for people with Lewy body dementia and their families

The modelling of internal combustion engine thermal systems and behaviour

The work described in this thesis concerns the continued development and application of a computational model to simulate the thermal behaviour of internal combustion engines. The model provides information on temperature and heat flow distributions within the engine structure, and on temperatures of oil, coolant and engine-out exhaust gas. Sub-models calculate friction levels, fuel flow rates and gas-side heat transfer, including the effects of exhaust gas recirculation (EGR), spark advance and turbocharging. The effects of auxiliary components such as a cabin heater, oil cooler, intercooler, supplementary heater and EGR cooler can also be simulated. Model developments are aligned towards improving the accessibility of the model and the scope of engine systems that can be simulated. Early versions of the model have been converted from 'C' into the current MATLAB/Simulink versions. The model structure and conversion process are described. New developments undertaken have focused on the external coolant circuit and include the modelling of the thermostat and radiator. A semi-empirical thermostat model is presented. A radiator model based on the effectiveness-NTU method is described. Simulations using the developed model, including the thermostat and radiator sub-models, investigate the effect of thermostat position on engine thermal behaviour. Positioning the thermostat on the inlet to the engine reduces thermal shock. Applications of the model to investigations of sensitivity and performance illustrate the accuracy of and confidence in model predictions. Assessments demonstrate that the model is relatively insensitive to variations of 100/0 in user inputs and is very sensitive to model assumptions if simulation conditions, implied in the model assumptions, are not matched to test conditions. A process for evaluating model performance is described. Evaluation exercises applied to three different engines demonstrate that values predicted by the model are to within 5 to 10% of experimental values. Investigations using the model of methods to improve warm-up times and fuel consumption prior to fully warm conditions show the benefits or otherwise of reduced thermal capacity, an oil cooler, a sump oil heater and an oil-exhaust gas heat exchanger. Each method is assessed over the New European Drive Cycle (NEDC) from a -10°C start. Of these methods, a combined reduction in coolant volume and engine structural mass is most beneficial for reducing coolant warm-up times. An oil-exhaust gas heat exchanger produces the greatest reduction in fuel consumption

The modelling of internal combustion engine thermal systems and behaviour

The work described in this thesis concerns the continued development and application of a computational model to simulate the thermal behaviour of internal combustion engines. The model provides information on temperature and heat flow distributions within the engine structure, and on temperatures of oil, coolant and engine-out exhaust gas. Sub-models calculate friction levels, fuel flow rates and gas-side heat transfer, including the effects of exhaust gas recirculation (EGR), spark advance and turbocharging. The effects of auxiliary components such as a cabin heater, oil cooler, intercooler, supplementary heater and EGR cooler can also be simulated. Model developments are aligned towards improving the accessibility of the model and the scope of engine systems that can be simulated. Early versions of the model have been converted from 'C' into the current MATLAB/Simulink versions. The model structure and conversion process are described. New developments undertaken have focused on the external coolant circuit and include the modelling of the thermostat and radiator. A semi-empirical thermostat model is presented. A radiator model based on the effectiveness-NTU method is described. Simulations using the developed model, including the thermostat and radiator sub-models, investigate the effect of thermostat position on engine thermal behaviour. Positioning the thermostat on the inlet to the engine reduces thermal shock. Applications of the model to investigations of sensitivity and performance illustrate the accuracy of and confidence in model predictions. Assessments demonstrate that the model is relatively insensitive to variations of 100/0 in user inputs and is very sensitive to model assumptions if simulation conditions, implied in the model assumptions, are not matched to test conditions. A process for evaluating model performance is described. Evaluation exercises applied to three different engines demonstrate that values predicted by the model are to within 5 to 10% of experimental values. Investigations using the model of methods to improve warm-up times and fuel consumption prior to fully warm conditions show the benefits or otherwise of reduced thermal capacity, an oil cooler, a sump oil heater and an oil-exhaust gas heat exchanger. Each method is assessed over the New European Drive Cycle (NEDC) from a -10°C start. Of these methods, a combined reduction in coolant volume and engine structural mass is most beneficial for reducing coolant warm-up times. An oil-exhaust gas heat exchanger produces the greatest reduction in fuel consumption

