Experiences of advance care planning in Parkinson’s disease and atypical Parkinsonian disorders: a mixed methods systematic review

Background and purpose: Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals. Methods: A systematic search of online databases was conducted in April 2019 using a narrative synthesis approach with thematic analysis and tabulation to synthesize the findings. Results: In all, 507 articles were identified and 27 were included. There were five overarching themes: (i) what is involved in advance care planning discussions, (ii) when and how advance care planning discussions are initiated, (iii) barriers to advance care planning, (iv) the role of healthcare professionals and (v) the role of the family carer. This evidence was used to highlight eight effective components to support optimal advance care planning in parkinsonian disorders: advance care planning discussions should be individualized in content, timing and approach; patients should be invited to discuss advance care planning early and regularly; palliative care services should be introduced early; a skilled professional should deliver advance care planning; support to family carers should be offered in the advance care planning process; healthcare professionals should be educated on parkinsonian disorders and palliative care; advance care planning should be clearly documented and shared with relevant services; and healthcare professionals should be enabled to conduct effective advance care planning. Conclusions: These components can inform best practice in advance care planning in patients with parkinsonian disorders

Changes in the Circadian Rhythm in Patients with Primary Glaucoma

Purpose The current study was undertaken to investigate whether glaucoma affects the sleep quality and whether there is any difference between patients with primary glaucoma (primary open angle glaucoma, POAG and primary angle-closure glaucoma, PACG) and healthy subjects, using a validated self-rated questionnaire, the Pittsburgh Sleep Quality Index (PSQI). Methods The sleep quality of patients with POAG and PACG was tested against normal controls. Subjects were divided into three sub-groups according to age. Differences in the frequency of sleep disturbances (PSQI score >7) were assessed. The differences of sleep quality within the three groups and within the POAG group depending on the patients’ intraocular pressure (IOP) and impairment of visual field (VF) were also studied. Results 92 POAG patients, 48 PACG patients and 199 controls were included. Sleep quality declined with age in control and POAG group (tendency chi-square, P0.05). No significant differences were found in POAG group between patients with a highest IOP in daytime and at nighttime (χ2-test, P>0.05). Conclusions The prevalence of sleep disorders was higher in patients with POAG and PACG than in controls. PACG patients seemed to have a more serious problem of sleep disorders than POAG patients between 61 to 80 years old. No correlation was found between the prevalence of sleep disorders and impairment of VF or the time when POAG patients showed a highest IOP

The Evolution of the Silver Hills Volcanic Center, and Revised 40Ar/39Ar Geochronology of Montserrat, Lesser Antilles, With Implications for Island Arc Volcanism

Studying the older volcanic centers on Montserrat, Centre Hills and Silver Hills, may reveal how volcanic activity can change over long time periods (≥1 Myr), and whether the recent activity at the Soufrière Hills is typical of volcanism throughout Montserrat's history. Here, we present the first detailed mapping of the Silver Hills, the oldest and arguably least studied volcanic center on Montserrat. Volcanism at the Silver Hills was dominated by episodic andesite lava dome growth and collapse, produced Vulcanian style eruptions, and experienced periodic sector collapse events, similar to the style of volcanic activity that has been documented for the Centre Hills and Soufrière Hills. We also present an updated geochronology of volcanism on Montserrat, by revising existing ages and obtaining new 40Ar/39Ar dates and palaeomagnetic ages from marine tephra layers. We show that the centers of the Silver, Centre, and Soufrière Hills were active during at least ∼2.17–1.03 Ma, ∼1.14–0.38 Ma, and ∼0.45 Ma–present, respectively. Combined with timings of volcanism on Basse-Terre, Guadeloupe these ages suggest that ∼0.5–1 Ma is a common lifespan for volcanic centers in the Lesser Antilles. These new dates identify a previously unrecognized overlap in activity between the different volcanic centers, which appears to be a common phenomenon in island arcs. We also identify an older stage of Soufrière Hills activity ∼450–290 ka characterized by the eruption of hornblende-orthopyroxene-phyric lavas, demonstrating that the petrology of the Soufrière Hills eruptive products has changed at least twice throughout the volcano's development

