Lost in translation: how can education about dementia be effectively integrated into medical school contexts? A realist synthesis

\ua9 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. OBJECTIVES: The prevalence of dementia in both community and hospital settings requires a clinical workforce that is skilled in diagnosis and management of the condition to competently care for patients. Though evidence of successful educational interventions about dementia exists, effective translation into medical school curricula is the exception rather than the norm. DESIGN: We adopted a realist synthesis approach following Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines to answer the following questions: (1) what are the barriers to integrating effective interventions about dementia into medical school curricula and (2) where they are successfully delivered, what are the contextual factors that allow for this enactment? DATA SOURCES: We searched PubMed, Embase, CINAHL and PsycINFO using the MesH terms Schools, Medical; Students, Medical; Education, Medical AND Neurocognitive disorders or the closest possible set of terms within each database. ELIGIBILITY CRITERIA: Undergraduate or graduate entry medical school programme, teaching and learning focussing on dementia, evaluating student outcomes (satisfaction, knowledge, skills, attitudes or behaviours), interventions described clearly enough to classify teaching method, any research design (quantitative and qualitative), English language. DATA EXTRACTION AND SYNTHESIS: We used a shared spreadsheet to enter key information about eligible studies and the reasons for excluding studies that did not fit eligibility criteria. We extracted descriptive data about the nature of educational interventions and narrative information as to barriers and facilitators to implementing those interventions. RESULTS: Our initial literature search identified 16 relevant papers for review. Systematic extraction of data informed the development of an initial programme theory (IPT) structured around four contextual barriers: \u27culture\u27, \u27concern for patient welfare\u27, \u27student attitudes\u27 and \u27logistics\u27 with associated facilitatory mechanisms embed medical education about dementia. CONCLUSIONS: We outline the process of generating our IPT, including overlap with Cultural Historical Activity Theory. We outline our intention to refine our programme theory through ongoing review of the evidence base and collaboration with stakeholders, with the aim of finalising a model for successful integration of dementia education

Innovation through Neurodiversity: Diversity is Beneficial

Those experiencing high rapport or strong social connection are more likely to copy each other, or emulate each other’s ideas, either consciously or sub-consciously. In this study, we use this phenomenon to examine whether neurotype match or mismatch impacts degree of imitation in a creative task. We asked 71 participants in neurodiverse pairs (including both autistic and non-autistic participants) and single-neurotype pairs (both autistic or both non-autistic), where one participant builds and one observes, to build the tallest possible tower from dried spaghetti and plasticine. We measured the height of each tower and photographed them to create a stimulus set. We then asked independent raters (n = 351, 62 autistic) to rate towers for degree of similarity. We hypothesised that lower similarity scores would be generated for towers created by people in neurodiverse pairs, showing positive innovation. Results showed towers built in the neurodiverse condition had least similarity, whereas towers built in the autistic and non-autistic conditions were significantly more similar. There was no difference in performance (height of tower) based on condition. Our results are the first to examine creativity within single-neurotype and neurodiverse pairs; they indicate that neurological diversity may be beneficial within a group setting. Subsequent research is required to examine how this interacts with divergent communication styles

Effects of climatic conditions on the lying behavior of a group of primiparous dairy cows

Currently, lying behavior can be assessed using continuous observations from sensors (e.g., accelerometers). The analysis of digital data deriving from accelerometers is an effective tool for studying livestock behaviors. Despite the large interest in the lying behavior of dairy cows, no reference was found in literature regarding the prediction of lying behavior as a function of the interaction of environmental parameters. The present study aimed to evaluate the influence of climatic conditions (temperature-humidity index, solar radiation, air velocity and rainfalls) on the lying behavior of a group of primiparous dairy cows, using data from accelerometers, and develop a prediction model to identify and predict the lying behavior of dairy cows as a function of the effects of environmental conditions. Results from the. GLM Procedure (SAS) showed that the model was highly significant (p < 0.001) and the r2 was 0.84. All of the effects in the model resulted in being highly significant (p < 0.001). This model, if validated properly, could be a valid early warning system to identify any deviation from the expected behavior, and to assess the effectiveness of thermal stress mitigation strategies

