A guide to best practice dementia care: lessons learnt from a serious case review

This reflective paper discussed a clinical scenario and compares best practice guidelines with published literature against a backdrop of evidence taken from a serious case review (SCR). Mrs B (pseudonym) was a 94 year old lady with dementia and blinds, plus several other co-morbidties, including a previous stroke, She lived in a care home and had a history of falling. The last fall was fatal, due to aspiration pneumonia and fractured vertebrae of the neck. A serious case review process highlighted a number of failures in interdisciplinary working practice which contributed ultimately to Mrs B's avoidable death. The article discusses how applying evidence based best practice could have led to better care outcomes. A series of severn recommendations and lessons learned are presented for multi-agency approach to best practice in dementia car

Working with Children and Young People with Learning Disabilities and Comorbid Mental Health/ Autism/ Challenging Behaviour Conditions: A Workforce Development Project

London South Bank University (LSBU) are pleased to present a project report for Health Education England on the staffing needs for Children and Young People with a learning disability, mental health problem and challenging behaviours. Many families have complained about poor services. People have told us about: • Poor access and referral to services • A lack of awareness by staff of the things that matter to people with learning disability • Not getting the right support • Having services not near to where we live • People being sent to hospital or long term residential services This project report talks about who are the most suitable staff needed to help to improve services to offer high quality, family centred care packages, working across health and social care services. The aims are to provide the right care for Children and Young People (CYP) closer to their homes and families. The information was collected from looking at published reports and hearing about people’s experiences of service changes taking place today. The report will be shared with the group who will make recommendations for better services to the Government

Angle-dependence of quantum oscillations in YBa2Cu3O6.59 shows free spin behaviour of quasiparticles

Measurements of quantum oscillations in the cuprate superconductors afford a new opportunity to assess the extent to which the electronic properties of these materials yield to a description rooted in Fermi liquid theory. However, such an analysis is hampered by the small number of oscillatory periods observed. Here we employ a genetic algorithm to globally model the field, angular, and temperature dependence of the quantum oscillations observed in the resistivity of YBa2Cu3O6.59. This approach successfully fits an entire data set to a Fermi surface comprised of two small, quasi-2-dimensional cylinders. A key feature of the data is the first identification of the effect of Zeeman splitting, which separates spin-up and spin-down contributions, indicating that the quasiparticles in the cuprates behave as nearly free spins, constraining the source of the Fermi surface reconstruction to something other than a conventional spin density wave with moments parallel to the CuO2 planes.Comment: 8 pages, 4 figure

Classical swine fever virus Npro antagonises IRF3 to prevent IFN-independent TLR3 and RIG-I-mediated apoptosis

Classical swine fever virus (CSFV) is the causative agent of classical swine fever,a notifiable disease of economic importance that causes severe leukopenia, fever and haemorrhagic disease in domesticated pigs and wild boar across the globe. CSFV has been shown to antagonise the induction of type I IFN, partly through a function of its N-terminal protease (Npro) which binds IRF3 and targets it for proteasomal degradation. Additionally, Npro has been shown to antagonise apoptosis triggered by the dsRNA-homologpoly (I:C), however the exact mechanism by which this is achieved has not been fully elucidated. In this study we confirm the ability of Npro to inhibit dsRNA-mediated apoptosis and show that Npro is also able to antagonise Sendai virus-mediated apoptosis in PK-15 cells. Gene editedPK-15 cell lines were used to show the dsRNA-sensing pathogen recognition receptors (PRRs) TLR3 and RIG-I specifically respond to poly(I:C) and SeV respectively, subsequently triggering apoptosis through pathways that convergeon IRF3 and culminate in the cleavage of caspase-3.Importantly, this IRF3-mediated apoptosis was found to be dependent on transcription-independent functions of IRF3 and also on Bax, a pro-apoptotic Bcl-2 family protein, through a direct interaction between the two proteins. Deletion of IRF3, stable expression of Npro and infection with wild-type CSFV were found to antagonise the mitochondrial localisation of Bax, a key hallmark of the intrinsic, mitochondrial pathway of apoptosis. Together, these findings show that Npro’s putative interaction with IRF3 is involved not only in its antagonism of type I IFN, but also dsRNA-mediated mitochondrial apoptosis

Superconductivity. Quasiparticle mass enhancement approaching optimal doping in a high-T(c) superconductor.

In the quest for superconductors with higher transition temperatures (T(c)), one emerging motif is that electronic interactions favorable for superconductivity can be enhanced by fluctuations of a broken-symmetry phase. Recent experiments have suggested the existence of the requisite broken-symmetry phase in the high-T(c) cuprates, but the impact of such a phase on the ground-state electronic interactions has remained unclear. We used magnetic fields exceeding 90 tesla to access the underlying metallic state of the cuprate YBa2Cu3O(6+δ) over a wide range of doping, and observed magnetic quantum oscillations that reveal a strong enhancement of the quasiparticle effective mass toward optimal doping. This mass enhancement results from increasing electronic interactions approaching optimal doping, and suggests a quantum critical point at a hole doping of p(crit) ≈ 0.18.This work is supported by the US Department of Energy BES \Science at 100 T," the National Science Foundation, the State of Florida, the Natural Science and Engineering Research Council of Canada and the Canadian Institute for Advanced Research. S.E.S. ac- knowledges support from the Royal Society and the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013) / ERC Grant Agree- ment no. 337425.This is the accepted manuscript. The final version is available at http://www.sciencemag.org/content/348/6232/317.abstract?sid=a882093c-ded2-481c-b62b-2f79a56b5689

