Shortwave absorption by wildfire smoke dominated by dark brown carbon

Wildfires emit large amounts of black carbon and light-absorbing organic carbon, known as brown carbon, into the atmosphere. These particles perturb Earth's radiation budget through absorption of incoming shortwave radiation. It is generally thought that brown carbon loses its absorptivity after emission in the atmosphere due to sunlight-driven photochemical bleaching. Consequently, the atmospheric warming effect exerted by brown carbon remains highly variable and poorly represented in climate models compared with that of the relatively nonreactive black carbon. Given that wildfires are predicted to increase globally in the coming decades, it is increasingly important to quantify these radiative impacts. Here we present measurements of ensemble-scale and particle-scale shortwave absorption in smoke plumes from wildfires in the western United States. We find that a type of dark brown carbon contributes three-quarters of the short visible light absorption and half of the long visible light absorption. This strongly absorbing organic aerosol species is water insoluble, resists daytime photobleaching and increases in absorptivity with night-time atmospheric processing. Our findings suggest that parameterizations of brown carbon in climate models need to be revised to improve the estimation of smoke aerosol radiative forcing and associated warming.

86 STAFF EXPERIENCES OF COVID-19 MANAGEMENT IN A LONG-TERM CARE FACILITY FOR OLDER PEOPLE IN IRELAND

Background

Long term care (LTC) facilities for older people have been challenged by COVID-19 in an unprecedented manner. The impact of COVID-19 on health care professionals working in LTC facilities for older people is emerging as a crucial topic. Healthcare workers in LTC for older people were already pre COVID-19 experiencing high levels of stress and compassionate fatigue. The aim of the study was to capture the experiences of staff working during COVID-19 pandemic in a LTC facility for older people in Ireland.

Methods

Semi-structured interviews were conducted with 28 participants who were staff members, both clinical and non-clinical, in a LTC facility for older people in Ireland. Informed consent was obtained from all participants in accordance with the principles of the Helsinki Declaration. Data were interpreted using thematic analysis which allows for patterns of meaning to emerge by creating themes.

Results

21 clinical and 7 non-clinical staff members participated in interviews conducted between June and September 2021. Through analysis four main themes were identified: ‘Fear of COVID-19’, ‘Coping’, ‘Crisis and communication’ and ‘Teamwork’. Themes were interlinked with each other and mainly highlights the high level of adaption by staff in various roles during a time of uncertainty.

Conclusion

The findings are supported by previous studies into staff experiences of COVID-19 in which the level of uncertainty and stress caused by COVID-19 impacted staff on both professional and personal levels. Although positive examples of strong teamwork and a sense of working together were found, there was also fatigue as the pandemic continues. Future studies into staff stress levels and coping with COVID-19 should include the voices of healthcare professionals in LTC facilities for older people.

91 MONITORING FOR CLINICAL DETERIORATION; NURSES EXPERIENCE USING MODIFIED IRISH NATIONAL EARLY WARNING SYSTEM IN AN OLDER PERSON RESIDENTIAL CARE SERVICE

Background

We are a 140-bed Care of the Older Person facility. Approximately 50% of Sepsis cases occur in this demographic. The Irish National Early Warning System (INEWS) is an early warning system to assist staff recognise and respond appropriately to clinical deterioration. Currently there is no INEWS for Older Person Residential Services. Challenges for treatment relating to deterioration in our service are; detecting ‘new confusion’, access to doctors, treatment options available and the necessity to transfer a resident to the Acute Care sector if intravenous antibiotics were required. We used the National Clinical Guideline INEWS Version 2 (2020) to develop a clinical monitoring and escalation protocol. This was rolled out December 2021.

Methods

A Nurses Opinion survey was carried out to determine Nurses experience with using the locally modified Early Warning System.

Results

There was a 63% (n=35) response rate. 100% reported improvement in identifying clinical deterioration in a timely manner and effective monitoring for deteriorating residents. 96% reported improvement in confidence with monitoring unwell residents, confidence with transfer out decisions and referring the resident to the doctor for review. 91% noted improvement in communicating residents’ condition to doctors. 87% improvement in clinical practice when monitoring vital signs. 82% improved communication using the ISBAR. On reviewing clinical documentation for all residents who had deteriorated post implementation there was a significant improvement in monitoring and documentation. 23% stated increased time and staffing levels were required for monitoring of residents. 9% stated doctors didn’t always understand the INEWS.

