Effectiveness of counselling and psychotherapeutic interventions for people with dementia and their families: a systematic review

As there is currently no cure for dementia, providing psycho-social support is imperative. Counselling and psychotherapeutic interventions offer a way to provide individualised support for people with dementia and their families. However, to date, there has not been a systematic review examining the research evidence for these interventions. This review aimed to examine the following research questions: (1) Are counselling/psychotherapeutic interventions effective for people with dementia?, (2) Are counselling/psychotherapeutic interventions effective for care-givers of people with dementia? and (3) Which modes of delivery are most effective for people with dementia and care-givers of people with dementia? A systematic literature search was conducted in MEDLINE (via PubMed), PsycINFO and CINAHL in March 2019. Keyword searches were employed with the terms ‘dement*’, ‘counsel*’, ‘psychotherapy’, ‘therap*’, ‘care’ and ‘outcome’, for the years 2000–2019. Thirty-one papers were included in the review, from seven countries. Twenty studies were randomised controlled trials (RCTs) or adopted a quasi-experimental design. The remaining studies were qualitative or single-group repeated-measures design. The review identified variation in the counselling/psychotherapeutic approaches and mode of delivery. Most interventions adopted either a problem-solving or cognitive behavioural therapy approach. Mixed effectiveness was found on various outcomes. The importance of customised modifications for people with dementia was highlighted consistently. Understanding the dyadic relationships between people with dementia and their care-givers is essential to offering effective interventions and guidance for practitioners is needed. Information about the cognitive impairment experienced by participants with dementia was poorly reported and is essential in the development of this research area. Future studies should consider the impact of cognitive impairment in developing guidance for counselling/psychotherapeutic intervention delivery for people with dementia

Merging fragments of classical logic

We investigate the possibility of extending the non-functionally complete logic of a collection of Boolean connectives by the addition of further Boolean connectives that make the resulting set of connectives functionally complete. More precisely, we will be interested in checking whether an axiomatization for Classical Propositional Logic may be produced by merging Hilbert-style calculi for two disjoint incomplete fragments of it. We will prove that the answer to that problem is a negative one, unless one of the components includes only top-like connectives.Comment: submitted to FroCoS 201

Evaluation of an Oxide Layer on NI-CR-MO-W Alloy Using Electrochemical Impedance Spectroscopy and Surface Analysis

High corrosion resistance under very aggressive conditions is a distinguishing property of Ni-Cr-Mo-W alloys. One such alloy, Alloy 22, is a candidate material for fabrication of the outer layer of high-level nuclear waste (HLNW) packages for the proposed HLNW repository at Yucca Mountain, Nevada, USA. We are using Electrochemical Impedance Spectroscopy (EIS), ex-situ X-Ray Photoelectron Spectroscopy (XPS) and Time of Flight Secondary Ion Mass Spectroscopy (ToF SIMS) to characterize the electrochemical properties and composition of the protective oxide formed on Alloy 22 surfaces. These studies have been conducted at temperatures up to 90 C at potentials from -0.8 V to 0.8 V (vs. Ag/AgCl (sat'd KCl)) in deaerated 5 mol L{sup -1} NaCl solution. Using this combination of techniques, we can correlate the electrical (from EIS) and compositional properties (from XPS, ToF SIMS) of the oxide. At more negative potentials (-0.8 V to -0.4 V) the film exhibits a low charge transfer resistance and high capacitance, indicating the presence of a very defective film with a high concentration of electronic defects. The presence of additional elements in the equivalent circuit, corresponding to water reduction, supports this suggestion. At these potentials, surface analysis techniques show a thin oxide layer with a low concentration of Cr203. Increasing the potential (to between -0.2 and 0.2 V) leads to a major increase in overall interfacial resistance consistent with the formation of an oxide with a small concentration of electronic defects. At the same time, the surface analysis techniques show increases in the film thickness and the Cr{sub 2}O{sub 3} content. A further increase in potential to 0.8 V, in general, leads to a decrease in interfacial resistance throughout the film. When the Cr{sub 2}O{sub 3} barrier layer is degraded, then the higher oxidation states of Mo and W species (MO{sup VI}, W{sup VI}) increase in concentration and are stored in the outer part of the film (at temperatures up to 60 C). The storage of these high oxidation state ions generates a high interfacial capacitance. At high temperature (above 60 C), the XPS and EIS show that the high oxidation states of Mo and W are absent. We think this is because they dissolve from the oxide under those conditions

Human-animal relationships and interactions during the Covid-19 lockdown phase in the UK: Investigating links with mental health and loneliness

