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To develop a staff training intervention for agitation in people with severe dementia, reaching end-of-life, residing in nursing homes (NHs), test feasibility, acceptability, and whether a trial is warranted.
Feasibility study with pre- and post-intervention data collection, qualitative interviews, and focus groups.
Three NHs in South East England with dementia units, diverse in terms of size, ownership status, and location.
Residents with a dementia diagnosis or scoring ≥2 on the Noticeable Problems Checklist, rated as “severe” on Clinical Dementia Rating Scale, family carers, and staff (healthcare assistants and nurses).
Manualized training, delivered by nonclinical psychology graduates focusing on agitation in severe dementia, underpinned by a palliative care framework.
Main outcomes were feasibility of recruitment, data collection, follow-up, and intervention acceptability. We collected resident, family carer, and staff demographics. Staff provided data on resident’s agitation, pain, quality of life, and service receipt. Staff reported their sense of competence in dementia care. Family carers reported on satisfaction with end-of-life care. In qualitative interviews, we explored staff and family carers’ views on the intervention.
The target three NHs participated: 28 (49%) residents, 53 (74%) staff, and 11 (85%) family carers who were eligible to participate consented. Eight-four percent of staff attended ≥3 sessions, and we achieved 93% follow-up. We were able to complete quantitative interviews. Staff and family carers reported the intervention and delivery were acceptable and helpful.
The intervention was feasible and acceptable indicating a larger trial for effectiveness may be warranted.
Cardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.
To determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.
A microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.
The SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.
The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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.
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.
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.
Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
As part of further investigations into three linked haemorrhagic fever with renal syndrome (HFRS) cases in Wales and England, 21 rats from a breeding colony in Cherwell, and three rats from a household in Cheltenham were screened for hantavirus. Hantavirus RNA was detected in either the lungs and/or kidney of 17/21 (81%) of the Cherwell rats tested, higher than previously detected by blood testing alone (7/21, 33%), and in the kidneys of all three Cheltenham rats. The partial L gene sequences obtained from 10 of the Cherwell rats and the three Cheltenham rats were identical to each other and the previously reported UK Cherwell strain. Seoul hantavirus (SEOV) RNA was detected in the heart, kidney, lung, salivary gland and spleen (but not in the liver) of an individual rat from the Cherwell colony suspected of being the source of SEOV. Serum from 20/20 of the Cherwell rats and two associated HFRS cases had high levels of SEOV-specific antibodies (by virus neutralisation). The high prevalence of SEOV in both sites and the moderately severe disease in the pet rat owners suggest that SEOV in pet rats poses a greater public health risk than previously considered.
Passive surveillance for lyssaviruses in UK bats has been ongoing since 1987 and has identified 13 cases of EBLV-2 from a single species; Myotis daubentonii. No other lyssavirus species has been detected. Between 2005 and 2015, 10 656 bats were submitted, representing 18 species, creating a spatially and temporally uneven sample of British bat fauna. Uniquely, three UK cases originate from a roost at Stokesay Castle in Shropshire, England, where daily checks for grounded and dead bats are undertaken and bat carcasses have been submitted for testing since 2007. Twenty per cent of Daubenton's bats submitted from Stokesay Castle since surveillance began, have tested positive for EBLV-2. Phylogenetic analysis reveals geographical clustering of UK viruses. Isolates from Stokesay Castle are more closely related to one another than to viruses from other regions. Daubenton's bats from Stokesay Castle represent a unique opportunity to study a natural population that appears to maintain EBLV-2 infection and may represent endemic infection at this site. Although the risk to public health from EBLV-2 is low, consequences of infection are severe and effective communication on the need for prompt post-exposure prophylaxis for anyone that has been bitten by a bat is essential.
The WR stellar population can be distinguished, at least partially, from other stellar populations by broad-band IR colour selection. We present the use of a machine learning classifier to quantitatively improve the selection of Galactic Wolf-Rayet (WR) candidates. These methods are used to separate the other stellar populations which have similar IR colours. We show the results of the classifications obtained by using the 2MASS J, H and K photometric bands, and the Spitzer/IRAC bands at 3.6, 4.5, 5.8 and 8.0μm. The k-Nearest Neighbour method has been used to select Galactic WR candidates for observational follow-up. A few candidates have been spectroscopically observed. Preliminary observations suggest that a detection rate of 50% can easily be achieved.
Most evidence in the UK on the effectiveness of brief therapy for depression concerns cognitive behaviour therapy (CBT). In a trial published in 2000, we showed that non-directive counselling and CBT were equally effective in general practice for patients with depression and mixed anxiety and depression. Our results were criticized for including patients not meeting diagnostic criteria for a depressive disorder. In this reanalysis we aimed to compare the effectiveness of the two therapies for patients with an ICD-10 depressive episode.
Patients with an ICD-10 depressive episode or mixed anxiety and depression were randomized to counselling, CBT or usual general practitioner (GP) care. Counsellors provided nondirective, interpersonal counselling following a manual that we developed based on the work of Carl Rogers. Cognitive behaviour therapists provided CBT also guided by a manual. Modelling was carried out using generalized estimating equations with the multiply imputed datasets. Outcomes were mean scores on the Beck Depression Inventory, Brief Symptom Inventory, and Social Adjustment Scale at 4 and 12 months.
A total of 134 participants were randomized to CBT, 126 to counselling and 67 to usual GP care. We undertook (1) an interaction analysis using all 316 patients who were assigned a diagnosis and (2) a head-to-head comparison using only those 130 (41%) participants who had an ICD-10 depressive episode at baseline. CBT and counselling were both superior to GP care at 4 months but not at 12 months. There was no difference in the effectiveness of the two psychological therapies.
We recommend that national clinical guidelines take our findings into consideration in recommending effective alternatives to CBT.
