'Across the pond'—a response to the NICE guidelines for management of multi-morbidity in older people

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Thyroid hormone therapy for older adults with subclinical hypothyroidism

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Serotonin and Serotonergic Type-2 Antagonists in Hypertension and Adult Atopic Asthma

Serotonin is a naturally occuring amine with vaso-active properties; its role in the pathogenesis of hypertension is unknown. Serotonin in blood is stored in platelets, and is released during platelet aggregation. Normally, only negligable amounts of serotonin are present in the plasma. Platelets from patients with untreated essential hypertension (n=22) showed increased serotonin-induced aggregation in whole blood in-vitro compared to age and sex matched normotensive controls (n=20). Enhanced platelet aggregation could contribute to raised arterial pressure in hypertension, by increasing free plasma levels of vasoconstrictors such as serotonin. However, spontaneous platelet aggregation in whole blood was not enhanced in these hypertensive patients

Informant single screening questions for delirium and dementia in acute care – a cross-sectional test accuracy pilot study

Background Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.<p></p> To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.<p></p> Methods Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.<p></p> Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).<p></p> Results Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.<p></p> Conclusions These findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.<p></p&gt

An inclusive approach to partnerships for the Sustainable Development Goals (SDGs): Using a relationship lens to explore the potential for transformational collaboration

Partnerships are positioned as critical for the achievement of the Sustainable Development Goals and the United Nations transformational agenda for 2030. The widespread use of terms such as ‘collaboration’, ‘partnership’ and ‘cooperation’ has, however, led to debates about the expectations of such relationships and calls have been made for more rigorous clarification and classification of these related concepts. Drawing upon a comprehensive literature review, we argue in this conceptual paper that the broad spectrum of personal and organizational interactions within, between and across different sectors, domains, disciplines and contexts makes the quest to delineate and categorize these diverse forms of collaboration a seemingly impossible task. We further suggest that such efforts advance a narrow view of partnership as little more than a means to an end, thus limiting understanding of the integrative and intrinsic value of working in this way. We believe that a more inclusive understanding of partnerships may be achieved by exploring them through a relationship lens that acknowledges the importance of inter-personal connections in partnerships more deeply. In doing so, the capacity of partnerships to generate the systemic change that is at the heart of the 2030 Agenda for Sustainable Development may be enhanced and ultimately realized

The V_H repertoire and clonal diversification of B cells in inflammatory myopathies

The contribution of antigen-driven B-cell adaptive immune responses within the inflamed muscle of inflammatory myopathies (IMs) is largely unknown. In this study, we investigated the immunoglobulin VH gene repertoire, somatic hypermutation, clonal diversification, and selection of infiltrating B cells in muscle biopsies from IM patients (dermatomyositis and polymyositis), to determine whether B cells and/or plasma cells contribute to the associated pathologies of these diseases. The data reveal that Ig V<sub>H</sub> gene repertoires of muscle-infiltrating B cells deviate from the normal VH gene repertoire in individual patients, and differ between different types of IMs. Analysis of somatic mutations revealed clonal diversification of muscle-infiltrating B cells and evidence for a chronic B-cell response within the inflamed muscle. We conclude that muscle-infiltrating B cells undergo selection, somatic hypermutation and clonal diversification in situ during antigen-driven immune responses in patients with IMs, providing insight into the contribution of B cells to the pathological mechanisms of these disorders