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This poster was presented by Astrid E. Delorme at the 7th International Marine Debris Conference 19th - 23rd of September 2022 in Busan, South Korea, under Track 2: Research. Accepted Abstract: Recent global plastic pollution models predict that two thirds of the plastic mass released from land into the ocean since 1950s is likely to have stranded around the world’s shoreline. Yet, our knowledge about the degradation, burial and transportation fate of beached Marine Plastic Debris (MPD) remains limited and little is known about the exact capacity of beaches to store MPD. In this poster contribution we present the MSCA-HE project STORAGE, which aims to fill in current knowledge gaps in global monitoring of MPD. Our approach is based on repeated field-surveys of surface and buried MPD and studying the physico-chemical transformations induced by MPD weathering on Hawaiian beaches. The beaches of Hawaii accumulate high amounts of MPD given their location and proximity to the North Pacific Subtropical Gyre (also known as the North Pacific Garbage Patch, NPGP). Data collected from surveys of surface and buried MPD on beaches will generate 3D maps of MPD and by repeating the surveys over a time period of approximately two years will allow us to assess changes in MPD concentration and distribution over time and across seasons. Moreover, through the dynamic 3D maps of MPD we will evaluate MPD fluctuations with respect to sand column depth, beach morphology, distance from the tide line, seasonality, polymer type, size and density. Following the weathering of plastic debris when stored on beaches will reveal dominating MPD transformations and rates, including fragmentation rates, which will provide key information (e.g. changes in density, buoyancy and fragmentation) to understand the fate (transportation and transformation) of MPD in coastal environments. Data from the repeated field-surveys on Hawaiian beaches and the analyses of weathered-induced transformations of beached MPD will be used in numerical models in order to fill in knowledge gaps in MPD transportation. We envision that STORAGE will encourage evidence-based actions and policies to effectively target plastic pollution which will consequently reduce plastic entering the ocean. For example, targeted beach clean-ups, especially in areas where degradation is fast, could provide a ‘last chance’ to remove temporarily beached MPD before released into the vast ocean as secondary microplastic or being buried in beach sediment. The interdisciplinary transfer of knowledge needed for STORAGE will be facilitated through bringing together key actors in MPD analysis and sampling, plastic pollution modelling and polymer science.

Recent advances in molecular biology have led to the CRISPR revolution, but the lack of an efficient and safe delivery system into cells and tissues continues to hinder clinical translation of CRISPR approaches. Polymeric vectors offer an attractive alternative to viruses as delivery vectors due to their large packaging capacity and safety profile. In this paper, we have demonstrated the potential use of a highly branched poly(β-amino ester) polymer, HPAE-EB, to enable genomic editing via CRISPRCas9-targeted genomic excision of exon 80 in the COL7A1 gene, through a dual-guide RNA sequence system. The biophysical properties of HPAE-EB were screened in a human embryonic 293 cell line (HEK293), to elucidate optimal conditions for efficient and cytocompatible delivery of a DNA construct encoding Cas9 along with two RNA guides, obtaining 15–20% target genomic excision. When translated to human recessive dystrophic epidermolysis bullosa (RDEB) keratinocytes, transfection efficiency and targeted genomic excision dropped. However, upon delivery of CRISPR–Cas9 as a ribonucleoprotein complex, targeted genomic deletion of exon 80 was increased to over 40%. Our study provides renewed perspective for the further development of polymer delivery systems for application in the gene editing field in general, and specifically for the treatment of RDEB.

Background and Purpose: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded ( Conclusions: A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02072681.

Individuals higher in grandiose narcissism strive to create and maintain their inflated self-views through self-aggrandizing and other-derogating behaviors. Drawing from the dual-process model of narcissistic admiration and rivalry, we proposed that individuals higher in narcissism may contribute to more competitive and less cooperative conflict processes. We tracked over 100 project design teams from inception to dissolution, gathering data at three time points. We evaluated how team levels of narcissism (i.e., maximum team score, team mean, and team variance) related to latent team means of cooperative and competitive conflict processes. Team mean scores of narcissistic rivalry corresponded to less cooperative and more competitive team conflict processes as teams approached their final project deadline. Our results show how narcissistic rivalry (but not admiration) alters the types of team conflict processes that arise within groups, and is particularly consequential as teams approach major project deadlines.

