Nonpharmacological interventions for psychotic symptoms in people with dementia

Abstract Background: Psychotic symptoms are common in people with dementia. They are associated with an increased burden of care and higher rates of institutionalisation. Pharmacological interventions lack sufficient efficacy and are associated with numerous deleterious side effects. The present thesis aims to build a rationale and an evidence base to enable the development of a non-pharmacological intervention specifically targeting psychotic symptoms in people with dementia, to provide an effective and safer alternative to current pharmacological treatments. Methods: Two empirical studies were conducted to determine whether psychotic symptoms in people with dementia are associated with reduced quality of life in community dwelling individuals and people living in nursing homes. A Delphi study, incorporating a detailed scoping review, was conducted to identify the best nonpharmacological intervention that could be readily adapted to target psychotic symptoms in people with dementia. Study 1: Impact of psychotic symptoms on living well in people with dementia living in the community This study aimed to investigate whether psychotic symptoms impact the ability of community-dwelling people with dementia to live well by assessing three outcome measures: quality of life (QoL), wellbeing and life satisfaction. The analysis was conducted on cross-sectional data from 1257 community-dwelling people with dementia and their caregivers, using data from the “Improving the experience of Dementia and Enhancing Active Life (IDEAL)” study cohort. This cohort consists mainly of individuals with mild dementia. The study examined differences on three validated measures of living well - Quality of Life in Alzheimer’s Disease scale, World Health Organization-Five Well-being Index and Satisfaction with Life Scale – for people with dementia experiencing or not experiencing delusions and for people with dementia experiencing or not experiencing auditory hallucinations. Analysis of co-variance was used to determine the confounding contributions of cognition (assessed with the Mini-Mental State Examination), depression (assessed with the Geriatric Depression Scale-10), caregivers stress *assessed with the Relative Stress Scale) and antipsychotic usage. Delusions were not associated with more impaired QoL, reduced wellbeing or altered satisfaction with life. The presence of auditory hallucinations was however associated with lower scores for QoL [p<0.001, η2=0.013], wellbeing [p<0.001, η2=0.016] and satisfaction with life [p<0.001, η2=0.010]. After controlling for confounding factors, the relationship between auditory hallucinations and QoL [p=0.003, pη2= 0.011] and wellbeing [p <0.001, pη2= 0.018] remained significant, but there was no significant association with satisfaction with life. In summary, the presence of auditory hallucinations but not delusions were associated with lower QoL and wellbeing in people with dementia living in the community. The results help refine a treatment target for a non-pharmacological therapy for the treatment of a key psychotic symptom in people with dementia Study 2: Impact of psychotic symptoms and concurrent neuropsychiatric symptoms on QoL in people with dementia living in nursing homes This study aimed to investigate whether psychotic symptoms had an impact on QoL in people with dementia living in nursing homes. Cross-sectional data from971 people with dementia was obtained from the “Improving Well-being and Health for people with dementia (WHELD)” study, a cohort exclusively consisting of people with dementia living in nursing homes. Additionally, this chapter investigates the mediating impact of other concurrent neuropsychiatric symptoms QoL. The Neuropsychiatric Inventory - Nursing Home (NPI-NH) version was completed by informant interview. The study compared mean differences in proxy-rated QoL scores (DEMQOL-Proxy) for people with dementia experiencing or not experiencing delusions and for people with dementia experiencing or not experiencing hallucinations. Backward multiple regression was used to determine the added contributions of agitation (Cohen-Mansfield Agitation Inventory), anxiety (NPI-NH-Anxiety), depression (Cornell Scale for Depression in Dementia), dementia severity (Clinical Dementia Rating – sum of boxes score), pain (Abbey Pain Scale) and antipsychotic prescription. Mediation analysis was conducted for agitation, anxiety and depression. The presence of both delusions (p<0.001, B = -8.39) and hallucinations (p<0.00, B = -7.78) was associated with more impaired QoL. Both associations remained significant after controlling for other factors. Agitation, anxiety and depression partially mediated the relationship between each psychotic symptom and QoL. In summary, delusions and hallucinations in people with dementia are associated with more impaired QoL among people with dementia living in nursing homes. The effects remain significant after adjusting for confounding variables. Direct effects of each symptom-maintained significance, with further significant mediation from concurrent neuropsychiatric symptoms. Study 3: Adapting nonpharmacological interventions to manage psychotic symptoms in dementia: a Delphi study This study aimed to determine which nonpharmacological interventions could be best adapted to target psychotic symptoms in people with dementia. Nonpharmacological interventions are recommended as the first line option for treatment, however there is a paucity of evidence for any specific nonpharmacological interventions to primarily target psychotic symptoms. A modified Delphi process was used in the study to establish a consensus from a panel of experts, identify which interventions would most be suitable for adaption. Two rounds of feedback were conducted, and a directed scoping review was undertaken. The expert panel included 12 members with clinical and research expertise in managing psychotic symptoms in people with dementia The study was not able to reach consensus regarding which nonpharmacological treatment could be most readily adaptable to manage psychotic symptoms. However, there were three top nominated treatment options: cognitive behavioural therapy (CBT), family intervention, and environmental/sensory interventions. The suggestions focused strongly on assessing individual situations and triggers, with a further recommendation for a combination of nonpharmacological treatments to be used depending upon the specific needs of an individual with dementia experiencing psychotic symptoms. In summary, whilst consensus could not be reached, there were clear recommendations for three nonpharmacological options to be adapted and clear suggestion for a combination of options to be implemented depending on individual circumstances. General result summary: In people with dementia living in the community, auditory hallucination but not delusions were associated with reduced quality of life. In people with dementia living in nursing homes both delusions and hallucinations were associated with lower quality of life. The Delphi identified 3 therapeutic approaches for possible adaptation of the treatment of psychosis in people with Alzheimer’s disease: cognitive behavioural therapy, family intervention and environmental intervention. Conclusions and Implications: Psychotic symptom are associated with reduced quality of life for people with dementia dwelling in the community and or people with dementia living in nursing homes. The different environments and the different severity of dementia across these two settings has important implications with respect to the selection of the most appropriate psychological intervention and the types of adaptation that will need to be made. It is likely that the development of the interventions suggested by the Delphi will need to be undertaken in several different ways to ensure they are adapted to the needs of the different groups of individuals

