International research priorities for integrated care and cross-boundary working: an electronic Delphi study.

BACKGROUND: Integrated care can be broadly defined as the delivery of high-quality and safe care for patients as they cross organisational boundaries or when care is delivered with multiple healthcare teams, professions or organisations. Successful integration of care services is contingent on multiple and complex factors across macro-, meso- and micro-levels of health and social care systems in lower-, middle- and higher-income countries. Previous priorities for the future development of integrated care have focused on designing and implementing models or approaches to integrated care rather than establishing the research needed to underpin them. This study aimed to address this evidence gap by developing a consensus on international research priorities related to integration of care and cross-boundary working. METHODS: We conducted a sequential electronic Delphi (eDelphi) study from September 2023 to December 2023. The eDelphi process consisted of initial priority generation followed by two rounds of consensus development via an online survey. Sixty-six priorities were generated by 19 delegates at an international conference workshop titled, "Priority setting for future research on integration of care and cross-boundary working." Workshop delegates then identified other experts in integrated care and cross-boundary working from their networks. In each eDelphi round, participants then provided item-by-item responses using a seven-point Likert scale, with consensus defined a priori as ≥80% agreement (strongly agree or agree). Priorities that reached consensus were conceptually grouped into topics. RESULTS: Twenty-five of 66 unique (37.9%) research priorities achieved consensus after two eDelphi rounds. In Round 1, 63/85 (74.1%) experts from ten countries across four continents achieved consensus on 12/66 (18.2%) priorities. In Round 2, 51/63 (81.0%) experts achieved consensus on a further 13/54 (24.1%) priorities. From the 25 priorities, we derived six conceptual groupings that represent broad topics for future research on integrated care and cross-boundary working: (1) access to care, (2) data sharing and technology, (3) measurement of care quality, (4) patient experience and satisfaction, (5) service design, integration and governance, and (6) teamwork and leadership. CONCLUSION: Integrating care services and improving cross-boundary working is important for improving the quality of care provided to patients regardless of country, therefore the conceptual topics and individual priorities identified in this study can inform policy makers, practitioners, and researchers when designing or evaluating integrated care services across the world in the pursuit of improved integrated care systems.

Directional Localization from a Magnetic Field in Moiré Systems.

Moiré materials provide a highly tunable platform in which novel electronic phenomena can emerge. We study strained moiré materials in a uniform magnetic field and predict highly anisotropic electrical conductivity that switches easy axis as magnetic field or strain is varied. The dramatic anisotropy reflects one-dimensional localization (directional localization) of the electron wave functions along a crystal axis due to quantum interference effects. This can be understood in an effective one-dimensional quasiperiodic Aubry-André-Harper-like model, or in a complementary semiclassical picture. This phenomenon should be observable in strained moiré materials at realistic fields and low strain disorder, as well as unstrained systems with anisotropic Fermi surfaces.

Exploring the needs and experiences of contact tracing staff during the COVID-19 pandemic in Ireland.

BACKGROUND: Contact tracing is a key component in controlling the spread of COVID-19, however little research has focused on learning from the experiences of contact tracing staff. Harnessing learning from those in this role can provide valuable insights into the process of contact tracing and how best to support staff in this crucial role. METHODS: Thematic analysis was used to analyse 47 semi-structured interviews conducted with contact tracing staff via telephone or Zoom at three time points in 2021: March, May and September-October. RESULTS: Six themes related to the contact tracing role were identified, including training, workforce culture, systems issues, motivation and support. While initially nervous in the role, participants were motivated to contribute to the pandemic response and believed the role provided them with valuable transferable skills. Participants described the training as having improved over time while desiring more proactive training. Sources of frustration included a perceived lack of opportunity for feedback and involvement in process changes, feelings of low autonomy, and a perception of high staff turnover. Participants expressed a need for improved communication of formal emotional supports. Increased managerial support and provision of opportunities for career advancement may contribute to increased motivation among staff. CONCLUSIONS: These findings identify the experiences of contact tracing staff working during the COVID-19 pandemic, and have important implications for the improvement of the contact tracing system. Recommendations based on learning from participants offer suggestions as to how best to support the needs of contact tracing staff during a pandemic response.

