What Do We Know About Behavioral Crises in Dementia? A Systematic Review

Background: Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. Objective: To determine the factors associated with dementia-related behavioral crises. Methods: We searched MEDLINE, CINAHL, PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results: Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering/absconding, and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion: Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises. Keywords: Behavior; behavioral symptoms; crisis intervention; dementia; hospitalization; institutionalization

The role of the Self in assessing doping cognition: Implicit and explicit measures of athletes' doping-related prototype perceptions

Objectives: To examine athletes’ implicit and explicit prototype perceptions of performance enhancing substance (PES) users and non-users. Design: A cross-sectional mixed-method study. Methods: Competitive athletes from 39 sports (N=226; mean age= 27.66±9.74 years; 59% male) completed four self-report questions and two Brief Implicit Association Tests online, assessing prototype favourability and similarity of PES users and non-users. Results: Athletes explicitly associated themselves with a non-user (M= 3.13±0.92) more than a PES user (M= 0.56±0.88) and perceived a non-user (M= 89.92±14.98) more favourably than a PES user (M= 13.18±21.38). Indexing behaviour on self-reports, doping contemplators did not differ from ‘clean’ athletes in their perceptions of PES user prototypes while dopers perceived PES users favourably and similar to themselves. In comparison, doping contemplators paired the concept of 'dopers' easier with themselves than with others, while clean athletes and dopers had no preference for either pairing (D = -0.33, -0.08 and 0.01, respectively). All groups demonstrated some degree of preference for ‘good and doper’, moving from slight to moderate to strong preference in the groups of clean athletes, dopers and contemplators, respectively (D = -0.20, -0.37 and -0.80, respectively). Conclusions: Results suggest that doping contemplators may have a positive bias towards doping which is not endorsed in self-reports. Implicit preferences, along with the disparity between the implicit and explicit measures of athletes’ doping-related prototype perceptions advance understanding of doping behaviour and make a unique contribution to research methodology. Factors influencing the interplay between explicit and implicit endorsements of PES user prototypes warrant further research

Contributions of Caregiver Management Styles to the Discrepancy Between Reported and Observed Task Performance in People with Dementia

Background: The identification and understanding of the discrepancy between caregivers’ reports of people with dementia’s (PwD) performance of activities of daily living (ADLs) and observed performance, could clarify what kind of support a PwD effectively needs when completing tasks. Strategies used by caregivers have not been included in the investigation of this discrepancy. Objectives: To (1) investigate if caregivers’ report of PwD’s ADL performance are consistent with PwD’s observed performance; (2) explore if caregiver management styles, depression, and anxiety, contribute to this discrepancy. Methods: PwD (n=64) were assessed with standardised performance-based (AMPS) and informant-based (DAD) ADL assessments. Caregivers completed depression (PHQ-9), anxiety (GAD-7), and dementia management style (DMSS: criticism, active-management, and encouragement) questionnaires. Cohen’s kappa determined agreement/disagreement in ADL performance. To investigate the potential discrepancy between the DAD and AMPS, a continuous variable was generated: comparative ADL score. Multiple linear regression analysis explored whether caregivers’ management styles, depression or anxiety could explain the ADL discrepancy. Results: Poor level of agreement between observed and reported ADL performance [k= -0.025 (95%CI -0.123 – 0.073)] was identified, with most caregivers underestimating ADL performance. The combined model explained 18% (R2=0.18, F(5, 55)=2.52,p=<0.05) of the variance of the comparative ADL score. Active-management (β=-0.037,t(60)=-3.363, p=0.001) and encouragement (β=0.025,t(60)=2.018, p=0.05) styles made the largest and statistically significant contribution to the model. Conclusions: Encouragement style could be advised for caregivers who underestimate ADL performance, while active management style for those who overestimate it. Findings have scope to increase caregivers’ abilities to support PwD activity engagement in daily life

The role of fractional exhaled nitric oxide in the assessment of athletes reporting exertional dyspnoea

Background: Exercise-induced bronchoconstriction (EIB) is a common cause of breathing difficulty in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect marker of airway inflammation, recommended for the assessment and management of asthma; however, the role of FeNO in detecting and monitoring EIB has yet to be fully established. The aim of this study was therefore to evaluate the predictive value of FeNO to confirm or refute EIB in athletes presenting with exertional dyspnoea. Method: Seventy athletes (male: n = 45) (age: 35 ± 11 years) reporting respiratory symptoms (i.e. wheeze, cough and dyspnoea) during exercise attended the laboratory on a single occasion. All athletes performed resting FeNO and spirometry pre-and-post a eucapnic voluntary hyperpnoea challenge (EVH) in accordance with international guidelines. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for established FeNO thresholds: (intermediate [≥25ppb] and high [>50ppb]) and evaluated against objective evidence of EIB: (EVH diagnostic cut-off [-10% ΔFEV1 at two consecutive time-points] and [-15% ΔFEV1 at one time-point]). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC). Results: All had normal resting lung function (>80% FEV1 pred). The prevalence of EIB was 33% (-10% ΔFEV1) and 23% (-15% ΔFEV1) (median (IQR) ΔFEV1 = -7% (10.02)). FeNO values ≥25ppb and >50ppb were observed in 49% and 23% of the cohort, respectively. ROC-AUC for FeNO was 75% (-10% ΔFEV1) and 86% (-15% ΔFEV1). Sensitivity, specificity, PPV and NPV are presented in Table 1. Conclusion: Our findings indicate that FeNO >50ppb provides good specificity for a positive EVH test; however, should not replace indirect bronchoprovocation for diagnostic purposes. The high proportion of athletes reporting breathing difficulty in the absence of EIB highlights the requirement to consider alternative causes of exertional dyspnoea during clinical work-up

