Pain assessment and pain treatment for community-dwelling people with dementia: A systematic review and narrative synthesis.

OBJECTIVES: To describe the current literature on pain assessment and pain treatment for community-dwelling people with dementia. METHOD: A comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full-text articles were sequentially screened. Standardised data extraction and quality appraisal exercises were conducted. RESULTS: 32 studies were included in the review, 11 reporting findings on pain assessment tools or methods, and 27 reporting findings on treatments for pain. In regard to pain assessment, a large proportion of people with moderate to severe dementia were unable to complete a self-report pain instrument. Pain was more commonly reported by informal caregivers than the person with dementia themselves. Limited evidence was available for pain focused behavioural observation assessment. In regard to pain treatment, paracetamol use was more common in community-dwelling people with dementia compared to people without dementia. However, non-steroidal anti-inflammatory drugs (NSAIDs) were used less. For stronger analgesics, community-dwelling people with dementia were more likely to receive strong opioids (e.g. fentanyl) than people without dementia. CONCLUSION: This review identifies a dearth of high quality studies exploring pain assessment and/or treatment for community-dwelling people with dementia, not least into non-pharmacological interventions. The consequences of this lack of evidence, given the current and projected prevalence of the disease, are very serious and require urgent redress. In the meantime, clinicians should adopt a patient and caregiver centred, multi-dimensional, longitudinal approach to pain assessment and pain treatment for this population

Road verges support pollinators in agricultural landscapes, but are diminished by heavy traffic and summer cutting

This is the final version. Available from the publisher via the DOI in this record.Data available via the University of Exeter's institutional repository https://doi.org/10.24378/exe.1563Supporting pollinators in agricultural landscapes is important for reversing their global decline. Road verges and hedges are used by pollinators for feeding and reproduction, but few studies consider entire pollinator communities, and it remains unclear how they are distributed across adjacent verges, hedges and fields, or how they are affected by traffic and verge cutting. We surveyed flowers and pollinators, using transect counts and pan traps, to explore the role of road verges and their associated hedges in supporting pollinators in an agricultural landscape in southwest England, and the impacts of traffic and verge cutting. At 19 sites, we surveyed the road verge (verge edge and verge centre), the verge hedge (both sides), a field hedge and the field interior. Road verges and hedges had a much greater flower abundance, flower species richness and pollinator abundance than field interiors. Verge hedges had far less woody cover than field hedges, but greater flower species richness. There were fewer pollinators along verge edges (next to roads) than along verge centres (2–11 m from roads) and fewer pollinators in road verges next to busier roads. Road verges were generally cut once (in summer), and cuttings were never removed. There were substantially fewer flowers and pollinators in road verges that had been cut, even though surveys often took place many weeks after cutting. Synthesis and applications. Road verges and their associated hedges can provide hotspots of resources for pollinators in agricultural landscapes, but their capacity to do so is reduced by heavy traffic and summer verge cutting. We recommend that beneficial management for pollinators should prioritize wider road verges (at least 2 m wide), roads with less traffic, and areas away from the immediate vicinity of the road. Where possible, verge cutting should not be carried out during peak flowering times.Natural Environment Research Council (NERC)Cornwall Area of Outstanding Natural Beauty uni

Spatial extent of road pollution: a national analysis

This is the final version. Available on open access from Elsevier via the DOI in this recordNatural Environment Research Council (NERC)Cornwall Area of Outstanding Natural Beauty (AONB) Uni

Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: a case report

Background: Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI’s have been used in the targeted treatment of visual hallucinations in dementia and Parkinson’s Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatment Case Presentation: We present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully. Conclusions: This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field. Background Visual hallucinations occur in a variety of neurologica

Road verge extent and habitat composition across Great Britain

This is the final version. Available on open access from Elsevier via the DOI in this recordThere is growing societal and scientific interest in enhancing road verges for nature and the environment. This is partly because they are estimated to cover large areas in some regions. Yet, to our knowledge, there has been no quantitative assessment of national road verge extent, or of the habitats they encompass. We present a novel method for characterising and classifying road verges remotely, with which we evaluate the extent and habitat composition of road verges across Great Britain, and opportunities for improving verges for nature and the environment. We use stratified random sampling of freely-available road maps combined with satellite (Google Earth) and ground-level imagery (Google Street View). Overall, we estimate that there are 2,579 km2 (2,149- 3,010 km2) of road verges across Great Britain, equivalent to 1.2% of land area, of which 707 km2 (27.47%) is short, frequently-mown grassland, 1,062 km2 (40.87%) is regular grassland, 480 km2 (18.73%) is woodland, and 272 km2 (10.66%) is scrub. By comparison, we estimate that there are 3,694 km2 of hard road surfaces across Great Britain, equivalent to 1.8% of land. Only 27% of frequently-mown grassland verges contained trees, indicating potential for planting trees or shrubs to provide environmental benefits. Our findings suggest that there are significant opportunities to enhance (i) verges along major roads, because these constitute a disproportionately large area of road verge and have the widest verges, and (ii) frequently-mown grassland verges for example by, where appropriate, reducing mowing frequencies and/or planting trees. Our method can be used, adapted and further developed to assess road verges across other regions, and in greater detailCornwall Area of Outstanding Natural Beauty (AONB) UnitNatural Environment Research Council (NERC

Mass-flowering crops have a greater impact than semi-natural habitat on crop pollinators and pollen deposition

