A systematic review of stress in staff caring for people with dementia living in 24-hour care settings

Background: Family carers of people with dementia are at risk of psychological morbidity, and it is suggested that this may also be the case in paid carers as caring for people with dementia can be emotionally and physically demanding. Care homes have historically had difficulty recruiting and retaining staff, and job stress has previously been linked to high turnover amongst long-term care staff. We performed a systematic review of studies of the prevalence of psychological stress in staff caring for people with dementia in residential long-term care settings.Methods: We conducted a comprehensive literature search of MEDLINE, PsychINFO and Web of Science databases up to May 2009, supplemented by a search of the references of all relevant articles. Search terms encompassed nursing staff, residential care and psychological distress. Validity of studies was graded by two authors independently using a standardized checklist.Results: We identified 601 studies of which five met our inclusion criteria. Two studies reported on prevalence rates of staff distress and found 37% and 5% levels of being "at risk" from burnout, four studies reported mean stress scores and all were low.Conclusions: All studies were either small or used instruments with unsatisfactory psychometric properties and so our conclusions are limited by the lack of good quality evidence. The preliminary evidence suggests that most staff who remain working in homes do not have a high prevalence of psychological stress or level of symptoms

Upgraded demonstration vehicle task report

Vehicle/battery performance capabilities and interface problems that occurred when upgraded developmental batteries were integrated with upgraded versions of comercially available electric vehicles were investigated. Developmental batteries used included nickel zinc batteries, a nickel iron battery, and an improved lead acid battery. Testing of the electric vehicles and upgraded batteries was performed in the complete vehicle system environment to characterize performance and identify problems unique to the vehicle/battery system. Constant speed tests and driving schedule range tests were performed on a chassis dynamometer. The results from these tests of the upgraded batteries and vehicles were compared to performance capabilities for the same vehicles equipped with standard batteries

Community case study of long-term survival with oesophageal candidiasis: a primary healthcare nursing study of support for a patient receiving home self-administered intravenous amphotericin

HIV infection predisposes a person to fungal infections because of failure in the host's cell-mediated immunity, which may result in a variety of fungal infections (1,2). Candidiasis is commonly caused by Candida albicans which can become a multi-system problem affecting the patient's nails, mouth, oesophagus, lower gastrointestinal tract, genitalia and rectum. Candida oesophagitis is a condition diagnostic of AIDS and characterised by erythematous lesions, pseudomembranous areas and/or ulcerations of the oesophagus. The condition may cause difficulty in swallowing, retrosternal pain, nausea and vomiting. Significant weight loss may also develop secondary to the characteristic symptoms of oesophageal candidiasis (3). Reports to date suggest therapy failure, incomplete response and decreasing susceptibility to azole medications such as ketoconazole, fluconazole and itraconazole (4). Whilst amphotericin remains the standard treatment for systemic or resistant mycoses (1), hospital experience with amphotericin toxicity may be a limiting factor against initiating homebased therapy (1). We report the outcomes for a clinically responding patient with a falling CD4 count diagnosed with oesophageal candidiasis receiving intravenous amphotericin at home for a continuous seventeen month period. This case fulfils current definitions of long-term survival (5,6). The patient initially presented over three years previously with HIV-related thrombocytopenia, a diagnosis made after counselling and HIV antibody testing showed HIV infection. Over successive years the patient received out-patient follow up including quarterly CD4 monitoring, treatment with Zidovudine, prophylaxis with Cotrimoxazole against Pneumocystis carinii pneumonia, psychological counselling, oral and dental, care and social welfare interventions. The out-patient service included written information for the patient's General Medical Practitioner after each out-patient visit, on patient request. On presentation with oesophageal candidiasis due to Candida albicans three years later, the patient requested homebased care in association with the General Medical Practitioner (GP) and the rest of the primary healthcare team. The patient wished to keep hospital stays and out-patient visits to a minimum. The blood results for the patient's serum creatinine, urea and potassium are shown in Figures 1-3, respectively, for a total period of seventeen months during which amphotericin was administered. The data covers both the two week period of hospital based induction therapy and the following seventeen months of homebased maintenance therapy

Measuring ligand efficacy at the mu-opioid receptor using a conformational biosensor.

