Role of nursing associates in addressing the needs of people with dementia in hospital

It is estimated that people with dementia comprise about one quarter of all inpatients in acute hospital wards, although this could be an underestimate. Healthcare assistants often lack the training and skills, and nurses often lack the time, to provide optimal care for these patients. As a result, the needs of hospital inpatients with dementia are often unmet, they may have suboptimal outcomes compared with inpatients who do not have dementia, and they may experience significantly reduced well-being and quality of life. Nursing associates have a hands-on role in patient care, and their training should equip them with the skills required to overcome communication barriers and identify patients' needs. This article explores the potential role of nursing associates in addressing the needs of inpatients with dementia. [Abstract copyright: © 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Living machines: An exhibition of biomimetic and biohybrid technologies and artworks

Living Machines is an international conference series concerned with the development of future real-world technologies that harness the principles underlying living systems and the flow of communication signals between living and artificial systems. The conference highlights the most exciting contemporary research in biomimetics—the development of ovel technologies through the distillation of principles from the study of biological systems, and biohybrids—formed by combining a biological component—an existing living system—with an artificial, newly-engineered component. The concept of “Living Machine” captures the insight that useful artificial entities can be designed by copying life, and, at the same time, that we can understand biological organisms, including ourselves, as living machines “designed” by nature. Some of the most interesting new developments in biomimetic and biohybrid technologies, grouped under five themes, together with some striking examples of contemporary biomimetic or biohybrid art, have been selected for presentation at the Living Machines Exhibition, a one-day event at the Science Museum in London. Highlights of the 2013 Living Machines exhibition include: • A musical performance featuring the iCub humanoid robot • Mammal-like robots with whiskered touch systems • A robot model of fossilised animal behaviour from the dawn of life • Biomimetic medical devices including a wasp-like needle for minimally-invasive surgery • A robot that powers itself by digesting human waste • Micro-flying robots, worm, octopus, fish and mammal-like robots • Biohybrid clothing made with living cells and robots controlled by slime mould • Live visual art generated by the Artificial Intelligence AARON, created by Harold Cohen • A string quartet performing music generated by the Artificial Intelligence EMI, created by David Cope

Defining Well Clear Separation for Unmanned Aircraft Systems Operating with Non-Cooperative Aircraft

Detect-and-Avoid (DAA) systems are essential to the safe operations of Unmanned Aircraft Systems, and have the objectives of mitigating collisions with and remaining Well Clear of manned aircraft. This paper analyzes four candidate DAA Well Clear definitions for non-cooperative aircraft using mitigated performance metrics of DAA systems. These DAA Well Clear definitions were proposed in previous work based on their unmitigated collision risk and maneuver initiation range. In this work they are evaluated using safety and operational suitability metrics computed from a large number of representative encounters. Results suggest that although the four candidate DAA Well Clear definitions provide comparable safety, the alerting characteristics give preference for the DAA Well Clear definition without a temporal parameter

An exploratory investigation of endotoxin levels in novice long distance triathletes, and the effects of a multi-strain probiotic/prebiotic, antioxidant intervention.

Abstract: Gastrointestinal (GI) ischemia during exercise is associated with luminal permeability and increased systemic lipopolysaccharides (LPS). This study aimed to assess the impact of a multistrain pro/prebiotic/ antioxidant intervention on endotoxin unit levels and GI permeability in recreational athletes. Thirty healthy participants (25 males, 5 females) were randomly assigned either a multistrain pro/prebiotic/ antioxidant (LAB4ANTI; 30 billion CFU.d-1 containing 10 billion CFU.d-1 Lactobacillus acidophilus CUL-60 [NCIMB 30157], 10 billion CFU.d-1 Lactobacillus acidophillus CUL-21 [NCIMB 30156], 9.5 billion CFU.d-1 Bifidobacterium bifidum CUL-20 [NCIMB 30172] and 0.5 billion CFU.d-1 Bifidobacterium animalis subspecies lactis CUL-34 [NCIMB 30153]/ 55.8 mg.d-1 fructooligosaccharides/ 400 mg.d-1 α-lipoic acid, 600 mg.d-1 N-acetyl-carnitine); matched pro/prebiotic (LAB4) or placebo (PL) for 12 weeks preceding a long-distance triathlon. Plasma endotoxin units (via Limulus amebocyte lysate chromogenic quantification) and GI permeability (via 5 hour urinary lactulose (L): mannitol (M) recovery) were assessed at baseline, pre-race and 6 days post-race. Endotoxin unit levels were not significantly different between groups at baseline (LAB4ANTI: 8.20±1.60 pg.ml-1; LAB4: 8.92±1.20 pg.ml-1; PL: 9.72± 2.42 pg.ml-1). The use of a 12 week LAB4ANTI intervention significantly reduced endotoxin units both pre-race (4.37± 0.51 pg.ml-1) and 6 days post-race (5.18±0.57 pg.ml-1; p=0.03, ηp2 = 0.35), but only 6 days post-race with LAB4 (5.01± 0.28 pg.ml-1; p=0.01, ηp2 = 0.43). In contrast, endotoxin units remained unchanged with PL. L:M significantly increased from 0.01±0.01 at baseline to 0.06± 0.01 with PL only (p=0.004, ηp2 = 0.51). Mean race times (hr:min:sec) were not statistically different between groups despite faster times with both pro/prebiotoic groups (LAB4ANTI:13:17:07±34:48; LAB4: 12:47:13±25:06; PL: 14:12:51±29:54; p>0.05). Combined multistrain pro/prebiotic use may reduce endotoxin unit levels, with LAB4ANTI potentially conferring an additive effect via combined GI modulation and antioxidant protection