Metastasis-initiating cells (MICs) display stem cell-like features and cause metastatic recurrences leading to patients' demise. We found that prostate and breast cancer cells with high surface expression of the chemokine receptor CX3CR1 (CX3CR1high) account for ~5-7% of the whole population and are endowed with metastasis-initiating ability and exhibits stemness features, including expression of pluripotency genes Nanog and Oct4a. Notably, impairing CX3CR1 signaling hinders metastatic initiation and progression in mouse models of human disease. We also found that cancer cells lacking surface CX3CR1 expression (CX3CR1low) can re-acquire CX3CR1-associated features over time by undergoing phenotypic plasticity. Accordingly, when grafted as pure CX3CR1low populations these cells could generate disseminated tumors in mice, implying that MICs can emerge from cancer cells lacking stemness features. In vitro studies by flow cytometry show that cell surface re-exposure of CX3CR1 by CX3CR1low cells begins within 2 days post-sorting, with the whole population reaching phenotypic equilibrium at 12-16 days post-sorting. Further mechanistic studies revealed that both CX3CR1 protein trafficking and transcriptional regulation play a role in phenotypic plasticity. Additionally, disseminated tumors in mice harbor higher percentages of CX3CR1high cells than in vitro cultures, suggesting that the tissue microenvironment of target organs promotes phenotypic plasticity. These findings nominate CX3CR1 as a novel marker of MICs and provide conceptual ground for future development of approaches targeting CX3CR1 signaling and (re)expression as therapeutic means to prevent or contain metastasis initiation and progression. Citation Format: Jieyi Zhang, Yetunde Oyende, Jennifer Lynch, Olimpia Meucci, Alessandro Fatatis. CX3CR1 surface expression and phenotypic plasticity in metastasis-initiating cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1292.

Integrating insights from interdependence theory with the narcissistic admiration and rivalry concept, we propose that a pivotal obstacle for narcissistic leaders is their inability to sustain benevolent perceptions over time. As people strive to interpret social behavior in terms of self- or other-interest, the narcissistic tendency of prioritizing self-interests over the collective may become apparent and eventually taint their reputation as a leader. We examined how interpersonal motive perceptions—based on attributions of self- and other-interest—would clarify the leadership paradox of narcissism. We tracked 472 participants in 119 teams across four time-points. Narcissistic rivalry (but not admiration) corresponded to increasingly negative leader effectiveness ratings. The extent to which individuals were perceived as self-maximizing and lacking concern for other interests was tightly connected to declines in leader effectiveness across time. Altogether, these results offer insight into how perceived interpersonal motives may explain the downfall of narcissistic leadership.

Background the COVID-19 pandemic disproportionately affected care home residents’ and staffs’ access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff. Methods a scoping review of the evidence on remote consultations between healthcare services and care homes. Interviews with English health and social care professionals about their experiences during the pandemic. Findings were synthesised using the non-adoption, abandonment, scale-up, spread, sustainability framework. Results 18 papers were included in the review. Twelve interviews were completed. Documented enablers and barriers affecting the uptake and use of technology (e.g. reliable internet; reduced travelling) resonated with participants. Interviews demonstrated rapid, widespread technology adoption overcame barriers anticipated from the literature, often strengthening working relationships with care homes. Novel implementation issues included using multiple platforms and how resident data were managed. Healthcare professionals had access to more bespoke digital platforms than their social care counterparts. Participants alternated between platforms depending on individual context or what their organisation supported. All participants supported ongoing use of technologies to supplement in-person consultations. Conclusions the evidence on what needs to be in place for video consultations to work with care homes was partly confirmed. The pandemic context demolished many documented barriers to engagement and provided reassurance that residents’ assessments were possible. It exposed the need to study further differing resident requirements and investment in digital infrastructure for adequate information management between organisations.

