Shared understandings of dementia? : An application of the Common Sense Self Regulation Model to a case study

Peer reviewedPostprin

High-resolution analysis of rapid climate change from Greenland ice cores

Extreme shifts in the climate system have long been recognized but the timescales for most events are large, occurring over millennia or longer. There is however, growing evidence for abrupt shifts in the climate system on much shorter timescales of centuries, decades or even years. It is these abrupt climate changes that would have the biggest impact on modern society with a potentially large and catastrophic climate shift occurring within the human lifespan. In this thesis I investigate two large and abrupt climate oscillations, as observed in the Greenland ice core record. The first is the most prominent cold event to have occurred during the Holocene, the cold event 8,200 years ago (the 8.2 kyr event) and the second is one of the strongest and longest glacial oscillations, Dansgaard-Oeschger event 8 (DO-8). I present a collection of high-resolution chemistry and stable isotope records from the plateau of the Greenland ice cap during the cold event 8,200 years ago. Using a composite of 4 records, the cold event is observed as a 160.5 year period during which decadal-mean isotopic values were below average, within which there is a central event of 69 years during which values were consistently more than one standard deviation below the average for the preceding period. The results show clear evidence for colder temperatures and a decrease in snow accumulation rate. However, the changes in chemical concentrations for the ions looked at here are small, suggesting only minor changes in atmospheric circulation for this event. Apart from the decrease in methane concentration, Greenland ice cores give only weak evidence for effects outside the North Atlantic region. A new high-resolution chemical and stable isotope record is presented, from the North Greenland Ice Core Project (NGRIP) ice core, during Dansgaard-Oeschger event 8. The onset of DO-8 is first observed as a rapid decrease in chemical deposition to Greenland, indicating a large and abrupt shift in oceanic and atmospheric circulation. The change in the chemical deposition is followed over a decade later by an increase in temperature of approximately 13°C, from extreme cold stadial conditions to warm interstadial conditions, accompanied by a 33 % increase in annual snow accumulation. The transition is observed in the deuterium excess record as an abrupt shift to warmer source water conditions in the period after the chemical transition but considerably earlier than interstadial temperatures have been reached

The Accuracy of Accredited Glaucoma Optometrists in the Diagnosis and Treatment Recommendation for Glaucoma

Background/aims: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of, and decision to treat glaucoma with that of routine hospital eye care against a reference standard of expert opinion, i.e. consultant ophthalmologist with a special interest in glaucoma. Methods: A directly comparative, masked, performance study was performed in Grampian, Scotland. 165 people were invited to participate and, of those, 100 (61%) were examined. People suspected of having glaucoma underwent a full ophthalmic assessment both in a newly established, community optometry led, glaucoma management scheme and in a consultant led hospital eye service within a month. Results: The agreement between the AGO and the consultant ophthalmologist in the diagnosis of glaucoma was substantial (89%, kappa = 0.703, SE=0.083). The agreement regarding the need for treatment was also substantial (88%, kappa = 0.716, SE =0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation were moderate (83%, kappa = 0.541, SE = 0.098, SE = 0.98; and 81%, kappa = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 [95% CI 0.85 to 0.97]) but lower for sensitivity at 0.76 (95% CI 0.57 to 0.89). The performance was similar when accuracy was assessed for treatment recommendation (sensitivity, 0.73[95% CI 0.57 to 0.85]; specificity 0.96[95% CI 0.88 to 0.99]). The differences in sensitivity and specificity between AGO and junior ophthalmologist was not statistically significant.Conclusions: Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma missed.Chief Scientist Office of the Scottish Executive Health Departmen

Social work as a career choice (a study of selected variables in the choice of social work as a career)

Thesis (M.S.)--Boston Universit

Differing patterns in intentional and unintentional poisonings among young people in England, 1998-2014: a population based cohort study

Background Accurate and up to date data on changes in poisoning incidence among young people are lacking. Recent linkage of UK primary care, hospital and mortality data allows these to be quantified to inform service delivery. Methods An open cohort study of 1 736 527 young people aged 10–24 between 1998 and 2014 was conducted using linked data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics deaths. Incidence rates (IRs) by poisoning intent were calculated by age, sex, deprivation and year. Results Total poisoning IRs increased by 25% from 1998/99 to 2013/14 [adjusted incidence rate ratio (aIRR) 1.25, 95% CI: 1.20–1.30]. Patterns differed markedly by intent. Intentional poisoning rates increased by 52% while unintentional rates remained unchanged. Intentional rates increased almost exclusively among females, gradually between 1998/99 and 2013/14 among 16–18 (88% increase) and 19–24 (36% increase) year olds but only increased among 10–15 year olds in the last 2 years (79% increase). A 2-fold increased risk of poisoning for the most compared to least deprived quintile existed (aIRR 2.21, 95% CI: 2.02–2.23) and remained over time. Conclusions Commissioning of primary and secondary prevention services needs to address the growing problem of intentional poisonings among young people

