Generation of thirst: a critical review of dehydration amongst older adults living in residential care

Dehydration is common amongst older adults and exacerbated in residential care. Herein we summarise the reported prevalence of dehydration in this sub-population group and evaluate the associated risks before reviewing interventions designed to improve hydration. Heterogeneity in methods to assess dehydration inhibits interpretation of both prevalence and intervention studies (primarily small randomised control trials and case-control observational studies). The estimated prevalence of dehydration amongst older adults in residential care is 20-38%, with further increased prevalence of inadequate fluid intake, leading to increased urological, gastrointestinal, circulatory and neurological disorders or, in extreme cases, death. Multi-component interventions that include changes to drinks, vessels, placement and drinking opportunity alongside staff training and support are most effective in tackling dehydration in residential care. The detection and prevention of dehydration is crucial and a practical, population-specific reference standard for adequate fluid intake is warranted. Future research should prioritise interventions that are individualised to residents’ needs according to dehydration typology. Ongoing investment in the care sector should address staff-to-resident ratios and enhance staff training on the detection and prevention of dehydration

Multi-theoretic approaches to understanding the science classroom

Multi-camera on-site video technology and post-lesson video stimulated interviews were used in a purposefully inclusive research design to generate a complex data set amenable to parallel analyses from several complementary theoretical perspectives. The symposium reports the results of parallel analyses employing positioning theory, systemic functional linguistics, distributed cognition and representational analysis of the same nine-lesson sequence in a single science classroom during the teaching of a single topic: States of Matter. Without contesting the coherence and value of a well-constructed mono-theoretic research study, the argument is made that all such studies present an inevitably partial account of a setting as complex as the science classroom: privileging some aspects and ignoring others. In this symposium, the first presentation examined the rationale for multi-theoretic research designs, highlighting the dangers of the circular amplification of those constructs predetermined by the choice of theory and outlining the intended benefits of multi-theoretic designs that offer less partial accounts of classroom practice. The second and third presentations reported the results of analyses of the same lesson sequence on the topic “states of matter” using the analytical perspectives of positioning theory and systemic functional linguistics. The final presentation reported the comparative analysis of student learning of density over the same three lessons from distributed cognition and representational perspectives. The research design promoted a form of reciprocal interrogation, where the analyses provided insights into classroom practice and the comparison of the analyses facilitated the reflexive interrogation of the selected theories, while also optimally anticipating the subsequent synthesis of the interpretive accounts generated by each analysis of the same setting for the purpose of informing instructional advocacy

Cystic fibrosis-related diabetes is caused by islet loss and inflammation

Cystic fibrosis-related (CF-related) diabetes (CFRD) is an increasingly common and devastating comorbidity of CF, affecting approximately 35% of adults with CF. However, the underlying causes of CFRD are unclear. Here, we examined cystic fibrosis transmembrane conductance regulator (CFTR) islet expression and whether the CFTR participates in islet endocrine cell function using murine models of beta cell CFTR deletion and normal and CF human pancreas and islets. Specific deletion of CFTR from murine beta cells did not affect beta cell function. In human islets, CFTR mRNA was minimally expressed, and CFTR protein and electrical activity were not detected. Isolated CF/CFRD islets demonstrated appropriate insulin and glucagon secretion, with few changes in key islet-regulatory transcripts. Furthermore, approximately 65% of beta cell area was lost in CF donors, compounded by pancreatic remodeling and immune infiltration of the islet. These results indicate that CFRD is caused by beta cell loss and intraislet inflammation in the setting of a complex pleiotropic disease and not by intrinsic islet dysfunction from CFTR mutation

Detectors and cryostat design for the SuMIRe Prime Focus Spectrograph (PFS)

We describe the conceptual design of the camera cryostats, detectors, and detector readout electronics for the SuMIRe Prime Focus Spectrograph (PFS) being developed for the Subaru telescope. The SuMIRe PFS will consist of four identical spectrographs, each receiving 600 fibers from a 2400 fiber robotic positioner at the prime focus. Each spectrograph will have three channels covering wavelength ranges 3800 {\AA} - 6700 {\AA}, 6500 {\AA} - 10000 {\AA}, and 9700 {\AA} - 13000 {\AA}, with the dispersed light being imaged in each channel by a f/1.10 vacuum Schmidt camera. In the blue and red channels a pair of Hamamatsu 2K x 4K edge-buttable CCDs with 15 um pixels are used to form a 4K x 4K array. For the IR channel, the new Teledyne 4K x 4K, 15 um pixel, mercury-cadmium-telluride sensor with substrate removed for short-wavelength response and a 1.7 um cutoff will be used. Identical detector geometry and a nearly identical optical design allow for a common cryostat design with the only notable difference being the need for a cold radiation shield in the IR camera to mitigate thermal background. This paper describes the details of the cryostat design and cooling scheme, relevant thermal considerations and analysis, and discusses the detectors and detector readout electronics