Towards Responsible Governance of Biological Design Tools

Recent advancements in generative machine learning have enabled rapid progress in biological design tools (BDTs) such as protein structure and sequence prediction models. The unprecedented predictive accuracy and novel design capabilities of BDTs present new and significant dual-use risks. For example, their predictive accuracy allows biological agents, whether vaccines or pathogens, to be developed more quickly, while the design capabilities could be used to discover drugs or evade DNA screening techniques. Similar to other dual-use AI systems, BDTs present a wicked problem: how can regulators uphold public safety without stifling innovation? We highlight how current regulatory proposals that are primarily tailored toward large language models may be less effective for BDTs, which require fewer computational resources to train and are often developed in an open-source manner. We propose a range of measures to mitigate the risk that BDTs are misused, across the areas of responsible development, risk assessment, transparency, access management, cybersecurity, and investing in resilience. Implementing such measures will require close coordination between developers and governments.Comment: 10 pages + references, 1 figure, accepted at NeurIPS 2023 Workshop on Regulatable ML as oral presentatio

Dispensing care?: The dosette box and the status of low‐fi technologies within older people’s end‐of‐life caregiving practices

Abstract: Technology has been lauded as a solution to range of challenges presented by ageing population internationally. While the lion‐share of scholarship has focussed on high‐fi, digital technologies, there has been a recent shift to exploring the contributions mundane, low‐fi technologies make to older people's daily lives and our understandings of health, illness and care more broadly. Drawing from serial narrative interview data collected with 19 married couples aged 70 and over living in the U.K., this article explores the way one medical technology—the dosette box—was taken‐up and deployed in their end‐of‐life caring process. Informed by actor–network theory and critical feminist scholarship, this article considers how the dosette box played an active role in structuring relationships, scheduling daily care activities and enforcing medical compliance. In doing so, we suggest that the dosette box provided an unexpected companion and ‘weapon of the weak’ for older partner's attempting to assert their expertise and power while caring. We also explore how the dosette box demanded an even higher level of regular, vital care from older partner's once introduced into the home, thus entrenching the physical and emotional demands of dispensing care

Regenerative capacity in the lamprey spinal cord is not altered after a repeated transection

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in PLoS One 14(1), (2019):e0204193, doi: 10.1371/journal.pone.0204193.The resilience of regeneration in vertebrates is not very well understood. Yet understanding if tissues can regenerate after repeated insults, and identifying limitations, is important for elucidating the underlying mechanisms of tissue plasticity. This is particularly challenging in tissues, such as the nervous system, which possess a large number of terminally differentiated cells and often exhibit limited regeneration in the first place. However, unlike mammals, which exhibit very limited regeneration of spinal cord tissues, many non-mammalian vertebrates, including lampreys, bony fishes, amphibians, and reptiles, regenerate their spinal cords and functionally recover even after a complete spinal cord transection. It is well established that lampreys undergo full functional recovery of swimming behaviors after a single spinal cord transection, which is accompanied by tissue repair at the lesion site, as well as axon and synapse regeneration. Here we begin to explore the resilience of spinal cord regeneration in lampreys after a second spinal transection (re-transection). We report that by all functional and anatomical measures tested, lampreys regenerate after spinal re-transection just as robustly as after single transections. Recovery of swimming, synapse and cytoskeletal distributions, axon regeneration, and neuronal survival were nearly identical after spinal transection or re-transection. Only minor differences in tissue repair at the lesion site were observed in re-transected spinal cords. Thus, regenerative potential in the lamprey spinal cord is largely unaffected by spinal re-transection, indicating a greater persistent regenerative potential than exists in some other highly regenerative models. These findings establish a new path for uncovering pro-regenerative targets that could be deployed in non-regenerative conditions.The authors would like to thank Dr. Cristina Roman-Vendrell and Louie Kerr, Director of the Central Microscopy Facility at the MBL, for technical support. We also thank Dr. Juan Diaz-Quiroz for helpful comments on the manuscript. EG was supported in part by an NSF REU Award (#1659604: Biological Discovery in Woods Hole at the Marine Biological Laboratory)