Applying psychological theory to evidence-based clinical practice : identifying factors predictive of managing upper respiratory tract infections without antibiotics

Background: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. Cnclusion: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the reation of a replicable methodology for identifying factors that predict clinical behaviour. Hwever, a number of conceptual and methodological challenges remain

The Lantern Vol. 3, No. 3, June 1935

• Scholarship\u27s Reward • Thus Endeth • Even in Dover • An Essay Submitted for the Paisley Prize: The Moral Standard to Which We Must Appeal in Judging Whether a Lie is Ever Justifiable • Towers of France • An Essay Submitted for the Paisley Prize • Initial Adventures in Psychiatry • In Commemoration of Comus • The Amish Maidenhttps://digitalcommons.ursinus.edu/lantern/1006/thumbnail.jp

Meningococcal Disease in Patients With Human Immunodeficiency Virus Infection: A Review of Cases Reported Through Active Surveillance in the United States, 2000-2008.

BackgroundAlthough human immunodeficiency virus (HIV) infection is an established risk factor for several bacterial infections, the association between HIV infection and meningococcal disease remains unclear.MethodsExpanded chart reviews were completed on persons with meningococcal disease and HIV infection reported from 2000 through 2008 from 9 US sites participating in an active population-based surveillance system for meningococcal disease. The incidence of meningococcal disease among patients meeting Centers for Disease Control and Prevention acquired immune deficiency syndrome (AIDS) surveillance criteria was estimated using data from the National HIV Surveillance System for the participating sites.ResultsThirty-three cases of meningococcal disease in individuals with HIV infection were reported from participating sites, representing 2.0% of all reported meningococcal disease cases. Most (75.8%) persons with HIV infection were adult males aged 25 to 64 years old. Among all meningococcal disease cases aged 25 to 64 years old, case fatality ratios were similar among HIV-infected and HIV-uninfected persons (13.3% vs 10.6%; P = .6). The cumulative, mean incidence of meningococcal disease among patients aged 25 to 64 years old with HIV infection ever classified as AIDS was 3.5 cases per 100000 person years (95% confidence interval [CI], 2.1-5.6), compared with 0.3 cases per 100000 person years (95% CI, 0.3-0.3) for persons of the same age group not reported to have AIDS (relative risk = 12.9; 95% CI, 7.9-20.9).ConclusionsIndividuals with HIV infection meeting the AIDS surveillance case definition have a higher incidence of meningococcal disease compared with the general adult population

The Iowa Homemaker vol.19, no.4

Art, page 1 Caroling Through Christmas, page 3 Personality Packages, page 4 Mask-Making, page 5 Chimes of Christmas, page 6 Fashion in Feasting, page 7 Sally Cheers, page 8 For a Festive Home, page 10 Hold That Tie!, page 11 What’s New in Home Economics, page 12 Packages Go Sophisticated, page 14 Silver Secrets for Santa, page 16 The Plight Before Christmas, page 18 Your Child’s Food, page 19 From Journalistic Spindles, page 20 Alums in the News, page 21 Behind Bright Jackets, page 22 Art with Practice, page 23 Biography of a Home Economist, page 2

In vivo cell-autonomous transcriptional abnormalities revealed in mice expressing mutant huntingtin in striatal but not cortical neurons

Huntington's disease (HD), caused by a CAG repeat expansion in the huntingtin (HTT) gene, is characterized by abnormal protein aggregates and motor and cognitive dysfunction. Htt protein is ubiquitously expressed, but the striatal medium spiny neuron (MSN) is most susceptible to dysfunction and death. Abnormal gene expression represents a core pathogenic feature of HD, but the relative roles of cell-autonomous and non-cell-autonomous effects on transcription remain unclear. To determine the extent of cell-autonomous dysregulation in the striatum in vivo, we examined genome-wide RNA expression in symptomatic D9-N171-98Q (a.k.a. DE5) transgenic mice in which the forebrain expression of the first 171 amino acids of human Htt with a 98Q repeat expansion is limited to MSNs. Microarray data generated from these mice were compared with those generated on the identical array platform from a pan-neuronal HD mouse model, R6/2, carrying two different CAG repeat lengths, and a relatively high degree of overlap of changes in gene expression was revealed. We further focused on known canonical pathways associated with excitotoxicity, oxidative stress, mitochondrial dysfunction, dopamine signaling and trophic support. While genes related to excitotoxicity, dopamine signaling and trophic support were altered in both DE5 and R6/2 mice, which may be either cell autonomous or non-cell autonomous, genes related to mitochondrial dysfunction, oxidative stress and the peroxisome proliferator-activated receptor are primarily affected in DE5 transgenic mice, indicating cell-autonomous mechanisms. Overall, HD-induced dysregulation of the striatal transcriptome can be largely attributed to intrinsic effects of mutant Htt, in the absence of expression in cortical neuron