Tools and methods for evaluating the change to health service delivery due to pandemics or other similar emergencies: A rapid evidence review.

The novel coronavirus, SARS-CoV-2 and its associated disease COVID-19, were declared a pandemic in March 2020. Countries developed rapid response activities within their health services to prevent spread of the virus and protect their populations. Evaluating health service delivery change is vital to assess how adapted practices worked, particularly during times of crisis. This review examined tools and methods that are used to evaluate health service delivery change during pandemics and similar emergencies. Five databases were searched, including PubMed, CENTRAL, Embase, CINAHL, and PsycINFO. The SPIDER tool informed the inclusion criteria for the articles. Articles in English and published from 2002 to 2020 were included. Risk of bias was assessed using the Mixed-Methods Appraisal Tool (MMAT). A narrative synthesis approach was used to analyse the studies. Eleven articles met the inclusion criteria. Many evaluation tools, methods, and frameworks were identified in the literature. Only one established tool was specific to a particular disease outbreak. Others, including rapid-cycle improvement and PDSA cycles were implemented across various disease outbreaks. Novel evaluation strategies were common across the literature and included checklists, QI frameworks, questionnaires, and surveys. Adherence practices, experience with telehealth, patient/healthcare staff safety, and clinical competencies were some areas evaluated by the tools and methods. Several domains, including patient/practitioner safety and patient/practitioner experience with telemedicine were also identified in the studies.

Phenomenology of the Prethermal Many-Body Localized Regime.

The dynamical phase diagram of interacting disordered systems has seen substantial revision over the past few years. Theory must now account for a large prethermal many-body localized regime in which thermalization is extremely slow, but not completely arrested. We derive a quantitative description of these dynamics in short-ranged one-dimensional systems using a model of successive many-body resonances. The model explains the decay timescale of mean autocorrelators, the functional form of the decay-a stretched exponential-and relates the value of the stretch exponent to the broad distribution of resonance timescales. The Jacobi method of matrix diagonalization provides numerical access to this distribution, as well as a conceptual framework for our analysis. The resonance model correctly predicts the stretch exponents for several models in the literature. Successive resonances may also underlie slow thermalization in strongly disordered systems in higher dimensions, or with long-range interactions.

Ergodicity breaking in rapidly rotating C60 fullerenes.

Ergodicity, the central tenet of statistical mechanics, requires an isolated system to explore all available phase space constrained by energy and symmetry. Mechanisms for violating ergodicity are of interest for probing nonequilibrium matter and protecting quantum coherence in complex systems. Polyatomic molecules have long served as a platform for probing ergodicity breaking in vibrational energy transport. Here, we report the observation of rotational ergodicity breaking in an unprecedentedly large molecule, 12C60, determined from its icosahedral rovibrational fine structure. The ergodicity breaking occurs well below the vibrational ergodicity threshold and exhibits multiple transitions between ergodic and nonergodic regimes with increasing angular momentum. These peculiar dynamics result from the molecule's distinctive combination of symmetry, size, and rigidity, highlighting its relevance to emergent phenomena in mesoscopic quantum systems.

Superconductivity and strong interactions in a tunable moiré quasicrystal.