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives

Background: Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice.Methods: The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability.Results: The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice’s local environment such as overlapping initiatives orchestrated by their CCG.Conclusions: The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation

COVID-19 UK family carers and policy implications

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers

The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study

Background: A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community. Methods: This is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery. Conclusion: This feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility

The ecology of exercise: mechanisms underlying Individual variation in behavior, activity, and performance: an introduction to symposium

Wild animals often engage in intense physical activity while performing tasks vital for their survival and reproduction associated with foraging, avoiding predators, fighting, providing parental care, and migrating. In this theme issue we consider how viewing these tasks as “exercise”—analogous to that performed by human athletes—may help provide insight into the mechanisms underlying individual variation in these types of behaviors and the importance of physical activity in an ecological context. In this article and throughout this issue, we focus on four key questions relevant to the study of behavioral ecology that may be addressed by studying wild animal behavior from the perspective of exercise physiology: (1) How hard do individual animals work in response to ecological (or evolutionary) demands?; (2) Do lab-based studies of activity provide good models for understanding activity in free-living animals and individual variation in traits?; (3) Can animals work too hard during “routine” activities?; and (4) Can paradigms of “exercise” and “training” be applied to free-living animals? Attempts to address these issues are currently being facilitated by rapid technological developments associated with physiological measurements and the remote tracking of wild animals, to provide mechanistic insights into the behavior of free-ranging animals at spatial and temporal scales that were previously impossible. We further suggest that viewing the behaviors of non-human animals in terms of the physical exercise performed will allow us to fully take advantage of these technological advances, draw from knowledge and conceptual frameworks already in use by human exercise physiologists, and identify key traits that constrain performance and generate variation in performance among individuals. It is our hope that, by highlighting mechanisms of behavior and performance, the articles in this issue will spur on further synergies between physiologists and ecologists, to take advantage of emerging cross-disciplinary perspectives and technologies

Spinal muscle activity in simulated rugby union scrummaging is affected by different engagement conditions

IntroductionPrevious kinetic and kinematics studies on machine(1) and live(2) scrummaging in Rugby Union indicated a reduction of the biomechanical load experienced by front row players when a ‘crouch-bind-set’ (CBS) engagement procedure was used instead of a ‘crouch-touch-set’ (CTS) one. These findings led to law amendments that were trialled during the 2013-14 competitive season. The reduction in biomechanical loading on front-row players may reduce stresses on the spinal structures, and ultimately decrease spinal injury incidence. The activation of neck and spinal muscles may have an effect on the stiffness of the cervical area and hence on the distribution of load, but the contribution of these muscles during the engagement phase has still to be thoroughly investigated. This study aimed to compare spinal muscles activation in three different scrummaging conditions.Materials and MethodsNine male front-row forwards were asked to perform individual scrum engagements. Three engagement conditions were analysed: CBS (players pre-bind before they engage) and CTS (players engage and bind simultaneously) against a scrum machine; and, “Live”, against one another in a two versus one live condition (passive engagement). Muscle activities of the sternocleidomastoid (SMC), upper trapezius (UT) and (ES) were measured over the pre-engagement, engagement and sustained push phases, with the latter being the only phase studied in the Live condition.ResultsMuscle activity tended to be higher in CBS than CTS, significantly (p < 0.05) for UT and SCM in the engagement phase (Figure 1 (a) and 1 (b)). The activity of ES was significantly higher (p < 0.05) in Live than either CBS or CTS during the sustained push phase (Figure 1 (c)).DiscussionThe increase in spinal muscle activation in CBS compared to CTS may be influenced by the differences in binding techniques between the conditions. Since the increase in UT and SCM activity increases upper truck stiffness, in CBS the higher activity of spinal muscles, combined with a decrease in spinal loading(2), may ultimately reduce spinal injuries when compared to the CTS condition.ES was significantly (p < 0.05) more activated in Live than in either of the machine conditions. In live conditions, front row players scrum against a dynamic and unstable target therefore they need extra activation for stabilising lumbar muscles to maintain optimal lumbar spinal posture, and decrease the risk of injuryConclusionThe increased activity of the UT and SCM in CBS indicates that a pre-bind procedure make the upper spine more prepared to accept external load. This may lead to a reduction in spinal injury rates. Machine scrummaging does not replicate the demands of a live contest. This emphasises the requirement of individuals to practise and learn scrummage techniques in a live situation, rather than against a machine.References(1) Preatoni et al. (2014). BJSM [Epub ahead of print] 10.1136/bjsports-2013-092938(2) Cazzola et al. (2014). BJSM [Epub ahead of print] doi: 10.1136/bjsports-2013-09290