Background and Purpose: Clinical fluctuations in ischemic stroke symptoms are common, but fluctuations before hospital arrival have not been previously characterized. Methods: A standardized qualitative assessment of fluctuations before hospital arrival was obtained in an observational study that enrolled patients with mild ischemic stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score of 0–5) present on arrival to hospital within 4.5 hours of onset, in a subset of 100 hospitals participating in the Get With The Guidelines–Stroke quality improvement program. The number of fluctuations, direction, and the overall improvement or worsening was recorded based on reports from the patient, family, or paramedics. Baseline NIHSS on arrival and at 72 hours (or discharge if before) and final diagnosis and stroke subtype were collected. Outcomes at 90 days included the modified Rankin Scale, Barthel Index, Stroke Impact Scale 16, and European Quality of Life. Prehospital fluctuations were examined in relation to hospital NIHSS change (admission to 72 hours or discharge) and 90-day outcomes. Results: Among 1588 participants, prehospital fluctuations, consisting of improvement, worsening, or both were observed in 35.5%: 25.1% improved once, 5.3% worsened once, and 5.1% had more than 1 fluctuation. Those who improved were less likely and those who worsened were more likely to receive alteplase. Those who improved before hospital arrival had lower change in the hospital NIHSS than those who did not fluctuate. Better adjusted 90-day outcomes were noted in those with prehospital improvement compared to those without any fluctuations. Conclusions: Fluctuations in neurological symptoms and signs are common in the prehospital setting. Prehospital improvement was associated with better 90-day outcomes, controlling for admission NIHSS and alteplase treatment. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 02072681.

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.

Background: The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. Aims: To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. Design: A systematic review of home palliative care interventions in dementia. Data sources: The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. Results: We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. Conclusions: The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.

Background Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection. Study registration This study is registered as PROSPERO CRD42016047512 Electronic supplementary material The online version of this article (10.1186/s12877-018-0995-9) contains supplementary material, which is available to authorized users.

The provision of reassurance is seen as a goal and benefit of the use of assistive technology (AT) in supporting people to manage their health and care needs at a distance. Conceptually, reassurance in health and care settings remains under-theorised with the benefits of experiencing reassurance through technology use assumed rather than understood. UK health and social care service goals of managing safety and risk have largely been equated with providing reassurance to users of AT and their carers. What has not been explored is how reassurance is experienced variably by users of different types of technology-enabled care. We present data from 3 case studies of different technologies in use in health and social care provision, analysed through a postphenomenology and sociomaterial lens. Our findings point to reassurance as an important facet of AT provision but the intended functions and uses of technological devices alone did not account for people's experiences of reassurance. Participant narratives referred variously to the comfort of being monitored, having their illness/wellness verified by the device, feeling reassured by the promise of help if needed, and imbuing the device with symbolic meaning (when the user associated the device with meanings and functions other than its technical capabilities). The different ways in which reassurance was experienced provides a useful way of understanding the potential tensions with AT policy goals as well as the positive meaning attributed to devices in some cases. This study reaffirms the importance of AT implementation being anchored in what matters to the user., Highlights • Reassurance is a goal of assistive technology implementation for the care of older people. • Postphenomenology can account for variations in people's experiences of technology. • People feel reassured through multistable human-technology relations. • A technology's materiality can generate symbolic meaning for the user. • Technology implementation must incorporate users' needs changing over time.

Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.

Background Worldwide, every three seconds someone develops dementia. Dementia is a terminal condition. Therefore, communication about future care preferences (advance care planning, ACP) is important for people with dementia (PwD) and their network. This review of reviews aims to synthesize the evidence on ACP for PwD and their carers. Methods PubMed, CINAHL Plus, SCOPUS, SocialCareOnline and Cochrane Library, were systematically searched for systematic reviews in July 2018. After tabulation of primary research, PubMed, CINAHL Plus and SCOPUS were searched for additional recent primary research articles in September. Methodological quality was assessed using AMSTAR-2 and the Joanna Briggs Institute instruments. Overarching themes were identified. Results 19 reviews and 10 primary research articles met the inclusion criteria. Methodological quality was variable. Preliminary analysis suggests that ACP interventions led to increased ACP documentation, an increase in PwD dying in their preferred place and a decrease in hospitalisations. Qualitative data showed that the ACP process can be experienced as stressful, but is also perceived as relevant by PwD and carers. Lack of knowledge about ACP and dementia were barriers to ACP use for all parties involved. Facilitators for ACP were; education to improve healthcare professionals’ communication skills and legal and ethical knowledge; education for PwD and carers about the ACP process, the differences between palliative and terminal care and the dementia disease trajectory. Conclusion ACP interventions have shown to be effective on health utilization outcomes, however education for all parties involved is key to optimize the ACP process for PwD and their carers.