Conclusion

Implementation of the modified INEWS has resulted in considerably improved clinical monitoring, documentation, & Nurses confidence. Significant challenges remain including ethical issues with decision to transfer out a resident for treatment. Recommendations are upskilling of Health Care Assistants to carry out vital signs monitoring, robust advanced healthcare decision making and implementation of an INEWS for Older Person Services.

270 ENHANCING CAPACITY TO CONSENT IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; USING SPEECH AND LANGUAGE THERAPY TO MAXIMISE COMMUNICATION

Background

For consent to be valid the resident must be able understand the information and communicate their choice. People with dementia can have a number of communication deficits; difficulty word finding, tendency to digress and repeat themselves, understanding the spoken word, maintaining a conversation topic without losing track, using semantically empty words (e.g. ‘thing’, ‘stuff’) in place of content words. This can limit their ability to express wishes and preferences. Out of 100 residents in our Older Person Residential Care facility 48% require some supports with communication; 25 diagnosed with dementia, 8 suspected (33%) and 15 with cognitive impairment. As per the HSE National Consent policy 2022 we have a duty to maximise capacity for our residents to consent to treatment and interventions. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited. Speech and Language Therapists (SALT) identify the specific nature of communication deficits for a person with dementia.

Methods

Our SALT reviewed our residents and advised on actions required to reduce the impact of communication deficits. We implemented a Communication care plan for our residents to include all identified communication abilities and disabilities for both speech and language across all modalities (reading, writing, gesture, symbols). To evidence understanding of consent, all staff interacting with residents were requested to undertake the HSELand National Consent policy module. All staff attended training which involved enhancing communication abilities.

Results

In February 2022, 95% of care plans audited had actions to address communication deficits in place. Ad hoc discussion with staff evidenced improved understanding of each resident’s communication deficits and necessity to use SALT reviews to enhance capacity to consent.

Conclusion

We have demonstrated that the use of SALT to enhance ability to communicate has enhanced capacity to consent for our residents. Staff also demonstrated improved communication practices.

Heterogeneity in the onwards transmission risk between local and imported cases affects practical estimates of the time-dependent reproduction number

During infectious disease outbreaks, inference of summary statistics characterizing transmission is essential for planning interventions. An important metric is the time-dependent reproduction number (Rt), which represents the expected number of secondary cases generated by each infected individual over the course of their infectious period. The value of Rt varies during an outbreak due to factors such as varying population immunity and changes to interventions, including those that affect individuals' contact networks. While it is possible to estimate a single population-wide Rt, this may belie differences in transmission between subgroups within the population. Here, we explore the effects of this heterogeneity on Rt estimates. Specifically, we consider two groups of infected hosts: those infected outside the local population (imported cases), and those infected locally (local cases). We use a Bayesian approach to estimate Rt, made available for others to use via an online tool, that accounts for differences in the onwards transmission risk from individuals in these groups. Using COVID-19 data from different regions worldwide, we show that different assumptions about the relative transmission risk between imported and local cases affect Rt estimates significantly, with implications for interventions. This highlights the need to collect data during outbreaks describing heterogeneities in transmission between different infected hosts, and to account for these heterogeneities in methods used to estimate Rt. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Understanding the Evolution of Smoke Mass Extinction Efficiency Using Field Campaign Measurements

Aerosol mass extinction efficiency (MEE) is a key aerosol property used to connect aerosol optical properties with aerosol mass concentrations. Using measurements of smoke obtained during the Fire Influence on Regional to Global Environments and Air Quality (FIREX-AQ) campaign we find that mid-visible smoke MEE can change by a factor of 2-3 between fresh smoke (<2 hr old) and one-day-old smoke. While increases in aerosol size partially explain this trend, changes in the real part of the aerosol refractive index (real(n)) are necessary to provide closure assuming Mie theory. Real(n) estimates derived from multiple days of FIREX-AQ measurements increase with age (from 1.40 - 1.45 to 1.5-1.54 from fresh to one-day-old) and are found to be positively correlated with organic aerosol oxidation state and aerosol size, and negatively correlated with smoke volatility. Future laboratory, field, and modeling studies should focus on better understanding and parameterizing these relationships to fully represent smoke aging.

