The disconnect between evidence and practice: A systematic review of person-centred interventions and training manuals for care home staff working with people with dementia

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordObjective The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. Design Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. Results A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. Conclusions Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence. Copyright © 2014 John Wiley & Sons, Ltd.National Institute for Health Research (NIHR

Practitioners’ understanding of barriers to accessing specialist support by family carers of people with dementia in distress

Distressing symptoms in dementia are hard to manage for many family carers. This article explores practitioners' perceptions of the barriers to accessing skilled behaviour management support encountered by carers. A survey of cases referred to the English National Health Service (n = 5,360) was followed by in-depth group discussions and practitioner interviews. Data revealed that practitioners focused on care home residents or older people with mental health problems other than dementia, rather than community-dwelling people with dementia and families. Barriers to access included misperceptions about the nature of distressing behaviour affecting carers and structural limitations in the capacity of specialist services to respond to carers

Water in HD 209458b's atmosphere from 3.6 - 8 microns IRAC photometric observations in primary transit

The hot Jupiter HD 209458b was observed during primary transit at 3.6, 4.5, 5.8 and 8.0 microns using the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. We detail here the procedures we adopted to correct for the systematic trends present in the IRAC data. The light curves were fitted including limb darkening effects and fitted using Markov Chain Monte Carlo and prayer-bead Monte Carlo techniques, finding almost identical results. The final depth measurements obtained by a combined Markov Chain Monte Carlo fit are at 3.6 microns, 1.469 +- 0.013 % and 1.448 +- 0.013 %; at 4.5 microns, 1.478 +- 0.017 % ; at 5.8 microns, 1.549 +- 0.015 % and at 8.0 microns 1.535 +- 0.011 %. Our results clearly indicate the presence of water in the planetary atmosphere. Our broad band photometric measurements with IRAC prevent us from determining the additional presence of other other molecules such as CO, CO2 and methane for which spectroscopy is needed. While water vapour with a mixing ratio of 10^-4-10^-3 combined with thermal profiles retrieved from the day-side may provide a very good fit to our observations, this data set alone is unable to resolve completely the degeneracy between water abundance and atmospheric thermal profile.Comment: 14 pages, 6 tables, 10 figures, Accepted for publication in MNRA

An ingress and a complete transit of HD 80606 b

We have used four telescopes at different longitudes to obtain near-continuous lightcurve coverage of the star HD 80606 as it was transited by its \sim 4-MJup planet. The observations were performed during the predicted transit windows around the 25th of October 2008 and the 14th of February 2009. Our data set is unique in that it simultaneously constrains the duration of the transit and the planet's period. Our Markov-Chain Monte Carlo analysis of the light curves, combined with constraints from radial-velocity data, yields system parameters consistent with previously reported values. We find a planet-to-star radius ratio marginally smaller than previously reported, corresponding to a planet radius of Rp = 0.921 \pm 0.036RJup .Comment: 6 pages, 2 figures, MNRAS accepte

Association between longer hospitalization and development of de novo donor specific antibodies in simultaneous liver–kidney transplant recipients

© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Background:De novo Donor Specific Antibodies (DSA) are considered as a risk factor for the kidney allograft outcomes in recipients after simultaneous liver–kidney transplantation (SLKT). We hypothesized that length of hospital stay (LOS) might be associated with de novo DSA development of due to the increased likelihood of receiving blood transfusions with reduced immunosuppressive regimens. Methods: This study is a single-center, retrospective cohort study consisting of 85 recipients who underwent SLKT from 2009 to 2018 in our hospital. We divided the patients into two groups according to LOS [long hospital stay (L) group (LOS \u3e14 days) and short hospital stay (S) group (LOS ≤14 days)]. Propensity score (PS) has been created using logistic regression to predict LOS greater than median of 14 days. The association between the presence of de novo DSA and LOS was assessed by logistic regression models adjusted for PS. Results: The mean age at transplantation of the entire cohort was 55.5 ± 10.1 years. Sixty percent of the recipients were male and Caucasian. Median LOS in (L) group was three-fold longer than (S) group [L: median 30 days (IQR: 21–52), S: median 8.5 days (IQR: 7–11)]. Eight patients developed de novo DSA after SLKT (9.4%), all of them were in (L) group. Longer LOS was significantly associated with higher risk of development of de novo DSA in unadjusted (OR+ each 5 days: 1.09, 95% CI:1.02–1.16) and PS adjusted (OR+ each 5 days: 1.11, 95% CI:1.02–1.21) analysis. Conclusion: Longer hospitalization is significantly associated with the development of de novo DSA in SLKT

Methane in the atmosphere of the transiting hot Neptune GJ436b?

We present an analysis of seven primary transit observations of the hot Neptune GJ436b at 3.6, 4.5 and $8~\mu$m obtained with the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. After correcting for systematic effects, we fitted the light curves using the Markov Chain Monte Carlo technique. Combining these new data with the EPOXI, HST and ground-based $V, I, H$ and $K_s$ published observations, the range $0.5-10~\mu$m can be covered. Due to the low level of activity of GJ436, the effect of starspots on the combination of transits at different epochs is negligible at the accuracy of the dataset. Representative climate models were calculated by using a three-dimensional, pseudo-spectral general circulation model with idealised thermal forcing. Simulated transit spectra of GJ436b were generated using line-by-line radiative transfer models including the opacities of the molecular species expected to be present in such a planetary atmosphere. A new, ab-initio calculated, linelist for hot ammonia has been used for the first time. The photometric data observed at multiple wavelengths can be interpreted with methane being the dominant absorption after molecular hydrogen, possibly with minor contributions from ammonia, water and other molecules. No clear evidence of carbon monoxide and dioxide is found from transit photometry. We discuss this result in the light of a recent paper where photochemical disequilibrium is hypothesised to interpret secondary transit photometric data. We show that the emission photometric data are not incompatible with the presence of abundant methane, but further spectroscopic data are desirable to confirm this scenario.Comment: 19 pages, 10 figures, 1 table, Astrophysical Journal in pres

