The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study

yesBackground: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. Method(s): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. Results: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p= 0.008). Nonpharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients’ admissions. Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.Alzheimer's Society; BUPA Foundatio

High interindividual variability in habitat selection and functional habitat relationships in European nightjars over a period of habitat change

An animal's choice of foraging habitat reflects its response to environmental cues and is likely to vary among individuals in a population. Analyzing the magnitude of individual habitat selection can indicate how resilient populations may be to anthropogenic habitat change, where individually varying, broadly generalist populations have the potential to adjust their behavior. We collected GPS point data from 39 European nightjars (Caprimulgus europaeus) at a UK breeding site where restoration measures have altered large areas of habitat between breeding seasons. We calculated individual habitat selection over four breeding seasons to observe changes that might align with change in habitat. We also analyzed change in home range size in line with change in habitat availability, to examine functional relationships that can represent trade‐offs made by the birds related to performance of the habitat.Individual explained more of the variation in population habitat selection than year for most habitat types. Individuals differed in the magnitude of their selection for different habitat types, which created a generalist population composed of both generalist and specialist individuals. Selection also changed over time but only significantly for scrub habitat (60% decrease in selection over 4 years). Across the population, individual home range size was 2% smaller where availability of cleared habitat within the home range was greater, but size increased by 2% where the amount of open water was higher, indicating the presence of trade‐offs related to habitat availability. These results highlight that using individual resource selection and specialization measures, in conjunction with functional responses to change, can lead to better understanding of the needs of a population. Pooling specialist and generalist individuals for analysis could hide divergent responses to change and consequently obscure information that could be important in developing effective conservation strategies

Impact of woody encroachment on soil organic carbon storage in the Lopé National Park, Gabon

This study quantifies changes in soil organic carbon (SOC) stock as a result of woody encroachment on savannas. Changes in SOC stocks occur below 30cm depth, indicating the subsoil as the principal compartment contributing to SOC sequestration, and suggesting the need to consider the entire profile (0–100cm) to thoroughly assess the effect of woody encroachment on SOC stocks

Building capacity through ethical understanding and practice

Fostering ethical understanding and practice in Work Integrated Learning (WIL) and other forms of experiential learning is integral to preparing students for engagement with society beyond university (Campbell, 2011; Campbell & Zegwaard, 2011a; Campbell & Zegwaard, 2011b). Ethical practice is a fundamental aspect of Macquarie University\u27s Professional and Community Engagement (PACE) initiative, and our research and practice to date have examined how ethical understanding can be translated into ethical practice by students (Baker et al., 2013). This paper details further developments in our endeavour to prepare students for ethical complexities and build their capacity to respond to them. It also discusses how efforts to foster and share consistent ethical understanding and practice, through an Ethical Practice Framework, have resulted in the establishment of a community of ethical practice. This building of capacity involves pushing pedagogical and institutional boundaries and stems from the realisation that developing curriculum can extend beyond a quality learning and teaching experience for PACE students, as well as clear benefits for: staff involved in PACE, the University, community-based partners, and others beyond. Qualitative data illustrates outcomes, while ongoing reflection upon ethical complexities highlights challenges and avenues for future research and development

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Background: One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual Shark Tank competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods: Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results: Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions: Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA\u27s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability

The trade-off between fix rate and tracking duration on estimates of home range size and habitat selection for small vertebrates