Telecare – services employing technology to monitor people’s movement, medication and home environment at a distance – has emerged as a key component of global social care and health policies. The relationship between policies about telecare and the experiences and aspirations of service users has been under-interrogated. This article draws on findings from an organisational case study involving people living with complex conditions using various telecare devices and employs Hajer’s (1995) concept of argumentative discourse analysis to identify two key storylines arguing that telecare improves people’s quality of life and promotes independence. While these storylines point to seemingly logical and incontestable objectives, uncritical policy and practice fails to recognise and prioritise the aspirations of service users, leading to unintended consequences that can deepen people’s isolation and minimise organisational benefits.

Using a high shear melt-processing method, graphene-reinforced polymer matrix composites (G-PMCs) were produced with good distribution and particle–matrix interaction of bi/trilayer graphene at 2 wt. % and 5 wt. % in poly ether ether ketone (2Gn-PEEK and 5Gn-PEEK). The morphology, structure, thermal properties, and mechanical properties of PEEK, 2Gn-PEEK and 5 Gn-PEEK were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermal gravimetric analysis (TGA), flexural mechanical testing, and dynamic mechanical analysis (DMA). Addition of graphene to PEEK induces surface crystallization, increased percent crystallinity, offers a composite that is thermally stable until 550 °C and enhances thermomechanical properties. Results show that graphene was successfully melt-blended within PEEK using this method.

It can be an arduous and time consuming task to manually curate video data for tracking the movement of an object. This is particularly challenging when tracking animals whose behaviour is sporadic and unpredictable, but it can provide pertinent information when monitoring health, conditions and treatments. Here, we evaluate the use of machine learning retroactively applied to automatically track specific steers in hours of video with minimal manual interaction. This is approached using the Faster R-CNN Object Detection algorithm with VGG-16 acting as a feature extractor. Performance on a number of video segments is presented and discussed, and the issues encountered are outlined. This highlights a number of guidelines that should be taken under consideration when generating video data to improve object detection performance, and helps define the applicability of the approach to pre-existing data.

BackgroundSome interventions are developed from practice, and implemented before evidence of effect is determined, or the intervention is fully specified. An example is Namaste Care, a multi-component intervention for people with advanced dementia, delivered in care home, community, hospital and hospice settings. This paper describes the development of an intervention description, guide and training package to support implementation of Namaste Care within the context of a feasibility trial. This allows fidelity to be determined within the trial, and for intervention users to understand how similar their implementation is to that which was studied.MethodsA four-stage approach: a) Collating existing intervention materials and drawing from programme theory developed from a realist review to draft an intervention description. b) Exploring readability, comprehensibility and utility with staff who had not experienced Namaste Care. c) Using modified nominal group techniques with those with Namaste Care experience to refine and prioritise the intervention implementation materials. d) Final refinement with a patient and public involvement panel.ResultsEighteen nursing care home staff, one carer, one volunteer and five members of our public involvement panel were involved across the study steps. A 16-page A4 booklet was designed, with flow charts, graphics and colour coded information to ease navigation through the document. This was supplemented by infographics, and a training package. The guide describes the boundaries of the intervention and how to implement it, whilst retaining the flexible spirit of the Namaste Care intervention.ConclusionsThere is little attention paid to how best to specify complex interventions that have already been organically implemented in practice. This four-stage process may have utility for context specific adaptation or description of existing, but untested, interventions. A robust, agreed, intervention and implementation description should enable a high-quality future trial. If an effect is determined, flexible practice implementation should be enabled through having a clear, evidence-based guide.

How employees construct and manage their identities at work has important consequences for individuals and organizations (Ashforth & Schinoff, 2016). Yet recent workplace trends are blurring the bo...

Plastic composites are relatively affordable, lightweight, durable, and are being studied for applications as a replacement to traditional materials, such as aluminum, concrete, glass, and steel. The purpose of this work was to characterize plastic composite blends of polystyrene and high-density polyethylene combined in different percentage weights, using a single screw extrusion melt-processing method. Mechanical, structural, and thermal properties of each composite blend were tested to characterize the samples. Flexural tests were performed to measure the amount of load the composites could withstand. Impact data revealed that the mid-level blends absorbed the least amount of energy, reflecting a low impact resistance. The differential scanning calorimetry (DSC) analysis showed that with an increase in polystyrene content, the melting and crystallization temperatures remained constant. This data allows for a detailed characterization of the various compositions of polystyrene and high-density polyethylene. The determined properties will be beneficial for future applications in materials science.