COVID-19 Mortality in Patients with a Ward-Based Ceiling of Care

\ua9 2021 by the authors.Objectives: COVID-19 patients thought unlikely to benefit from organ support, thereby having a ward-based ceiling of care (WBCoC), represent a distinct subgroup. There are no associated studies in mortality. We sought to identify clinical risk factors for inpatient COVID-19 mortality. Design and setting: this was a retrospective observational study of patients admitted to Northumbria Healthcare NHS Foundation Trust. Clinical variables were associated with inpatient mortality via logistic regression. Participants: all patients admitted with COVID-19 infection and who had a WBCoC at point of admission were included (n = 114). Main outcome measures: the outcome measure was inpatient death

Application of an early warning to detect enteropathies in intensive broiler farming

Remote and wearable sensors can be combined with smart algorithms to continuously monitor a wide range of animal responses linked with stress, health status and welfare. The idea of real time monitoring assumes a simple way to measure variable that can give an early warning for the farmer providing clear and suitable alerts to help them in their routine. The prompt reaction to any change in health, welfare and productive status is the key for the reduction in drugs usage and for the improvement of animal wellbeing. In intensive poultry farms, enteric disorders represent a major health issue; these pathologies could be multifactorial and are a major cause of performances reduction. Monitoring poultry health status takes a key role for management to reduce chemicals/drugs and their costs. Nowadays, the preventive use of antibiotics in intensive farming system is common and this practice could lead to the spreading of drugs in the environment, contributing to the phenomenon of antibiotic resistance. Due to the high priority of this issue, it is of great importance the early detection of any health problem in intensive farming. Precision Livestock Farming, through the combination of cheap technologies and specific algorithms, can provide valuable information for farmers starting from the huge amount of data collected in real time at farm level. This study was aimed to the application of a PLF diagnostic tool, sensible to the variation of volatile organic compounds, to promptly recognize enteric problems in intensive farming, supporting veterinarians and enabling specific treatments in case of disease

Abnormal prion protein in the retina of the most commonly occurring subtype of sporadic Creutzfeldt-Jakob disease

Background: Involvement of the eye has been reported in patients with variant Creutzfeldt-Jakob disease (vCJD), but there is disagreement on whether retinal involvement occurs in sporadic Creutzfeldt-Jakob disease (sCJD). Methods: Western blotting, paraffin embedded tissue blotting, and immunohistochemistry were used to test whether the abnormal form of the prion protein (PrP(Sc)) accumulates to detectable levels in the eye in a case of the most common subtype of sCJD (MM1). Results: Low levels of PrP(Sc) were detectable in the retina, localised to the plexiform layers of the central retina. PrP(Sc) was not detectable in other ocular tissues. Conclusions: The abnormal form of the prion protein is present in the retina in the most common sCJD subtype (MM1), albeit at levels lower than those found previously in vCJD and in sCJD of the VV2 subtype

Frequency analysis of vocalisations in relation to the growth in broiler chicken

Poultry is one of the lowest cost sources of animal protein in the world and, more than 40 billion chickens are produced every year globally. For reasons of public concern and due to the large number of animals involved, it is considered by many people to be important to take care of the welfare and health status of the chickens reared under intensive farm conditions. Precision Livestock Farming (PLF) can support the farmer in his day to day routine management through the use of sensors, cameras and microphones, and these have the potential to improve production and to enable monitoring of welfare status. In this context, the 7FP EU-PLF project aims to test the efficiency of the use of those sensors at farm level. In particular, the aim of this study was to record and analyse broiler vocalisations under normal farm conditions and to identify the relation between animal sounds, and growth trends. Recordings were made at regular intervals, for the entire short production life of the birds, in order to evaluate the variation of frequency and bandwidth of the sounds emitted by the animals during the cycle of production. The recordings were made in an automated, non-invasive and non-intrusive way and the sound data was compared with the weight of the birds automatically measured by a 'step on scale' placed on the floor of the broiler house. Sound analysis was performed based on the amplitude and frequency of the sound signal in audio files recorded at farm level. Through analysis of the sounds recorded, a significant correlation (P<0.001) between the frequencies of the vocalisations recorded and the weight of the broilers was found across all production cycles and farms assessed. The ongoing goal will be the development of a tool able to automatically detect the growth of the animals based on the frequency of the vocalisation emitted by the birds at different ages, and as a possible tool for determining deviations from their expected growth trend