Electronic states in quasicrystals generally preclude a Bloch description1, rendering them fascinating and enigmatic. Owing to their complexity and scarcity, quasicrystals are underexplored relative to periodic and amorphous structures. Here we introduce a new type of highly tunable quasicrystal easily assembled from periodic components. By twisting three layers of graphene with two different twist angles, we form two mutually incommensurate moiré patterns. In contrast to many common atomic-scale quasicrystals2,3, the quasiperiodicity in our system is defined on moiré length scales of several nanometres. This 'moiré quasicrystal' allows us to tune the chemical potential and thus the electronic system between a periodic-like regime at low energies and a strongly quasiperiodic regime at higher energies, the latter hosting a large density of weakly dispersing states. Notably, in the quasiperiodic regime, we observe superconductivity near a flavour-symmetry-breaking phase transition4,5, the latter indicative of the important role that electronic interactions play in that regime. The prevalence of interacting phenomena in future systems with in situ tunability is not only useful for the study of quasiperiodic systems but may also provide insights into electronic ordering in related periodic moiré crystals6-12. We anticipate that extending this platform to engineer quasicrystals by varying the number of layers and twist angles, and by using different two-dimensional components, will lead to a new family of quantum materials to investigate the properties of strongly interacting quasicrystals.

Exploring the psychological impact of contact tracing work on staff during the COVID-19 pandemic.

BACKGROUND: Contact tracing is a key control measure in the response to the COVID-19 pandemic. While quantitative research has been conducted on the psychological impact of the pandemic on other frontline healthcare workers, none has explored the impact on contact tracing staff. METHODS: A longitudinal study was conducted using two repeated measures with contact tracing staff employed in Ireland during the COVID-19 pandemic using two-tailed independent samples t tests and exploratory linear mixed models. RESULTS: The study sample included 137 contact tracers in March 2021 (T1) and 218 in September 2021 (T3). There was an increase from T1 to T3 in burnout related exhaustion (p < 0·001), post-traumatic stress disorder (PTSD) symptom scores (p < 0·001), mental distress (p < 0·01), perceived stress (p < 0·001) and tension and pressure (p < 0·001). In those aged 18-30, there was an increase in exhaustion related burnout (p < 0·01), PTSD symptoms (p < 0·05), and tension and pressure scores (p < 0·05). Additionally, participants with a background in healthcare showed an increase in PTSD symptom scores by T3 (p < 0·001), reaching mean scores equivalent to those of participants who did not have a background in healthcare. CONCLUSIONS: Contact tracing staff working during the COVID-19 pandemic experienced an increase in adverse psychological outcomes. These findings highlight a need for further research on psychological supports required by contact tracing staff with differing demographic profiles.

Integrating animal behaviour into research on multiple environmental stressors: a conceptual framework.

While a large body of research has focused on the physiological effects of multiple environmental stressors, how behavioural and life-history plasticity mediate multiple-stressor effects remains underexplored. Behavioural plasticity can not only drive organism-level responses to stressors directly but can also mediate physiological responses. Here, we provide a conceptual framework incorporating four fundamental trade-offs that explicitly link animal behaviour to life-history-based pathways for energy allocation, shaping the impact of multiple stressors on fitness. We first address how small-scale behavioural changes can either mediate or drive conflicts between the effects of multiple stressors and alternative physiological responses. We then discuss how animal behaviour gives rise to three additional understudied and interrelated trade-offs: balancing the benefits and risks of obtaining the energy needed to cope with stressors, allocation of energy between life-history traits and stressor responses, and larger-scale escape from stressors in space or time via large-scale movement or dormancy. Finally, we outline how these trade-offs interactively affect fitness and qualitative ecological outcomes resulting from multiple stressors. Our framework suggests that explicitly considering animal behaviour should enrich our mechanistic understanding of stressor effects, help explain extensive context dependence observed in these effects, and highlight promising avenues for future empirical and theoretical research.

Moiré Landau Fans and Magic Zeros.