Line-profile tomography of exoplanet transits -- II. A gas-giant planet transiting a rapidly-rotating A5 star

Most of our knowledge of extrasolar planets rests on precise radial-velocity measurements, either for direct detection or for confirmation of the planetary origin of photometric transit signals. This has limited our exploration of the parameter space of exoplanet hosts to solar- and later-type, sharp-lined stars. Here we extend the realm of stars with known planetary companions to include hot, fast-rotating stars. Planet-like transits have previously been reported in the lightcurve obtained by the SuperWASP survey of the A5 star HD15082 (WASP-33; V=8.3, v sin i = 86 km/sec). Here we report further photometry and time-series spectroscopy through three separate transits, which we use to confirm the existence of a gas giant planet with an orbital period of 1.22d in orbit around HD15082. From the photometry and the properties of the planet signal travelling through the spectral line profiles during the transit we directly derive the size of the planet, the inclination and obliquity of its orbital plane, and its retrograde orbital motion relative to the spin of the star. This kind of analysis opens the way to studying the formation of planets around a whole new class of young, early-type stars, hence under different physical conditions and generally in an earlier stage of formation than in sharp-lined late-type stars. The reflex orbital motion of the star caused by the transiting planet is small, yielding an upper mass limit of 4.1 Jupiter masses on the planet. We also find evidence of a third body of sub-stellar mass in the system, which may explain the unusual orbit of the transiting planet. In HD 15082, the stellar line profiles also show evidence of non-radial pulsations, clearly distinct from the planetary transit signal. This raises the intriguing possibility that tides raised by the close-in planet may excite or amplify the pulsations in such stars.Comment: 9 pages, 6 figures, accepted for publication in MNRA

Electronic communication of cells with a surface mediated by boronic acid saccharide interactions

The fabrication of a molecularly tailored surface functionalised with a saccharide binding motif, a phenyl boronic acid derivative is reported.The functionalised surface facilitated the transfer of electrons, via unique electronic interactions mediated by the presence of the boronic acid, from a macrophage cell line. This is the first example of eukaryotic cellular-electrical communication mediated by the binding of cells via their cell–surface saccharide units

Effects of mountain gorilla foraging activities on the productivity of their food plant species

Mountain gorillas subsist principally on foliage from the dense herbaceous understorey that is found throughout most of their habitat in the Virunga Volcanoes region. Their foraging activities cause considerable structural damage to this vegetation. Those plant species that are quantitatively most important in the gorillas' diet respond to this damage by increasing primary productivity. At a sample of spots at which gorillas had fed, these species showed significantly higher growth rates over a 6-month interval than they did at nearby spots that had not been touched by the gorillas. Stem densities of herbaceous food species at feeding spots increased markedly both in comparison to their original values and to values for the same species at untouched spots. As a result, spots at which gorillas have fed are likely to become very attractive as future feeding spots. It is unlikely that gorillas ‘manage’ their habitat in any specific fashion, largely because they do not have exclusive use of their home ranges. Their activities appear to maintain habitat productivity over the short term, on a time scale relevant to patterns of area revisits by social groups, and may contribute to long term beneficial alterations of regularly used areas, however. Effects of the type reported here may have been an important aspect of the adaptation by gorillas to terrestrial folivory. RÉSUMEÉ Les gorilles de montagne s'alimentent principalement de feuillages dans le sous-bois herbacÉ dense prÉsent presque partout dans leur habitat de la rÉgion des volcans Virunga. Leurs activitÉs alimentaires causent des dommages structurels considÉrables À cette vÉgÉtation. Les plantes des espÈces qui sont quantitativement les plus importants dans le rÉgime du gorille rÉagissent À ces dÉgats en augmentant leur productivitÉ primaire. Aux postes Échantillons oÙ les gorilles se sont nourris, ces espÈces prÉsentent des taux de croissance significantivement supÉrieurs sur un intervalle de six mois, par rapport aux postes voisins qui n'ont pas ÉtÉ touchÉs par les gorilles. Les densitÉs de tiges des espÈces herbacÉes appÉtÉes aux postes de nourrissage augmentent nettement aussi bien en comparaison avec leurs valeurs antÉrieures qu'avec celles de ces měmes espÈces dans des stations non touchÉes. En consÉquence, les postes oÙ les gorilles se sont nourris ont plus de chance de devenir des futurs postes de nourrissage trÈs attractifs. Il est peu probable que les gorilles ‘gÈrent’ leur habitat d'une quelconque faÇon, surtout parce qu'ils n'ont pas l'utilisation exclusive de leur domaine vital. Leurs activitÉs semblent maintenir À court terme la productivitÉ de leur habitat, sur une Échelle de temps comprenant les visites successives de groupes sociaux, et peuvent contribuer À long terme À des altÉrations bÉnÉfiques pour ces zones rÉguliÉrement frÉquentÉes. Des effets du type rapportÉ ici peuvent avoir ÉtÉ un ÉlÉment important de l'adaptation des gorilles À la folivorie terrestre.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75171/1/j.1365-2028.1987.tb01102.x.pd