Monitoring and improving the quality of person-centred care in health and social settings using Dementia Care Mapping (DCM): Staff experiences of implementation barriers and supports

Dementia Care Mapping (DCM) is a person-centred care quality monitoring and improvement tool used for nearly 20 years in formal dementia care settings and there are thousands of people trained in its use internationally. However, little is known about if and how DCM is used in practice or regarding application of inter-rater reliability checks to ensure data quality. This study aimed to explore the application of DCM in practice in the UK. A mixed methods design including an on-line survey and in-depth, semi-structured interviews was employed. There were 98 survey respondents, representing 71 health and social care, University/research and training/consultancy organisations. Twenty-one people participated in the semi-structured interviews. Fifty-nine percent of survey respondents had used DCM since completing training. Those working in clinical roles and in health and social care provider organisations were least likely to have used DCM. A range of barriers and supports to use of DCM in practice after training were reported, including lack of management support and time. The majority of those who had used DCM also conducted inter-rater reliability checks at least once per year or more frequently. Of the 20% who did not the main barriers to this were absence of someone to conduct the checks with and lack of time and resources. The study has shown that it is possible to apply an evidence-based quality monitoring and improvement tool such as DCM to support implementation of person-centred care in practice, despite widespread limitations on time and resources as well as identifying a range of setting conditions that can help or hinder implementation

The consequences of feminization in breeding groups of wild fish

EHP is a publication of the U.S. government. Publication of EHP lies in the public domain and is therefore without copyright. Research articles from EHP may be used freely; however, articles from the News section of EHP may contain photographs or figures copyrighted by other commercial organizations and individuals that may not be used without obtaining prior approval from both the EHP editors and the holder of the copyright. Use of any materials published in EHP should be acknowledged (for example, "Reproduced with permission from Environmental Health Perspectives") and a reference provided for the article from which the material was reproduced.BACKGROUND: The feminization of nature by endocrine-disrupting chemicals (EDCs) is a key environmental issue affecting both terrestrial and aquatic wildlife. A crucial and as yet unanswered question is whether EDCs have adverse impacts on the sustainability of wildlife populations. There is widespread concern that intersex fish are reproductively compromised, with potential population-level consequences. However, to date, only in vitro sperm quality data are available in support of this hypothesis. OBJECTIVE: The aim of this study was to examine whether wild endocrine-disrupted fish can compete successfully in a realistic breeding scenario. METHODS: In two competitive breeding experiments using wild roach (Rutilus rutilus), we used DNA microsatellites to assign parentage and thus determine reproductive success of the adults. RESULTS: In both studies, the majority of intersex fish were able to breed, albeit with varying degrees of success. In the first study, where most intersex fish were only mildly feminized, body length was the only factor correlated with reproductive success. In the second study, which included a higher number of more severely intersex fish, reproductive performance was negatively correlated with severity of intersex. The intersex condition reduced reproductive performance by up to 76% for the most feminized individuals in this study, demonstrating a significant adverse effect of intersex on reproductive performance. CONCLUSION: Feminization of male fish is likely to be an important determinant of reproductive performance in rivers where there is a high prevalence of moderately to severely feminized males.Funding for this work was derived through the Endocrine Disruption in Catchments project, which was supported by the U.K. Department for Environment Food and Rural Affairs and the U.K. Environment Agency

Relative sea level, sediment supply and barrier dynamics as driving mechanisms of Holocene coastal change.

The combined effects of climate change and population pressure lead to regional and local coastal responses that pose major challenges for the future resilience of coastal landscapes, increasing the vulnerability of communities, infrastructure and nature conservation interests. Improving understanding of coastline evolution in the past, using the Holocene record of geomorphological change preserved within coastal stratigraphy, is one way to improving understanding of coastal evolution and coastal response to climate and geomorphic change. This thesis aims to improve understanding of long-term coastal system behaviour by investigating the role of relative sea level, sediment supply and barrier dynamics as driving mechanisms of Holocene coastal change. The Suffolk coast, an understudied and vulnerable section of coastline in southeast England, is used as a case study to improve understanding of the mechanisms driving Holocene coastal change. Stratigraphic investigation demonstrated significant spatial and temporal differences in sedimentation. A multiproxy approach, comprising lithostratigraphic, sedimentological, bio- and chronostratigraphic methods, identified and constrained the timing of major phases of coastal change. New sea-level index points (11 intercalated peat and 6 basal peat samples) constrain the position of relative sea level during the Holocene and support the gradual rise reconstructed by the existing data for southeast England. Changes in sea-level tendency during the mid-Holocene are consistent on the Suffolk coast and wider East Anglia region, with predominantly positive (increase in marine influence) changes recorded, indicating that coastal sedimentation was controlled predominantly by relative sea level. In contrast, changes in sea-level tendency during the late Holocene varied substantially, indicating that local factors, notably sediment supply and barrier dynamics, were the main influences on coastal sedimentation, with relative sea level acting only as a background control. The importance of sedimentological and morphological factors in shaping Holocene coastal changes requires consideration when using the southern North Sea basin database of evidence as an analogue for future change under accelerated sea-level rise