We present the observing modes that have been developed for maximizing the
science to be obtained from the HIFI instrument on board Herschel during
operations. The set of Astronomical Observation Templates and time estimator
based on these observing modes are also illustrated.
Massive stars have profound effects on their surroundings, influencing them by their energetic stellar winds, and finally by supernova explosions. We present a CO 2-1 map of the surroundings of the Wolf-Rayet star WR16, taken with AST/RO at the South Pole, which shows some of these effects.
In experiments performed aboard NASA's low-gravity KC-135 aircraft, it was found
that rapid active control of radial electrostatic stresses can be used to suppress the
growth of the (2,0) mode on capillary bridges in air. This mode naturally becomes
unstable on a cylindrical bridge when the length exceeds the Rayleigh–Plateau (RP)
limit. Capillary bridges having a small amount of electrical conductivity were deployed
with a ring electrode concentric with each end of the bridge. A signal produced by
optically sensing the shape of the bridge was used to control the electrode potentials
so as to counteract the growth of the (2,0) mode. Occasionally the uncontrolled
growth of the (3,0) mode was observed when the length far exceeded the RP limit.
Rapid breakup from the growth of the (2,0) mode on long bridges was confirmed
following deactivation of the control.
A questionnaire sent to trainees in three regions of the UK asked them which current issues they felt were most important in psychiatry. Comments were invited of ways to improve the UK practice of psychiatry.
Trainees from each of the regions were concerned about inadequate resourcing, public expectations, manpower and quality of training. Solutions to these problems were collated.
The opinion of trainees reflects the recent initiatives undertaken by the Royal College of Psychiatrists to improve recruitment and retention. Consultants and trainees have similar concerns, which need to be addressed and monitored at a local and national level.
To study vancomycin-resistant Enterococcus (VRE) prevalence, risk factors, and clustering among hospital inpatients.
Rectal-swab prevalence culture survey conducted from February 5 to March 22,1996.
The Veterans' Affairs Medical Center, Atlanta, Georgia.
Hospital (medical and surgical) inpatients.
The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6; P <.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found.
At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.
A novel method of suppressing the Rayleigh–Plateau capillary
instability of a cylindrical liquid bridge is demonstrated which uses the
radiation pressure of an ultrasonic
wave to control the shape of the bridge. The shape of the bridge is
optically sensed and the information used to control the spatial distribution
the radiation stress on
the surface of the bridge. The feedback is phased so as to suppress
the growth of the
axisymmetric mode which normally becomes unstable when the slenderness,
the length to diameter ratio, exceeds π. Stabilization is achieved
out to a slenderness
of 4.3 for a bridge density matched to the surrounding water bath in a
Breakup of such long bridges was found to produce a satellite drop from
thread of liquid. The active stabilization mechanism used may have application
other capillary systems.
Asymptotic results for the free decay of shape oscillations of viscous liquid spheres have been extended to include higher-order terms in the ratios of the inner and outer viscous penetration lengths to the radius. The new expressions are shown to be important for studies in which the two fluids have dissimilar densities and viscosities such as air/liquid systems. The analysis also includes an expansion for the frequency of maximum response of driven oscillations. The calculations are supported by measurements of the small-amplitude quadrupole mode free decay of nearly spherical bubbles acoustically levitated in clean water. The bubble radii ranged from 400 μm to 1400 μm. The results are interpreted in light of the initial-value problem. The lack of excess damping suggests that the interface behaves ideally for times up to two hours after bubble injection. Measurements were also carried out on bubbles in 0.5 m NaCl solution and in sea water. Larger bubbles (radius > 800 μm) in clean water exhibit damping two to four times larger than predicted by theory. The transition from this anomalous damping to theoretical damping is a very abrupt function of radius. All observations were carried out with similar acoustic fields for counteracting buoyancy. The excess damping appears to be associated with some nonlinear response of the bubble.
The frequency response of the shear layers separating from a circular cylinder subject to small-amplitude rotational oscillations has been investigated experimentally in water for the Reynolds number (Re) range 250 to 1200. A hot-film anemometer was placed in the separated shear layers from 1 to 1.5 diameters downstream of the cylinder, and connected to a lock-in analyser. by referencing the lock-in analyser to the cylinder oscillations, the amplitude and phase of the response to different frequency oscillations were measured directly. It is shown that rotational oscillations corresponding to cylinder peripheral speeds between 0.5 and 3% of the free stream can be used to influence the primary (Kármán) mode of vortex generation. For Re greater than ≈ 500, such oscillations can also force the shear-layer vortices associated with the instability of the separating shear layers. Corresponding to the primary and shear-layer modes are two distinct peaks in response amplitude versus frequency curves, and two very different phase versus frequency curves. The response of the shear layers (and near wake) in the range of Kármán frequency suggests qualitative similarities with the response of an oscillator near resonance. Forced oscillations in the higher-frequency shear-layer mode range are simply convected by the shear layers. Close to the cylinder, the shear-layer response is shown to be comparable to that of generic free shear layers studied by others.
1. The effects of ingestion of diets deficient in both copper and iron on storage of these elements and on the red cell indices have been studied in rats.
2. Injection of Cu into rats whose stores of Cu had been virtually exhausted resulted in a temporary increase in the concentration of plasma Fe and depletion of the Fe stored in the liver. Storage of Fe in the spleen seemed to be affected somewhat differently from that in the liver.
3. Fe injected into Cu-deficient rats was transported to storage sites but, although the plasma Fe concentration was presumably transiently increased thereby, there was no lasting effect.
4. The hypotheses that Cu mediates in the release of Fe from ferritin and that of Osaki, Johnson & Frieden (1966) that caeruloplasmin promotes the rate of Fe-saturation of apotransferrin are discussed.
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