Beyond Rubik: The Embodiment-Presence-Interactivity Cube applied to exercise.

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Data availability: Data and code are available via the Open Science FrameworkEvidence-based interventions are needed to promote engagement in physical activity. Audio-visual stimuli are frequently employed to enhance the exercise experience. Nonetheless, there is a paucity of research that examines the qualities of technological devices that are employed. Using the Embodiment-Presence-Interactivity Cube (Flavián et al., 2019) as a guiding conceptual framework, the aim of this registered report was to examine how each dimension of the cube (i.e., embodiment, presence and interactivity) influenced a range of exercise-related affective and perceptual variables. A counterbalanced within-subjects design was employed (N = 24). Participants completed 20-min exercise bouts on a cycle ergometer under four conditions: Television, augmented reality, 360° video and virtual reality. A repeated-measures ANOVA indicated a significant Condition × Timepoint interaction for affective valence (p = .046), with greater embodiment offered by technological devices leading to more positive responses. Analyses also indicated main effects of condition for exercise enjoyment, remembered pleasure and forecasted pleasure, with greater presence of technological devices leading to more positive responses. Technologies that combine high levels of embodiment, presence and interactivity (e.g., virtual reality) appear to yield several benefits in terms of in-task (e.g., affective valence) and post-task (e.g., remembered pleasure) responses for exercise conducted at ventilatory threshold

Petrogenesis of alkaline rocks and the lithospheric mantle evolution of the Kaapvaal Craton, southern Africa

Alkaline mafic-ultramafic igneous rocks are known across the Kaapvaal Craton of southern Africa, forming in pulses from the Mesoproterozoic to the Cenozoic. These rocks, formed from the low-degree partial melting of diverse upper mantle domains, are intrinsically linked to the global processes responsible for reorganisation of continental plates (the supercontinent cycle). In this thesis, the effects of the supercontinental cycle and the evolution of the Kaapvaal Craton are probed through analyses of a major swarm of carbonate-rich olivine-bearing cratonic lamproites from the Western Limb of the Bushveld Complex (the Western Bushveld lamproites), and a minor cluster of alkaline lamprophyres near Pretoria (the Greenview lamprophyres). 40Ar/39Ar phlogopite dating of the Western Bushveld lamproites reveals a genetic association between the 146–137 Ma dykes and the disaggregation of Gondwana throughout the Mesozoic. Intra-continental rifts propagated between East and West Gondwana triggering low-degree melting of the Kaapvaal subcontinental lithospheric mantle (SCLM), channelling melt into the crust through ancient cratonic lineaments. Combined investigations on the petrology, bulk-rock geochemistry, mineral chemistry, and radiogenic (Sr-Nd-Hf) isotope compositions of the lamproites place constraints on magma petrogenesis and the nature of their source. A period of ancient subduction was key to the development of the lamproite source, whereby slab-derived fluids metasomatised the Kaapvaal cratonic keel, producing isotopically distinct SCLM metasomes. After a considerable period of isolation from the convecting mantle, low-degree partial melting of this source formed the diverse, but universally incompatible element- and isotopically-enriched, lamproite primary melts. Metasomatic enrichment of the SCLM was key in producing the (relatively) elevated platinum-group element (PGE) concentrations of the Western Bushveld lamproites. The introduction of volatile-rich and highly fusible PGE-bearing assemblages into the SCLM allowed for efficient transfer of PGE-rich materials into ascending lamproite melt(s). In contrast, the PGE concentrations of the Greenview lamprophyres primarily reflect melting of sulfide in an asthenospheric source. The diverse petrogeneses and PGE systematics of differing alkaline mafic-ultramafic igneous rocks highlights the importance of a SCLM metasomatised by fluids of subduction origin in promoting highly siderophile element mobility

Effects of two different polymers and calcium chloride solution on the swelling behavior of an expansive soil

This is the author accepted manuscript. The final version is available from ASTM International via the DOI in this recordIn this research the swelling properties of an expansive soil (bentonite) were investigated through experimental tests, focusing on the effects of two different polymers: polyethylene oxide or polyethylene glycol (PEO) and polyacrylamide (PAM), as well as calcium chloride (CaCl2) solution. The soil samples were compacted by static compaction in a special mold, to create consistent samples. Subsequently, the samples were subjected to flooding with distilled water, solutions of the two polymers, or a CaCl2 solution at concentrations of 2, 4, 6, and 8 g/l. The swelling potential and swelling pressure of the samples were measured to assess their response. The results showed that the polymer solutions effectively reduced both the swelling potential and swelling pressure of the samples, indicating an interaction between the polymers and the soil. This interaction was further supported by the scanning electron microscopy (SEM) results. Furthermore, the type of flooding fluids (polymer or CaCl2 solution) and its concentration were found to significantly influence on both the swelling potential and swelling pressure. Comparing the results obtained, it was observed that PEO exhibited a greater reduction in soil swelling compared to PAM. Additionally, the CaCl2 solution showed a more pronounced effect on soil swelling compared to both polymers

Editorial: Reviews in networks in the brain system

This is the final version. Available on open access from Frontiers Media via the DOI in this recor

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews.

This is the final version. Available from Wiley via the DOI in this record. BACKGROUND: In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes. OBJECTIVES: The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes. SEARCH METHODS: In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. SELECTION CRITERIA: Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. DATA COLLECTION AND ANALYSIS: Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM. STAKEHOLDER INVOLVEMENT: We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. MAIN RESULTS: We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. AUTHORS’ CONCLUSIONS: This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.National Institute for Health Researc

Longitudinally Spaced Observations of a Magnetic Cloud-Like Structure Embedded in a Co-rotating Interaction Region

This is the author accepted manuscriptData availability. The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable requestInteraction mechanisms in the solar wind affect the evolution of magnetic structures, thereby mediating the properties acquired during their formation processes at the Sun as they propagate outward. Using remote-sensing and in-situ observations across multiple spacecraft we investigate a Magnetic Cloud-Like structure (MCL) detected in-situ on 3-4 July 2007 near the ecliptic at different longitudes with OMNI, STEREO-A and -B. The MCL is entrained in a Corotating Interaction Region (CIR) originating in the Northern heliospheric sector, creating a Merged Interaction Region (MIR). Our multi-spacecraft analysis, facilitated by the small angular separation of 17° in longitude and the solar minimum background, reveals the 'aging' of the MCL-CIR interaction. Local negative expansion speeds of the MCL indicate compression increasing further downstream. Differences in size, the formation of the sheath, the presence of forward and reverse waves, and the small-scale structuring demonstrate the progression of the interaction. This unique opportunity to observe the temporal evolution of the MCL-CIR interaction highlights the intricate nature of solar wind structures and their interactions at 1 AU.Science and Technology Facilities Council (STFC