The intrinsic efficacy of orthosteric ligands acting at G-protein-coupled receptors (GPCRs) reflects their ability to stabilize active receptor states (R*) and is a major determinant of their physiological effects. Here, we present a direct way to quantify the efficacy of ligands by measuring the binding of a R*-specific biosensor to purified receptor employing interferometry. As an example, we use the mu-opioid receptor (µ-OR), a prototypic class A GPCR, and its active state sensor, nanobody-39 (Nb39). We demonstrate that ligands vary in their ability to recruit Nb39 to µ-OR and describe methadone, loperamide, and PZM21 as ligands that support unique R* conformation(s) of µ-OR. We further show that positive allosteric modulators of µ-OR promote formation of R* in addition to enhancing promotion by orthosteric agonists. Finally, we demonstrate that the technique can be utilized with heterotrimeric G protein. The method is cell-free, signal transduction-independent and is generally applicable to GPCRs

Fiscal year 1981 US corn and soybeans pilot preliminary experiment plan, phase 1

A draft of the preliminary experiment plan for the foreign commodity production forecasting project fiscal year 1981 is presented. This draft plan includes: definition of the phase 1 and 2 U.S. pilot objectives; the proposed experiment design to evaluate crop calendar, area estimation, and area aggregation components for corn and soybean technologies using 1978/1979 crop-year data; a description of individual sensitivity evaluations of the baseline corn and soybean segment classification procedure; and technology and data assessment in support of the corn and soybean estimation technology for use in the U.S. central corn belt

Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

Objective: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.Method: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.Results: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.Conclusions: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research ( only nine level-1 studies were identified). More high-quality investigation is needed

Comparing proxy rated quality of life of people living with dementia in care homes

Background: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently

Protein-DNA charge transport: Redox activation of a DNA repair protein by guanine radical

DNA charge transport (CT) chemistry provides a route to carry out oxidative DNA damage from a distance in a reaction that is sensitive to DNA mismatches and lesions. Here, DNA-mediated CT also leads to oxidation of a DNA-bound base excision repair enzyme, MutY. DNA-bound Ru(III), generated through a flash/quench technique, is found to promote oxidation of the [4Fe-4S](2+) cluster of MutY to [4Fe-4S](3+) and its decomposition product [3Fe-4S](1+). Flash/quench experiments monitored by EPR spectroscopy reveal spectra with g = 2.08, 2.06, and 2.02, characteristic of the oxidized clusters. Transient absorption spectra of poly(dGC) and [Ru(phen)(2)dppz](3+) (dppz = dipyridophenazine), generated in situ, show an absorption characteristic of the guanine radical that is depleted in the presence of MutY with formation instead of a long-lived species with an absorption at 405 nm; we attribute this absorption also to formation of the oxidized [4Fe-4S](3+) and [3Fe4S](1+) clusters. In ruthenium-tethered DNA assemblies, oxidative damage to the 5'-G of a 5'-GG-3' doublet is generated from a distance but this irreversible damage is inhibited by MutY and instead EPR experiments reveal cluster oxidation. With ruthenium-tethered assemblies containing duplex versus single-stranded regions, MutY oxidation is found to be mediated by the DNA duplex, with guanine radical as an intermediate oxidant; guanine radical formation facilitates MutY oxidation. A model is proposed for the redox activation of DNA repair proteins through DNA CT, with guanine radicals, the first product under oxidative stress, in oxidizing the DNA-bound repair proteins, providing the signal to stimulate DNA repair

Disseminating START: training clinical psychologists and admiral nurses as trainers in a psychosocial intervention for carers of people with dementia's depressive and anxiety symptoms

OBJECTIVES: To put into practice and to evaluate an initial dissemination programme for the Strategies for Relatives (START), a clinically and cost-effective manualised intervention for family carers of people with dementia. SETTING: We offered 3-hour 'train-the-trainer' sessions through the British Psychological Society and Dementia UK. PARTICIPANTS: Clinical psychologists and admiral nurses across the UK. PRIMARY AND SECONDARY OUTCOME MEASURES: After the training session, attendees completed an evaluation. Attendees were asked how they had implemented START 6 and 12 months later, and to participate in telephone interviews about their experiences of what helps or hinders implementation 1 year after training. RESULTS: We trained 134 clinical psychologists and 39 admiral nurses through 14 training sessions between October 2014 and September 2015 in nine UK locations and made materials available online. The 40 survey respondents had trained 75 other staff. By this time, 136 carers had received START across 11 service areas. Findings from 13 qualitative interviews indicated that some clinical psychologists had begun to implement START, facilitated by buy-in from colleagues, existing skills in delivering this type of intervention, availability of other staff to deliver the intervention and support from the research team. Admiral nurses did not supervise other staff and were unable to cascade the intervention. Where START has not been used, common barriers included lack of staff to deliver the intervention and family carer support not being a service priority. Participants wanted the training to be longer. CONCLUSIONS: We trained clinical psychologists and admiral nurses to deliver and implement START locally. Results from survey respondents show that it was cascaded further and used in practice in some areas, but we do not know whether START was implemented by non-respondents. Future dissemination requires management buy-in, availability of practitioners and supervisors and consideration of other ways of delivery