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The incidence of dementia in Black, Asian and minority ethnic (BAME) groups is increasing in the UK, with concern about underdiagnosis and late presentation.
By reviewing referrals to memory clinics from Leicester City we examined whether the following differed by ethnicity: the proportion with a diagnosis of dementia, type of dementia and severity at presentation.
We examined referrals between 2010 and 2017: all those whose ethnicity was recorded as Black (n = 131) and a random sample of 260 Asian and 259 White British referrals. Severity of dementia was assessed by record review. Odds ratios (ORs) were adjusted for general practice, age, gender and year of referral.
A diagnosis of dementia was recorded in 193 (74.5%) White British, 96 (73.3%) Black and 160 (61.5%) Asian referrals. Compared with Asians, White British had twice the adjusted odds of a dementia diagnosis (OR = 1.99 (1.23–3.22). Of those with dementia, Alzheimer's disease was more common in White British (57.0%) than in Asian (43.8%) and Black referrals (51.0%): adjusted OR White British versus Asian 1.76 (1.11–2.77). Of those with dementia, the proportion with moderate/severe disease was highest in White British (66.8%), compared with 61.9% in Asian and 45.8% in Black groups. The adjusted OR for the White versus Black groups was 2.03 (1.10–3.72), with no significant difference between Asian and White British groups.
Differences in confirmed dementia suggest general practitioners have a lower threshold for referral for possible dementia in some BAME groups. Unlike other centres, we found no evidence of greater severity at presentation in Asian and Black groups.
To examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition.
ICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation.
Routine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians.
There were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged.
ICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Forty-eight competency statements in 8 domains were developed.
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The translation of discoveries to drugs, devices, and behavioral interventions requires well-prepared study teams. Execution of clinical trials remains suboptimal due to varied quality in design, execution, analysis, and reporting. A critical impediment is inconsistent, or even absent, competency-based training for clinical trial personnel.
In 2014, the National Center for Advancing Translational Science (NCATS) funded the project, Enhancing Clinical Research Professionals’ Training and Qualifications (ECRPTQ), aimed at addressing this deficit. The goal was to ensure all personnel are competent to execute clinical trials. A phased structure was utilized.
This paper focuses on training recommendations in Good Clinical Practice (GCP). Leveraging input from all Clinical and Translational Science Award hubs, the following was recommended to NCATS: all investigators and study coordinators executing a clinical trial should understand GCP principles and undergo training every 3 years, with the training method meeting the minimum criteria identified by the International Conference on Harmonisation GCP.
We anticipate that industry sponsors will acknowledge such training, eliminating redundant training requests. We proposed metrics to be tracked that required further study. A separate task force was composed to define recommendations for metrics to be reported to NCATS.
A developmental model, based upon murine rodents, has been proposed by Kavanagh et al. (2007) to explain lower molar proportions in mammals. We produce a clade-wide macroevolutionary test of the model using the dental evolutionary trends in a unique radiation of extinct mammals endemic to South America (“Meridiungulata”) that comprise a diverse array of molar morphologies. All of the South American ungulate groups examined follow the inhibitory cascade model with the exception of two groups: Interatheriidae (Notoungulata) and Astrapotheria. For most taxa studied, ratios between lower molar areas are greater than 1.0, indicating a weak inhibition by m1 on the subsequent molars in the tooth row, and a trend to greater absolute size of the posterior molars. Comparisons of mean ratios between clades indicate that a significant phylogenetic signal can be detected, particularly between the two groups within Notoungulata— Typotheria and Toxodontia. Body mass estimates were found to be significantly correlated with both m3/m1 and m2/m1 ratios, suggesting that the larger body size achieved the weaker inhibition between the lower molars. Molar ratio patterns are examined and discussed in relation to the independent and numerous acquisitions of hypsodonty that are characteristic of dental evolution in “Meridiungulata.”
Studies of marine reserves typically focus upon differences in the size and abundance of target organisms inside versus outside reserve borders, but they seldom provide spatially explicit measurements of how reserves influence mortality rates. This study investigated mortality rates for female California spiny lobster (Panulirus interruptus) at multiple sites inside and outside of three marine reserves at the Santa Barbara Channel Islands, California, USA. Mean total mortality (Z) of female lobsters was lower at sites inside reserves (Z = 0.22 [± 0.05 SE]) than at sites outside reserves (Z = 0.59 [± 0.02 SE]). Mean mortality at all sites inside reserves, and among sites near reserve centres (where Z = 0.17 [± 0.05 SE]), was similar to estimates of natural mortality for other temperate spiny lobster species. Among sites inside reserves, there was a positive relationship between mortality and proximity to reserve borders, but this relationship was absent among sites outside reserves. Mortality estimates were much more variable among sites inside reserves than at sites in fished areas. This variation is probably due to differential emigration rates from the three reserves, as well as site-specific ecological factors that influence population structure, demonstrating the importance of spatially explicit reserve sampling and understanding how ecological heterogeneity influences fisheries models.
The transition from Palaeoindian to Archaic societies in North America is often viewed as a linear progression over a brief but time-transgressive period. New evidence from the Wilson-Leonard site in Texas suggests social experimentation by Palaeoindians over a 2500-year period eventually resulted in Archaic societies. The process was neither short nor linear, and the evidence shows that different but contemporaneous lifeways existed in a variety of locales in the south-central US in the Early Holocene.
This study investigated the psychometric properties of the revised Positive and Negative Affect Schedule for Children (PANAS-C; Joiner, Catanzaro & Laurent, 1996) in 228 nonclinical children and adolescents aged between 8 and 15 years. The results revealed that the PANAS-C possesses high internal consistency and encouraging convergent validity, as demonstrated by correlations with the theoretically related constructs of Neuroticism and Extraversion. Construct validity was supported through confirmatory factor analysis, which revealed a two dimensional structure comprising Negative and Positive Affect. Divergent validity was confirmed by the nonsignificant correlation between positive and negative affect. Thus, the PANAS-C was demonstrated to have good reliability and validity, subject to minor changes in item content.
Cylas formicarius (F.) shows a strong overall sexual monomorophism, with external differences noted in only three organs: (a) relative size of the hind wings; (b) form of the antennal club and numbers of its different types of sensillum; and (c) size of the compound eyes and their individual facets. We relate these to known or predicted behavioural differences. Eye dimorphism is used to test a theoretical rule on the relationship between differences in overall eye size and in the size of individual ommatidia. Some sexually monomorphic features are briefly discussed, including two types of putatively sensory hairs not found on the antennae.
In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.
A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: (1) diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; (2) the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and (3) the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.
The scores of 269 depressed patients on the Depressive Category-Type Scale were analysed. The distributions of component and total scores were found to be bimodal, indicating that most depressed patients can be divided into an endogenous group and another characterized by the presence of neurotic features and the absence of endogenous ones. These findings were discussed in relation to those of other investigators. The relationship between the differentiation of syndromes and the classification of patients into corresponding diagnostic groups was considered. Finally, it was suggested that it should be interesting to try to estimate, from published data, the correlation between endogenous and neurotic depression in the general population.
Medusahead (Elymus caput-medusae L.) matures later in the spring than most associated species, and has a seed head moisture content of above 30 per cent for approximately a month after leaves and stems begin to dry. High temperature is more injurious to seed viability when seed moisture content is high. Control burns of medusahead infested rangeland were most effective in late afternoon when burning slowly (into a mild wind) and at the soft dough stage of medusahead seed development.
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