A comparative study of the effect of the Time for Dementia programme on medical students

Background Traditional healthcare education typically focuses on short block clinical placements based on acute care, investigations, and technical aspects of diagnosis and treatment. It may therefore fail to build the understanding, compassion, and person‐centred empathy needed to help those with long‐term conditions, like dementia. Time for Dementia was developed to address this. Method Parallel group comparison of two cohorts of UK medical students from universities, one participating in Time for Dementia (intervention group) and one not (control group). In Time for Dementia students visit a person with dementia and their family in pairs for two hours three times a year for two years, the control group received their normal curriculum. Results In an adjusted multilevel model of data (intervention group n=274, control n=112), there was strong evidence supporting improvements for Time for Dementia participants in: total Approaches to Dementia Questionnaire score (coefficient 2.19, p=0.003), and its person‐centredness subscale (1.32, p=0.006), and weaker evidence in its hopefulness subscale (0.78, p=0.070); Dementia Knowledge Questionnaire score (1.63, p<0.001); and Dementia Attitudes Scale (total score 6.55, p<0.001; social comfort subscale 4.15, p<0.001; dementia knowledge subscale 3.38, p=0.001) scores. No differences were observed on the Alzheimer's Disease Knowledge Scale, the Medical Condition Regard Scale, or the Jefferson Scale of Empathy. Discussion Time for Dementia may help improve the attitudes of medical students towards dementia promoting a person‐centred approach and increasing social comfort. Such patient‐focused programmes may be a useful complement to traditional medical education

Rapid global ocean-atmosphere response to Southern Ocean freshening during the last glacial

This is the final version of the article. Available from Springer Nature via the DOI in this record.Contrasting Greenland and Antarctic temperatures during the last glacial period (115,000 to 11,650 years ago) are thought to have been driven by imbalances in the rates of formation of North Atlantic and Antarctic Deep Water (the 'bipolar seesaw'). Here we exploit a bidecadally resolved (14)C data set obtained from New Zealand kauri (Agathis australis) to undertake high-precision alignment of key climate data sets spanning iceberg-rafted debris event Heinrich 3 and Greenland Interstadial (GI) 5.1 in the North Atlantic (~30,400 to 28,400 years ago). We observe no divergence between the kauri and Atlantic marine sediment (14)C data sets, implying limited changes in deep water formation. However, a Southern Ocean (Atlantic-sector) iceberg rafted debris event appears to have occurred synchronously with GI-5.1 warming and decreased precipitation over the western equatorial Pacific and Atlantic. An ensemble of transient meltwater simulations shows that Antarctic-sourced salinity anomalies can generate climate changes that are propagated globally via an atmospheric Rossby wave train.A challenge for testing mechanisms of past climate change is the precise correlation of palaeoclimate records. Here, through climate modelling and the alignment of terrestrial, ice and marine (14)C and (10)Be records, the authors show that Southern Ocean freshwater hosing can trigger global change.This work was funded by the Australian Research Council (FL100100195, DP170104665 and SR140300001) and the Natural Environment Research Council (NE/H009922/1 and NE/H007865/1)

On the Mechanism of Electron Beam Radiation-Induced Modification of Poly(lactic Acid) for Applications in Biodegradable Food Packaging

Gemstone Team PRODUCEPoly(lactic acid) (PLA) is a biodegradable polymer used for food packaging. The effects of electron beam radiation on the chemical and physical properties of amorphous PLA were studied. In this study, amorphous, racemic PLA was irradiated at doses of 5, 10, 15, and 20 kGy in the absence of oxygen. Utilizing electron paramagnetic resonance spectrometry, it was found that alkoxyl radicals are initially formed as a result of C-O-C bond scissions on the backbone of the PLA. The dominant radiation mechanism was determined to be H-abstraction by alkoxyl radicals to form C-centered radicals. The C-centered radicals undergo a subsequent peroxidation reaction with oxygen. The gel permeation chromatography (GPC) results indicate reduction in polymer molecular mass. The differential scanning calorimetry and X-ray diffraction results showed a subtle increase in crystallinity of the irradiated PLA. Water vapor transmission rates were unaffected by irradiation. Further mechanical testing showed mechanical properties in line with reduced molecular mass. In conclusion, these results support that irradiated PLA is a suitable material for applications in irradiation of food packaging, including food sterilization and biodegradation

Drivers of Transfusion Decision Making and Quality of the Evidence in Orthopedic Surgery: A Systematic Review of the Literature

Reasons for variation in transfusion practice in orthopedic surgery are not well understood. This systematic review identified and appraised the quality of the literature in this area to assess the impact of factors associated with the use of allogeneic red blood cell (RBC) transfusion in orthopedic procedures. MEDLINE and EMBASE databases were searched for relevant English language publications. Articles containing a range of MeSH and text terms regarding “blood transfusion,” “predictors,” and “multiple logistic regression” were retrieved. Articles that focused on patients undergoing orthopedic procedures and that met prespecified inclusion criteria were appraised in terms of potential bias and the appropriateness of statistical approach. A total of 3641 citations were retrieved, and 29 met the inclusion criteria for the review. Articles reported on a range of orthopedic procedures including total hip arthroplasty; total knee arthroplasty, total shoulder arthroplasty, and spinal surgery. Most studies were conducted in the United States (n = 12) or Canada (n = 5). Study quality was moderate; 50% or more of the quality criteria were assessed in 15 articles. Particular areas of concern were the lack of prospective studies, lack of clarity in defining the time interval between risk factor assessment and transfusion outcome, and lack of model validation. A narrative synthesis found that 2 factors consistently influenced the use of RBC transfusion—decreased hemoglobin (n = 25) and increased patient age (n = 18). Increased surgical complexity (n = 12), low body weight (n = 9), presence of additional comorbidities (n = 9), and female sex (n = 7) were also important factors. The general quality of the studies in the field is weak. However, low hemoglobin and increasing age were consistently identified as independent risk factors for RBC transfusion in orthopedic practice. Additional or alternative analytical approaches are required to obtain a more comprehensive, holistic understanding of the decision to transfuse RBCs to patients undergoing orthopedic surgery.<br/