Risk factor for footpad dermatitis and hock burns in broiler chickens

Footpad dermatitis (FPD) and hock burn (HB) are a major welfare concern in broiler chicken farming. In general, foot lesions are linked to poor environmental conditions. Ulcers caused by advanced lesions can negatively affect the gait of the birds, with effects on the welfare of animals, including, in the worst cases, inability to reach the feed or water. FPD and HB score data were collected manually at two broiler farms across Europe, during welfare assessments performed within the EU-PLF (Precision Livestock Farming) project, which is supported by the European Commission. This ongoing project aims to create "added value" for the farmer through the application of sensors and information technology at farm level. On those broiler farms, a number of variables such as temperature, relative humidity, ventilation rate, bird weight, light schedule, and feed and water consumption rates are measured automatically. The welfare of the chickens was assessed three times per cycle (at week 3, 4 and 5), scoring FPD, HB, gait score, cleanliness of the birds and litter quality. Data analysis was performed by combining data from the welfare assessments with environmental data collected by the automatic monitoring systems. The analysis showed that FPD and HB were more frequent when the flock was exposed to poor environmental conditions for prolonged periods of time. As environmental conditions can be measured continuously, and the risk factor for FPD and HB increases with poor environmental conditions, there is potential to develop a detection and control system for foot and hock lesions.</p

p53 mutation is a poor prognostic indicator for survival in patients with hepatocellular carcinoma undergoing surgical tumour ablation.

Forty-two patients with hepatocellular carcinoma (HCC) were resected and their tumours were analysed for p53 mutations by GC-clamped denaturing gradient gel electrophoresis (DGGE), single-strand conformation polymorphism (SSCP) and gene sequencing. All the exons have been analysed in this study. Eight of 12 HCCs with cirrhosis due to viral hepatitis and the two patients with sarcomatoid changes displayed p53 mutations. In contrast, no mutation was observed in the fibrolamellar variant (n = 9), non-cirrhotics (n = 13) and alcoholic cirrhosis (n = 6). The mutations observed were in exons 5-8. Two mutations were observed in codons 136 and 213 as well as a T insertion between residues 156 and 157 (exon 5) and these are reported for the first time in HCC. Likewise, the silent mutation polymorphism in codon 213 was noticed in 3 of the 42 patients. Survival analysis of these patients after surgery showed the mean and median survival in patients with wild-type p53 to be 60 and 43 months respectively. In the group with p53 mutations, the mean and median survival was 15 and 12 months. The difference was statistically significant (P= 0.003)

Pengendalian Frekuensi Dengan Menggunakan Kontrol Fuzzy Prediktif Pada Simulator Plant Turbin-Generator Pada PLTU

Sistem pembangkit dirasakan sangat perlu guna memenuhi kebutuhan tenaga listrik yang semakin meningkat, kestabilan sangat dibutuhkan pada proses pembangkit sehingga sistem pengendalian digunakan untuk menjaga variabel proses tersebut tetap stabil. Salah satunya adalah dengan melakukan pengendali frekuensi pada tubin-generator suatu pembangkit listik, contohnya PLTU (Pembangkit Listrik Tenaga Uap). Frekuensi dari turbin uap harus dijaga kestabilannya agar keluaran daya listrik di generator berjalan dengan baik. Fluktuasi frekuensi adalah salah satu kendala penyampaian daya listrik ke beban, juga waktu kembali yang tidak segera ke kondisi normal akan mengakibatkan kerusakan pada sistem seperti patahnya poros turbin-generator dan kemungkinan terjadi gangguan pada jaringan listrik, sehingga perlu dilakukan pengaturan laju aliran uap yang masuk ke turbin. Kontroler yang digunakan untuk menjaga Perubahan frekuensi adalah kontrol fuzzy prediktif, dengan penambahan gain K1 pada kontrol fuzzy prediktif sebesar 42.35 yang bekerja secara sucsessive kontroler ini dapat mengurangi error sebesar 1,04% jika sistem hanya menggunakan kontroler fuzzy pada saat terjadi Perubahan beban