A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

Biocompatibility of an implantable ophthalmic drug delivery device

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2007.Includes bibliographical references (p. 90-94).Diseases of the posterior eye present clinicians with a treatment challenge mainly due to the region's inaccessible location. Several drugs, including those available for the treatment of exudative age-related macular degeneration, are currently delivered by periodic injection into the eyeball. To avoid the risks and complications associated with this method, several implantable, timed release devices have been investigated to deliver these drugs directly to affected areas. Draper Laboratory and Massachusetts Eye and Ear Infirmary have proposed an implantable, fully programmable, mechanical device for long-term drug delivery to the eye wall. To investigate the biocompatibility of this solution, test devices containing gears or a ball bearing were designed to mimic elements of its moving parts, geometry and materials. Cell culture studies identified a polytetrafluoroethylene filter with 100m pores as a promising addition to seal devices from interaction with fibroblasts. Test devices with or without this membrane were implanted on the rabbit eye for 2 or 10 week periods. They were evaluated mechanically after implant, and surrounding tissues were inspected histologically. Gross observation revealed a significant amount of tissue formation around the devices, especially in the conjunctiva.(cont.) Devices had to be cut away from the eye surface, and there was a significant amount of tissue inside the gear devices. Notably less tissue surrounded and invaded the ball bearing devices. Histological evaluation identified the invading tissue as fibrotic at both time points, though significantly more was seen at longer implant times. Eye wall tissue was typically unharmed during implant, though an additional layer of fibrosis between the eye and the device was common. Mechanical testing of long-term gear devices after implant revealed a 1000 fold increase in torque required to turn the elements, but long-term ball bearing devices were significantly less affected (100 fold increase). Torque also increased in devices with membrane covers, due to similar fibrosis. However, in these implants, tissue was forced to enter through only the 0.002in. openings around the base of the devices. Biocompatibility for this device may best be achieved by minimizing the amount of relative micro motion allowed between the device and the eye and by sealing all openings with a porous polytetrafluoroethylene filter.by Sarah J. Cohen.S.M

Preliminary indications of the effect of a brief yoga intervention on markers of inflammation and DNA methylation in chronically stressed women

© The Author(s) 2016. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if thematerial is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material.Yoga is associated with reduced stress and increased well-being, although the molecular basis for these benefits is not clear. Mounting evidence implicates the immune response, with current studies focused on protein immune markers (such as cytokines) in clinical populations. To explore the molecular impact, this pilot study uses a subsample (n = 28) from a randomised waitlist control trial Investigating the impact of an 8-week yoga intervention in a community population of women reporting psychological distress (N = 116). We measured interleukin-6 (IL-6), tumour necrosis factor (TNF) and C-reactive protein (CRP) protein levels, and the DNA methylation of these genes and the global indicator, LINE-1. Correlations between these and psychological variables were explored, identifying moderate correlations with CRP protein levels, and methylation of IL-6, CRP and LINE-1. Many cytokine samples were below detection, however a Mann–Whitney U demonstrated a trend of moderate between-group effect for elevated IL-6 in the yoga group. Methylation analyses applied cross-sectional and non-controlled longitudinal analyses. Waist-to-height ratio and age were covaried. We demonstrated reduced methylation of the TNF region in the yoga group relative to the waitlist control group. No other genes demonstrated a significant difference. Longitudinal analysis further supported these results. This study is one of the first to explore yoga and immunological markers in a non-clinical population, and is the first study to explore DNA methylation. These findings indicate that further research into molecular impact of yoga on markers of immune function is warranted, with larger studies required

Gender equality in climate policy and practice hindered by assumptions

Gender has a powerful influence on people’s experience of, and resilience to, climate change. Global climate change policy is committed to tackling gender inequalities in mitigation and adaptation. However, progress is hindered by numerous challenges, including an enduring set of gender assumptions: women are caring and connected to the environment, women are a homogenous and vulnerable group, gender equality is a women’s issue and gender equality is a numbers game. We provide an overview of how these assumptions essentialize women’s and men’s characteristics, narrowly diagnose the causes of gender inequality, and thereby propel strategies that have unintended and even counterproductive consequences. We offer four suggestions for a more informed pursuit of gender equality in climate change policy and practice

