Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE): study protocol for a single-arm feasibility study.

Background: Increases in life expectancy have resulted in a global rise in dementia prevalence. Dementia is associated with poor wellbeing, low quality of life and increased incidence of mental health difficulties such as, low mood or depression. However, currently there is limited access to evidence-based psychological interventions for people with dementia experiencing low mood and poor wellbeing. Behavioural activation-based self-help, supported by informal carers and guided by mental health professionals, may represent an effective and acceptable solution. Methods/design: The present study is a Phase II (feasibility) single-arm trial informed by the MRC Complex Interventions Research Methods Framework. Up to fifty dementia participant/informal carer dyads will be recruited from a variety of settings including primary care, dementia-specific health settings, and community outreach. People living with dementia will receive behavioural activation based self-help and be supported by their informal carer who has received training in the skills required to support the self-help approach. In turn, during the use of the intervention the informal carer will be guided by mental health professionals to help them work through the materials and problem solve any difficulties. Consistent with the objectives of feasibility studies, outcomes relating to recruitment from different settings, employment of different recruitment methods, attrition, data collection procedures, clinical delivery and acceptability of the intervention will be examined. Clinical outcomes for people with dementia (symptoms of depression and quality of life) and informal carers (symptoms of depression and anxiety, carer burden and quality of life) will be measured pretreatment and at 3 months post-treatment allocation. Discussion: This study will examine the feasibility and acceptability of a novel behavioural activation-based self-help intervention designed to promote wellbeing and improve low mood in people living with dementia, alongside methodological and procedural uncertainties associated with research-related procedures. As determined by pre-specified progression criteria, if research procedures and the new intervention demonstrate feasibility and acceptability, results will then be used to inform the design of a pilot randomised controlled trial (RCT) to specifically examine remaining methodological uncertainties associated with recruitment into a randomised controlled design.This study is collaboratively funded by Cornwall Foundation Partnership Trust, South West Peninsula Academic Health Sciences Network and the University of Exeter

Management and outcomes of myocardial infarction in people with impaired kidney function in England

Background: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK. Methods: Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015–2017. Results: In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people. Conclusions: In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI

Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study

OBJECTIVES: Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets. METHODS: We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Project (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES or both were included in the study cohort. CKD status was defined using eGFR, derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR <60 mL/min/1.73 m2, and mild CKD or at risk of CKD was defined as eGFR ≥60 mL/min/1.73 m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD and Stages 1-2 (eGFR missing or ≥60 mL/min/1.73 m2), (2) Stage 3a (eGFR 45-59 mL/min/1.73 m2), (3) Stage 3b (eGFR 30-44 mL/min/1.73 m2) and (4) Stages 4-5 (eGFR <30 mL/min/1.73 m2). RESULTS: We identified 6748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared with people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs 11%, respectively), or MINAP only (22% vs 5%), and less likely to be recorded in HES only (36% vs 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared with those recorded in both (adjusted OR 1.61, 95% CI 1.32 to 1.96 and OR 1.60, 95% CI 1.26 to 2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, SE 0.012). CONCLUSIONS: AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity

Spontaneous coronary artery dissection: Current state of the science: A scientific statement from the American Heart Association

© 2018 American Heart Association, Inc. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented

How child‐centred education favours some learners more than others

Debates on how best to educate young children have been raging over the last 100 years—more often fuelled by ideological preferences rather than empirical evidence. To some extent this is hardly surprising given the difficulty of examining pupil progress in a systematic and comparative way. However, the introduction of a new child‐centred curriculum in Wales provides the opportunity to undertake just such an examination. The Foundation Phase curriculum, introduced in 2008, is designed to provide all 3‐ to 7‐year‐olds with a developmental, experiential, play‐based approach to learning. Evidence from a major 3‐year evaluation of this intervention finds that, overall, pupil progress and well‐being is fostered in those settings where the principles of the Foundation Phase have been most closely followed. However, the evidence also suggests that even within these contexts, progress is uneven and that some kinds of children seem to gain more from this approach than others. The ‘losers’ appear to be boys and those living in poverty. Drawing on the theories of Basil Bernstein, the paper explores why this may be the case and examines the relative significance of teacher dispositions, teacher–learner dynamics and the availability of resources. The paper concludes by arguing that these issues will need to be addressed if the benefits of child‐centred approaches are to benefit all

