4,189 research outputs found

    Extreme drought impacts have been underestimated in grasslands and shrublands globally

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    Climate change is increasing the frequency and severity of short-term (~1 y) drought events—the most common duration of drought—globally. Yet the impact of this intensification of drought on ecosystem functioning remains poorly resolved. This is due in part to the widely disparate approaches ecologists have employed to study drought, variation in the severity and duration of drought studied, and differences among ecosystems in vegetation, edaphic and climatic attributes that can mediate drought impacts. To overcome these problems and better identify the factors that modulate drought responses, we used a coordinated distributed experiment to quantify the impact of short-term drought on grassland and shrubland ecosystems. With a standardized approach, we imposed ~a single year of drought at 100 sites on six continents. Here we show that loss of a foundational ecosystem function—aboveground net primary production (ANPP)—was 60% greater at sites that experienced statistically extreme drought (1-in-100-y event) vs. those sites where drought was nominal (historically more common) in magnitude (35% vs. 21%, respectively). This reduction in a key carbon cycle process with a single year of extreme drought greatly exceeds previously reported losses for grasslands and shrublands. Our global experiment also revealed high variability in drought response but that relative reductions in ANPP were greater in drier ecosystems and those with fewer plant species. Overall, our results demonstrate with unprecedented rigor that the global impacts of projected increases in drought severity have been significantly underestimated and that drier and less diverse sites are likely to be most vulnerable to extreme drought

    Interaction and evolution of phases at the coating/substrate interface in galvannealed 3rd Gen AHSS with high Si content

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    Optimization of the galvannealing for cutting-edge 3rd generation AHSS requires detailed structural and chemical characterization. Alloying elements such as Si dramatically modify the steel surface, forming an oxide layer during pre-annealing, which suppresses the desired interfacial interaction. Progress is impossible without understanding the phases' interplay at the steel-coating interface. We investigated this area in high-Si (1.49 wt%) galvanized AHSS at different annealing times via TEM and revealed that while hot-dip galvanizing at 460 °C the surface oxide prevents the desired Fe-Al reaction and liquid Zn penetrating gaps in the oxide membrane forms a δ phase layer underneath. Located between the steel substrate and the oxide layer, the δ phase can grow during subsequent annealing due to incoming liquid Zn, while Fe diffusion into the coating is suppressed. The oxide film remains stable even after long-term annealing (120 s at 480 °C) separating the coating from the reaction zone. The growing δ layer interacting with the steel substrate consumes dissolved Si. Reaching a certain threshold concentration, supersaturated δ decomposes forming a δ matrix with Fe-Si-Al-based nanoprecipitates. Using EDX data, phase configuration was refined via Thermo-Calc by the Fe–Zn–Si–Al system simulation suggesting that nanoprecipitates are based on Al- and Si-rich type of α-Fe

    Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: A rapid systematic overview of systematic reviews

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    Objective Falls are a common cause of potentially preventable death, disability and loss of independence with an annual estimated cost of £4.4bn. People living with dementia (PlwD) or mild cognitive impairment (MCI) have an increased fall risk. This overview evaluates evidence for technologies aiming to reduce falls and fall risk for PlwD or MCI. Methods In October 2022, we searched five databases for evidence syntheses. We used standard methods to rapidly screen, extract data, assess risk of bias and overlap, and synthesise the evidence for each technology type. Results We included seven systematic reviews, incorporating 22 relevant primary studies with 1,412 unique participants. All reviews had critical flaws on AMSTAR-2: constituent primary studies were small, heterogeneous, mostly non-randomised and assessed as low or moderate quality. Technologies assessed were: wearable sensors, environmental sensor-based systems, exergaming, virtual reality systems. We found no evidence relating to apps. Review evidence for the direct impact on falls was available only from environmental sensors, and this was inconclusive. For wearables and virtual reality technologies there was evidence that technologies may differentiate PlwD who fell from those who did not; and for exergaming that balance may be improved. Conclusions The evidence for technology to reduce falls and falls risk for PlwD and MCI is methodologically weak, based on small numbers of participants and often indirect. There is a need for higher-quality RCTs to provide robust evidence for effectiveness of fall prevention technologies. Such technologies should be designed with input from users and consideration of the wider implementation context

    Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme

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    BackgroundMost people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being.MethodsLongitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used.ResultsOn average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer’s and vascular) dementia had more health conditions than those with Alzheimer’s disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time.ConclusionsPeople with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being

    Scaling-up an evidence-based intervention for family carers of people with dementia: current and future costs and outcomes

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    Objectives: The STrAtegies for RelaTives (START) intervention is effective and cost-effective in supporting family carers of people with dementia. It is currently not available to all eligible carers in England. What would be the impacts on service costs and carer health-related quality of life if START was provided to all eligible carers in England, currently and in future? Methods: Effectiveness and cost-effectiveness data from a previously conducted randomised controlled trial were combined with current and future projections of numbers of people with newly diagnosed dementia to estimate overall and component costs and health-related quality of life outcomes between 2015 (base year for projections) and 2040. Results: Scaling-up START requires investments increasing annually but would lead to significant savings in health and social care costs. Family carers of people with dementia would experience improvements in mental health and quality of life, with clinical effects lasting at least 6 years. Scaling up the START intervention to eligible carers was estimated to cost £9.4 million in 2020, but these costs would lead to annual savings of £68 million, and total annual quality-adjusted life year (QALY) gains of 1,247. Although the costs of START would increase to £19.8 million in 2040, savings would rise to £142.7 million and QALYs gained to 1,883. Conclusions: Scaling-up START for family carers of people with dementia in England would improve the lives of family carers and reduce public sector costs. Family carers play a vital part in dementia care; evidence-based interventions that help them to maintain this role, such as START, should be available across the country

    Psychological support for individuals historically infected with HIV and/or hepatitis C as a result of NHS-supplied blood transfusions and blood products, and for affected families

