What are best practice service models in rural areas for the delivery of end of life and palliative care? A rapid review

In 2014 Welsh Government set out to explore options for the provision of high quality and sustainable health care in mid Wales. The Mid Wales Healthcare Collaborative Board (MWHCB) was subsequently developed to shape the rural mid Wales commissioning intentions of Powys Teaching Health Board, Hywel Dda Local Health Board and Betsi Cadwaladr Local Health Board, as described in the Mid Wales Healthcare Study. The Board is held accountable for its work by the Minister for Health and Social Services. Palliative and End of Life Care was identified by the MWHCB as one of the eight Innovation Sub Groups developed to deliver the programme of work as described in the Mid Wales Healthcare Study. The findings from the rapid review will be used by the End of Life / Palliative Care Sub Group to inform recommendations for service improvements / service change for end of life / palliative care services in rural mid Wales

Quantitative Electroencephalography Analyzed by Statistical Pattern Recognition as a Diagnostic and Prognostic Tool in Mild Cognitive Impairment:Results from a Nordic Multicenter Cohort Study

Aim: To examine diagnostic and prognostic potential of quantitative electroencephalography (qEEG) analyzed by the statistical pattern recognition (SPR) method in patients with cognitive impairment. We compared the differential diagnostic ability of SPR to visual EEG analysis. Correlation between SPR findings and cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers were evaluated. Methods: It is a multicenter cohort study involving 129 patients, (mild cognitive impairment [MCI], AD, and healthy controls). Standardized EEG was performed at baseline. Patients were continuously clinically evaluated. Results: Receiver Operating Characteristic curves showed a low discriminative ability of SPR and no ability to predict clinical progression in patients with MCI. Moderate correlation between SPR analysis and CSF AD biomarkers was found. Conclusion: The diagnostic and prognostic abilities of qEEG were low. The SPR method was superior to the visual EEG analysis. The qEEG method correlates well to CSF AD biomarkers, suggesting association with pathology in AD

Does advance care planning alter management decisions made by healthcare professionals?

“Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline. If the individual wishes, their family and friends may be included. It is recommended that with the individual’s agreement this discussion is documented, regularly reviewed, and communicated to key persons involved in their care”. http://www.ncpc.org.uk/sites/default/files/AdvanceCarePlanning.pdf Although there is a significant body of literature informing the development and implementation of advance care planning processes, the impact of completed advance care plans on the decision making of healthcare professionals at the time of a medical event is less clear. Evidence for the impact of advance care planning programmes on the quality of care provided is required to underpin funding and delivery of integrated advance care planning across care settings. The purpose of this rapid review is to examine whether there is evidence that having an advance care plan in place assists healthcare professionals with care and medical intervention decisions at the time of a change in condition. The scope of the review is to assess for evidence for treatment decisions other than cardiopulmonary resuscitation which is a specific order often completed out with other advance care plan-ning events

Gray whale detection in satellite imagery using deep learning

The combination of very high resolution (VHR) satellite remote sensing imagery and deep learning via convolutional neural networks provides opportunities to improve global whale population surveys through increasing efficiency and spatial coverage. Many whale species are recovering from commercial whaling and face multiple anthropogenic threats. Regular, accurate population surveys are therefore of high importance for conservation efforts. In this study, a state-of-the-art object detection model (YOLOv5) was trained to detect gray whales (Eschrichtius robustus) in VHR satellite images, using training data derived from satellite images spanning different sea states in a key breeding habitat, as well as aerial imagery collected by unoccupied aircraft systems. Varying combinations of aerial and satellite imagery were incorporated into the training set. Mean average precision, whale precision, and recall ranged from 0.823 to 0.922, 0.800 to 0.939, and 0.843 to 0.889, respectively, across eight experiments. The results imply that including aerial imagery in the training data did not substantially impact model performance, and therefore, expansion of representative satellite datasets should be prioritized. The accuracy of the results on real-world data, along with short training times, indicates the potential of using this method to automate whale detection for population surveys

Adaption to water shortage through the implementation of a unique pipeline system in Victoria, Australia

Abstract Water resource development has played a crucial role in the Grampians, Wimmera and Mallee regions of Australia, with the main source of surface water located in several reservoirs in the Grampians mountain ranges. Historically, water was delivered by gravity through a vast 19 500 km earthen channel system from the reservoirs to the townships and farms. As a result of the severe and protracted drought experienced in the region over the past 13 years and the projected drying climate, there have been fundamental changes made to the management of water in order to better cope with water scarcity. The primary strategic effort to sustainably manage water resources was by removing the unsustainable transport of water via the open channels which resulted in very high losses through seepage and evaporation. This inefficient system has been replaced by a pressurised pipeline, the largest geographical water infrastructure project of its type in Australia, spreading across an area of approximately 20 000 km2. To manage the change in water balance as a result of the pipeline and drying climate, the regions water corporations and environmental agencies have designed a scheme for water allocations intended to sustain local communities, allow for regional development and improve environmental conditions. This paper describes the unique pipeline system recently completed, provides a brief summary of water sharing arrangements and introduces the research program currently underway to optimise the performance of the pipeline system

Understanding how shared decision‐making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review

Background: Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision‐aids and shared decision‐making (SDM) approaches that influence patient outcomes. Methods: We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory. Results: From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret. Conclusions: Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer. Patient and Public Contribution: We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research

Reprogramming of CTLs into natural killer–like cells in celiac disease

Celiac disease is an intestinal inflammatory disorder induced by dietary gluten in genetically susceptible individuals. The mechanisms underlying the massive expansion of interferon γ–producing intraepithelial cytotoxic T lymphocytes (CTLs) and the destruction of the epithelial cells lining the small intestine of celiac patients have remained elusive. We report massive oligoclonal expansions of intraepithelial CTLs that exhibit a profound genetic reprogramming of natural killer (NK) functions. These CTLs aberrantly expressed cytolytic NK lineage receptors, such as NKG2C, NKp44, and NKp46, which associate with adaptor molecules bearing immunoreceptor tyrosine-based activation motifs and induce ZAP-70 phosphorylation, cytokine secretion, and proliferation independently of T cell receptor signaling. This NK transformation of CTLs may underlie both the self-perpetuating, gluten-independent tissue damage and the uncontrolled CTL expansion leading to malignant lymphomas in severe forms of celiac disease. Because similar changes were detected in a subset of CTLs from cytomegalovirus-seropositive patients, we suggest that a stepwise transformation of CTLs into NK-like cells may underlie immunopathology in various chronic infectious and inflammatory diseases