Analgesic prescribing in care home residents: how epidemiological studies may inform clinical practice

Care home residents are often frail with multiple comorbidities and cognitive impairment, most commonly caused by dementia. This population is under-represented in clinical trials, leading to a lack of valid and reliable evidence to inform clinicians’ prescribing practice. This paper summarizes how epidemiological research conducted in similar populations can inform pain management by describing pain prevalence, risk factors, typical features and functional consequences. This evidence can help overcome the numerous barriers to optimal pain management in care home residents

A case report of Parry Romberg Syndrome initially presenting as periodontitis

Parry Romberg Syndrome (PRS) is a rare disorder of progressive hemifacial atrophy, involving soft tissues, fat and occasionally bone. It can co-exist with presentations of Morphea. We describe an unusual case of persistent periodontal and alveolar destruction associated with PRS. A 56-year-old African female initially presented with persistent periodontal destruction, which showed minimal response to conventional periodontal treatment. After non-surgical treatment, surgical debridement followed by extraction of the two right maxillary incisor teeth was required to halt the periodontal destruction. Atrophy was not limited to the periodontal tissues. Multidisciplinary care and extensive investigations were required to diagnose PRS. Once the PRS has stabilised, adipose tissue transplants will be required to improve the facial appearance. We highlight the need for extensive investigations and a multidisciplinary approach to diagnose rare systemic causes for recalcitrant periodontal disease

Solution heat treatment, forming and in-die quenching of a commercial sheet magnesium alloy into a complex-shaped component: experimentation and FE analysis

Interest in lightweight materials, particularly magnesium alloys, has increased significantly with rising efficiency requirements in the automotive sector. Magnesium is the lightest available structural metal, with a density approximately 35% lower than that of aluminium. The potential is great for magnesium to become a primary material used in future low carbon vehicle structures; however, there are significant obstacles, namely low ductility and formability, particularly at room temperature. The aim of this work is to present the feasibility of using the solution Heat treatment, Forming, and in-die Quenching (HFQ) process to produce complex shapes from a sheet magnesium alloy, and to use the results to verify a simulation of the process developed using commercial FE software. Uniaxial tensile tests were initially conducted to establish the optimum parameters for forming the part. Stamping trials were then carried out using these parameters, and a simulation set up modelling the forming operation. It was shown that the HFQ process could be used to form a successful component from this alloy, and that a good match was achieved between the results of the forming experiments and the simulation.The authors gratefully acknowledge the support from the EPSRC (Grant Ref: EP/I038616/1) for TARF-LCV: Towards Affordable, Closed-Loop Recyclable Future Low Carbon Vehicle Structures

Identification of Small-Molecule Inhibitors against Meso-2, 6-Diaminopimelate Dehydrogenase from Porphyromonas gingivalis

Species-specific antimicrobial therapy has the potential to combat the increasing threat of antibiotic resistance and alteration of the human microbiome. We therefore set out to demonstrate the beginning of a pathogen-selective drug discovery method using the periodontal pathogen Porphyromonas gingivalis as a model. Through our knowledge of metabolic networks and essential genes we identified a “druggable” essential target, meso-diaminopimelate dehydrogenase, which is found in a limited number of species. We adopted a high-throughput virtual screen method on the ZINC chemical library to select a group of potential small-molecule inhibitors. Meso-diaminopimelate dehydrogenase from P. gingivaliswas first expressed and purified in Escherichia coli then characterized for enzymatic inhibitor screening studies. Several inhibitors with similar structural scaffolds containing a sulfonamide core and aromatic substituents showed dose-dependent inhibition. These compounds were further assayed showing reasonable whole-cell activity and the inhibition mechanism was determined. We conclude that the establishment of this target and screening strategy provides a model for the future development of new antimicrobials

A substitute for the singular Green kernel in the Newtonian potential of celestial bodies

The "point mass singularity" inherent in Newton's law for gravitation represents a major difficulty in accurately determining the potential and forces inside continuous bodies. Here we report a simple and efficient analytical method to bypass the singular Green kernel 1/|r-r'| inside the source without altering the nature of the interaction. We build an equivalent kernel made up of a "cool kernel", which is fully regular (and contains the long-range -GM/r asymptotic behavior), and the gradient of a "hyperkernel", which is also regular. Compared to the initial kernel, these two components are easily integrated over the source volume using standard numerical techniques. The demonstration is presented for three-dimensional distributions in cylindrical coordinates, which are well-suited to describing rotating bodies (stars, discs, asteroids, etc.) as commonly found in the Universe. An example of implementation is given. The case of axial symmetry is treated in detail, and the accuracy is checked by considering an exact potential/surface density pair corresponding to a flat circular disc. This framework provides new tools to keep or even improve the physical realism of models and simulations of self-gravitating systems, and represents, for some of them, a conclusive alternative to softened gravity.Comment: Accepted for publication in A&A; 7 pages, color figure

