(Un)blurred lines? Sex, disability, and the dynamic boundaries of mental capacity law

In this article, we consider the approach to decisions regarding capacity and sexual relations in the Court of Protection in England and Wales, and the boundaries drawn through its application of the Mental Capacity Act 2005 (MCA). We discuss recent developments in the law following the UK Supreme Court case A Local Authority v JB [2021] UKSC 52, which recast how capacity in relation to sexual relations ought to be assessed. Noting that this case has been warmly received by some feminist theorists for the centrality it affords to mutual consent, we draw on critical approaches from feminist, Black feminist, and disability scholarship, to call attention to the legal techniques and judicial reasoning in this case and the ways in which this embeds problematic norms and reinforces the marginalisation of disabled people. We call attention to the impoverished notions of equality advanced in the case and the assumptions that this appears to rely upon which obscure the realities and histories of legal intervention in disabled people's lives. We further argue that the approach in sexual relations cases appears to use capacity determinations as a vehicle to supplement gaps left by the criminal law, blurring their distinct rationalities and enabling further opportunities for control. We suggest that important insights can be gained from bringing these critical perspectives into conversation, including unsettling assumptions contained in the judgment and in mental capacity scholarship more broadly, manoeuvring us out of the perceived intractability of legal reasoning in this context, and offering productive ways forward

Decreased Epidermal Lipid Synthesis Accounts for Altered Barrier Function in Aged Mice

The epidermis of aged mice displays decreased stratum corneum (SC) lipid content and decreased extracellular bilayers, which result in impaired barrier recovery following the solvent treatment or tape stripping. We assessed the role of altered lipid synthesis as the cause of the abnormal barrier and lipid content in aged epidermis, both under basal conditions and in response to acute barrier perturbations. In aged epidermis (≥18months), synthesis of one of the three key lipid classes (cholesterol) is decreased under basal conditions, and sterologenesis fails to attain the levels reached in young epidermis following comparable acute perturbations. In contrast, fatty acid and sphingolipid synthesis in aged epidermis increase sufficiently to approach the levels attained in stimulated young epidermis. The abnormalities in sterologenesis in aged epidermis are paralleled by a decrease in activity of its rate-limiting enzyme, 3-hydroxy-3-methylglutaryl-coenzyme A reductase, under basal conditions, and enzyme activity also fails to increase as much as in young epidermis after barrier disruption. That defective lipid generation contributes to the barrier defect is shown directly by the ability of either a cholesterol-containing mixture of SC lipids or cholesterol alone to enhance barrier recovery. Finally, lipid-induced acceleration of barrier recovery in aged epidermis correlates with repletion of the extracellular spaces with normal lamellar structures. Thus, a deficiency in lipid synthesis, particularly in cholesterologenesis, accounts for the barrier abnormality in aged epidermis

MicroRNA-dependent regulation of Hox gene expression sculpts fine-grain morphological patterns in a Drosophila appendage

Disruptions of normal Hox gene expression can lead to severe morphological defects revealing a link between the regulation of Hox expression and pattern formation. Here we explore these links focusing on the impact of microRNA regulation on the expression of the Drosophila Hox gene Ultrabithorax (Ubx) during haltere development. Through the combination of bioinformatic and transcriptomic analyses we identify the miR-310/313 cluster (miR-310C) as a candidate regulator of Ubx. Several experiments confirm this. First, miR-310C and Ubx protein show complementary expression patterns in haltere imaginal discs; second, artificial activation of miR-310C expression in haltere discs leads to Ubx-like phenotypes. Third, expression of a fluorescent reporter bearing Ubx 3'UTR sequences is reduced when co-expressed with miR-310C Fourth, deletion of miR-310C leads to Ubx upregulation and changes the array of mechanosensory sensilla at the base of the haltere. Fifth, artificial increase of Ubx levels within the miR-310C expression domain phenocopies the mechanosensory defects observed in miR-310C mutants. We propose that miR-310C-mediated repression delimits Ubx fine-grain expression contributing to the sculpting of complex morphologies in the Drosophila haltere. Our work reveals a novel role of microRNA regulation in the control of Hox gene expression with impact on morphology

Unsafe care in residential settings for older adults. A content analysis of accreditation reports.

Background Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against national standards every year. From these assessments, the ACQSC generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory and service levels. Methods An analytical framework was developed based on the World Health Organization’s International Classification for Patient Safety (ICPS) and other fields including Clinical Issue (the issue related to the incident impacting on the resident e.g., wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted and a content analysis undertaken using the analytical framework. Clinical Issue and the ICPS-based classification were combined to describe a clinically intuitive category (“Safety Risks”) to describe ways in which residents could experience unsafe care e.g., diagnosis/assessment of pain. The resulting data were descriptively analysed. Results The analysis included 65 Site Audit Reports that were undertaken between September 2020 – March 2021. There were 2,267 incidents classified into 274 types of resident Safety Risks. The twelve most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, falls; and multiple stages of wounds/skin management e.g., diagnosis/assessment, documentation, treatment, and deterioration. Conclusion The analysis has shown that accreditation reports contain valuable data that may inform prioritisation of resident Safety Risks in the Australian residential aged care sector. A large number of low frequency resident Safety Risks were detected in the accreditation reports. To address these, organisations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces’ clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management

Asthma in the elderly: what we know and what we have yet to know

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients

Development and validation of the multi-dimensional questionnaire of scientifically unsubstantiated beliefs

Objective: There are several existing questionnaires measuring paranormal or scientifically unsubstantiated beliefs but none cover a broad spectrum of cognitions while also being up-to-date and unconstrained by theoretical limitations. There is also a debate about the number of separate types of belief. Thereby, reported here is the development and validation of a new multidimensional questionnaire measure of scientifically unsubstantiated beliefs in the general UK population. Method & Results. In Study 1, participants (N=393) completed a questionnaire containing a pool of 82 items covering nine facets of belief discernible conceptually within the existing research literature. Scree analysis followed by exploratory factor analysis indicated the existence of four empirically observable factors: belief in supernatural forces; belief in God and destiny; belief in alien visitation, monsters and conspiracies; and belief in consciousness beyond the body. Twenty-four items were selected as measures of these factors. Studies 2, 3 and 4 demonstrated the convergent and divergent validity of the four empirically-derived questionnaire subscales and their internal reliability. Conclusion. The resultant new Multi-dimensional Questionnaire of Scientifically Unsubstantiated Beliefs (MQSUB) is a psychometrically robust measure and comprises a comprehensive framework which can be used to systematically investigate the psychological and social concomitants of such beliefs

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

Background: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. Methods: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. Results: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. Conclusions: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts