Palliative Care in Dementia

An optimal approach to palliative care for people with dementia has been defined by the European Association for Palliative Care with 11 domains including applicability of palliative care; person-centered care, communication, and shared decision-making; and setting care goals and advance care planning. Not all people with dementia will require specialist palliative care, and all involved in dementia care should be able to provide palliative care focusing on care and treatment which aims to increase the comfort and quality of life of the individual and supporting their family. There are many complications and symptoms which may arise for someone with dementia including increased infections, shortness of breath, swallowing difficulties, and pain which the individual may not be able to clearly express. These complications can lead to difficult decisions which need to be made by not only practitioners but also family caregivers as proxy. There should be a shared decision-making approach to these complications and symptoms, with advance care planning performed where possible. Caring for someone with dementia is one of the most difficult caring roles; support for family caregivers as part of a palliative approach is essential. Each person with dementia is different, and needs should be assessed on an individual basis, adopting a person-centered approach to care

Positive effects of methylphenidate on hyperactivity are moderated by monoaminergic gene variants in children with autism spectrum disorders.

Methylphenidate (MPH) reduces hyperactive-impulsive symptoms common in children with autism spectrum disorders (ASDs), however, response and tolerability varies widely. We hypothesized monoaminergic gene variants may moderate MPH effects in ASD, as in typically developing children with attention-deficit/hyperactivity disorder. Genotype data were available for 64 children with ASD and hyperactivity who were exposed to MPH during a 1-week safety/tolerability lead-in phase and 58 who went on to be randomized to placebo and three doses of MPH during a 4-week blinded, crossover study. Outcome measures included the Clinical Global Impression-Improvement (CGI-I) scale and the Aberrant Behavior Checklist (ABC-hyperactivity index). A total of 14 subjects discontinued the study because of MPH side effects. Subjects were genotyped for variants in DRD1-DRD5, ADRA2A, SLC6A3, SLC6A4, MAOA and MAOB, and COMT. Forty-nine percent of the sample met positive responder criteria. In this modest but relatively homogeneous sample, significant differences by DRD1 (P=0.006), ADRA2A (P<0.02), COMT (P<0.04), DRD3 (P<0.05), DRD4 (P<0.05), SLC6A3 (P<0.05) and SLC6A4 (P<0.05) genotypes were found for responders versus non-responders. Variants in DRD2 (P<0.001) and DRD3 (P<0.04) were associated with tolerability in the 14 subjects who discontinued the trial. For this first MPH pharmacogenetic study in children with ASD, multiple monoaminergic gene variants may help explain individual differences in MPH's efficacy and tolerability

A new mass-loss rate prescription for red supergiants

Evolutionary models have shown the substantial effect that strong mass-loss rates (⁠M˙s) can have on the fate of massive stars. Red supergiant (RSG) mass-loss is poorly understood theoretically, and so stellar models rely on purely empirical M˙–luminosity relations to calculate evolution. Empirical prescriptions usually scale with luminosity and effective temperature, but M˙ should also depend on the current mass and hence the surface gravity of the star, yielding more than one possible M˙ for the same position on the Hertzsprung–Russell diagram. One can solve this degeneracy by measuring M˙ for RSGs that reside in clusters, where age and initial mass (Minit) are known. In this paper we derive M˙ values and luminosities for RSGs in two clusters, NGC 2004 and RSGC1. Using newly derived Minit measurements, we combine the results with those of clusters with a range of ages and derive an Minit-dependent M˙ prescription. When comparing this new prescription to the treatment of mass-loss currently implemented in evolutionary models, we find models drastically overpredict the total mass-loss, by up to a factor of 20. Importantly, the most massive RSGs experience the largest downward revision in their mass-loss rates, drastically changing the impact of wind mass-loss on their evolution. Our results suggest that for most initial masses of RSG progenitors, quiescent mass-loss during the RSG phase is not effective at removing a significant fraction of the H-envelope prior to core-collapse, and we discuss the implications of this for stellar evolution and observations of SNe and SN progenitors

A Spatial Analysis of Rift Valley Fever Virus Seropositivity in Domestic Ruminants in Tanzania

Rift Valley fever (RVF) is an acute arthropod-borne viral zoonotic disease primarily occurring in Africa. Since RVF-like disease was reported in Tanzania in 1930, outbreaks of the disease have been reported mainly from the eastern ecosystem of the Great Rift Valley. This cross-sectional study was carried out to describe the variation in RVF virus (RVFV) seropositivity in domestic ruminants between selected villages in the eastern and western Rift Valley ecosystems in Tanzania, and identify potential risk factors. Three study villages were purposively selected from each of the two Rift Valley ecosystems. Serum samples from randomly selected domestic ruminants (n = 1,435) were tested for the presence of specific immunoglobulin G (IgG) and M (IgM), using RVF enzyme-linked immunosorbent assay methods. Mixed effects logistic regression modelling was used to investigate the association between potential risk factors and RVFV seropositivity. The overall RVFV seroprevalence (n = 1,435) in domestic ruminants was 25.8% and species specific seroprevalence was 29.7%, 27.7% and 22.0% in sheep (n = 148), cattle (n = 756) and goats (n = 531), respectively. The odds of seropositivity were significantly higher in animals sampled from the villages in the eastern than those in the western Rift Valley ecosystem (OR = 1.88, CI: 1.41, 2.51; p<0.001), in animals sampled from villages with soils of good than those with soils of poor water holding capacity (OR = 1.97; 95% CI: 1.58, 3.02; p< 0.001), and in animals which had been introduced than in animals born within the herd (OR = 5.08, CI: 2.74, 9.44; p< 0.001). Compared with animals aged 1-2 years, those aged 3 and 4-5 years had 3.40 (CI: 2.49, 4.64; p< 0.001) and 3.31 (CI: 2.27, 4.82, p< 0.001) times the odds of seropositivity. The findings confirm exposure to RVFV in all the study villages, but with a higher prevalence in the study villages from the eastern Rift Valley ecosystem