New risks and opportunities for food security: scenario analyses for 2015 and 2050

"Given the number of undernourished people in the developing world and the increasingly complex risks to food security, policymakers are faced with an enormous agenda. Freeing people from hunger will require more and better-targeted investments, innovations, and policy actions, driven by a keen understanding of the dynamic risks and forces that shape the factors affecting people's access to food and the links with nutrition. The International Food Policy Research Institute's (IFPRI's) International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT) provides insight into the management of these risks through appropriate policy actions. By projecting future global food scenarios to 2050, IMPACT explores the potential implications of policy action and inaction in several main risk areas as well as the effects on child malnutrition in the developing world, commodity prices, demand, cereal yields, production, and net trade. In the progressive policy actions scenario, which assumes increased investment in rural development, health, education, and agricultural research and development, developing country governments and the international community are able to dramatically reduce the number of food-insecure people, leading to a worldwide decline in hunger. Under these conditions, Latin America and China are able to virtually eliminate child malnutrition by 2050. Bolstered by the development and dissemination of improved technologies and better infrastructure, crop production and yields increase in developing countries. Notably, the bulk of the growth in production is driven by yield increases rather than by expanding land area. Spurred by growth in the agricultural sector, average incomes in developing countries increase. Rising incomes bolster demand for high-value agricultural products, such as meat, dairy, and fruits and vegetables; global livestock production more than doubles, for example. Average per capita calorie supplies for developing countries exceed 3,400 per day, well in excess of minimum requirements. The policy failure scenario assumes greater political discord and more extensive agricultural protectionism, together with the failure of policies to deal with food emergencies related to conflict. Slow growth and trade restrictions lead to stagnation in average per capita calorie availability, which remains only slightly above minimum requirements until after 2030, when availability increases. In addition, crucial investments in agriculture, rural development, and poverty reduction are forgone or displaced. Because of limited investment in agricultural research and technology, this scenario has a high level of crop area expansion as a result of relatively rapid population growth and slim yield improvements in developing countries. This scenario also results in flat maize prices, declining per capita cereal demand, falling beef prices, and relatively flat meat demand. As a result of the policies in this scenario, the number of malnourished children in developing countries rises between 1997 and 2015, after which there are only modest declines. In the technology and natural resource management failure scenario, yield growth falls even more than under the preceding scenario, forcing farmers to move into marginal producing areas, which causes a more rapid expansion of cereal area into less productive land that does not compensate for the yield shortfalls (and causes environmental degradation). As a result, cereal prices rise substantially through 2030 and then fall off only gradually. Beef and other meat prices, which are affected by the price of feed, follow a similar pattern. Developing-country per capita calorie availability is essentially unchanged over 1997–2050 and remains at a barely adequate average level. Given unequal access to the food that is available, millions of people actually consume less than the minimum. The occurrence of child undernourishment is even higher than under the policy failure scenario in all developing-country regions. Overall, the technology and natural resource management failure scenario results in the worst impact on food security and child malnourishment in the developing world. The progressive policy scenario outlines several of the most crucial positive steps. National governments and the international community must assume a new focus on agricultural growth and rural development, along with increasing their investments in education, social services, and health. Policies to encourage synergistic growth in the nonfarm sectors are also needed to spur broad-based economic growth. Underpinning these strategies and research agendas must be a firm commitment to reducing hunger and improving the welfare of the world's undernourished people." From Authors' Executive SummaryImpact model, Caloric intake, Safety nets,

