Developing a core outcome set (COS) for Dementia with Lewy bodies (DLB) [version 2; peer review: 2 approved, 1 approved with reservations]

\ua9 2023 Grycuk E et al.Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with a range of clinical manifestations, including motor, neuropsychiatric, and autonomic symptoms. Compared with more common forms of dementia such as Alzheimer’s disease, DLB has been the focus of significantly fewer treatment studies, often with diverse outcome measures, making comparison and clinical implementation difficult. A core outcome set (COS) can address this by ensuring that data are comparable, relevant, useful, and usable for making the best healthcare decisions. Methods: Using a multi-stage approach, development of the DLB-COS will include the following stages: (1) A systematic review, following PRISMA guidelines to create an initial long list of outcomes; (2) A two-round online Delphi including clinicians, scientists, policymakers, and individuals with lived experience of DLB and their representatives; (3) An online consensus meeting to agree on the final core list of outcomes (the final DLB-COS) for use in research and clinical practice; (4) A literature search to identify appropriate measurement instruments for the DLB-COS outcomes; (5) A final consensus meeting of the professional stakeholders who attended the online consensus meeting to agree on the instruments that should be used to measure the outcomes in the DLB-COS; and (6) Global dissemination. Discussion: This is a multi-stage project to develop a COS to be used in treatment trials for DLB. A DLB-COS will ensure the selection of relevant outcomes and will identify the instruments to be used to measure DLB globally

Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: Before and during the COVID-19 pandemic.

BACKGROUND: Public health restrictions due to the COVID-19 (SARS CoV-2) pandemic have disproportionately affected informal caregivers of people living with long term health conditions. We aimed to explore levels of care burden, loneliness, and social isolation among caregivers of people with enduring physical and brain health conditions in English-speaking regions worldwide, by investigating outcomes before and during the COVID-19 pandemic. METHODS: A cross-sectional anonymous online survey data from 2287 English-speaking caregivers of people with long term health conditions from four English-speaking regions (UK, Ireland, USA, New Zealand) included measures of care burden, loneliness, and social isolation, reported before and during the COVID-19 pandemic. Analyses were descriptive, followed by an ordinal regression model for predictors of burden. RESULTS: Compared to pre-pandemic levels, all caregivers experienced a significant increase in burden, loneliness, and isolation. Caregivers of people with both brain health and physical conditions were the most burdened and had the highest levels of loneliness and isolation compared to caregivers of people with either a brain health or physical condition only. The increase in care burden among caregivers of people with brain health challenges was associated with caregiver's gender, moderate and severe emotional loneliness, magnitude and frequency of isolation during the pandemic, and care circumstances (cohabitation with the care recipient, restrictions on the ability to provide care). CONCLUSIONS: Health and social care interventions should target caregivers' care circumstances and psychological outcomes, particularly in women, accounting for the significant additional burden of care, loneliness, and isolation resulting from pandemic-related restrictions

A model for furcate septal increase in a Triassic scleractiniamorph

Triassic corals with septa that branch repeatedly and centripetally are here assigned to a new genus Furcophyllia. Septa of F. septafindens (Volz, 1896), re−described from the Italian Dolomites, are composed of 3–10 blades (“septal brooms”). Distances between adjacent septa and their branches are equal, and the thickness of all blades is approximately the same throughout ontogeny. However, none of the septal brooms show the same branching pattern. Proposed herein is a simple computer model that reproduces septal pattern, similar to that of Furcophyllia, based on a minimal set of rules: (i) uniform coverage of intra−calicular space; (ii) regular bifurcations following some probability; (iii) keeping some minimal distance between septal branches. The elaborate septal pattern of Furcophyllia suggests a distinct organization of the polyp’s soft tissue, especially mesenteries whose appearance in modern corals is associated with insertion of sclerosepta. Hypothesis 1 suggests that mesenterial pairs flanked only “septal brooms” and that septal branches functionally corresponded with septal microarchitecture. Hypothesis 2 suggests that mesenterial pairs developed between all septal branches that functionally correspond with conventional septa. Delicate menianae, which developed on Furcophyllia septal faces (and many other Triassic corals) resemble similar septal microarchitecture of the Recent agariciid Leptoseris fragilis and may be closely related to the suspension feeding strategy of this coral. The furcate septal arrangement in Furcophyllia is unique among Triassic corals, and generally, among Mesozoic and Cenozoic corals. The only analogous corals are Cretaceous aulastraeoporids (e.g., Preverastrea, Paronastraea), Trochoidomeandra, and some Jurassic rhipidogyrids having secondary (apophysal) septal branches. In some Recent caryophylliids (Trochocyathus rhombocolumna, Phacelocyathus flos) primary septa may also split dichotomously and centripetally