Psychological well-being and incident frailty in men and women:the English Longitudinal Study of Ageing

Background: observations that older people who enjoy life more tend to live longer suggest that psychological well-being may be a potential resource for healthier ageing. We investigated whether psychological well-being was associated with incidence of physical frailty.Method: we used multinomial logistic regression to examine the prospective relationship between psychological well-being, assessed using the CASP-19, a questionnaire that assesses perceptions of control, autonomy, self-realization and pleasure, and incidence of physical frailty or pre-frailty, defined according to the Fried criteria (unintentional weight loss, weakness, self-reported exhaustion, slow walking speed and low physical activity), in 2557 men and women aged 60 to ?90 years from the English Longitudinal Study of Ageing (ELSA).Results: men and women with higher levels of psychological well-being were less likely to become frail over the 4-year follow-up period. For a standard deviation higher score in psychological well-being at baseline, the relative risk ratio (RR) for incident frailty, adjusted for age, sex and baseline frailty status, was 0.46 [95% confidence interval (CI) 0.40–0.54]. There was a significant association between psychological well-being and risk of pre-frailty (RR 0.69, 95% CI 0.63–0.77). Examination of scores for hedonic (pleasure) and eudaimonic (control, autonomy and self-realization) well-being showed that higher scores on both were associated with decreased risk. Associations were partially attenuated by further adjustment for other potential confounding factors but persisted. Incidence of pre-frailty or frailty was associated with a decline in well-being, suggesting that the relationship is bidirectional.Conclusions: maintaining a stronger sense of psychological well-being in later life may protect against the development of physical frailty. Future research needs to establish the mechanisms underlying these finding

End-Stage Kidney Failure in Oman: An Analysis of Registry Data with an Emphasis on Congenital and Inherited Renal Diseases

\ua9 2017 Intisar Al Alawi et al. Globally, end-stage kidney disease (ESKD) is a huge burden on health care systems. The aims of this study were to perform a comprehensive epidemiological and etiological report of ESKD patients commencing RRT in Oman with an emphasis on genetic causes and inherited kidney disease. All newly registered Omani patients with ESKD commencing RRT from 2001 until 2015 (n=2,922) were analysed using the RRT register in Oman. All potentially genetic or inherited causes of ESKD were reviewed. In Oman, ESKD is more prevalent in males (57.1%) than females (42.9%) with a median age of incident ESKD of 53 years. Diabetic nephropathy was the most prevalent cause of ESKD (46%), followed by hypertensive nephropathy (19%), glomerulonephritis (15%), and inherited kidney disease (5%). For patients less than 20 years of age inherited kidney disease accounted for 32.5% of cases. Of this cohort with inherited renal disease, 40.3% had autosomal dominant polycystic kidney disease, 11.5% had congenital anomalies of the kidney and urinary tract, 9.4% had Alport syndrome, and 7.2% had autosomal recessive polycystic kidney disease. This study represents a comprehensive population-based epidemiological and etiological report of ESKD patients in Oman commencing RRT. Inherited kidney disease was the leading cause of paediatric ESKD

Aortic Morphology Following Endovascular Repair of Acute and Chronic Type B Aortic Dissection: Implications for Management

AbstractObjectiveThe study aimed to define early clinical outcomes, and medium term morphological changes, following endovascular treatment of acute (AAD) and chronic (CAD) Type B aortic dissections.Main outcomesThe cohort comprised 78 patients who underwent endovascular repair for AAD (38) and CAD (40). Early and late clinical outcomes were prospectively recorded. All patients underwent serial follow up with CT scanning. False lumen thrombosis rates, true, false and total aortic short axis diameter were recorded at the mid point of the endograft and below this level in the thoracic aorta. The total maximum aortic diameter in the thoracic, abdominal aorta was quantified.ResultsThe 30-d mortality was 2.6% in AAD and 7.5% in CAD. The 30-d stroke and paraplegia rates were 5.3% and 0% in AAD. There were no cases of stroke or paraplegia in patients with CAD. At 30 months follow up, the cumulative survival for the two groups was 93% for AAD and 66.5% for CAD (P=0.015, Kaplan Meier) and the cumulative re-intervention rate was 62% and 55% in AAD and CAD respectively (P=0.961, Kaplan-Meier). False lumen thrombosis rates were equivalent in the two groups and were higher at the level of the endograft than below this level (P<0.05). Aortic remodelling was greater in AAD, whereas the aortic dimensions after treatment of CAD remained relatively static. Up to 20% of patients in both groups demonstrated enlargement of the thoracic aorta.ConclusionsThe data support the use of endovascular repair of the thoracic aorta in Type B aortic dissection. 30-d outcomes are acceptable. Patients with AAD demonstrate significant aortic remodelling whereas patients with CAD do not. This has significant implications for practice as patients with CAD must rely on maintenance of false lumen thrombosis to preserve the integrity of the endovascular repair