Engineering the Fab fragment of the anti-IgE omalizumab to prevent Fab crystallization and permit IgE-Fc complex crystallization

Immunoglobulin E (IgE) plays a central role in the allergic response, in which cross-linking of allergen by Fc[epsilon]RI-bound IgE triggers mast cell and basophil degranulation and the release of inflammatory mediators. The high-affinity interaction between IgE and Fc[epsilon]RI is a long-standing target for therapeutic intervention in allergic disease. Omalizumab is a clinically approved anti-IgE monoclonal antibody that binds to free IgE, also with high affinity, preventing its interaction with Fc[epsilon]RI. All attempts to crystallize the pre-formed complex between the omalizumab Fab and the Fc region of IgE (IgE-Fc), to understand the structural basis for its mechanism of action, surprisingly failed. Instead, the Fab alone selectively crystallized in different crystal forms, but their structures revealed intermolecular Fab/Fab interactions that were clearly strong enough to disrupt the Fab/IgE-Fc complexes. Some of these interactions were common to other Fab crystal structures. Mutations were therefore designed to disrupt two recurring packing interactions observed in the omalizumab Fab crystal structures without interfering with the ability of the omalizumab Fab to recognize IgE-Fc; this led to the successful crystallization and subsequent structure determination of the Fab/IgE-Fc complex. The mutagenesis strategy adopted to achieve this result is applicable to other intractable Fab/antigen complexes or systems in which Fabs are used as crystallization chaperones

Age-dependent changes in mean and variance of gene expression across tissues in a twin cohort

\ua9 The Author(s) 2017.Changes in the mean and variance of gene expression with age have consequences for healthy aging and disease development. Age-dependent changes in phenotypic variance have been associated with a decline in regulatory functions leading to increase in disease risk. Here, we investigate age-related mean and variance changes in gene expression measured by RNA-seq of fat, skin, whole blood and derived lymphoblastoid cell lines (LCLs) expression from 855 adult female twins. We see evidence of up to 60% of age effects on transcription levels shared across tissues, and 47% of those on splicing. Using gene expression variance and discordance between genetically identical MZ twin pairs, we identify 137 genes with age-related changes in variance and 42 genes with age-related discordance between co-twins; implying the latter are driven by environmental effects. We identify four eQTLs whose effect on expression is age-dependent (FDR 5%). Combined, these results show a complicated mix of environmental and genetically driven changes in expression with age. Using the twin structure in our data, we show that additive genetic effects explain considerably more of the variance in gene expression than aging, but less that other environmental factors, potentially explaining why reliable expression-derived biomarkers for healthy-aging have proved elusive compared with those derived from methylation

Measurement of the emission spectrum of a semiconductor laser using laser-feedback interferometry

The effects of optical feedback (OF) in lasers have been observed since the early days of laser development. While OF can result in undesirable and unpredictable operation in laser systems, it can also cause measurable perturbations to the operating parameters, which can be harnessed for metrological purposes. In this work we exploit this ‘self-mixing’ effect to infer the emission spectrum of a semiconductor laser using a laser-feedback interferometer, in which the terminal voltage of the laser is used to coherently sample the reinjected field. We demonstrate this approach using a terahertz frequency quantum cascade laser operating in both single- and multiple-longitudinal mode regimes, and are able to resolve spectral features not reliably resolved using traditional Fourier transform spectroscopy. We also investigate quantitatively the frequency perturbation of individual laser modes under OF, and find excellent agreement with predictions of the excess phase equation central to the theory of lasers under OF

Theoretical and experimental analysis of the photoluminescence and photoluminescence excitation spectroscopy spectra of m\textit{m}-plane InGaN/GaN quantum wells

We present a combined theoretical and experimental analysis of the optical properties of $\textit{m}$-plane InGaN/GaN quantum wells. The sample was studied by photoluminescence and photoluminescence excitation spectroscopy at low temperature. The spectra show a large Stokes shift between the lowest exciton peak in the excitation spectra and the peak of the photoluminescence spectrum. This behavior is indicative of strong carrier localization effects. These experimental results are complemented by tight-binding calculations, accounting for random alloy fluctuations and Coulomb effects. The theoretical data explain the main features of the experimental spectra. Moreover, by comparison with calculations based on a virtual crystal approximation, the importance of carrier localization effects due to random alloy fluctuations is explicitly shown.This work was supported by Science Foundation Ireland (Project No. 13/SIRG/2210) and the United Kingdom Engineering and Physical Sciences Research Council (Grant Agreement Nos. EP\J001627\1 and EP\J003603\1). S.S. acknowledges computing resources provided by the SFI/HEA Irish Centre for High-End Computing. R.A.O. and F.T. acknowledge the support of the European Research Council under the European Community's 7th Framework Programme (FP7/2007–2013)/ERC Grant Agreement No. 279361 (MACONS)