Discovery of a large 2.4 Ma Plinian eruption of Basse-Terre, Guadeloupe, from the marine sediment record

Large volcanic eruptions are major geohazards, so identifying their frequency in the geologic record is critical for making predictions and hazard assessments. Following the discovery of a thick (18 cm) tephra layer in marine sediments from Integrated Ocean Drilling Program (IODP) Site U1396 between Montserrat and Guadeloupe in the Caribbean Sea, we document here how high-precision Pb isotopes, trace elements, and grain morphological analyses of the tephra can be used, together with volcanological models, to identify a large (Volcanic Explosivity Index ?6) Plinian eruption from Basse-Terre, Guadeloupe, at ca. 2.36 Ma. This previously unrecognized eruption is believed to be the largest documented volcanic event in this region since this time. We hypothesize that this large eruption was associated with the final stage in the evolution of an individual volcanic center, which has implications for prediction of geohazards in this setting

VULNERABLITY OF YEARLING AND 2-YEAR-OLD BULL MOOSE TO TWO ANTLER BASED HARVEST REGULATIONS IN BRITISH COLUMBIA

A spike-fork (S/F) general open season (GOS) for bull moose (Alces alces) was introduced with a lottery draw, limited entry hunting (LEH) in the Omineca (1981), Thompson (1993), and Okanagan (1993) regions of British Columbia. The S/F regulation permitted harvest of a bull having no more than two tines on one antler, including the tines on the main antler and brow palms; the LEH controlled the harvest of bulls with antlers >S/F. In the Peace region, the S/F regulation was implemented (1996) as part of SOFT regulations which permitted harvest of bulls with spike, fork, or antlers with 3 or more points on either brow palm; in 2003, SOFT10 regulations permitted the harvest of bull moose with ≥10 points on one or both antlers. These combinations with the S/F regulation were meant to control annual harvest of bulls, maintain herd social structure, and maximize recreational opportunity. We used age and antler point data collected through a Voluntary Tooth Return Program (VTRP) from 1988 to 2003 (n = 39,325) to assess vulnerability of yearlings (n = 12,743) and 2-year-olds (n = 8,712) to the S/F regulation as well as a hypothetical spike-only regulation. For each age class, we defined potential vulnerability to the S/F regulation as the proportion of bulls in the harvest with S/F antlers when no antler-based restrictions were in place. We similarly defined potential vulnerability to the spike-only regulation as the proportion of bulls in the harvest with at least one spike antler. Potential vulnerability across British Columbia to the spike-fork regulation was 43% for yearlings and 10% for 2-year-old bulls, whereas potential vulnerability to the spike-only regulation was 8% for yearlings and 1% for 2-year-old bulls. Realized vulnerability to harvest of each age class was defined as the proportion of that age class with spike-fork antlers when there were spike-fork regulations combined with either LEH or other antler-based restrictions. Similarly, realized vulnerability to harvest for spike-only bulls in each age class was the proportion of harvested bulls with at least one spike antler when spike-fork regulations were combined with either LEH or as part of the SOFT or SOFT10 regulations. Realized vulnerability across British Columbia to the S/F regulation was 49% for yearlings and 7% for 2-year-old bulls; realized vulnerability to the spike-only regulation was 9% for yearlings and 1% for 2-year-old bulls. Potential vulnerabilities and realized vulnerabilities varied regionally and annually, which may reflect different subspecies of moose (A. a. shirasi, A. a. andersoni, A. a. gigas) with different antler architectures, but more likely, differences related to habitat quality across the latitudinal breadth of British Columbia. The S/F regulation provides hunting opportunity, but combined with other hunting seasons/regulations, may not provide adequate protection of yearling and 2-year-old bulls in some regions. The spike-only regulation exposes fewer yearling and 2-year-old bulls to harvest and offers an alternative to regulate bull harvests while maintaining hunter opportunity

Emplacement of the Cabezo Mar?a lamproite volcano (Miocene, SE Spain)