Social networks, social capital and end-of-life care for people with dementia: a realist review

OBJECTIVES (1) To develop an understanding of how social capital may be conceptualised within the context of endof-life care and how it can influence outcomes for people with dementia and their families with specific reference to the context and mechanisms that explain observed outcomes. (2) To produce guidance for healthcare systems and researchers to better structure and design a public health approach to end-of-life care for people with dementia. DESIGN A realist review. Data sources MEDLINE, EMBASE, CINAHL and grey literature. ANALYSIS We conceptualised social capital as a complex intervention and, in order to understand how change is generated, used realist evaluation methods to create different configurations of context, mechanism and outcomes. We conducted an iterative search focusing on social capital, social networks and end-of-life care in dementia. All study designs and outcomes were screened and analysed to elicit explanations for a range of outcomes identified. Explanations were consolidated into an overarching programme theory that drew on substantive theory from the social sciences and a public health approach to palliative care. RESULTS We identified 118 articles from 16 countries ranging from 1992 to 2018. A total of 40 contextmechanism-outcome configurations help explain how social capital may influence end-of-life care for people with dementia. Such influence was identified within five key areas. These included: (1) socially orientating a person with dementia following diagnosis; (2) transitions in the physical environment of care; (3) how the caregiving experience is viewed by those directly involved with it; (4) transition of a person with dementia into the fourth age; (5) the decision making processes underpinning such processes. CONCLUSION This review contributes to the dispassionate understanding of how complex systems such as community and social capital might be viewed as a tool to improve end-of-life care for people with dementia. PROSPERO REGISTRATION NUMBER CRD42018084524

Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing.

OBJECTIVES: To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. DESIGN: Systematic review. SETTING: We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). PARTICIPANTS: LTC residents. MEASUREMENTS: We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. RESULTS: Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. CONCLUSION: Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively

Effective action for strongly correlated electron systems

The su(2|1) coherent-state path-integral representation of the partition function of the t - J model of strongly correlated electrons is derived at finite doping. The emergent effective action is compared to the one proposed earlier on phenomenological grounds by Shankar to describe holes in an antiferromagnet (Nucl.Phys. B330 (1990) 433). The t - J model effective action is found to have an important "extra" factor with no analogue in Shankar's action. It represents the local constraint of no double electron occupancy and reflects the rearrangement of the underlying phase-space manifold due to the presence of strong electron correlation. This important ingredient is shown to be essential to describe the physics of strongly correlated electron systems. Keywords: t - J model of strongly correlated electrons; su(2|1) coherent-state path integralComment: 22 page

Psychotropic prescribing for English care home residents with dementia compared with national guidance: findings from the MARQUE national longitudinal study

Background Despite policy pressure and concerns regarding the use of antipsychotics and benzodiazepines, many care home residents with dementia are prescribed psychotropic medication, often off licence. This is the first large study to report psychotropic prescribing and ‘as required’ administration patterns in English care homes. Aims To explore the prevalence and associates of psychotropic prescription in care home residents with dementia and compare the results with national guidance. Method We collected data in a longitudinal cohort study of residents with diagnosed or probable dementia in 86 care homes in England in 2014–2016. We reported the prevalence of psychotropic (antipsychotics, anxiolytics/hypnotics, antidepressants) prescriptions and drug receipt. We explored the associations between resident factors (sociodemographic, agitation [Cohen–Mansfield Agitation Inventory], dementia severity [Clinical Dementia Rating]) and care home factors (type, ownership, size, dementia registration/specialism, quality rating) in prescription and ‘as required’ administration, using multilevel regression models. Results We analysed data from 1425 residents. At baseline, 822 residents (57.7%, 95% CI: 55.1–60.2) were prescribed a psychotropic drug, 310 residents (21.8% 95% CI: 19.7–24.0) were prescribed an anxiolytic/hypnotic, 232 (94.3%, 95% CI: 90.6–96.6) were prescribed one antipsychotic and 14 (5.7%, 95% CI: 3.4–9.4) were prescribed two antipsychotics. The median prescription duration during the study was 1 year. Residents with clinically significant agitation were prescribed more antipsychotics (odds ratio [OR] = 2.00, 95% CI: 1.64–2.45) and anxiolytics/hypnotics (OR = 2.81, 95% CI: 2.31–3.40). Conclusions Antipsychotics and anxiolytics/hypnotics are more commonly prescribed for people with dementia in care homes than in the community, and prescribing may not reflect guidelines. Policies which advocate reduced use of psychotropics should better support psychosocial interventions