Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

Objective: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.Method: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.Results: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.Conclusions: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research ( only nine level-1 studies were identified). More high-quality investigation is needed

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Modifications of Gait as Predictors of Natural Osteoarthritis Progression in STR/Ort Mice

OBJECTIVE: Osteoarthritis (OA) is a common chronic disease for which disease-modifying therapies are not currently available. Studies to seek new targets for slowing the progress of OA rely on mouse models, but these do not allow for longitudinal monitoring of disease development. This study was undertaken to determine whether gait can be used to measure disease severity in the STR/Ort mouse model of spontaneous OA and whether gait changes are related to OA joint pain. METHODS: Gait was monitored using a treadmill-based video system. Correlations between OA severity and gait at 3 treadmill speeds were assessed in STR/Ort mice. Gait and pain behaviors of STR/Ort mice and control CBA mice were analyzed longitudinally, with monthly assessments. RESULTS: The best speed to identify paw area changes associated with OA severity in STR/Ort mice was found to be 17 cm · seconds(−1). Paw area was modified with age in CBA and STR/Ort mice, but this began earlier in STR/Ort mice and correlated with the onset of OA at 20 weeks of age. In addition, task noncompliance appeared at 20 weeks. Surprisingly, STR/Ort mice did not show any signs of pain with OA development, even when treated with the opioid antagonist naloxone, but did exhibit normal pain behaviors in response to complete Freund's adjuvant–induced arthritis. CONCLUSION: The present results identify an animal model in which OA severity and OA pain can be studied in isolation from one another. The findings suggest that paw area and treadmill noncompliance may be useful tools to longitudinally monitor nonpainful OA development in STR/Ort mice. This will help in providing a noninvasive means of assessing new therapies to slow the progression of OA

Braided peridotite sills and metasomatism in the Rum Layered Suite, Scotland

The Rum Eastern Layered Intrusion (ELI; Scotland) is an open-system layered intrusion constructed of 16 macro-rhythmic units. Each of the macro-rhythmic units consists of a peridotite base and a troctolite (+/- gabbro) top, previously attributed to the fractional crystallisation of a single magma batch. This classic paradigm has been challenged, however, with evidence presented for the emplacement of peridotite sills in Units 9, 10, and 14, such as cross-cutting relationships, upward-oriented apophyses, and lateral discontinuities. To test whether the other major peridotites within the ELI represent sills, we have carried out new field, petrographic, and mineral chemical analyses of the peridotites in Units 7, 8 and 9. The peridotites display large- and small-scale cross-cutting relationships with the overlying troctolite, indicative of an intrusive relationship. The peridotites also show large-scale coalescence and lateral spatial discontinuities such that the ELI unit divisions become arbitrary. Harrisite layers and Cr-spinel seams found throughout Units 7, 8, and 9 suggest the peridotites were constructed incrementally via repeated injections of picritic magma. Our observations allow for distinct subtypes of peridotite to be defined, separated by intrusive contacts, allowing for their relative chronology to be determined. Older, poikilitic peridotite, rich in clinopyroxene, is truncated by younger, well-layered peridotite, containing abundant harrisite layers. In addition to the new peridotite subtypes defined in this study, we find strong evidence for laterally oriented metasomatism within clinopyroxene-rich wehrlites at the top of the Unit 8 peridotite. The wehrlites and surrounding peridotites record a complex series of metasomatic reactions that transformed thin picrite sills into clinopyroxene-rich wehrlites without any evidence for the sort of vertical melt movement typically posited in layered intrusions. The observations presented in this study from the ELI cannot be reconciled with the classic magma chamber paradigm and are better explained by the emplacement of composite sills into pre-existing feldspathic cumulate (gabbro or troctolite). The evidence for sill emplacement presented here suggests that the layered complex was constructed by a combination of sill emplacement and metasomatism, forming many of the unusual (often clinopyroxene-rich) lithologies that surround the sills. The broad-scale formation of the layered peridotites via incremental sill emplacement, suggested by the occurrence of upward-oriented apophyses, coalescence, and lateral discontinuity, could be applied to much larger ultramafic intrusions, which might have formed by similar mechanisms

Comparative assessment of passive surveillance in disease-free and endemic situation: Example of Brucella melitensis surveillance in Switzerland and in Bosnia and Herzegovina

<p>Abstract</p> <p>Background</p> <p>Globalization and subsequent growth in international trade in animals and animal products has increased the importance of international disease reporting. Efficient and reliable surveillance systems are needed in order to document the disease status of a population at a given time. In this context, passive surveillance plays an important role in early warning systems. However, it is not yet routinely integrated in the assessment of disease surveillance systems because different factors like the disease awareness (DA) of people reporting suspect cases influence the detection performance of passive surveillance. In this paper, we used scenario tree methodology in order to evaluate and compare the quality and benefit of abortion testing (ABT) for <it>Brucella melitensis </it>(<it>Bm</it>) between the disease free situation in Switzerland (CH) and a hypothetical disease free situation in Bosnia and Herzegovina (BH), taking into account DA levels assumed for the current endemic situation in BH.</p> <p>Results</p> <p>The structure and input parameters of the scenario tree were identical for CH and BH with the exception of population data in small ruminants and the DA in farmers and veterinarians. The sensitivity analysis of the stochastic scenario tree model showed that the small ruminant population structure and the DA of farmers were important influential parameters with regard to the unit sensitivity of ABT in both CH and BH. The DA of both farmers and veterinarians was assumed to be higher in BH than in CH due to the current endemic situation in BH. Although the same DA cannot necessarily be assumed for the modelled hypothetical disease free situation as for the actual endemic situation, it shows the importance of the higher vigilance of people reporting suspect cases on the probability that an average unit processed in the ABT-component would test positive.</p> <p>Conclusion</p> <p>The actual sensitivity of passive surveillance approaches heavily depends on the context in which they are applied. Scenario tree modelling allows for the evaluation of such passive surveillance system components under assumed disease free situation. Despite data gaps, this is a real opportunity to compare different situations and to explore consequences of changes that could be made.</p