Tinker, tailor or transform: gender equality amidst social-ecological change

Global visions of environmental change consider gender equality to be a foundation of sustainable social-ecological systems. Similarly, social-ecological systems frameworks position gender equality as both a precursor to, and a product of, system sustainability. Yet, the degree to which gender equality is being advanced through social-ecological systems change is uncertain. We use the case of small-scale fisheries in the Pacific Islands region to explore the proposition that different social-ecological narratives: (1) ecological, (2) social-ecological, and (3) social, shape the gender equality priorities, intentions and impacts of implementing organizations. We conducted interviews with regional and national fisheries experts (n = 71) and analyzed gender commitments made within policies (n = 29) that influence small-scale fisheries. To explore these data, we developed a 'Tinker-Tailor-Transform' gender assessment typology. We find that implementing organizations aligned with the social-ecological and social narratives considered social (i.e., human-centric) goals to be equally or more important than ecological (i.e., eco-centric) goals. Yet in action, gender equality was pursued instrumentally to achieve ecological goals and/or shallow project performance targets. These results highlight that although commitments to gender equality were common, when operationalized commitments become diluted and reoriented. Across all three narratives, organizations mostly 'Tinkered' with gender equality in impact, for example, including more women in spaces that otherwise tended to be dominated by men. Impacts predominately focused on the individual (i.e., changing women) rather than driving communal-to-societal level change. We discuss three interrelated opportunities for organizations in applying the 'Tinker-Tailor-Transform' assessment typology, including its utility to assist organizations to orient toward intrinsic goals; challenge or reconfigure system attributes that perpetuate gender inequalities; and consciously interrogate discursive positions and beliefs to unsettle habituated policies, initiatives and theories of change

Antimicrobial treatment improves mycobacterial survival in nonpermissive growth conditions

Antimicrobials targeting cell wall biosynthesis are generally considered inactive against nonreplicating bacteria. Paradoxically, we found that under nonpermissive growth conditions, exposure of Mycobacterium bovis BCG bacilli to such antimicrobials enhanced their survival. We identified a transcriptional regulator, RaaS (for regulator of antimicrobial-assisted survival), encoded by bcg1279 (rv1219c) as being responsible for the observed phenomenon. Induction of this transcriptional regulator resulted in reduced expression of specific ATP-dependent efflux pumps and promoted long-term survival of mycobacteria, while its deletion accelerated bacterial death under nonpermissive growth conditions in vitro and during macrophage or mouse infection. These findings have implications for the design of antimicrobial drug combination therapies for persistent infectious diseases, such as tuberculosis

Language Matters: Developing Educators’ Expertise for English Learners in Linguistically Diverse Communities

The population of English learners (ELs) continues to grow in schools across the United States and around the world. In this article, we share one urban university’s collaborative approach to building educational capacity for cultural and linguistic diversity through professional development efforts that brought together stakeholders from classrooms, schools, communities, and districts. This grant-funded project aimed to build educator expertise to effectively support and positively influence students’ language development and disciplinary learning. Grounded in sociocultural theory, we used an apprenticeship framework of teacher development, strategically planning and implementing collaborative capacity building efforts to foster learning across individual, interpersonal, and institutional planes. In this paper, we share the results of professional development efforts across three years of this project, drawing from observation, interview, and focus group data. Findings indicate that classroom-, school-, and district-level educators developed knowledge of discipline-specific language development, pedagogical skills for effective EL teaching and learning, and leadership abilities to positively shape institutional responses to their culturally and linguistically diverse student populations. Implications focus on fostering teacher professionalism through bottom-up development of EL-specific expertise and expanded opportunities for leadership

Do adults with high functioning autism or Asperger Syndrome differ in empathy and emotion recognition?

The present study examined whether adults with high functioning autism (HFA) showed greater difficulties in (i) their self-reported ability to empathise with others and/or (ii) their ability to read mental states in others’ eyes than adults with Asperger syndrome (AS). The Empathy Quotient (EQ) and ‘Reading the Mind in the Eyes’ Test (Eyes Test) were compared in 43 adults with AS and 43 adults with HFA. No significant difference was observed on EQ score between groups, while adults with AS performed significantly better on the Eyes Test than those with HFA. This suggests that adults with HFA may need more support, particularly in mentalizing and complex emotion recognition, and raises questions about the existence of subgroups within autism spectrum conditions