Management of lower urinary tract symptoms in men : summary of NICE guidance

Peer reviewedPublisher PD

Sodium sulfate decomposition in dry atmospheres

Na2SO4 in silicate glass batches is an environmental issue, since it releases SOx upon decomposition. Decomposition of Na2SO4 in different environments is studied by mass-loss measurements combined with evolved gas analysis, and thermochemical modeling. The decomposition experiments are undertaken in dry, pure O2(g), Ar(g), N2(g), and air(g) at 95 kPa total pressure. Thermochemical calculations using the code F*A*C*T predict SO2(g), Na(g), Na2SO4(g), NaO(g), and, in some cases, NO(g) as major emission species. The concentrations of these species increase with temperature. Na2SO4 decomposition initiates at ≈1373 K. Isothermal decomposition exhibits linear behavior with respect to time in 1473 to 1673 Κ range. At 1673 K, the decomposition rate is 24 · 10^-4 mg/(mm2 min) in UHP (ultra-high purity) O2 and 69 · 10^-4 mg/(mm2 min) in UHP N2. Evolved gas analyses identify SO(g)/SO2(g) as the emitted pollutants. In O2-rich atmospheres, SO(g) is a significant product as well as SO2(g). In inert atmospheres, SO2(g) is the sole decomposition product. At 1673 Κ in UHP O2, the concentration is 55 ppm (by volume) for SO(g) and 61 ppm for SO2. At 1673 Κ in UHP N2, SO2(g) concentration is 651 ppm. The decomposition is described by a surface reaction mechanism, in which SOx is generated by surface rearrangement of sulfur-oxygen complexes on the Na2So4 melt surface. Inert atmospheres increase SOx emission by facilitating this rearrangement process. O2-rich atmospheres passivate the melt surface, which favors the emission of lighter molecules such as SO(g)

Mindfulness- Based Functional Therapy: a preliminary open trial of an integrated model of care for people with persistent low back pain

Objectives: This pilot study investigated the feasibility and clinical utility of implementing a novel, evidence-informed, interdisciplinary group intervention—Mindfulness Based Functional Therapy (MBFT)—for the management of persistent low back pain (LBP) in primary care. MBFT aimed to improve physical and psychological functioning in patients with persistent LBP. Design: A single-group repeated measures design was utilized to gather data about feasibility, effect sizes, clinically significant changes and patient satisfaction. Setting: A community sample of 16 adults (75% female), mean (SD) age 47.00 (9.12) years (range 26–65 years), with mean (SD) LBP duration of 8.00 (9.00) years participated, using a simulated primary care setting at Curtin University in Australia. Intervention: MBFT is an 8-week group intervention co-facilitated by psychology and physiotherapy disciplines. Content includes: mindfulness meditation training, cognitive-functional physiotherapeutic movement retraining, pain education, and group support.Main outcome measures: Several validated self-report measures were used to assess functional disability, emotional functioning, mindfulness, pain catastrophizing, health-related quality of life at baseline, post-intervention, and 6 months follow-up. Results: Adherence and satisfaction was high, with 85% of participants highly satisfied with MBFT. Clinical significance analysis and effect size estimates showed improvements in a number of variables, including pain catastrophizing, physical functioning, role limitations due to physical condition, and depression, although these may have occurred due to non-intervention effects. Conclusions: MBFT is feasible to implement in primary care. Preliminary findings suggest that a randomized controlled trial is warranted to investigate its efficacy in improving physical and emotional functioning in people with disabling persistent LBP

Promotion of healthy aging within a community center through behavior change: health and fitness findings from the AgeWell pilot randomized controlled trial

The purpose of this randomized controlled trial was to determine if behavior change through individual goal setting (GS) could promote healthy aging, including health and fitness benefits in older adults who attended a community “AgeWell” Center for 12 months. Seventy-five older adults were randomly allocated to either a control or a GS group. Health outcomes were measured at baseline and after 12 months of the participants’ having access to the exception of Agewell Center facilities. The findings demonstrate that participation in the Center in itself was beneficial, with improved body composition and reduced cardiovascular risk in both groups (p < .05), and that this kind of community-based resource offers valuable potential for promoting protective behaviors and reducing health risk. However, a specific focus on identifying individual behavior change goals was required in order to achieve increased activity engagement (p < .05) and to bring about more substantial improvements in a range of health, diet, and physical function measures (p < .05)

Patient Self-Testing of Kidney Function at Home, a Prospective Clinical Feasibility Study in Kidney Transplant Recipients

