The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study

yesBackground: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. Method(s): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. Results: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p= 0.008). Nonpharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients’ admissions. Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.Alzheimer's Society; BUPA Foundatio

Benchmark low-mass objects in Moving Groups

This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.In order to compile a sample of ultracool dwarfs that will serve as benchmarks for testing theoretical formation and evolutionary models, we selected low-mass cool (>M7) objects that are potentially members of five known young Moving Groups in the solar neighbourhood. We have studied the kinematics of the sample, finding that 49 targets belong to the young disk area, from which 36 are kinematic member of one of the five moving groups under study. Some of the identified low-mass members have been spectroscopically characterised (T-eff, log g) and confirmed as young members through a detailed study of age indicators

Development of a Passive Sampling Technique for Measuring Pesticides in Waters and Soils

It is essential to monitor pesticides in the environment to help ensure water and soil quality. The diffusive gradients in thin-films (DGT) technique can measure quantitative in situ labile (available) concentrations of chemicals in water, soil, and sediments. This study describes the systematic development of the DGT technique for nine current pesticides, selected to be representative of different classes with a wide range of properties, with two types of resins (HLB (hydrophilic-lipophilic-balanced) and XAD 18) as binding layer materials. The masses of pesticides accumulated by DGT devices were proportional to the deployment time and in inverse proportion to the thickness of the diffusive layer, in line with DGT theoretical predictions. DGT with both resin gels were tested in the laboratory for the effects of typical environmental factors on the DGT measurements. DGT performance was independent of the following: pH in the range of 4.7-8.2; dissolved organic matter concentrations <20 mg L-1 and ionic strength from 0.01 to 0.25 M, although it was slightly affected at 0.5 M in some cases. This confirms DGT as a sampler suitable for controlled studies of environmental processes affecting pesticides. Field applications of DGT to measure pesticides in situ in waters and controlled laboratory measurements on five different soils (prepared at fixed soil/water ratios) demonstrated DGT is a suitable tool for environmental monitoring in waters and for investigating chemical processes in soils

Characterization of plasma thiol redox potential in a common marmoset model of aging☆

Due to its short lifespan, ease of use and age-related pathologies that mirror those observed in humans, the common marmoset (Callithrix jacchus) is poised to become a standard nonhuman primate model of aging. Blood and extracellular fluid possess two major thiol-dependent redox nodes involving cysteine (Cys), cystine (CySS), glutathione (GSH) and glutathione disulfide (GSSG). Alteration in these plasma redox nodes significantly affects cellular physiology, and oxidation of the plasma Cys/CySS redox potential (EhCySS) is associated with aging and disease risk in humans. The purpose of this study was to determine age-related changes in plasma redox metabolites and corresponding redox potentials (Eh) to further validate the marmoset as a nonhuman primate model of aging. We measured plasma thiol redox states in marmosets and used existing human data with multivariate adaptive regression splines (MARS) to model the relationships between age and redox metabolites. A classification accuracy of 70.2% and an AUC of 0.703 were achieved using the MARS model built from the marmoset redox data to classify the human samples as young or old. These results show that common marmosets provide a useful model for thiol redox biology of aging

Invariance and plasticity in the Drosophila melanogaster metabolomic network in response to temperature

BACKGROUND: Metabolomic responses to extreme thermal stress have recently been investigated in Drosophila melanogaster. However, a network level understanding of metabolomic responses to longer and less drastic temperature changes, which more closely reflect variation in natural ambient temperatures experienced during development and adulthood, is currently lacking. Here we use high-resolution, non-targeted metabolomics to dissect metabolomic changes in D. melanogaster elicited by moderately cool (18°C) or warm (27°C) developmental and adult temperature exposures. RESULTS: We find that temperature at which larvae are reared has a dramatic effect on metabolomic network structure measured in adults. Using network analysis, we are able to identify modules that are highly differentially expressed in response to changing developmental temperature, as well as modules whose correlation structure is strongly preserved across temperature. CONCLUSIONS: Our results suggest that the effect of temperature on the metabolome provides an easily studied and powerful model for understanding the forces that influence invariance and plasticity in biological networks. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12918-014-0139-6) contains supplementary material, which is available to authorized users

Save our surgeons: an ergonomics evaluation of laparoscopic hysterectomy

This paper presents an investigation of ergonomic issues and coping strategies during gynaecological laparoscopic surgery. Data were collected with questionnaires, postural analysis and interviews. The results suggest that work-related musculoskeletal disorders were present in almost 90% of survey respondents. The workplace factors included equipment dimensions, preference of port positioning and patient size with limited adjustability for all surgeons to perform comfortably and effectively. These findings have implications for service provision (availability of surgeons) and patient safety (human interface design)

Human factors evaluation of surgeons’ working positions for gynecologic minimal access surgery

Study Objective: To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients. Design: Mixed methods Design classification: Level III (descriptive and qualitative) Setting: UK Teaching Hospital Patients: Not applicable Interventions: Not applicable Measurements: Survey, observations (anthropometry, postural analysis) and interviews. Results: WRMSD were present in 63% of survey respondents (n=67). The pilot study (n=11) identified contributory factors including workplace layout, equipment design and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average size mannequin and plus size mannequin) but not between patient size groups suggesting that port preference may be driven by surgeon preference (and experience) rather than patient size. Conclusion: Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a work place which supports adaptation to the task, surgeon and patient

