A model for pediatric neurocognitive interventions: considering the role of development and maturation in rehabilitation planning.

PublishedJournal ArticleThe need for post-acute neurorehabilitation after childhood acquired brain injury is increasingly recognized but recent reviews highlight the limited evidence-base and lack of a neuropsychological treatment model. Evidence from different fields was reviewed to inform the development of a pediatric neurocognitive interventions (PNI) model. The review included literature from child neuropsychology, adult neuropsychology, cognitive neuroscience, learning disabilities, education, and mental health. The resulting PNI model provides a systematic approach to delivering and evaluating appropriate care while minimizing the obstacles to successful outcomes. The model emphasizes the role of development and cognitive maturation in the planning of rehabilitation. Areas that represent significant gaps in our knowledge are discussed and future research directions are suggested based on predictions generated by the proposed model

Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE): study protocol for a single-arm feasibility study.

Background: Increases in life expectancy have resulted in a global rise in dementia prevalence. Dementia is associated with poor wellbeing, low quality of life and increased incidence of mental health difficulties such as, low mood or depression. However, currently there is limited access to evidence-based psychological interventions for people with dementia experiencing low mood and poor wellbeing. Behavioural activation-based self-help, supported by informal carers and guided by mental health professionals, may represent an effective and acceptable solution. Methods/design: The present study is a Phase II (feasibility) single-arm trial informed by the MRC Complex Interventions Research Methods Framework. Up to fifty dementia participant/informal carer dyads will be recruited from a variety of settings including primary care, dementia-specific health settings, and community outreach. People living with dementia will receive behavioural activation based self-help and be supported by their informal carer who has received training in the skills required to support the self-help approach. In turn, during the use of the intervention the informal carer will be guided by mental health professionals to help them work through the materials and problem solve any difficulties. Consistent with the objectives of feasibility studies, outcomes relating to recruitment from different settings, employment of different recruitment methods, attrition, data collection procedures, clinical delivery and acceptability of the intervention will be examined. Clinical outcomes for people with dementia (symptoms of depression and quality of life) and informal carers (symptoms of depression and anxiety, carer burden and quality of life) will be measured pretreatment and at 3 months post-treatment allocation. Discussion: This study will examine the feasibility and acceptability of a novel behavioural activation-based self-help intervention designed to promote wellbeing and improve low mood in people living with dementia, alongside methodological and procedural uncertainties associated with research-related procedures. As determined by pre-specified progression criteria, if research procedures and the new intervention demonstrate feasibility and acceptability, results will then be used to inform the design of a pilot randomised controlled trial (RCT) to specifically examine remaining methodological uncertainties associated with recruitment into a randomised controlled design.This study is collaboratively funded by Cornwall Foundation Partnership Trust, South West Peninsula Academic Health Sciences Network and the University of Exeter

Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies: A National Registry Dataset Analysis

Background: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. Objectives: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. Methods: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. Results: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. Conclusions: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes

Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies: A National Registry Dataset Analysis.

BACKGROUND: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. OBJECTIVES: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. METHODS: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. RESULTS: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. CONCLUSIONS: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes

Equivalence problem for the orthogonal webs on the sphere

We solve the equivalence problem for the orthogonally separable webs on the three-sphere under the action of the isometry group. This continues a classical project initiated by Olevsky in which he solved the corresponding canonical forms problem. The solution to the equivalence problem together with the results by Olevsky forms a complete solution to the problem of orthogonal separation of variables to the Hamilton-Jacobi equation defined on the three-sphere via orthogonal separation of variables. It is based on invariant properties of the characteristic Killing two-tensors in addition to properties of the corresponding algebraic curvature tensor and the associated Ricci tensor. The result is illustrated by a non-trivial application to a natural Hamiltonian defined on the three-sphere.Comment: 32 page

A comparison of food portion size estimation by older adults, young adults and nutritionists

Objectives To investigate the ability of older adults, younger adults and nutritionists to assess portion size using traditional methods versus a computer-based method. This was to inform the development of a novel dietary assessment method for older adults “The NANA system”. Design Older and younger adults assessed the portion size of self-served portions of foods from a buffet style set up using traditional and computerised portion size assessment aids. Nutritionists assessed the portion size of foods from digital photographs using computerised portion size aids. These estimates were compared to known weights of foods using univariate analyses of covariance (ANCOVA). Setting The University of Sheffield, United Kingdom. Subjects Forty older adults (aged 65 years and over), 41 younger adults (aged between 18 and 40 years) and 25 nutritionists. Results There was little difference in the abilities of older and younger adults to assess portion size using both assessment aids with the exception of small pieces morphology. Even though the methods were not directly comparable among the test groups, there was less variability in portion size estimates made by the nutritionists. Conclusion Older adults and younger adults are similar in their ability to assess food portion size and demonstrate wide variability of estimation compared to the ability of nutritionists to estimate portion size from photographs. The results suggest that the use of photographs of meals consumed for portion size assessment by a nutritionist may improve the accuracy of dietary assessment. Improved portion size assessment aids are required for all age groups

Acceptability and feasibility of collecting psychosocial data from fathers of very low birth weight infants

The aim of this study was to determine the feasibility and acceptability of collecting outcome data from parents of very low birth weight infants, and to explore the psychological and social adaptation of fathers. Questionnaires were distributed to 38 parents of very low birth weight infants and 36 parents of term infants within a hospital Neonatal Intensive Care Unit. Field notes were also taken. Parents indicated collecting outcome data in this population was feasible and acceptable, but barriers and difficulties in data collection were identified, particularly for fathers. Furthermore, parents highlighted a lack of emotional support for fathers. In conclusion, research with parents of very low birth weight infants should happen with consultation, flexibility, and measures designed specifically for this population