IntroductionPeople with long-term health conditions often attend clinics for kidney function tests. The Self-Testing Own Kidneys (STOK) study assessed feasibility of kidney transplant recipients using hand-held devices to self-test kidney function at home and investigated agreement between home self-test and standard clinic test results.MethodsA prospective, observational, single-center, clinical feasibility study (TRN: ISRCTN68116915), with N = 15 stable kidney transplant recipients, investigated blood potassium and creatinine results agreement between index self-tests at home (patient self-testing of capillary blood, using Abbott i-STAT Alinity analyzers [i-STAT]) and reference tests in clinic (staff sampled venous blood, analyzed with laboratory Siemens Advia Chemistry XPT analyzer) using Bland-Altman and error grid analysis.ResultsThe mean within-patient difference between index and reference test in creatinine was 2.25 μmol/l (95% confidence interval [CI]: −12.13, 16.81 μmol/l) and in potassium was 0.66 mmol/l (95% CI: −1.47, 2.79 mmol/l). All creatinine pairs and 27 of 40 (67.5%) potassium pairs were judged clinically equivalent. Planned follow-up analysis suggests that biochemical variables associated with potassium measurement in capillary blood were predominant sources of paired test result differences. Paired patient and nurse i-STAT capillary blood test potassium results were not statistically significantly different.ConclusionsThis small feasibility study observed that training selected patients to competently use hand-held devices to self-test kidney function at home is possible. Self-test creatinine results showed good analytical and clinical agreement with standard clinic test results. Self-test potassium results showed poorer agreement with standard clinic test results; however, patient use of hand-held devices to self-test at home was not a statistically significant source of paired potassium test result differences

The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people.

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.All cited psychopharmacological work from Professor Sahakian laboratory was funded by a Wellcome Trust Grant (089589/Z/09/Z) awarded to T.W. Robbins, B.J. Everitt, A.C. Roberts, J.W. Dalley, and B.J. Sahakian, and it was conducted at the Behavioural and Clinical Neuroscience Institute, which is supported by a joint award from the Medical Research Council and Wellcome Trust (G00001354). B.J. Sahakian receives funding from the Human Brain Project. We thank Janssen/J&J for funding the study on cognitive training in schizophrenia.This is the final version of the article. It first appeared from RSC via http://dx.doi.org/10.1098/rstb.2014.021

Dyadic perspectives on loneliness and social isolation among people with dementia and spousal carers: findings from the IDEAL programme

YesThis study aims to investigate the impact of self and partner experiences of loneliness and social isolation on life satisfaction in people with dementia and their spousal carers. We used data from 1042 dementia caregiving dyads in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme cohort. Loneliness was measured using the six-item De Jong Gierveld loneliness scale and social isolation using the six-item Lubben Social Network Scale. Data were analysed using the Actor-Partner Interdependence Model framework. Self-rated loneliness was associated with poorer life satisfaction for both people with dementia and carers. The initial partner effects observed between the loneliness of the carer and the life satisfaction of the person with dementia and between social isolation reported by the person with dementia and life satisfaction of the carer were reduced to nonsignificance once the quality of the relationship between them was considered. Experiencing greater loneliness and social isolation is linked with reduced life satisfaction for people with dementia and carers. However, having a positive view of the quality of the relationship between them reduced the impact of loneliness and social isolation on life satisfaction. Findings suggest the need to consider the experiences of both the person with dementia and the carer when investigating the impact of loneliness and social isolation. Individual interventions to mitigate loneliness or isolation may enhance life satisfaction for both partners and not simply the intervention recipient.‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16- 001

Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme

BackgroundMost people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being.MethodsLongitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used.ResultsOn average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer’s and vascular) dementia had more health conditions than those with Alzheimer’s disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time.ConclusionsPeople with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being

Longitudinal trajectories of quality of life among people with mild-to-moderate dementia: a latent growth model approach with IDEAL cohort study data

Objectives We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify sub-groups with distinct QoL trajectories. Method We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the IDEAL cohort study (baseline n=1537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive and psychological covariates with the intercept and slope of QoL. We employed growth mixture modelling to identify multiple growth trajectories. Results Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: two with higher baseline QoL scores, labelled Stable (74.9%) and Declining (7.6%), and two with lower baseline QoL scores, labelled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterised by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores. Discussion Understanding individual trajectories can contribute to personalised care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure

BugSigDB captures patterns of differential abundance across a broad range of host-associated microbial signatures

The literature of human and other host-associated microbiome studies is expanding rapidly, but systematic comparisons among published results of host-associated microbiome signatures of differential abundance remain difficult. We present BugSigDB, a community-editable database of manually curated microbial signatures from published differential abundance studies accompanied by information on study geography, health outcomes, host body site and experimental, epidemiological and statistical methods using controlled vocabulary. The initial release of the database contains >2,500 manually curated signatures from >600 published studies on three host species, enabling high-throughput analysis of signature similarity, taxon enrichment, co-occurrence and coexclusion and consensus signatures. These data allow assessment of microbiome differential abundance within and across experimental conditions, environments or body sites. Database-wide analysis reveals experimental conditions with the highest level of consistency in signatures reported by independent studies and identifies commonalities among disease-associated signatures, including frequent introgression of oral pathobionts into the gut