Glass in the submarine section of the HSDP2 drill core, Hilo, Hawaii

The Hawaii Scientific Drilling Project recovered ~3 km of basalt by coring into the flank of Mauna Kea volcano at Hilo, Hawaii. Rocks recovered from deeper than ~1 km were deposited below sea level and contain considerable fresh glass. We report electron microprobe analyses of 531 glasses from the submarine section of the core, providing a high-resolution record of petrogenesis over ca. 200 Kyr of shield building of a Hawaiian volcano. Nearly all the submarine glasses are tholeiitic. SiO2 contents span a significant range but are bimodally distributed, leading to the identification of low-SiO2 and high-SiO2 magma series that encompass most samples. The two groups are also generally distinguishable using other major and minor elements and certain isotopic and incompatible trace element ratios. On the basis of distributions of high- and low-SiO2 glasses, the submarine section of the core is divided into four zones. In zone 1 (1079–~1950 mbsl), most samples are degassed high-SiO2 hyaloclastites and massive lavas, but there are narrow intervals of low-SiO2 hyaloclastites. Zone 2 (~1950–2233 mbsl), a zone of degassed pillows and hyaloclastites, displays a continuous decrease in silica content from bottom to top. In zone 3 (2233–2481 mbsl), nearly all samples are undegassed low-SiO2 pillows. In zone 4 (2481–3098 mbsl), samples are mostly high-SiO2 undegassed pillows and degassed hyaloclastites. This zone also contains most of the intrusive units in the core, all of which are undegassed and most of which are low-SiO2. Phase equilibrium data suggest that parental magmas of the low-SiO2 suite could be produced by partial melting of fertile peridotite at 30–40 kbar. Although the high-SiO2 parents could have equilibrated with harzburgite at 15–20 kbar, they could have been produced neither simply by higher degrees of melting of the sources of the low-SiO2 parents nor by mixing of known dacitic melts of pyroxenite/eclogite with the low-SiO2 parents. Our hypothesis for the relationship between these magma types is that as the low-SiO2 magmas ascended from their sources, they interacted chemically and thermally with overlying peridotites, resulting in dissolution of orthopyroxene and clinopyroxene and precipitation of olivine, thereby generating high-SiO2 magmas. There are glasses with CaO, Al2O3, and SiO2 contents slightly elevated relative to most low-SiO2 samples; we suggest that these differences reflect involvement of pyroxene-rich lithologies in the petrogenesis of the CaO-Al2O3-enriched glasses. There is also a small group of low-SiO2 glasses distinguished by elevated K2O and CaO contents; the sources of these samples may have been enriched in slab-derived fluid/melts. Low-SiO2 glasses from the top of zone 3 (2233–2280 mbsl) are more alkaline, more fractionated, and incompatible-element-enriched relative to other glasses from zone 3. This excursion at the top of zone 3, which is abruptly overlain by more silica-rich tholeiitic magmas, is reminiscent of the end of Mauna Kea shield building higher in the core