This is the final version. Available from Springer via the DOI in this record. Datasets available in the NERC Environmental Information Data Centre repository https://doi.org/10.5285/6128a4f7-d2ac-43c5-b492-af4c654e89b8.Context: Maximising insect pollination of mass-flowering crops is a widely-discussed approach to sustainable agriculture. Management actions can target landscape-scale semi-natural habitat, cropping patterns or field-scale features, but little is known about their relative effectiveness. Objective: To test how landscape composition (area of mass-flowering crops and semi-natural habitat) and field-scale habitat (margins and hedges) affect pollinator species richness, abundance, and pollen deposition within crop fields. Methods: We surveyed all flower visitors (Diptera, Coleoptera and Hymenoptera) in oilseed rape fields and related them to landscape composition and field features. Flower visitors were classified as bees, non-bee pollinators and brassica specialists. Total pollen deposition by individual taxa was estimated using single visit pollen deposition on stigmas combined with insect abundance. Results: The area of mass-flowering crop had a negative effect on the species richness and abundance of bees in fields, but not other flower visitors. The area of semi-natural habitat in the surrounding landscape had a positive effect on bees, but was not as important as the area of mass-flowering crop. Taxonomic richness and abundance varied significantly between years for non-bee pollinators. Greater cover of mass-flowering crops surrounding fields had a negative effect on pollen deposition, but only when non-bee pollinator numbers were reduced. Conclusions: Management choices that result in landscape homogenisation, such as large areas of mass-flowering crops, may reduce pollination services by reducing the numbers of bees visiting fields. Non-bee insect pollinators may buffer these landscape effects on pollen deposition, and management to support their populations should be considered.Natural Environment Research Counci

Crystal Structure of the PIM2 Kinase in Complex with an Organoruthenium Inhibitor

BACKGROUND: The serine/threonine kinase PIM2 is highly expressed in human leukemia and lymphomas and has been shown to positively regulate survival and proliferation of tumor cells. Its diverse ATP site makes PIM2 a promising target for the development of anticancer agents. To date our knowledge of catalytic domain structures of the PIM kinase family is limited to PIM1 which has been extensively studied and which shares about 50% sequence identity with PIM2. PRINCIPAL FINDINGS: Here we determined the crystal structure of PIM2 in complex with an organoruthenium complex (inhibition in sub-nanomolar level). Due to its extraordinary shape complementarity this stable organometallic compound is a highly potent inhibitor of PIM kinases. SIGNIFICANCE: The structure of PIM2 revealed several differences to PIM1 which may be explored further to generate isoform selective inhibitors. It has also demonstrated how an organometallic inhibitor can be adapted to the binding site of protein kinases to generate highly potent inhibitors. ENHANCED VERSION: This article can also be viewed as an enhanced version in which the text of the article is integrated with interactive 3D representations and animated transitions. Please note that a web plugin is required to access this enhanced functionality. Instructions for the installation and use of the web plugin are available in Text S1

Impacts of multiple pollutants on pollinator activity in road verges

Funder: Cornwall Area of Outstanding Natural Beauty unitTo tackle pollinator declines, there is a major need to increase the quantity of flower‐rich habitats. Road verges offer one such opportunity but are exposed to diverse forms of pollution from roads and road traffic. We carried out a broad initial assessment to establish if and how pollution affects the quality of road verges as pollinator foraging environments. We assessed the spatial distribution of pollution, flowers and pollinators in road verges, then used field experiments to simulate and measure the impacts of four ubiquitous and little studied forms of road pollution (noise, turbulence, dust and metals) on pollinator densities and foraging behaviour. We found that pollinators in road verges were exposed to noise, turbulence, dust and metal pollution, which decreased with distance from the road edge but, with the exception of turbulence, extended more than 8 m into road verges. Pollinator densities were lower closer to the road edge—particularly within first 2 m (55% lower than at 7–9 m)—where pollution is greatest. This was despite a similar density and species richness of flowers. Simulated turbulence deterred pollinators by causing intermittent disturbance (reducing visit duration by up to 54%), and some pollinator taxa preferentially avoided concentrations of metals that were more frequently found in flowers within 2 m of roads (resulting in up to 75% fewer visits), while noise and dust had no apparent effect. Synthesis and applications. Pollinators in road verges are exposed to many forms of pollution, and we found impacts of roadside‐realistic levels of turbulence and metals on pollinator densities and foraging behaviour. Although the findings suggest that road verges are largely suitable for pollinator conservation, management enhancements should prioritise areas more than 2 m from the road edge, and verges along roads with relatively lower traffic densities

Reading faces: differential lateral gaze bias in processing canine and human facial expressions in dogs and 4-year-old children

Sensitivity to the emotions of others provides clear biological advantages. However, in the case of heterospecific relationships, such as that existing between dogs and humans, there are additional challenges since some elements of the expression of emotions are species-specific. Given that faces provide important visual cues for communicating emotional state in both humans and dogs, and that processing of emotions is subject to brain lateralisation, we investigated lateral gaze bias in adult dogs when presented with pictures of expressive human and dog faces. Our analysis revealed clear differences in laterality of eye movements in dogs towards conspecific faces according to the emotional valence of the expressions. Differences were also found towards human faces, but to a lesser extent. For comparative purpose, a similar experiment was also run with 4-year-old children and it was observed that they showed differential processing of facial expressions compared to dogs, suggesting a species-dependent engagement of the right or left hemisphere in processing emotions

Emergent complex neural dynamics

A large repertoire of spatiotemporal activity patterns in the brain is the basis for adaptive behaviour. Understanding the mechanism by which the brain's hundred billion neurons and hundred trillion synapses manage to produce such a range of cortical configurations in a flexible manner remains a fundamental problem in neuroscience. One plausible solution is the involvement of universal mechanisms of emergent complex phenomena evident in dynamical systems poised near a critical point of a second-order phase transition. We review recent theoretical and empirical results supporting the notion that the brain is naturally poised near criticality, as well as its implications for better understanding of the brain