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    BACKGROUND: Between 1970 and 1991, between 30,000 and 33,000 people in the UK were infected with HIV and/or hepatitis C as a result of treatment with NHS blood and blood products; 2,900 deaths during 1970-2019 are estimated to be attributable to these infections, and people are still dying. The statutory Infected Blood Inquiry, launched in July 2018, has been investigating the circumstances that led to individuals becoming infected and the impacts this has had on them and their families. Among the many issues raised, the Inquiry emphasised the psychosocial impacts and the lack of access to dedicated psychological support for those infected and affected. The England Infected Blood Support Scheme (EIBSS) provides access to a discretionary payment of up to £900 for privately arranged psychological support per year (with the option of ‘further treatment’ funding), which can be accessed upon application. However, uptake of the payment among EIBSS beneficiaries and their family members has been very low, and the reasons for this are unclear. There is lack of robust evidence on the needs for psychological support among those infected and affected by infected blood and blood products. The need for this evidence has become more urgent with the Inquiry concluding in autumn 2023. This study was commissioned to help fill this evidence gap and to inform and consider options for improving the existing offer of psychological support services for infected and affected people. APPROACH We conducted in-depth interviews with 52 infected and affected people and 14 mental health practitioners and experts to understand these needs and explore possible service improvements. Interview participants came from a fairly broad age range and across regions in England, although there were a larger number of women and people identifying as White British than would reflect the UK population. Interviews were conducted between January and May 2023. PRINCIPAL FINDINGS: The infected blood scandal had, and continues to have, a profound impact on the mental health and wellbeing of infected and affected people. Study participants shared multiple accounts of grief and loss, anger, fear and anxiety, guilt, and facing stigma, isolation and discrimination because of infection. About half of the people who participated in the study explicitly said they had experienced trauma, and most described incidents that have caused them significant distress. Additionally, many participants described further long-term ill health linked to the side-effects of their infection(s) and their treatments, which many described as having life-changing impacts on their wellbeing. Affected people also reported very significant impacts of their loved one’s infection on their own wellbeing, including profound emotional and financial consequences of bereavement. Only some of those interviewed for this study had been able to access and use psychological support services for their mental health over the years, and only just over half of the study participants were aware of EIBSS payments for psychological support. Some participants only learnt about the availability of the EIBSS discretionary payment during the research interview. Identified barriers that prevented people from accessing counselling and psychological support included social and personal issues, such as feeling unable to open up, stigma 2 of NHS-supplied blood transfusions and blood products, and for affected families – Final report through encounters with the wider health system; study participants reported instances of discrimination in healthcare settings, which made it even more difficult for people to seek professional help. Only a very small number of people found the EIBSS payment scheme for psychological support easy to work through. Most described this route as requiring substantial effort, and being physically and mentally unwell further exacerbated these experiences. Study participants described feeling burdened by the application process and reported that finding a competent and suitable practitioner was often difficult. There is a substantial need for psychological support in the infected and affected communities, and this need is likely to increase once the Inquiry concludes. Practitioners working with infected and affected people cited instances where the Inquiry had already impeded the progress of clients working towards improving their mental health outcomes. Conclusions Existing psychological support services in England – whether accessed through the NHS or privately – do not currently meet the needs of infected and affected communities. Access to psychological support that is effective and experienced as tailored to an individual’s needs is not common and finding the right match between client and therapist is often down to chance. Accordingly, a future improved psychological support service should: • involve infected and affected people with a range of experiences in the development and design of the psychological support service; • address the substantial distrust in and legacy of EIBSS and the wider health system to provide an effective service; • be offered as standard to all individuals known to be infected or affected, and not just upon application; • be proactive, reaching out to and encouraging individuals to take up support; • be accessible through various routes with self-referral important to empower people and reduce access barriers; • be inclusive and broadened to a wider group of affected people than is currently the case; • be flexible and agile, allowing infected and affected people to access the service when they need it and re-enter it without additional administrative burdens for them; • be compassionate, respectful of its clients and non-judgemental. • be set in a specialist setting, include assessment, and offer individual therapy as well as peer support; • offer a range of therapeutic modalities and delivery modes (in-person, online, telephone); • work with adequately qualified, accredited and registered practitioners who have experience of working with trauma-affected populations, understand long-term health conditions that impact mental health and vice versa, and, importantly, have sensitivity to, and knowledge about the infected blood scandal, and related conditions including but not limited to HIV and hepatitis C. The service should be of high quality, with appropriate mechanisms for oversight and accountability. It should be embedded in a wider support system that is proactive, so that those who face the highest barriers or who are most vulnerable are still able to engage and benefit from this support service. This includes the creation of a single contact point or person (a navigator) who assists individuals to navigate the health and social care system more effectively. A service that ‘does the work’ by proactively reaching out to infected and affected people was seen as an important way in which the government could begin to address the harm it caused

    Effects of mental health status during adolescence on primary care costs in adulthood across three British cohorts

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    PURPOSE: This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. METHODS: We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). RESULTS: Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. CONCLUSION: Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. TRIAL REGISTRATION: Not applicable

    Economic evaluation of anti-epileptic medicines for autistic children with epilepsy

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    We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children’s families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure

    Do Research Practice Partnerships offer a promising approach to producing knowledge that improves social care practice and outcomes?

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    There are many pressing questions about how to deliver adult social care services. Where research evidence exists to address these questions, there is often limited use by social care commissioners, providers and the workforce. Sometimes this is attributed to the lack of perceived relevance and accessibility of the research itself, at other times it is considered to be a matter of individual and organisational capacity. As things stand, there is a gap between social care research and practice. Improving interaction between different stakeholders in the research process is a contemporary mechanism for promoting the production of research that is useful, usable and used. This paper describes one collaborative approach called Research Practice Partnerships (RPPs). These partnerships share the goal of benefit for all partners and are supported by a growing international evidence base. This paper summarises some of the key literature from different countries and contexts where the approach has been tried. It highlights the main features of RPPs, introduces a project setting up three new partnerships in the care home sector in England and highlights aspects of the theory of change that will guide the evaluation of the partnerships. In doing so, the paper introduces a promising collaborative approach to a social care audience and considers whether RPPs have the potential to achieve meaningful and impactful research in social care contexts
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