We study the energy spectrum of moiré systems under a uniform magnetic field. The superlattice potential generally broadens Landau levels into Chern bands with finite bandwidth. However, we find that these Chern bands become flat at a discrete set of magnetic fields which we dub "magic zeros." The flat band subspace is generally different from the Landau level subspace in the absence of the moiré superlattice. By developing a semiclassical quantization method and taking account of superlattice induced Bragg reflection, we prove that magic zeros arise from the simultaneous quantization of two distinct k-space orbits. For instance, we show the chiral model of TBG has flat bands at special fields for any twist angle in the nth Landau level for |n|>1. The flat bands at magic zeros provide a new setting for exploring crystalline fractional quantum Hall physics.

Boosting the Quantum State of a Cavity with Floquet Driving.

The striking nonlinear effects exhibited by cavity QED systems make them a powerful tool in modern condensed matter and atomic physics. A recently discovered example is the quantized pumping of energy into a cavity by a strongly coupled, periodically driven spin. We uncover a remarkable feature of these energy pumps: they coherently translate, or boost, a quantum state of the cavity in the Fock basis. Current optical cavity and circuit QED experiments can realize the required Hamiltonian in a rotating frame. Boosting thus enables the preparation of highly excited nonclassical cavity states in near-term experiments.

Non-adherence to COVID-19 containment behaviours: results from an all-Ireland telephone survey.

BACKGROUND: COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines. METHODS: A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health. RESULTS: 3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9). CONCLUSIONS: Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.

Polyandry as a Male Strategy? A Game between Aggressive and Tolerant Males, Arbitrated by Females.

AbstractUnrelated males sometimes share their nests and their mates, an example of male-male cooperation that calls for an evolutionary explanation. We developed a game-theoretic model of this situation under the assumption that males could be either "aggressors," attempting to drive off any other arriving male, or "tolerators," willing to share a nest and mates with another tolerator male. We modeled nest dynamics by changing the frequency of the two types in the population and determined how this affected their fitness. We use the sea lamprey as a case study to generate a plausible array of behavioral traits and ecological conditions for the model. Under these conditions, only aggressors or only tolerators could persist, not both, but we also show how exceptions can arise. Aggressors predominated for the standard conditions we chose, but tolerators could take over when females favored them through nest choice or increased mating rate. High nesting densities and high fighting costs also tended to favor tolerators. At moderate to low densities of individuals in the nesting area, female behavior, based on their own costs and benefits, should determine the outcome.

Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has produced radical changes in international health services. In Ireland, the National Ambulance Service established a novel home and community testing service that was central to the national COVID-19 screening programme. This service was overseen by a multidisciplinary response room. This research examined the response room service, particularly areas that performed well and areas requiring improvement, using a quality improvement (QI) framework. DESIGN: This was a qualitative study comprising semi-structured, individual interviews. Maximum variation sampling was used. The data were analysed using an established thematic analysis procedure. The analysis was guided by the framework, which comprised six QI drivers. SETTING: Response room employees, including clinicians, dispatchers and administrators, were interviewed via telephone. RESULTS: Leadership for quality: participants valued person-oriented leadership, including regular, open communication and consultation with staff. Person/family engagement: participants endeavoured to provide patient-centred care. Formal patient feedback mechanisms and shared decision-making could be beneficial in the future. Staff engagement: working in a response room could affect well-being, though it also provided networking and learning opportunities. Staff require support and teambuilding. Use of improvement methods: improvements were made in a relatively informal, ad hoc manner. The use of robust methods based on improvement science was not reported. Measurement for quality: data were collected to improve efficiency and accuracy. More rigorous measurement would be beneficial, especially formally collecting stakeholder feedback. Governance for quality: close alignment with collaborators and clear communication with staff are essential. Information and communications technology for quality: this seventh driver was added because the importance of information technology specially designed for pandemics was frequently highlighted. CONCLUSIONS: The study provides insights on what worked well and what required improvement in a pandemic response room. It can inform health services, particularly emergency services, in their preparation for additional COVID-19 waves, as well as future crises.

Resolving conflict over within-pair mating rate in external fertilizers.