X-ray Fluorescence Analysis of Feldspars and Silicate Glass: Effects of Melting Time on Fused Bead Consistency and Volatilisation

Reproducible preparation of lithium tetraborate fused beads for XRF analysis of glass and mineral samples is of paramount importance for analytical repeatability. However, as with all glass melting processes, losses due to volatilisation must be taken into account and their effects are not negligible. Here the effects of fused bead melting time have been studied for four Certified Reference Materials (CRM’s: three feldspars, one silicate glass), in terms of their effects on analytical variability and volatilisation losses arising from fused bead preparation. At melting temperatures of 1065 °C, and for feldspar samples, fused bead melting times shorter than approximately 25 min generally gave rise to a greater deviation of the XRF-analysed composition from the certified composition. This variation might be due to incomplete fusion and/or fused bead inhomogeneity but further research is needed. In contrast, the shortest fused bead melting time for the silicate glass CRM gave an XRF-analysed composition closer to the certified values than longer melting times. This may suggest a faster rate of glass-in-glass dissolution and homogenization during fused bead preparation. For all samples, longer melting times gave rise to greater volatilisation losses (including sulphates and halides) during fusion. This was demonstrated by a linear relationship between SO3 mass loss and time1/2, as predicted by a simple diffusion-based model. Iodine volatilisation displays a more complex relationship, suggestive of diffusion plus additional mechanisms. This conclusion may have implications for vitrification of iodine-bearing radioactive wastes. Our research demonstrates that the nature of the sample material impacts on the most appropriate fusion times. For feldspars no less than ~25 min and no more than ~60 min of fusion at 1065 °C, using Li2B4O7 as the fusion medium and in the context of feldspar samples and the automatic fusion equipment used here, strikes an acceptable (albeit non-ideal) balance between the competing factors of fused bead quality, analytical consistency and mitigating volatilisation losses. Conversely, for the silicate glass sample, shorter fusion times of less than ~30 min under the same conditions provided more accurate analyses whilst limiting volatile losses

Highly efficient aqueous phase reduction of nitroarenes catalyzed by phosphine-decorated polymer immobilized ionic liquid stabilized PdNPs

Palladium nanoparticles stabilized by lightly cross-linked phosphine-decorated polymer immobilized ionic liquids (PIIL) and their PEGylated counterparts (PEGPIIL) are highly effective catalysts for the aqueous phase hydrogenation and sodium borohydride-based reduction of a wide range of nitroaromatic and heteroaromatic compounds under mild conditions with low catalyst loadings. Introduction of extensive cross-linking with tris(4-vinylphenyl)phosphine to isolate the phosphine-based heteroatom and limit the number of surface Pd⋯P interactions did not have a significant influence on catalyst performance. Comparative testing revealed PdNPs immobilized on lightly cross-linked phsophine-decoarted PEGylated polymer to be a highly efficient catalyst for the aqueous phase reduction of nitroarenes with a TON of 36 000 (TOF = 2580 h−1) for hydrogenation and a TON of 274 000 (TOF = 17 125 h−1) for transfer hydrogenation. Even though these reactions occur under diffusion control due the poor solubility of the substrate these values are the highest to be reported for the room temperature aqueous phase reduction of nitroarenes catalyzed by a nanoparticle-based system. A continuous flow reduction of nitrobenzene in a packed bed reactor operated over a period of 250 min with no sign of catalyst deactivation and the corresponding space-time-yield of 0.738 g L−1 min−1 is a marked improvement on that of 0.384 g L−1 min−1 obtained in batch. The same system also catalyzes a tandem Suzuki–Miyaura cross coupling-nitroarene reduction sequence to afford high yields of biaryl amine in an operationally straightforward single-pot procedure. This is a highly versatile protocol which will enable the aromatic nitro fragment to be introduced as a nitro-substituted aryl or heteroaryl halide and as such will lend itself to rapid diversification for the synthesis of a wide range of amines

String cosmology from Poisson-Lie T-dual sigma models on supermanifolds

We generalize the formulation of Poisson-Lie T-dual sigma models on manifolds to supermanifolds. In this respect, we formulate 1+1 dimensional string cosmological models on the Lie supergroup C^3 and its dual (A_1,1 + 2A)^0_(1,0,0), which are coupled to two fermionic fields. Then, we solve the equations of motion of the models and show that there is a essential singularity for the metric of the original model and its dual.Comment: 17 pages, Appendix and three references have adde

Remote sensing to characterize inundation and vegetation dynamics of upland lagoons

Understanding broad trends in the distribution and composition of wetlands is essential for making evidence-based management decisions. Determining temporal change in the extent of inundation in wetlands using remote sensing remains challenging and requires on-ground verification to determine accuracy and precision. Therefore, optimization and validation of remote sensing methods in threatened wetlands is a high priority for their conservation. Despite their ecological importance in the landscape, we have little knowledge of the variation in the spatial extent of inundation in upland lagoons, a threatened ecological community in New South Wales, Australia. Our project developed locally trained algorithms to predict the extent of water and emergent vegetation using imagery from the Landsat-5, -7, and -8 satellites. The best model for upland lagoons used shortwave infrared reflectance (performing better than normalized difference spectral indices), with model accuracy against validation transects greater than 95%. We applied the model to images from 1988 to 2020 across 58 lagoons to generate a dataset that demonstrates the variable water regime and vegetation change in response to local rainfall over 32 years such as in the lagoons. Our results reduce threats to a dynamic threatened ecological community by filling an important knowledge gap and demonstrate a valuable method to understand historical and current changes in the hydrology of dynamic wetland systems more broadly