10,896 research outputs found
Analgesic prescribing in care home residents: how epidemiological studies may inform clinical practice
Care home residents are often frail with multiple comorbidities and cognitive impairment, most commonly caused by dementia. This population is under-represented in clinical trials, leading to a lack of valid and reliable evidence to inform cliniciansâ prescribing practice. This paper summarizes how epidemiological research conducted in similar populations can inform pain management by describing pain prevalence, risk factors, typical features and functional consequences. This evidence can help overcome the numerous barriers to optimal pain management in care home residents
A case report of Parry Romberg Syndrome initially presenting as periodontitis
Parry Romberg Syndrome (PRS) is a rare disorder of progressive hemifacial atrophy, involving soft tissues, fat and occasionally bone. It can co-exist with presentations of Morphea. We describe an unusual case of persistent periodontal and alveolar destruction associated with PRS. A 56-year-old African female initially presented with persistent periodontal destruction, which showed minimal response to conventional periodontal treatment. After non-surgical treatment, surgical debridement followed by extraction of the two right maxillary incisor teeth was required to halt the periodontal destruction. Atrophy was not limited to the periodontal tissues. Multidisciplinary care and extensive investigations were required to diagnose PRS. Once the PRS has stabilised, adipose tissue transplants will be required to improve the facial appearance. We highlight the need for extensive investigations and a multidisciplinary approach to diagnose rare systemic causes for recalcitrant periodontal disease
Solution heat treatment, forming and in-die quenching of a commercial sheet magnesium alloy into a complex-shaped component: experimentation and FE analysis
Interest in lightweight materials, particularly magnesium alloys, has increased significantly with rising efficiency requirements in the automotive sector. Magnesium is the lightest available structural metal, with a density approximately 35% lower than that of aluminium. The potential is great for magnesium to become a primary material used in future low carbon vehicle structures; however, there are significant obstacles, namely low ductility and formability, particularly at room temperature. The aim of this work is to present the feasibility of using the solution Heat treatment, Forming, and in-die Quenching (HFQ) process to produce complex shapes from a sheet magnesium alloy, and to use the results to verify a simulation of the process developed using commercial FE software. Uniaxial tensile tests were initially conducted to establish the optimum parameters for forming the part. Stamping trials were then carried out using these parameters, and a simulation set up modelling the forming operation. It was shown that the HFQ process could be used to form a successful component from this alloy, and that a good match was achieved between the results of the forming experiments and the simulation.The authors gratefully acknowledge the support from the EPSRC (Grant Ref: EP/I038616/1) for TARF-LCV: Towards Affordable, Closed-Loop Recyclable Future Low Carbon Vehicle Structures
Identification of Small-Molecule Inhibitors against Meso-2, 6-Diaminopimelate Dehydrogenase from Porphyromonas gingivalis
Species-specific antimicrobial therapy has the potential to combat the increasing threat of antibiotic resistance and alteration of the human microbiome. We therefore set out to demonstrate the beginning of a pathogen-selective drug discovery method using the periodontal pathogen Porphyromonas gingivalis as a model. Through our knowledge of metabolic networks and essential genes we identified a âdruggableâ essential target, meso-diaminopimelate dehydrogenase, which is found in a limited number of species. We adopted a high-throughput virtual screen method on the ZINC chemical library to select a group of potential small-molecule inhibitors. Meso-diaminopimelate dehydrogenase from P. gingivaliswas first expressed and purified in Escherichia coli then characterized for enzymatic inhibitor screening studies. Several inhibitors with similar structural scaffolds containing a sulfonamide core and aromatic substituents showed dose-dependent inhibition. These compounds were further assayed showing reasonable whole-cell activity and the inhibition mechanism was determined. We conclude that the establishment of this target and screening strategy provides a model for the future development of new antimicrobials
A substitute for the singular Green kernel in the Newtonian potential of celestial bodies
The "point mass singularity" inherent in Newton's law for gravitation
represents a major difficulty in accurately determining the potential and
forces inside continuous bodies. Here we report a simple and efficient
analytical method to bypass the singular Green kernel 1/|r-r'| inside the
source without altering the nature of the interaction. We build an equivalent
kernel made up of a "cool kernel", which is fully regular (and contains the
long-range -GM/r asymptotic behavior), and the gradient of a "hyperkernel",
which is also regular. Compared to the initial kernel, these two components are
easily integrated over the source volume using standard numerical techniques.