Introducing a Peoples Academy into Higher Education: A coproduction approach to sustained wellbeing

Purpose: The introduction of a People’s Academy within the School of Health and Social Care at London South Bank University has created ripples across the pond that is Higher Education. Approach: Working as a coproduction innovation hub, the People’s Academy celebrates inclusion of those with a lived experience of health and social care services into the academic community as valued members of the teaching and learning team. In it’s second year the People’s Academy has gained attention and achieved a ‘highly commended’ status from external regulating bodies. Findings: In this paper we report on aspects arising from an entrepreneurial education approach. First, is the work based learning experience students achieve within the Higher Education Institution setting, preparing them for clinical placements and client encounters. Second are ripples of activity the People’s Academy workstreams have sent throughout the academic staff via critically creative working practices as a process of entrepreneurial education. Conclusions focus on a sustainable approach to recovery and resilience (whether physical or psychological) and overall wellbeing that People’s Academy members recognise as a raised level of compassion for sustainable health and wellbeing for all. Originality: The work and enthusiasm of the People’s Academy as an authentic social engagement process rippling across the ‘University’ experience; whether for students in the classroom or when working alongside academic staff, is identifiable in all aspects of academic activities. Most importantly is a positive gain in terms of knowledge, skills and confidence for the People’s Academy members themselves and their own wellbeing enhancement

Age, gender and disability predict future disability in older people: the Rotterdam Study

<p>Abstract</p> <p>Background</p> <p>To develop a prediction model that predicts disability in community-dwelling older people. Insight in the predictors of disability is needed to target preventive strategies for people at increased risk.</p> <p>Methods</p> <p>Data were obtained from the Rotterdam Study, including subjects of 55 years and over. Subjects who had complete data for sociodemographic factors, life style variables, health conditions, disability status at baseline and complete data for disability at follow-up were included in the analysis. Disability was expressed as a Disability Index (DI) measured with the Health Assessment Questionnaire.</p> <p>We used a multivariable polytomous logistic regression to derive a basic prediction model and an extended prediction model. Finally we developed readily applicable score charts for the calculation of outcome probabilities.</p> <p>Results</p> <p>Of the 5027 subjects included, 49% had no disability, 18% had mild disability, 16% had severe disability and 18% had deceased at follow-up after six years. The strongest predictors were age and prior disability. The contribution of other predictors was relatively small. The discriminative ability of the basic model was high; the extended model did not enhance predictive ability.</p> <p>Conclusion</p> <p>As prior disability status predicts future disability status, interventive strategies should be aimed at preventing disability in the first place.</p

Integrated functional visualization of eukaryotic genomes

BACKGROUND: Increasing amounts of data from large scale whole genome analysis efforts demands convenient tools for manipulation, visualization and investigation. Whole genome plots offer an intuitive window to the analysis. We describe two applications that enable users to easily plot and explore whole genome data from their own or other researchers' experiments. RESULTS: STRIPE and GFFtool (General Feature Format Tool) are softwares designed to support integration, visualization and exploration of whole genome data from eukaryotic genomes. STRIPE, in addition to providing a highly customizable and interactive data plot, provides access to numerous well-selected databases with updated information on all genes of a genome. GFFtool provides a user-friendly solution to integrating experimental data with the genomic information available in public databases. They also obviate the need for users to maintain large annotation resources, as they link to well-known resources using standard gene and protein identifiers. CONCLUSION: The programs provide the user with broad genomic overviews of data distribution, fast access to data of interest, and the ability to navigate speedily from one resource to another, and gain a better understanding of result of whole genome analysis experiments

Neurocognitive outcomes in neurofibromatosis clinical trials

Neurofibromatosis type 1 (NF1) is associated with neurocognitive deficits that can impact everyday functioning of children, adolescents, and adults with this disease. However, there is little agreement regarding measures to use as cognitive endpoints in clinical trials. This article describes the work of the Neurocognitive Committee of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration. The goal of this committee is to identify standardized and specific cognitive assessment tools for use in NF clinical trials. The committee first identified cognitive domains relevant to NF1 and prioritized attention as the first domain of focus given prior and current trends in NF1 cognitive clinical trials. Performance measures and behavioral rating questionnaires of attention were reviewed by the group using established criteria to assess patient characteristics, psychometric properties, and feasibility. The highest rated tests underwent side-by-side comparison. The Digit Span subtest from the Wechsler scales was given the highest ratings of the performance measures due to its good psychometrics, feasibility, utility across a wide age range, and extensive use in previous research. The Conners scales achieved the highest ratings of the behavioral questionnaires for similar reasons. Future articles will focus on other cognitive domains, with the ultimate goal of achieving agreement for cognitive endpoints that can be used across NF clinical trials

Ecological implications of a flower size/number trade-off in tropical forest trees

Peer reviewedPublisher PD