177 REDUCTION OF RESTRICTIVE PRACTICES IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; THE IMPACT ON HUMAN RIGHTS AND RESIDENT SAFETY

Background

We are a 140 bed long term care residential care facility for older people. We strive to achieve a ‘Restraint Free Environment’ in accordance with Article 40.4 of the Irish Constitution and Articles 14 (liberty and security) and 15 (freedom from torture or cruel, inhuman or degrading treatment) of the UN Convention on Rights of Persons with Disabilities(1). Health Act 2007, Regulations 2013 defines restrictive practice as ‘the intentional restriction of a person’s voluntary movement or behaviour’. Use of restrictive practices is warranted when there is a real and substantial risk to a person and this risk cannot be addressed by non-restrictive means’ (HIQA, 2019) (2).

Methods

An extensive review of non pharmacological restrictive practices in the Organisation was undertaken. This included One to One supervision, use of bedrails, Exit Alarm mats and Electronic Monitoring bracelets. Bedrails were replaced for some residents with Safety Wedges and Ultra Low beds.

Results

Review of restraint interventions showed no clear link to prevention of falls or injuries as a result of restraint. Contrary there was evidence of breach of dignity and privacy for the residents. Based on the review, bedrail use was reduced radically between 2016 and 2021 by 79% (42–9). Falls rate remained consistent approximately 3.6–3.2 per 1,000 Occupied Bed Days.

Exit Alarm mats, Electronic Monitoring bracelets and One to One supervision was discontinued. These were replaced with direct observation and two hourly anticipation of needs. Cost saving on One to One estimated to have been €25,000 in 2016 alone. Clear care planning of the resident’s needs are core.

Conclusion

We have demonstrated that we could successfully reduce restrictive practices, thus respecting Human Rights, with no compromise to resident safety.

References

1. United Nations Convention on Rights for Persons with Disabilities (2007)

2. H.I.Q.A 2019 Guidance on promoting a Care Environment that is Free of Restrictive Practice.

The effects of iPod and text-messaging use on driver distraction: a bio-behavioral analysis

This study was designed to empirically examine the effects of iPod device and text-messaging activities on driver distraction. Sixty participants were asked to perform a driving simulation task while searching for songs using an iPod device or text messaging. Driving errors as measured by lane deviations were recorded and analyzed as a function of the distracters. Physiological measures (EEG) were also recorded during the driving phases in order to measure participant levels of cortical arousal. It was hypothesized that iPod use and text messaging would result in a profound effect on driving ability. The results showed a significant effect of iPod use and text-messaging on driving performance. Increased numbers of driving errors were recorded during the iPod and text-messaging phases than the pre- and post-allocation phases. Higher levels of Theta activity were also observed during the iPod and Text-messaging phase than the pre- and post-allocation phases. Implications for in-vehicle systems design, training, and safety are also discussed.

Dose-dependent effects of alcohol on appetite and food intake

To examine the potential dose-response effect of alcohol on appetite and food intake, 12 males attended the laboratory on three occasions. On each occasion, they were given a standard breakfast, then lunch 3 h later, and dinner, 4 h after that. Thirty minutes before lunch, Ss received 330 ml of no-alcohol lager (263 kJ: no-alcohol condition), the same amount of lager spiked with 1 unit (1 UA: 8 g ethyl alcohol, 498.2 kJ) or 4 units of alcohol (4 UA: 32 g ethyl alcohol, 1203.8 kJ). Visual analogue scale (VAS) ratings of appetite and mood were recorded before and after preloads and lunch, then hourly across the day. Intake at lunch (excluding energy from the preload) was significantly higher following 4 UA (5786+/-991 kJ) compared to 1 UA (4928+/-1245 kJ). Participants consumed more high-fat salty food items at lunch following 4 UA compared to the other preloads. Hunger was rated higher following 4 UA across the day in comparison to the other preloads, but fullness ratings failed to reflect any difference by condition. Energy intake at dinner was similar in all conditions and total energy intake across the day was significantly higher after 4 UA (14,615+/-1540 kJ) than after 1 UA (13,204+/-2156 kJ). In conclusion, above a certain threshold, alcohol appears to stimulate appetite in part, due to elevated levels of subjective hunger. When this occurs, energy intake is not reduced at subsequent meals. Thus, alcohol may contribute to positive energy balance via its additive effects to total energy intake and by short-term appetite stimulation.