The ‘Pritchard Trap’: a novel quantitative survey method for crayfish

1. As crayfish invasions continue to threaten native freshwater biota, a detailed understanding of crayfish distribution and population structure becomes imperative. Nonetheless, most current survey methods provide inadequate demographic data. The quantitative ‘Triple Drawdown’ (TDD) dewatering method has highlighted the importance of such data, yet practical constraints prevent its large-scale application. 2. Here, we introduce the ‘Pritchard Trap’, a novel passive sampling method that reliably generates quantitative crayfish population data while requiring substantially lower sampling effort than TDDs. This quadrat-style sampler was extensively tested in headwater streams of North Yorkshire, England, along an invasion gradient for signal crayfish (Pacifastacus leniusculus) from well-established sites to mixed populations of signal crayfish and native white-clawed crayfish (Austropotamobius pallipes). 3. The Pritchard Trap was trialled over several time intervals to determine the minimum required trap deployment time. TDDs at the same sites allowed for a robust evaluation of Pritchard Trap sampling accuracy in representing crayfish densities and population structure. 4. The Pritchard Trap successfully sampled both invasive and native crayfish (8–42 mm carapace length). A minimum passive deployment time of 4 days was required. At low crayfish densities (0.5 individuals m−2), increased trapping effort was necessary to achieve accurate population density and size class distribution estimates. The Pritchard Trap required substantially less sampling effort (working hours) and resources than the TDD, whilst also posing less risk to non-target species. 5. The Pritchard Trap, for the first time, affords logistically simple, truly quantitative investigations of crayfish population demographics for headwater systems. It could be integrated into crayfish research and management, for example to explore density-dependent ecological impacts of invasive crayfish and their management responses or to monitor populations and recruitment in native crayfish conservation initiatives

The East Lancashire Clinic Model: Supporting care homes to understand reactive behaviours (Innovative Practice)

The East Lancashire Clinic model is a consultancy-based approach to supporting care home staff to assess and respond to reactive behaviours of people with dementia and reduce the need to refer into secondary mental health services. The clinics are person centred and solution focused, aiming to promote recognition of unmet needs and early interventions implemented by staff. The pilot was able to resolve most cases and reduce referral rates into secondary care services. Through working collaboratively, it empowers staff to improve the care of all their residents, improves relationship with secondary care services and has potential to offer efficiency savings

Opportunity or dead end? Rethinking the study of entrepreneurial action without a concept of opportunity

This article has two objectives: to critique the dominant opportunity discovery and creation literatures and to propose a new, critical realist–inspired analytical framework to theorise the causes, processes and consequences of entrepreneurial action – one that needs no concept of opportunity. We offer three reasons to support our critique of opportunity studies. First, there are important absences, contradictions and inconsistencies in definitions of opportunity in theoretical and empirical work that mean the term cannot signal a clear direction for theorising or empirical research. Our central criticism is that the concept of opportunity cannot refer simultaneously, without contradiction, to a social context offering profit-making prospects, to particular practices and to agents’ subjective beliefs or imagined futures. Second, a new definition of opportunity would perpetuate the conceptual chaos. Third, useful concepts to capture important entrepreneurial processes are readily available, for instance, combining resources, creating new ventures and achieving product sales, which render a concept of opportunity superfluous. Instead, we conceptualise entrepreneurial action as investments in resources intended to create new goods and services for market exchange emergent from the interaction between agential, socialstructural and cultural causal powers

A Fatal Outbreak of Campylobacter jejuni Enteritis in a Colony of Vervet Monkeys in Kenya

In a group of 50 wild-caught vervet monkeys trapped for experimental studies, 23 developed severe diarrhoea  during the quarantine period. While 10 of these responded well to routine treatment with metronidazole,  kaomycin and oral electrolytes, 13 initially showed slight improvement but later relapsed. Five of  these failed to respond altogether and were euthanised. Fresh faecal samples were collected from the surviving  eight monkeys and analysed for microbiology and drug sensitivity. Campylobacter jejuni, sensitive  to erythromycin, was isolated from all the faecal samples. Following treatment with erythromycin, seven  monkeys recovered fully within ten days but one died before the end of therapy. This study indicates that  wild non-human primates may play a significant role as a reservoir of C. jejuni, whereby they may act as  natural carriers of this human pathogen. Screening for Campylobacter sp in newly acquired monkeys is  advisable as part of the quarantine procedures.