The demonstration is presented for three-dimensional distributions in
cylindrical coordinates, which are well-suited to describing rotating bodies
(stars, discs, asteroids, etc.) as commonly found in the Universe. An example
of implementation is given. The case of axial symmetry is treated in detail,
and the accuracy is checked by considering an exact potential/surface density
pair corresponding to a flat circular disc. This framework provides new tools
to keep or even improve the physical realism of models and simulations of
self-gravitating systems, and represents, for some of them, a conclusive
alternative to softened gravity.Comment: Accepted for publication in A&A; 7 pages, color figure
Social networks, social capital and end-of-life care for people with dementia: a realist review
OBJECTIVES (1) To develop an understanding of how social
capital may be conceptualised within the context of endof-life care and how it can influence outcomes for people
with dementia and their families with specific reference
to the context and mechanisms that explain observed
outcomes. (2) To produce guidance for healthcare systems
and researchers to better structure and design a public
health approach to end-of-life care for people with
dementia.
DESIGN A realist review.
Data sources MEDLINE, EMBASE, CINAHL and grey
literature.
ANALYSIS We conceptualised social capital as a complex
intervention and, in order to understand how change is
generated, used realist evaluation methods to create
different configurations of context, mechanism and
outcomes. We conducted an iterative search focusing
on social capital, social networks and end-of-life care in
dementia. All study designs and outcomes were screened
and analysed to elicit explanations for a range of outcomes
identified. Explanations were consolidated into an
overarching programme theory that drew on substantive
theory from the social sciences and a public health
approach to palliative care.
RESULTS We identified 118 articles from 16 countries
ranging from 1992 to 2018. A total of 40 contextmechanism-outcome configurations help explain how
social capital may influence end-of-life care for people
with dementia. Such influence was identified within five
key areas. These included: (1) socially orientating a person
with dementia following diagnosis; (2) transitions in the
physical environment of care; (3) how the caregiving
experience is viewed by those directly involved with it; (4)
transition of a person with dementia into the fourth age;
(5) the decision making processes underpinning such
processes.
CONCLUSION This review contributes to the dispassionate
understanding of how complex systems such as
community and social capital might be viewed as a tool to
improve end-of-life care for people with dementia.
PROSPERO REGISTRATION NUMBER CRD42018084524
Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing.
OBJECTIVES: To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. DESIGN: Systematic review. SETTING: We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). PARTICIPANTS: LTC residents. MEASUREMENTS: We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. RESULTS: Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. CONCLUSION: Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively
Effective action for strongly correlated electron systems
The su(2|1) coherent-state path-integral representation of the partition
function of the t - J model of strongly correlated electrons is derived at
finite doping. The emergent effective action is compared to the one proposed
earlier on phenomenological grounds by Shankar to describe holes in an
antiferromagnet (Nucl.Phys. B330 (1990) 433). The t - J model effective action
is found to have an important "extra" factor with no analogue in Shankar's
action. It represents the local constraint of no double electron occupancy and
reflects the rearrangement of the underlying phase-space manifold due to the
presence of strong electron correlation. This important ingredient is shown to
be essential to describe the physics of strongly correlated electron systems.
Keywords: t - J model of strongly correlated electrons; su(2|1)
coherent-state path integralComment: 22 page
Psychotropic prescribing for English care home residents with dementia compared with national guidance: findings from the MARQUE national longitudinal study
Background
Despite policy pressure and concerns regarding the use of antipsychotics and benzodiazepines, many care home residents with dementia are prescribed psychotropic medication, often off licence. This is the first large study to report psychotropic prescribing and âas requiredâ administration patterns in English care homes.
Aims
To explore the prevalence and associates of psychotropic prescription in care home residents with dementia and compare the results with national guidance.
Method
We collected data in a longitudinal cohort study of residents with diagnosed or probable dementia in 86 care homes in England in 2014â2016. We reported the prevalence of psychotropic (antipsychotics, anxiolytics/hypnotics, antidepressants) prescriptions and drug receipt. We explored the associations between resident factors (sociodemographic, agitation [CohenâMansfield Agitation Inventory], dementia severity [Clinical Dementia Rating]) and care home factors (type, ownership, size, dementia registration/specialism, quality rating) in prescription and âas requiredâ administration, using multilevel regression models.
Results
We analysed data from 1425 residents. At baseline, 822 residents (57.7%, 95% CI: 55.1â60.2) were prescribed a psychotropic drug, 310 residents (21.8% 95% CI: 19.7â24.0) were prescribed an anxiolytic/hypnotic, 232 (94.3%, 95% CI: 90.6â96.6) were prescribed one antipsychotic and 14 (5.7%, 95% CI: 3.4â9.4) were prescribed two antipsychotics. The median prescription duration during the study was 1 year. Residents with clinically significant agitation were prescribed more antipsychotics (odds ratio [OR] = 2.00, 95% CI: 1.64â2.45) and anxiolytics/hypnotics (OR = 2.81, 95% CI: 2.31â3.40).
Conclusions
Antipsychotics and anxiolytics/hypnotics are more commonly prescribed for people with dementia in care homes than in the community, and prescribing may not reflect guidelines. Policies which advocate reduced use of psychotropics should better support psychosocial interventions
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