Besides egg fertilization, females of many taxa obtain direct fitness benefits from male mates, such as food, protection or paternal care. But males often increase their own fitness by mating with several females, among which they distribute sperm along with the above-mentioned benefits, reducing the benefits to individual females. These diverging interests lead to a conflict in which each female may try to ensure male fidelity and get exclusive access to male-provided benefits. Here, we use a theoretical model to show how a female of an externally fertilizing species may achieve mate fidelity by soliciting copulations at such a rate that the male has insufficient sperm left to increase his fitness with additional females. We show that three alternative condition-dependent evolutionarily stable mating relationships emerge in this scenario, based on whether one mate's preference for mating rate dominates, or the conflict is resolved by what amounts to negotiation. We demonstrate how these outcomes depend on some features of physiology, ecology, and behavior. In particular, a greater reproductive benefit to a female from exclusive access to a male partner-or the occasional tendency of females to withhold eggs during mating-can increase male fidelity; and continuous sperm regeneration rather than an initially-set stock of sperm allows for multiple within-pair mating across all three mating patterns.

Contact tracing during the COVID-19 outbreak: a protocol for enabling rapid learning from experiences and exploring the psychological impact on contact tracers.

Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs . Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff.

Media Representations of Science during the First Wave of the COVID-19 Pandemic: A Qualitative Analysis of News and Social Media on the Island of Ireland.

COVID-19 is arguably the most critical science communication challenge of a generation, yet comes in the wake of a purported populist turn against scientific expertise in western societies. This study advances understanding of science-society relations during the COVID-19 pandemic by analysing how science was represented in news and social media coverage of COVID-19 on the island of Ireland. Thematic analysis was performed on a dataset comprising 952 news articles and 603 tweets published between 1 January and 31 May 2020. Three themes characterised the range of meanings attached to science: 'Defining science: Its subjects, practice and process', 'Relating to science: Between veneration and suspicion' and 'Using science: As solution, policy and rhetoric'. The analysis suggested that the COVID-19 pandemic represented a platform to highlight the value, philosophy, process and day-to-day activity of scientific research. However, the study also identified risks the pandemic might pose to science communication, including feeding public alienation by disparaging lay understandings, reinforcing stereotypical images of scientists, and amplifying the politicisation of scientific statements.

Bordering on crisis: A qualitative analysis of focus group, social media, and news media perspectives on the Republic of Ireland-Northern Ireland border during the 'first wave' of the COVID-19 pandemic.

RATIONALE: International border controls were among the earliest and most effective of measures to constrain transmission of COVID-19. However, such measures are complex when established borders are open yet politically contested, as for the border that divides the Republic of Ireland (ROI) from Northern Ireland (NI). Understanding how this border affected the everyday lives of both populations during the pandemic is important for informing the continued development of effective responses to COVID-19 and future health crises. OBJECTIVE: This multi-methods study aimed to explore public perspectives on how the ROI-NI border affected experiences of and responses to the 'first wave' of the pandemic. METHOD: The study collated data from focus groups (n = 8), news articles (n = 967), and Twitter posts (n = 356) on the island of Ireland, which mentioned the ROI-NI border in relation to COVID-19. Thematic analysis was used to explore the range of perspectives on the role played by the border during the early months of the pandemic. RESULTS: Analysis identified three themes: Cross-Border Interdependencies illustrated the complexity and challenges of living near the border; Interpretations of Cross-Border Policy Disparities showed that lay publics perceived NI and ROI policy approaches as discordant and politicised; and Responses to Cross-Border Policy Disparities revealed alternating calls to either strengthen border controls, or pursue a unified all-island approach. CONCLUSIONS: Results reveal clear public appetite for greater synchronisation of cross-border pandemic responses, emphasise the specific vulnerability of communities living near the border, and highlight the risk of long-term socio-political repercussions of border management decisions taken during the pandemic. Findings will inform implementation of pandemic responses and public health policies in jurisdictions that share a porous land border.