Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community:a mixed studies review

BACKGROUND: Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. METHODS: A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). RESULTS: Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. CONCLUSIONS: This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes

Domestic Water Demand During Droughts in Temperate Climates: Synthesising Evidence for an Integrated Framework

In the upcoming years, as the population is growing and ageing, as lifestyle changes create the need for more water and as fewer people live in each household, the UK water sector will have to deal with challenges in the provision of adequate water services. Unless critical action is taken, every area in the UK may face a supply-demand gap by the 2080s. Extreme weather events and variations that alter drought and flood frequency add to these pressures. However, little evidence is available about householders’ response to drought and there are few if any studies incorporating this evidence into models of demand forecasting. The present work lays the groundwork for modelling domestic water demand response under drought conditions in temperate climates. After discussing the current literature on estimating and forecasting domestic water consumption under both ‘normal’ and drought conditions, this paper identifies the limited ability of current domestic demand forecasting techniques to include the many different and evolving factors affecting domestic consumption and it stresses the need for the inclusion of inter and intra household factors as well as water use practices in future demand forecasting models

Receptors for Hyaluronic Acid and Poliovirus: A Combinatorial Role in Glioma Invasion?

Background: CD44 has long been associated with glioma invasion while, more recently, CD155 has been implicated in playing a similar role. Notably, these two receptors have been shown closely positioned on monocytes. Methods and Findings: In this study, an up-regulation of CD44 and CD155 was demonstrated in established and earlypassage cultures of glioblastoma. Total internal reflected fluorescence (TIRF) microscopy revealed close proximity of CD44 and CD155. CD44 antibody blocking and gene silencing (via siRNA) resulted in greater inhibition of invasion than that for CD155. Combined interference resulted in 86 % inhibition of invasion, although in these investigations no obvious evidence of synergy between CD44 and CD155 in curbing invasion was shown. Both siRNA-CD44 and siRNA-CD155 treated cells lacked processes and were rounder, while live cell imaging showed reduced motility rate compared to wild type cells. Adhesion assay demonstrated that wild type cells adhered most efficiently to laminin, whereas siRNA-treated cells (p,0.0001 for both CD44 and CD155 expression) showed decreased adhesion on several ECMs investigated. BrdU assay showed a higher proliferation of siRNA-CD44 and siRNA-CD155 cells, inversely correlated with reduced invasion. Confocal microscopy revealed overlapping of CD155 and integrins (b1, avb1 and avb3) on glioblastoma cell processes whereas siRNAtransfected cells showed consequent reduction in integrin expression with no specific staining patterns. Reduced expression of Rho GTPases, Cdc42, Rac1/2/3, RhoA and RhoB, was seen in siRNA-CD44 and siRNA-CD155 cells. In contrast t

Multi-minicore Disease

Multi-minicore Disease (MmD) is a recessively inherited neuromuscular disorder characterized by multiple cores on muscle biopsy and clinical features of a congenital myopathy. Prevalence is unknown. Marked clinical variability corresponds to genetic heterogeneity: the most instantly recognizable classic phenotype characterized by spinal rigidity, early scoliosis and respiratory impairment is due to recessive mutations in the selenoprotein N (SEPN1) gene, whereas recessive mutations in the skeletal muscle ryanodine receptor (RYR1) gene have been associated with a wider range of clinical features comprising external ophthalmoplegia, distal weakness and wasting or predominant hip girdle involvement resembling central core disease (CCD). In the latter forms, there may also be a histopathologic continuum with CCD due to dominant RYR1 mutations, reflecting the common genetic background. Pathogenetic mechanisms of RYR1-related MmD are currently not well understood, but likely to involve altered excitability and/or changes in calcium homeoestasis; calcium-binding motifs within the selenoprotein N protein also suggest a possible role in calcium handling. The diagnosis of MmD is based on the presence of suggestive clinical features and multiple cores on muscle biopsy; muscle MRI may aid genetic testing as patterns of selective muscle involvement are distinct depending on the genetic background. Mutational analysis of the RYR1 or the SEPN1 gene may provide genetic confirmation of the diagnosis. Management is mainly supportive and has to address the risk of marked respiratory impairment in SEPN1-related MmD and the possibility of malignant hyperthermia susceptibility in RYR1-related forms. In the majority of patients, weakness is static or only slowly progressive, with the degree of respiratory impairment being the most important prognostic factor

A Glial Variant of the Vesicular Monoamine Transporter Is Required To Store Histamine in the Drosophila Visual System

Unlike other monoamine neurotransmitters, the mechanism by which the brain's histamine content is regulated remains unclear. In mammals, vesicular monoamine transporters (VMATs) are expressed exclusively in neurons and mediate the storage of histamine and other monoamines. We have studied the visual system of Drosophila melanogaster in which histamine is the primary neurotransmitter released from photoreceptor cells. We report here that a novel mRNA splice variant of Drosophila VMAT (DVMAT-B) is expressed not in neurons but rather in a small subset of glia in the lamina of the fly's optic lobe. Histamine contents are reduced by mutation of dVMAT, but can be partially restored by specifically expressing DVMAT-B in glia. Our results suggest a novel role for a monoamine transporter in glia that may be relevant to histamine homeostasis in other systems

Dinosaurs, But Not Only: Vertebrate Evolution in the Mesozoic

If we imagine walking through Mesozoic lands, we would be able to observe vertebrates with peculiar combinations of morphological traits, some of which would seem to be intermediary to animals seen today. We would witness a terrestrial vertebrate fauna dominated by dinosaurs of various sizes and diversity, accompanied by many other animal groups that often are overlooked. Current research suggests that many of the main vertebrate clades existing today originated or diversified sometime in the Triassic or Early to Middle Jurassic. Herein, we profile some of the major transformations in both terrestrial and aquatic vertebrate evolution during the Mesozoic. We highlight: the appearance of features that allowed sauropod dinosaurs to become the largest animals to ever walk on Earth’s continents, the appearance of herbivory among the usually carnivorous theropod dinosaurs, and we follow the specific changes that led to the evolution of avian flight. Our Mesozoic tour across the globe will allow us to see how different evolutionary forces led to convergent shifts to quadrupedality in ornithischian dinosaurs and to an aquatic lifestyle in turtles, crocodiles, and plesiosaurs. Last, but not least, we examine changes in the Mesozoic fauna linked to the rise of mammals, and the diversification patterns in several clades of fishes after the End-Permian Mass Extinction