A foundation model enhanced approach for generative design in combinational creativity

This is the final version. Available on open access from Taylor & Francis via the DOI in this recordIn creativity theory, combining two unrelated concepts into a novel idea is a common means of enhancing creativity. Designers can integrate the Additive concept into the Base concept to inspire and facilitate creative tasks. However, conceiving high-quality combinational ideas poses a challenge that combinational creativity itself demands the consideration of conceptual reasoning and synthesis. We propose an AI foundation model enhanced approach for supporting combinational creativity. This approach derives combinational embodiments, and assists humans in verbalising and externalising combinational ideas. Our experimental study demonstrates that the generated combinational ideas by the approach obtained highest scores compared to those ideas generated without an AI foundation model or combinational strategy. We built a combinational creativity tool called CombinatorX based on this approach to generate ideas. In a study with the comparison of an existing combinational creativity tool and Internet search, we validated that our approach improves the effectiveness of combinational idea generation, enables a reduction in labour force, and facilitates the refinement of combinational ideation.National Key R&D Program of ChinaNational Natural Science Foundation of Chin

Synthesis of the land carbon fluxes of the Amazon region between 2010 and 2020

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: The spatial dataset of the main figures are available in a raster format and can be found at https://doi.org/10.5281/zenodo.10423522. The annual carbon fluxes from each model used in this research (disturbances, old-growth sink and net flux) for the Brazilian Amazon and whole Biogeographical Amazon are available at https://doi.org/10.5281/zenodo.8348434.Code availability: The code and tables used to reproduce the main paper graphics of Figs. 2a, b, 3a, b, 4a and 5a are available in Zenodo https://doi.org/10.5281/zenodo.8348435. Further editions to combine the layout of graphics and maps were made in a design software (InkScape).The Amazon is the largest continuous tropical forest in the world and plays a key role in the global carbon cycle. Human-induced disturbances and climate change have impacted the Amazon carbon balance. Here we conduct a comprehensive synthesis of existing state-of-the-art estimates of the contemporary land carbon fluxes in the Amazon using a set of bottom-up methods (i.e., dynamic vegetation models and bookkeeping models) and a top-down inversion (atmospheric inversion model) over the Brazilian Amazon and the whole Biogeographical Amazon domain. Over the whole biogeographical Amazon region bottom-up methodologies suggest a small average carbon sink over 2010-2020, in contrast to a small carbon source simulated by top-down inversion (2010-2018). However, these estimates are not significantly different from one another when accounting for their large individual uncertainties, highlighting remaining knowledge gaps, and the urgent need to reduce such uncertainties. Nevertheless, both methodologies agreed that the Brazilian Amazon has been a net carbon source during recent climate extremes and that the south-eastern Amazon was a net land carbon source over the whole study period (2010-2020). Overall, our results point to increasing human-induced disturbances (deforestation and forest degradation by wildfires) and reduction in the old-growth forest sink during drought.Newton FundRECCAP2 projectEuropean Union Horizon 2020UK National Centre for Earth ObservationState of Sao Paulo Science Foundation (FAPESP

Nexus between agriculture and photovoltaics (agrivoltaics, agriphotovoltaics) for sustainable development goal: A review

This is the final version. Available on open access from Elsevier via the DOI in this recordThe coexistence of agricultural land and solar photovoltaics (PV) can be named Agriphotovoltaics (APV). APV concept was developed two decades ago however its actual implementation is happening nowadays. APV directly solves SDGs 7, and 11 by generating benevolent renewable energy without damaging the land and keep producing food for people. In this work, a comprehensive review of the APV system is documented. Currently available software tools, field experiment results, and PV for APV are described in this work which identified that for forecasting APV, a more robust tool is required. Vertically placed Bifacial PV, transparent, and semitransparent tilted PVs can be suitable for shade-intolerant crops whereas opaque PVs are appropriate for shade-tolerant crops. The knowledge gap between various stakeholders such as solar PV researchers, agricultural researchers, and land users needs to be more rigorous. Economic and policymakers should share dialogue to improve the growth of APV which not only solves SDG 7, and 11 but also meets the target for SDG 5, 8, 9,12, and 15