British Art after Brexit

'What does it mean to correlate art and art history with “nation”? At the time of publication, the full impact and effects of the United Kingdom’s withdrawal from the European Union are just beginning to manifest. In this feature, we are interested in the art-historical, historiographic, curatorial, political, legal, creative, and other aspects of how Brexit impacts on art making and the study of art history in relation to Britain.

Multiomic features associated with mucosal healing and inflammation in paediatric Crohn's disease

Background The gastrointestinal microbiota has an important role in mucosal immune homoeostasis and may contribute to maintaining mucosal healing in Crohn's disease (CD). Aim To identify changes in the microbiota, metabolome and protease activity associated with mucosal healing in established paediatric CD. Methods Twenty‐five participants aged 3‐18 years with CD, disease duration of over 6 months, and maintenance treatment with biological therapy were recruited. They were divided into a low calprotectin group (faecal calprotectin 100 μg/g, “mucosal inflammation,” n = 11). 16S gene‐based metataxonomics, 1H‐NMR spectroscopy‐based metabolic profiling and protease activity assays were performed on stool samples. Results Relative abundance of Dialister species was six times greater in the low calprotectin group (q = 0.00999). Alpha and beta diversity, total protease activity and inferred metagenomic profiles did not differ between groups. Pentanoate (valerate) and lysine were principal discriminators in a machine‐learning model which differentiated high and low calprotectin samples using NMR spectra (R2 0.87, Q2 0.41). Mean relative concentration of pentanoate was 1.35‐times greater in the low calprotectin group (95% CI 1.03‐1.68, P = 0.036) and was positively correlated with Dialister. Mean relative concentration of lysine was 1.54‐times greater in the high calprotectin group (95% CI 1.05‐2.03, P = 0.028). Conclusions This multiomic study identified an increase in Dialister species and pentanoate, and a decrease in lysine, in patients with “mucosal healing.” It supports further investigation of these as potential novel therapeutic targets in CD

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners' and people living with Long COVID:a qualitative study

OBJECTIVES: To explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DESIGN: Qualitative descriptive study employing one-to-one semistructured virtual interviews analysed using the framework method.SETTING: Four National Health Service Scotland territorial health boards.PARTICIPANTS: 11 people with Long COVID (1 male, 10 female; aged 40-65 (mean 53) and 13 GPs (5 male, 8 female).RESULTS: Four key themes were identified: (1) The lived experience of Long COVID, describing the negative impact of Long COVID on participants' health and quality of life; (2) The challenges of an emergent and complex chronic condition, including uncertainties related to diagnosis and management; (3) Systemic challenges for Long COVID service delivery, including lack of clear pathways for access and referral, siloed services, limited resource and a perceived lack of holistic care, and (4) Perceptions and experiences of Long COVID and its management, including rehabilitation. In this theme, a lack of knowledge by GPs and people with Long COVID on the potential role of community rehabilitation for Long COVID was identified. Having prior knowledge of rehabilitation or being a healthcare professional appeared to facilitate access to community rehabilitation. Finally, people with Long COVID who had received rehabilitation had generally found it beneficial.CONCLUSIONS: There are several patient, GP and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. The findings of this study can be used by those (re)designing community rehabilitation services for people with Long COVID.</p

Exploring the perceptions and experiences of community rehabilitation for long COVID from the perspectives of Scottish General Practitioners and people living with long COVID: a qualitative study.

The objective of this study was to explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and General Practitioners (GPs). This was a qualitative descriptive study, employing one-to-one semi-structured virtual interviews that were analysed using the framework method. The study focused on four NHS Scotland territorial health boards. Participants included eleven people with Long COVID (1 male, 10 female; aged 40-65 [mean 53]), and 13 GPs (5 male, 8 female). Four key themes were identified: i) The lived experience of Long COVID; ii) The challenges of an emergent and complex chronic condition; iii) Systemic challenges for Long COVID service delivery, and iv) Perceptions and experiences of Long COVID and its management, including rehabilitation. The study concluded that there are several patient, GP, and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs, and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. Service providers need to consider availability and accessibility of Long COVID rehabilitation and ensure adequate interprofessional communication and collaboration to enhance the experience for people with Long COVID