Volatiles in glasses from the HSDP2 drill core

H2O, CO2, S, Cl, and F concentrations are reported for 556 glasses from the submarine section of the 1999 phase of HSDP drilling in Hilo, Hawaii, providing a high-resolution record of magmatic volatiles over ~200 kyr of a Hawaiian volcano's lifetime. Glasses range from undegassed to having lost significant volatiles at near-atmospheric pressure. Nearly all hyaloclastite glasses are degassed, compatible with formation from subaerial lavas that fragmented on entering the ocean and were transported by gravity flows down the volcano flank. Most pillows are undegassed, indicating submarine eruption. The shallowest pillows and most massive lavas are degassed, suggesting formation by subaerial flows that penetrated the shoreline and flowed some distance under water. Some pillow rim glasses have H2O and S contents indicating degassing but elevated CO2 contents that correlate with depth in the core; these tend to be more fractionated and could have formed by mixing of degassed, fractionated magmas with undegassed magmas during magma chamber overturn or by resorption of rising CO2-rich bubbles by degassed magmas. Intrusive glasses are undegassed and have CO2 contents similar to adjacent pillows, indicating intrusion shallow in the volcanic edifice. Cl correlates weakly with H2O and S, suggesting loss during low-pressure degassing, although most samples appear contaminated by seawater-derived components. F behaves as an involatile incompatible element. Fractionation trends were modeled using MELTS. Degassed glasses require fractionation at pH2O ≈ 5–10 bars. Undegassed low-SiO2 glasses require fractionation at pH2O ≈ 50 bars. Undegassed and partially degassed high-SiO2 glasses can be modeled by coupled crystallization and degassing. Eruption depths of undegassed pillows can be calculated from their volatile contents assuming vapor saturation. The amount of subsidence can be determined from the difference between this depth and the sample's depth in the core. Assuming subsidence at 2.5 mm/y, the amount of subsidence suggests ages of ~500 ka for samples from the lower 750 m of the core, consistent with radiometric ages. H2O contents of undegassed low-SiO2 HSDP2 glasses are systematically higher than those of high-SiO2 glasses, and their H2O/K2O and H2O/Ce ratios are higher than typical tholeiitic pillow rim glasses from Hawaiian volcanoes

Nurse-led volunteer support care plan

The Nurse-Led Volunteer Support Care Plan described in “Nurses leading volunteer support for older adults in hospital: A discussion paper” is made available. This care plan is designed for nurses to develop a plan to direct volunteer support to better meet the individual needs of patients

The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data : a systematic review

Background: Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. Methods: A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. Results: From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. Conclusions: Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions

Prevalence of frailty and pain in hospitalised cancer patients: Implications for older adult care

A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer

Complex-type N-glycan recognition by potent broadly neutralizing HIV antibodies

Broadly neutralizing HIV antibodies (bNAbs) can recognize carbohydrate-dependent epitopes on gp120. In contrast to previously characterized glycan-dependent bNAbs that recognize high-mannose N-glycans, PGT121 binds complex-type N-glycans in glycan microarrays. We isolated the B-cell clone encoding PGT121, which segregates into PGT121-like and 10-1074–like groups distinguished by sequence, binding affinity, carbohydrate recognition, and neutralizing activity. Group 10-1074 exhibits remarkable potency and breadth but no detectable binding to protein-free glycans. Crystal structures of unliganded PGT121, 10-1074, and their likely germ-line precursor reveal that differential carbohydrate recognition maps to a cleft between complementarity determining region (CDR)H2 and CDRH3. This cleft was occupied by a complex-type N-glycan in a “liganded” PGT121 structure. Swapping glycan contact residues between PGT121 and 10-1074 confirmed their importance for neutralization. Although PGT121 binds complex-type N-glycans, PGT121 recognized high-mannose-only HIV envelopes in isolation and on virions. As HIV envelopes exhibit varying proportions of high-mannose- and complex-type N-glycans, these results suggest promiscuous carbohydrate interactions, an advantageous adaptation ensuring neutralization of all viruses within a given strain

Frailty and pain in an acute private hospital: An observational point prevalence study

Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0 – 10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9 % of eligible). The prevalence of frailty was 26.7 %, prevalence of current pain was 68.1 % and prevalence of pain in the last 24 h was 81.3 %. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95 % CI 5.7 – 32.8), mental health (AOR: 6.3, 95 % CI 1. 9 – 20.9) and rehabilitation (AOR: 8.1, 95 % CI 2.4 – 37.1) and moderate pain (AOR: 3.9, 95 % CI 1. 6 – 9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management. Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020)

Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: protocol for a cluster randomised controlled trial

Introduction: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. Methods and analysis: This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. Ethics and dissemination: Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media

Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: Protocol for a cluster randomised controlled trial

INTRODUCTION: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. METHODS AND ANALYSIS: This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. ETHICS AND DISSEMINATION: Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12620001173987