Efficacy of increased resistant starch consumption in human type 2 diabetes

Resistant starch (RS) has been shown to beneficially affect insulin sensitivity in healthy individuals and those with metabolic syndrome, but its effects on human type 2 diabetes (T2DM) are unknown. This study aimed to determine the effects of increased RS consumption on insulin sensitivity and glucose control and changes in postprandial metabolites and body fat in T2DM. Seventeen individuals with well-controlled T2DM (HbA1c 46.6±2 mmol/mol) consumed, in a random order, either 40 g of type 2 RS (HAM-RS2) or a placebo, daily for 12 weeks with a 12-week washout period in between. At the end of each intervention period, participants attended for three metabolic investigations: a two-step euglycemic–hyperinsulinemic clamp combined with an infusion of [6,6-2H2] glucose, a meal tolerance test (MTT) with arterio-venous sampling across the forearm, and whole-body imaging. HAM-RS2 resulted in significantly lower postprandial glucose concentrations (P=0.045) and a trend for greater glucose uptake across the forearm muscle (P=0.077); however, there was no effect of HAM-RS2 on hepatic or peripheral insulin sensitivity, or on HbA1c. Fasting non-esterified fatty acid (NEFA) concentrations were significantly lower (P=0.004) and NEFA suppression was greater during the clamp with HAM-RS2 (P=0.001). Fasting triglyceride (TG) concentrations and soleus intramuscular TG concentrations were significantly higher following the consumption of HAM-RS2 (P=0.039 and P=0.027 respectively). Although fasting GLP1 concentrations were significantly lower following HAM-RS2 consumption (P=0.049), postprandial GLP1 excursions during the MTT were significantly greater (P=0.009). HAM-RS2 did not improve tissue insulin sensitivity in well-controlled T2DM, but demonstrated beneficial effects on meal handling, possibly due to higher postprandial GLP1

Biogeochemical processes in the active layer and permafrost of a high Arctic fjord valley

Warming of ground is causing microbial decomposition of previously frozen sedimentary organic carbon in Arctic permafrost. However, the heterogeneity of the permafrost landscape and its hydrological processes result in different biogeochemical processes across relatively small scales, with implications for predicting the timing and magnitude of permafrost carbon emissions. The biogeochemical processes of iron- and sulfate-reduction produce carbon dioxide and suppress methanogenesis. Hence, in this study, the biogeochemical processes occurring in the active layer and permafrost of a high Arctic fjord valley in Svalbard are identified from the geochemical and stable isotope analysis of aqueous and particulate fractions in sediment cores collected from ice-wedge polygons with contrasting water content. In the drier polygons, only a small concentration of organic carbon (<5.40 dry weight%) has accumulated. Sediment cores from these drier polygons have aqueous and solid phase chemistries that imply sulfide oxidation coupled to carbonate and silicate dissolution, leading to high concentrations of aqueous iron and sulfate in the pore water profiles. These results are corroborated by δ34S and δ18O values of sulfate in active layer pore waters, which indicate the oxidative weathering of sedimentary pyrite utilising either oxygen or ferric iron as oxidising agents. Conversely, in the sediments of the consistently water-saturated polygons, which contain a high content of organic carbon (up to 45 dry weight%), the formation of pyrite and siderite occurred via the reduction of iron and sulfate. δ34S and δ18O values of sulfate in active layer pore waters from these water-saturated polygons display a strong positive correlation (R2 = 0.98), supporting the importance of sulfate reduction in removing sulfate from the pore water. The significant contrast in the dominant biogeochemical processes between the water-saturated and drier polygons indicates that small-scale hydrological variability between polygons induces large differences in the concentration of organic carbon and in the cycling of iron and sulfur, with ramifications for the decomposition pathway of organic carbon in permafrost environments

Revealing the importance of groundwater for potable private water supplies in Wales

At least 77,000 people across Wales rely on private water supplies for their drinking water, with 94 % of these supplies dependent on groundwater. Potable private water supplies were mapped to Lower Super Output Area Level, creating the first map of its kind for Wales. Some rural areas report nearly 43 % of properties using private water supplies as their principal source of water. Simplifying the complex geology of Wales into ‘hydrostratigraphic units’ shows that 97 % of private water supplies are sourced from secondary aquifers which have low productivity and storage. Ordovician and Silurian bedrock aquifers and associated Quaternary deposits support nearly 75 % of all private water supplies. The total volume of groundwater abstracted by licensed and unlicensed potable private water supplies across Wales is estimated at 24.6 ML /day. In times of drought many of Wales’ low storage aquifers can experience insufficiency events. During 2018, reports of 132 dry supplies were collated, however we suspect many cases were not reported. In a changing climate with more extreme weather events, and as working from home becomes more common, private water supply users in low-storage and low-permeability aquifers may find themselves at increasing risk of insufficiency events