Effectiveness of exercise interventions for adults over 65 with moderate-to-severe dementia in community settings: a systematic review

PurposeTo conduct a systematic review of the literature to evaluate the effectiveness of exercise interventions for people with moderate-to-severe dementia in community settings.MethodsEight electronic databases (MEDLINE, Embase, CINAHL, AMED, PsycINFO, PEDro, The Cochrane Library and BNI) were searched from inception to July 2018. Snowball searching identified additional articles not identified initially. Articles were included if they: reported randomised or quasi-randomised controlled trials comparing exercise with usual care or no treatment; and involved people over 65 with moderate-to-severe dementia in community settings. Outcome measures of interest were strength, endurance, mobility, mood and quality of life. Titles and abstracts of all studies were screened by one reviewer. Two reviewers independently screened full text articles for all eligible studies, extracted data and assessed quality and risk of bias.ResultsEight studies with 819 participants were included. Interventions were variable in terms of content, duration and frequency. There was some evidence exercise programmes may improve physical function of people with moderate-to-severe dementia, with significant effects seen for gait speed and endurance, and a trend towards improvement in strength. There was little evidence to suggest exercise programmes improve mood. Most studies were of low quality.ConclusionExercise was associated with improvements in gait speed and endurance for older people with moderate-to-severe dementia living in the community, but the quality of evidence was low. There was no conclusive evidence regarding effect on strength or mood. Findings are limited by the quality of the available evidence

Governing the souls of young women: exploring the perspectives of mothers on parenting in the age of sexualisation

The sexualisation of young women has emerged as a growing concern within contemporary western cultures. This has provoked adult anxieties that young women are growing up too fast by adopting inappropriate sexual practices and subjectivies. Psychological discourses have dominated which position sexualisation as a corrupting force that infects the ‘true self’ of young women, so they develop in abnormal ways. This in turn allows psychological practices to govern how to parent against sexualisation within families. To explore this further, six mothers each with daughters aged between eight and twelve years old took part in one to one semi-structured interviews designed to explore how they conceptualised and parented against the early sexualisation of young women. A Foucauldian inspired discourse analysis was employed, which suggested that the mothers talk was situated within a psychological discourse. This enabled sexualisation to be positioned as a corrupting force that disrupted the natural development of young women through deviant bodily practices (e.g. consuming sexualised goods), which prevented them from becoming their ‘true self’. Through the disciplinary gaze of psychology, class inequalities were reproduced where working class families were construed as ‘chavs’ who were bad parents and a site of contagion for sexualisatio

The format of children's mental images: Evidence from mental scanning.

This study examined the development and format of children's mental images. Children (4-, 5-, 6-7-, 8-9-, and 11-year-olds) and adults (N=282) viewed a map of a fictitious island containing various landmarks and two misleading signposts, indicating that some equidistant landmarks were different distances apart. Five-year-olds already revealed the linear time-distance scanning effect, previously shown in adults (Experiments 1 and 2): They took longer to mentally scan their image of the island with longer distances between corresponding landmarks, indicating the depictive format of children's mental images. Unlike adults, their scanning times were not affected by misleading top-down distance information on the signposts until age 8 (Experiment 1) unless they were prompted to the difference from the outset (Experiment 2). Findings provide novel insights into the format of children's mental images in a mental scanning paradigm and show that children's mental images can be susceptible to top-down influences as are adults'

The format of children’s mental images: Penetrability of spatial images

To investigate the format of mental images and the penetrability of mental imagery performance to top-down influences in the form of gravity information, children (4-, 6-, 8- and 10-year-olds) and adults (N = 112) performed mental rotation tasks. A linear increase in response time with rotation angle emerged at 6-years, suggesting that spatial properties are represented in children’s mental images. Moreover, 6-, 8-, and 10-year-olds, but not 4-year-olds or adults, took longer to respond to rotated stimuli pairs when gravity information was incongruent with the direction of rotation rather than congruent. Overall, findings suggest that in contrast to adults’, 6- to 10-year-olds’ mental rotation performance was penetrated by top-down information. This research (a) provides insight into the format of young children’s mental images and (b) shows that children’s mental rotation performance is penetrable by top-down influences

How Visuo-Spatial Mental Imagery Develops: Image Generation and Maintenance

Two experiments examined the nature of visuo-spatial mental imagery generation and maintenance in 4-, 6-, 8-, 10-year old children and adults (N = 211). The key questions were how image generation and maintenance develop (Experiment 1) and how accurately children and adults coordinate mental and visually perceived images (Experiment 2). Experiment 1 indicated that basic image generation and maintenance abilities are present at 4 years of age but the precision with which images are generated and maintained improves particularly between 4 and 8 years. In addition to increased precision, Experiment 2 demonstrated that generated and maintained mental images become increasingly similar to visually perceived objects. Altogether, findings suggest that for simple tasks demanding image generation and maintenance, children attain adult-like precision younger than previously reported. This research also sheds new light on the ability to coordinate mental images with visual images in children and adults

Sept8/SEPTIN8 involvement in cellular structure and kidney damage is identified by genetic mapping and a novel human tubule hypoxic model.

