Informant Personality Is Associated With Ratings of Memory Problems in Older Adults

Memory complaints are a key diagnostic criterion for dementia and Mild Cognitive Impairment. Rating scales can be used to capture information about individuals’ memory problems from informants such as family members. However, problems with scale reliability suggest that individual differences influence the ratings informants provide. This project tested whether informants’ neuroticism was associated with their ratings of an older adult’s memory. In an online study, 293 volunteers completed a Five Factor personality questionnaire and used two memory questionnaires to provide ratings of memory problems in an older individual they knew well. Rater neuroticism correlated positively with estimates of memory problems: more neurotic informants provided higher estimates of memory difficulties in the person they were rating. A second study replicated this finding with 786 volunteers and another widely used memory measure, the AD8. In both studies, exploratory analyses suggested the effect size was large enough to impact on clinical practice

Outcome Assessment of a Dedicated HIV Positive Health Care Worker Clinic at a Central Hospital in Malawi: A Retrospective Observational Study

BACKGROUND: Malawi has one of the world's lowest densities of Health Care Workers (HCW) per capita. This study evaluates outcomes of a dedicated HCW HIV clinic in Malawi, created at Zomba Central Hospital in January 2007. METHODS AND FINDINGS: Retrospective cohort data was analyzed comparing HCW clinic patient baseline characteristics and treatment outcomes at 18 months after inception, against those attending the general HIV clinic. In-depth interviews and focus group discussions were conducted to explore perceptions of patients and caregivers regarding program value, level of awareness and barriers for uptake amongst HCW. 306 patients were enrolled on antiretroviral therapy (ART) in the HCW HIV clinic, 6784 in the general clinic. Significantly (p<0.01) more HCW clients were initiated on ART on the basis of CD4 as opposed to WHO Stage 3/4 (36% vs.23%). Significantly fewer HCW clients defaulted (6% vs.17%), and died (4% vs.12%). The dedicated HCW HIV clinic was perceived as important and convenient in terms of reduced waiting times, and prompt and high quality care. Improved confidentiality was an appreciated quality of the HCW clinic however barriers included fear of being recognized. CONCLUSIONS/SIGNIFICANCE: Outcomes at the HCW clinic appear better compared to the general HIV clinic. The strategy of dedicated clinics to care for health providers is a means of HIV impact mitigation within human resource constrained health systems in high prevalence settings

Ultradeep ATCA imaging of 47 Tucanae reveals a central compact radio source

We present the results of an ultra-deep radio continuum survey, containing ~ 480 hours of observations, of the Galactic globular cluster 47 Tucanae with the Australia Telescope Compact Array. This comprehensive coverage of the cluster allows us to reach RMS noise levels of 1.19 uJY beam -1 at 5.5 GHz, 940 nJy beam-1 at 9 GHz, and 790 nJybeam-1 in a stacked 7.25 GHz image. This is the deepest radio image of a globular cluster, and the deepest image ever made with the Australia Telescope Compact Array. We identify ATCA J002405.702-720452.361, a faint (6.3+1.2uJy at 5.5 GHz, 5.4+0.9uJy at 9 GHz), flat-spectrum (a=-0.31+0.54) radio source that is positionally coincident with the cluster centre and potentially associated with a faint X-ray source. No convincing optical counterpart was identified. We use radio, X-ray, optical, and UV data to show that explanations involving a background active galactic nucleus, a chromospherically active binary, or a binary involving a white dwarf are unlikely. The most plausible explanations are that the source is an undiscovered millisecond pulsar or a weakly accreting black hole. If the X-ray source is associated with the radio source, the fundamental plane of black hole activity suggests a black hole mass of ~54-6000M⊙, indicating an intermediate-mass black hole or a heavy stellar-mass black hole

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.Five UK private sector care homes.41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.Problems addressed and changes in medicines prescribed.Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.ISRCTN 48133332

Genomic reconstruction of the SARS-CoV-2 epidemic in England.

The evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus leads to new variants that warrant timely epidemiological characterization. Here we use the dense genomic surveillance data generated by the COVID-19 Genomics UK Consortium to reconstruct the dynamics of 71 different lineages in each of 315 English local authorities between September 2020 and June 2021. This analysis reveals a series of subepidemics that peaked in early autumn 2020, followed by a jump in transmissibility of the B.1.1.7/Alpha lineage. The Alpha variant grew when other lineages declined during the second national lockdown and regionally tiered restrictions between November and December 2020. A third more stringent national lockdown suppressed the Alpha variant and eliminated nearly all other lineages in early 2021. Yet a series of variants (most of which contained the spike E484K mutation) defied these trends and persisted at moderately increasing proportions. However, by accounting for sustained introductions, we found that the transmissibility of these variants is unlikely to have exceeded the transmissibility of the Alpha variant. Finally, B.1.617.2/Delta was repeatedly introduced in England and grew rapidly in early summer 2021, constituting approximately 98% of sampled SARS-CoV-2 genomes on 26 June 2021