Bench-to-bedside review : targeting antioxidants to mitochondria in sepsis

Peer reviewedPublisher PD

Management of cardiac emergencies in women: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the Heart Failure Association (HFA), and the European Heart Rhythm Association (EHRA) of the ESC, and the ESC Working Group on Cardiovascular Pharmacotherapy.

Cardiac emergencies in women, such as acute coronary syndromes, acute heart failure, and cardiac arrest, are associated with a high risk of adverse outcomes and mortality. Although women historically have been significantly underrepresented in clinical studies of these diseases, the guideline-recommended treatment for these emergencies is generally the same for both sexes. Still, women are less likely to receive evidence-based treatment compared to men. Furthermore, specific diseases affecting predominantly or exclusively women, such as spontaneous coronary dissection, myocardial infarction with non-obstructive coronary arteries, takotsubo cardiomyopathy, and peripartum cardiomyopathy, require specialized attention in terms of both diagnosis and management. In this clinical consensus statement, we summarize current knowledge on therapeutic management of these emergencies in women. Key statements and specific quality indicators are suggested to achieve equal and specific care for both sexes. Finally, we discuss several gaps in evidence and encourage further studies designed and powered with adequate attention for sex-specific analysis

Anisotropic pH-Responsive Hydrogels Containing Soft or Hard Rod-Like Particles Assembled Using Low Shear

A simple and versatile low-shear approach for assembling hydrogels containing aligned rod-like particles (RLPs) that are birefringent and exhibit pH-triggered anisotropic swelling is developed. Anisotropic composite hydrogels are prepared by applying low shear (0.1 s–1) to mixtures of pH-responsive nanogels (NGs) and RLPs. The NGs, which contained high methacrylic acid contents, acted as both shear transfer vehicles and macro-cross-linkers for anisotropic gel formation. Three model RLP systems are investigated: (i) soft triblock copolymer worms, (ii) stiff self-assembled β-sheet peptide fibers, and (iii) ultrahigh modulus nanocrystalline cellulose fibers. RLP alignment was confirmed using polarized light imaging, atomic force microscopy, and small-angle X-ray scattering as well as modulus and anisotropic swelling experiments. Unexpectedly, the composite gel containing the soft copolymer worms showed the most pronounced anisotropy swelling. The copolymer worms enabled higher RLP loadings than was possible for the stiffer RLPs. For fixed RLP loading, the extent of anisotropic swelling increased with intra-RLP bonding strength. The facile and versatile approach to anisotropic gel construction demonstrated herein is expected to enable new applications for strain sensing or biomaterials for soft tissue repair

Gender and police leadership: time for a paradigm shift?

Despite a number of initiatives aimed at improving the representation and progression of women in the police service in England and Wales, the number of women in leadership ranks remains low. At the same time, concern over the quality of police leadership has been at the forefront of much public debate in recent years. This article focuses on recent proposals to reform the way in which senior officers are recruited through a discussion of the appointment of non-sworn/'outsider' officers through the adoption of direct and multiple entry models of recruitment as outlined by the Winsor Review (2012, Independent review of police officer and staff remuneration and conditions. Part 2. http://review.police.uk/part-two-report/). Hailed as an opportunity to secure an alternative face to police leadership, we reflect on the growing disquiet over police leaders and leadership and consider the possibilities of such a reform agenda for the representation and progression of women in policing. We propose that although a multipoint system of entry for specialisation or leadership roles may offer a number of opportunities to a service in crisis, such a reform agenda may ultimately serve to threaten and further undermine women's participation and status in policing as 'outsiders'