Chronic kidney disease (CKD), which can ultimately progress to kidney failure, is influenced by genetics and the environment. Genes identified in human genome wide association studies (GWAS) explain only a small proportion of the heritable variation and lack functional validation, indicating the need for additional model systems. Outbred heterogeneous stock (HS) rats have been used for genetic fine-mapping of complex traits, but have not previously been used for CKD traits. We performed GWAS for urinary protein excretion (UPE) and CKD related serum biochemistries in 245 male HS rats. Quantitative trait loci (QTL) were identified using a linear mixed effect model that tested for association with imputed genotypes. Candidate genes were identified using bioinformatics tools and targeted RNAseq followed by testing in a novel in vitro model of human tubule, hypoxia-induced damage. We identified two QTL for UPE and five for serum biochemistries. Protein modeling identified a missense variant within Septin 8 (Sept8) as a candidate for UPE. Sept8/SEPTIN8 expression increased in HS rats with elevated UPE and tubulointerstitial injury and in the in vitro hypoxia model. SEPTIN8 is detected within proximal tubule cells in human kidney samples and localizes with acetyl-alpha tubulin in the culture system. After hypoxia, SEPTIN8 staining becomes diffuse and appears to relocalize with actin. These data suggest a role of SEPTIN8 in cellular organization and structure in response to environmental stress. This study demonstrates that integration of a rat genetic model with an environmentally induced tubule damage system identifies Sept8/SEPTIN8 and informs novel aspects of the complex gene by environmental interactions contributing to CKD risk

Satellite-based emergency mapping using optical imagery: experience and reflections from the 2015 Nepal earthquakes

Landslides triggered by large earthquakes in mountainous regions contribute significantly to overall earthquake losses and pose a major secondary hazard that can persist for months or years. While scientific investigations of coseismic landsliding are increasingly common, there is no protocol for rapid (hours-to-days) humanitarian-facing landslide assessment and no published recognition of what is possible and what is useful to compile immediately after the event. Drawing on the 2015 Mw 7.8 Gorkha earthquake in Nepal, we consider how quickly a landslide assessment based upon manual satellite-based emergency mapping (SEM) can be realistically achieved and review the decisions taken by analysts to ascertain the timeliness and type of useful information that can be generated. We find that, at present, many forms of landslide assessment are too slow to generate relative to the speed of a humanitarian response, despite increasingly rapid access to high-quality imagery. Importantly, the value of information on landslides evolves rapidly as a disaster response develops, so identifying the purpose, timescales, and end users of a post-earthquake landslide assessment is essential to inform the approach taken. It is clear that discussions are needed on the form and timing of landslide assessments, and how best to present and share this information, before rather than after an earthquake strikes. In this paper, we share the lessons learned from the Gorkha earthquake, with the aim of informing the approach taken by scientists to understand the evolving landslide hazard in future events and the expectations of the humanitarian community involved in disaster response. Please read the corrigendum first before accessing the articl

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

A decade of stability for wMel Wolbachia in natural Aedes aegypti populations

Mosquitoes carrying Wolbachia endosymbionts are being released in many countries for arbovirus control. The wMel strain of Wolbachia blocks Aedes-borne virus transmission and can spread throughout mosquito populations by inducing cytoplasmic incompatibility. Aedes aegypti mosquitoes carrying wMel were first released into the field in Cairns, Australia, over a decade ago, and with wider releases have resulted in the near elimination of local dengue transmission. The long-term stability of Wolbachia effects is critical for ongoing disease suppression, requiring tracking of phenotypic and genomic changes in Wolbachia infections following releases. We used a combination of field surveys, phenotypic assessments, and Wolbachia genome sequencing to show that wMel has remained stable in its effects for up to a decade in Australian Ae. aegypti populations. Phenotypic comparisons of wMel-infected and uninfected mosquitoes from near-field and long-term laboratory populations suggest limited changes in the effects of wMel on mosquito fitness. Treating mosquitoes with antibiotics used to cure the wMel infection had limited effects on fitness in the next generation, supporting the use of tetracycline for generating uninfected mosquitoes without off-target effects. wMel has a temporally stable within-host density and continues to induce complete cytoplasmic incompatibility. A comparison of wMel genomes from pre-release (2010) and nine years post-release (2020) populations show few genomic differences and little divergence between release locations, consistent with the lack of phenotypic changes. These results indicate that releases of Wolbachia-infected mosquitoes for population replacement are likely to be effective for many years, but ongoing monitoring remains important to track potential evolutionary changes