Lamproite volcanoes are uncommon in the geological record but are exceptionally well preserved in the Betic Cordilleras of SE Spain, where they erupted during the Late Miocene (Tortonian to Messinian stages). The parent melts are thought to have been channelled through major lithospheric faults to erupt at or near the faulted margins of Neogene sedimentary basins. Lamproite magmas are thought to be relatively CO2-poor (2O<5 wt%) than other (ultra-) potassic rocks in SE Spain (e.g. Cancarix, Fortuna). The initial eruption stages were dominated by explosive magma-water interactions and the formation of peperites. These are characterised by angular fragments of glassy lamproite lavas (and isolated lobes) incorporated in sediments, locally showing the effects of thermal metamorphism. Further, elutriation pipes and ‘jigsaw-fit’ textures are observed in the peperites. The lavas and peperites are overlain by outward-dipping well-stratified scoria deposits defining part of a cinder cone, which is inferred to have emerged above sea level. Steep internal contacts with inward-dipping, structureless breccias likely represent the inner wall deposits of a central conduit. The deposits are cross-cut by late-stage dykes, which supplied fissure eruptions of geochemically similar lavas capping the scoria cone. The transition from explosive to effusive behaviour may reflect the decreased availability of water, possibly due to downward migration of the feeder conduit below the level of water-saturated sediments

Nutrition and hydration for people living with dementia near the end of life: A qualitative systematic review

Aims: To synthesize the qualitative evidence of the views and experiences of people living with dementia, family carers, and practitioners on practice related to nutrition and hydration of people living with dementia who are nearing end of life. Design: Systematic review and narrative synthesis of qualitative studies. Data sources: MEDLINE, Embase, PsycINFO, CINAHL. Review methods: Databases were searched for qualitative studies from January 2000‐February 2020. Quantitative studies, or studies reporting on biological mechanisms, assessments, scales or diagnostic tools were excluded. Results were synthesized using a narrative synthesis approach with thematic analysis. Results: Twenty studies were included; 15 explored the views of practitioners working with people living with dementia in long‐term care settings or in hospitals. Four themes were developed: challenges of supporting nutrition and hydration; balancing the views of all parties involved with ‘the right thing to do’; national context and sociocultural influences; and strategies to support nutrition and hydration near the end of life in dementia. Conclusion: The complexity of supporting nutrition and hydration near the end of life for someone living with dementia relates to national context, lack of knowledge, and limited planning while the person can communicate. Impact: This review summarizes practitioners and families’ experiences and highlights the need to include people living with dementia in studies to help understand their views and preferences about nutrition and hydration near the end of life; and those of their families supporting them in the community. The review findings are relevant to multidisciplinary teams who can learn from strategies to help with nutrition and hydration decisions and support

Surface orientation and ligand dependent quenching of the spin magnetic moment of Co porphyrins adsorbed on Cu substrates

Porphyrin molecules are particularly interesting candidates for spintronic applications due to their bonding flexibility, which allows to modify their properties substantially by the addition or transformation of ligands. Here, we investigate the electronic and magnetic properties of cobalt octaethylporphyrin (CoOEP), deposited on copper substrates with two distinct crystallographic surface orientations, Cu(100) and Cu(111), with X-ray absorption spectroscopy (XAS) and X-ray magnetic circular dichroism (XMCD). A significant magnetic moment is present in the Co ions of the molecules deposited on Cu(100), but it is completely quenched on Cu(111). Heating the molecules on both substrates to 500 K induces a ring-closure reaction with cobalt tetrabenzoporphyrin (CoTBP) as reaction product. In these molecules, the magnetic moment is quenched on both surfaces. Our XMCD and XAS measurements suggest that the filling of the dz2 orbital leads to a non-integer valence state and causes the quench of the spin moments on all samples except CoOEP/Cu(100), where the molecular conformation induces variations to the ligand field that lift the quench. We further employ density functional theory calculations, supplemented with on-site Coulomb correlations (DFT+U), to study the adsorption of these spin-bearing molecules on the Cu substrates. Our calculations show that charge transfer from the Cu substrates as well as charge redistribution within the Co 3d orbitals lead to the filling of the Co minority spin dz2 orbital, causing a ‘turning off’ of the exchange splitting and quenching of the spin moment at the Co magnetic centers. Our investigations suggest that, by this mechanism, molecule–substrate interactions can be used to control the quenching of the magnetic moments of the adsorbed molecules