Influences of complexity on decision making in young and older adults

Leading theory hypothesizes that age deficits in decision making may rise as the complexity of decision-related information increases. This suggests that older adults would benefit relative to young adults from simplification of information used to inform decision making. Participants indicated political, nutritional and medical preferences and then chose between politicians, foods and medicines. The amount of information presented was systematically varied but age differences were largely similar for simple and complex trials. Paradoxically, the data showed that decisions based on simpler information could be less aligned with participant’s preferences than decisions based on more complex information. Further analyses suggested that participants may have been responding purely on the basis of their most valued preferences and that when information about those preferences was not presented, decision making became poorer. Contrary to our expectations, simplification of information by exclusion may therefore hinder decision making and may not particularly help older adults

Associations between multimorbidity and neuropathology in dementia: Consideration of functional cognitive disorders, psychiatric illness and dementia mimics

\ua9 The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists.Background Multimorbidity, the presence of two or more health conditions, has been identified as a possible risk factor for clinical dementia. It is unclear whether this is due to worsening brain health and underlying neuropathology, or other factors. In some cases, conditions may reflect the same disease process as dementia (e.g. Parkinson\u27s disease, vascular disease), in others, conditions may reflect a prodromal stage of dementia (e.g. depression, anxiety and psychosis). Aims To assess whether multimorbidity in later life was associated with more severe dementia-related neuropathology at autopsy. Method We examined ante-mortem and autopsy data from 767 brain tissue donors from the UK, identifying physical multimorbidity in later life and specific brain-related conditions. We assessed associations between these purported risk factors and dementia-related neuropathological changes at autopsy (Alzheimer\u27s-disease related neuropathology, Lewy body pathology, cerebrovascular disease and limbic-predominant age-related TDP-43 encephalopathy) with logistic models. Results Physical multimorbidity was not associated with greater dementia-related neuropathological changes. In the presence of physical multimorbidity, clinical dementia was less likely to be associated with Alzheimer\u27s disease pathology. Conversely, conditions which may be clinical or prodromal manifestations of dementia-related neuropathology (Parkinson\u27s disease, cerebrovascular disease, depression and other psychiatric conditions) were associated with dementia and neuropathological changes. Conclusions Physical multimorbidity alone is not associated with greater dementia-related neuropathological change; inappropriate inclusion of brain-related conditions in multimorbidity measures and misdiagnosis of neurodegenerative dementia may better explain increased rates of clinical dementia in multimorbidit

A global checklist of the Bombycoidea (Insecta: Lepidoptera)

This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The attached file is the published pdf plus supplementary data file.NHM Repositor

Phylogenomics resolves major relationships and reveals significant diversification rate shifts in the evolution of silk moths and relatives

Background: Silkmoths and their relatives constitute the ecologically and taxonomically diverse superfamily Bombycoidea, which includes some of the most charismatic species of Lepidoptera. Despite displaying spectacular forms and diverse ecological traits, relatively little attention has been given to understanding their evolution and drivers of their diversity. To begin to address this problem, we created a new Bombycoidea-specific Anchored Hybrid Enrichment (AHE) probe set and sampled up to 571 loci for 117 taxa across all major lineages of the Bombycoidea, with a newly developed DNA extraction protocol that allows Lepidoptera specimens to be readily sequenced from pinned natural history collections. Results: The well-supported tree was overall consistent with prior morphological and molecular studies, although some taxa were misplaced. The bombycid Arotros Schaus was formally transferred to Apatelodidae. We identified important evolutionary patterns (e.g., morphology, biogeography, and differences in speciation and extinction), and our analysis of diversification rates highlights the stark increases that exist within the Sphingidae (hawkmoths) and Saturniidae (wild silkmoths). Conclusions: Our study establishes a backbone for future evolutionary, comparative, and taxonomic studies of Bombycoidea. We postulate that the rate shifts identified are due to the well-documented bat-moth “arms race”. Our research highlights the flexibility of AHE to generate genomic data from a wide range of museum specimens, both age and preservation method, and will allow researchers to tap into the wealth of biological data residing in natural history collections around the globe.Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.NHM Repositor

Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer\u27s disease

\ua9 The Author(s), 2023. Published by Cambridge University Press on behalf of International Neuropsychological Society. Objective: Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer\u27s disease (MCI-AD), and any performance deficits which emerged with sustained effort. Method: We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). Results: While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1-4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3-2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2-8.8). Conclusions: Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors

Energy epidemiology: a new approach to end-use energy demand research

The call for action to transform the built environment and address the threats of climate change has been clearly made. However, to support the development, implementation and on-going evaluation of energy demand policy, a strong evidence base is needed to identify associations and establish underlying causes behind outcomes and variations in end-use energy demand within the population. A new approach to end-use energy demand research is presented which is founded on the interdisciplinary health sciences research framework of epidemiology, along with the establishment of a research centre. A case is made that through an ‘energy epidemiology’ approach a strong, population-level, empirically based research foundation can be advanced. Energy epidemiology is a whole-system approach that focuses on empirical research and provides a methodological framework for building physicists, engineers, sociologists and economists to engage in interdisciplinary work. The adaptation of the epidemiological approach to end-use energy demand studies will provide the means to observe and describe the trends and patterns of energy demand, to undertake and contextualize interventional studies, and to establish strong associations between factors that lead to an energy demand-related outcome or event. Such an approach would strengthen the evidence base to inform policy decisions and evaluate past intervention programmes or regulatory actions