Despite advances in technology, there are still constraints on the use of some tracking devices for small species when gathering high temporal and spatial resolution data on movement and resource use. For small species, weight limits imposed on GPS loggers and the consequent impacts on battery life, restrict the volume of data that can be collected. Research on home range and habitat selection for these species should therefore incorporate a consideration of how different sampling parameters and methods may affect the structure of the data and the conclusions drawn. However, factors such as these are seldom explicitly considered. We applied two commonly-used methods of home range estimation, Movement-based Kernel Density Estimation (MKDE) and Kernel Density Estimation (KDE) to investigate the influence of fix rate, tracking duration and method on home range size and habitat selection, using GPS tracking data collected at two different fix rates from a small, aerially-insectivorous bird, the European nightjar Caprimulgus europaeus. Effects of tracking parameters varied with home range estimation method. Fix rate and tracking duration most strongly explained change in MKDE and KDE home range size respectively. Total number of fixes and tracking duration had the strongest impact on habitat selection. High between- and within-individual variation strongly influenced outcomes and was most evident when exploring the effects of varying tracking duration. To reduce skew and bias in home range size estimation and especially habitat selection caused by individual variation and estimation method, we recommend tracking animals for the longest period possible even if this results in a reduced fix rate. If accurate movement properties, (e.g. trajectory length and turning angle) and biologically-representative movement occurrence ranges are more important, then a higher fix rate should be used, but priority habitats can still be identified with an infrequent sampling strategy

Time-Lapse Seismic Imaging of Oceanic Fronts and Transient Lenses within South Atlantic Ocean

Oceanic fronts play a pivotal role in controlling water mass transfer, although little is known about deep frontal structure on appropriate temporal and spatial scales. Here, we present a sequence of calibrated time-lapse images from a three-dimensional seismic survey that straddles the Brazil-Malvinas Confluence— a significant feature of the merid- ional overturning circulation. Eight vertical transects reveal the evolution of a major front. It is manifest as a discrete planar surface that dips at less than 2 ◦ and is traceable to 1.5–2 km depth. Its shape and surface expression are consistent with sloping isopycnal surfaces of the calculated potential density field and with coeval sea surface tempera- ture measurements, respectively. Within the top ∼1 km, where cold fresh water subducts beneath warm salty water, a series of tilted lenses are banked up against the sharply de- fined front. The largest of these structures is centered at 700 m depth and is cored by cold fresh water. Time-lapse imagery demonstrates that this tilted lens grows and de- cays over nine days. It has a maximum diameter of < 34 ± 0.13 km and a maximum height of < 750±10 m. Beneath 1 km, where horizontal density gradients are negligi- ble, numerous deforming lenses and filaments on length scales of 10–100 km are being swept toward the advecting front

Incidence and survival for oropharynx and non-oropharynx head and neck cancers among veterans living with HIV

BACKGROUND: People living with HIV/AIDS (PLWH) have an excess risk for head and neck squamous cell carcinoma (HNSCC) compared to the general U.S. population, but little is known about HIV-specific risk factors associated with the incidence and outcomes HNSCC. We aim to identify clinical and HIV-specific risk factors associated with oropharyngeal and non-oropharyngeal HNSCC incidence and outcomes separately. METHODS: We constructed a retrospective cohort study of 45,052 PLWH aged 18 or above from the national Veteran Affairs (VA) Corporate Data from 1999 to 2015. We extracted demographic data and risk factor information, including history of alcohol abuse, smoking, CD4 count (cells/μl), and percent of follow-up time with undetectable HIV viral load as time-updated variables. We calculated the age-standardized incidence rates of oropharyngeal and non-oropharyngeal HNSCC and estimated adjusted hazard ratios (HR). We also examined overall survival using Kaplan-Meier curves and adjusted HR. RESULTS: The standardized incidence rate of oropharyngeal and non-oropharyngeal HNSCC in this veteran cohort of PLWH is 23.0 (95% confidence intervals (CIs): 17.1-28.9) and 55.4 (95% CI: 46.5-64.3) per 100,000 person-years, respectively. Nadir CD4 count ≤200 was associated with an increased risk of non-oropharyngeal HNSCC (HR: 1.78; 95% CI: 1.31-2.30 vs \u3e200). Five-year overall survival of OPSCC (37.0%) was significantly lower than non-oropharyngeal HNSCC (49.1%). CONCLUSIONS: PLWH who receive care in the VA had higher age-adjusted HNSCC incidence rates than reported in the general population, suggesting that HIV and immunosuppression play a role. Additional studies should be conducted to study the interaction between HPV and HIV