BACKGROUND: The Covid-19 pandemic raises questions about the role that relationships and interactions between humans and animals play in the context of widespread social distancing and isolation measures. We aimed to investigate links between mental health and loneliness, companion animal ownership, the human-animal bond, and human-animal interactions; and to explore animal owners' perceptions related to the role of their animals during lockdown. METHODS: A cross-sectional online survey of UK residents over 18 years of age was conducted between April and June 2020. The questionnaire included validated and bespoke items measuring demographics; exposures and outcomes related to mental health, wellbeing and loneliness; the human-animal bond and human-animal interactions. RESULTS: Of 5,926 participants, 5,323 (89.8%) had at least one companion animal. Most perceived their animals to be a source of considerable support, but concerns were reported related to various practical aspects of providing care during lockdown. Strength of the human-animal bond did not differ significantly between species. Poorer mental health pre-lockdown was associated with a stronger reported human-animal bond (b = -.014, 95% CI [-.023 - -.005], p = .002). Animal ownership compared with non-ownership was associated with smaller decreases in mental health (b = .267, 95% CI [.079 - .455], p = .005) and smaller increases in loneliness (b = -.302, 95% CI [-.461 - -.144], p = .001) since lockdown. CONCLUSION: The human-animal bond is a construct that may be linked to mental health vulnerability in animal owners. Strength of the human-animal bond in terms of emotional closeness or intimacy dimensions appears to be independent of animal species. Animal ownership seemed to mitigate some of the detrimental psychological effects of Covid-19 lockdown. Further targeted investigation of the role of human-animal relationships and interactions for human health, including testing of the social buffering hypothesis and the development of instruments suited for use across animal species, is required

AN EVALUATION OF HYDROGEN INDUCED CRACKING SUSCEPTIBILITY OF TITANIUM ALLOYS IN US HIGH-LEVEL NUCLEAR WASTE REPOSITORY ENVIRONMENTS

This paper evaluates hydrogen-induced cracking (HIC) susceptibility of titanium alloys in environments anticipated in the Yucca Mountain nuclear waste repository with particular emphasis on the. effect of the oxide passive film on the hydrogen absorption process of titanium alloys being evaluated. The titanium alloys considered in this review include Ti 2, 5 , 7, 9, 11, 12, 16, 17, 18, 24 and 29. In general, the concentration of hydrogen in a titanium alloy can increase due to absorption of atomic hydrogen produced from passive general corrosion of that alloy or galvanic coupling of it to a less noble metal. It is concluded that under the exposure conditions anticipated in the Yucca Mountain repository, the HIC of titanium drip shield will not occur because there will not be sufficient hydrogen in the metal even after 10,000 years of emplacement. Due to the conservatisms adopted in the current evaluation, this assessment is considered very conservative

Role of microstructure and surface defects on the dissolution kinetics of CeO2, a UO2 fuel analogue.

The release of radionuclides from spent fuel in a geological disposal facility is controlled by the surface mediated dissolution of UO2 in groundwater. In this study we investigate the influence of reactive surface sites on the dissolution of a synthesised CeO2 analogue for UO2 fuel. Dissolution was performed on: CeO2 annealed at high temperature, which eliminated intrinsic surface defects (point defects and dislocations); CeO2-x annealed in inert and reducing atmospheres to induce oxygen vacancy defects; and on crushed CeO2 particles of different size fractions. BET surface area measurements were used as an indicator of reactive surface site concentration. Cerium stoichiometry, determined using X-ray Photoelectron Spectroscopy (XPS) and supported by X-ray Diffraction (XRD) analysis, was used to determine oxygen vacancy concentration. Upon dissolution in nitric acid medium at 90°C, a quantifiable relationship was established between the concentration of high energy surface sites and CeO2 dissolution rate; the greater the proportion of intrinsic defects and oxygen vacancies, the higher the dissolution rate. Dissolution of oxygen vacancy-containing CeO2-x gave rise to rates that were an order of magnitude greater than for CeO2 with fewer oxygen vacancies. While enhanced solubility of Ce3+ influenced the dissolution, it was shown that replacement of vacancy sites by oxygen significantly affected the dissolution mechanism due to changes in the lattice volume and strain upon dissolution and concurrent grain boundary decohesion. These results highlight the significant influence of defect sites and grain boundaries on the dissolution kinetics of UO2 fuel analogues and reduce uncertainty in the long-term performance of spent fuel in geological disposal

Popular attitudes to memory, the body, and social identity : the rise of external commemoration in Britain, Ireland, and New England

A comparative analysis of samples of external memorials from burial grounds in Britain, Ireland and New England reveals a widespread pattern of change in monument style and content, and exponential growth in the number of permanent memorials from the 18th century onwards. Although manifested in regionally distinctive styles on which most academic attention has so far been directed, the expansion reflects global changes in social relationships and concepts of memory and the body. An archaeological perspective reveals the importance of external memorials in articulating these changing attitudes in a world of increasing material consumption

Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia.

Abstract Background: A better understanding is needed about how people make decisions about help seeking. Materials: Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members. Discussion: Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment. Conclusion: Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.N/

Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT

Background The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. Objective To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. Design A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. Setting Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. Participants Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer’s Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. Intervention Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. Main outcome measures The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. Results There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was –2.11 points, being lower in the intervention group than in the control (95% confidence interval –4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. Limitations The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. Conclusions There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. Future work Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. Trial registration Current Controlled Trials ISRCTN82288852. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information