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Snow and ice albedo play a crucial role in the mass losses from the NW Antarctic Peninsula and the South Shetlands Islands since absorption of solar radiation is the largest energy source for surface melt in the cryosphere. Snow albedo exhibits a large variation at different time scales (hours, days, seasonal, long-term trend). It has been established that the thickness of the snow/ice layer that affects the albedo varies from 20 cm to 50 cm. The surface geomorphology of this layer exerts a strong control in the snow albedo evolution over a day because they affect the amount of solar energy received, and the exposure to prevailing winds. In order to discover patterns of variation between snow albedo and surface geomorphology over Hurd Peninsula glaciers at metric scales, we used four DEMs (1957,2000, 2013 and 2019) of 1 m of spatial resolution. In the four DEMs topographical variables (altitude, slope, plan and profile curvature, aspect) and indexes (diurnal differential heating, wind exposition, roughness index) were calculated using QGis_Gdal_SAGA tools. Because of the high spatiotemporal variability of the snow cover, the albedo data obtained from fixed stations provide a partial picture of the actual field behaviour. In order to obtain spatially distributed albedo measurements over Hurd Peninsula glaciers, we designed a portable albedometer. The device consists of two pyranometers, one facing the sky and another facing the ground at 1,20m above the ground, working together with a GNSS. The dataloggers of each pyranometer were set up to take a measurement every 5 seconds. Using this equipment, in January of 2018 and 2019 we surveyed the glaciers of Hurd Peninsula along the same tracks but under different weather conditions (fog, clear sky, clouds and clearings). The population of albedo data obtained with this method was about 800 measured points per track per day. Using QGis we obtained the values of topographical variables and indexes for all the albedo points. Lineal correlations between albedo and topographical variables and indexes were explored. The R2 was especially high in the tracks performed during open sky days. There are not significant correlations between DTMs variables and albedo data in tracks performed in foggy days. Moreover, we built a Linear Regression Model (forward stepwise) of open_sky day’s albedo with Adjusted R²= 0.86 and Std. Error of estimate: 0.00428 with diurnal differential heating_2019, altitudes (1957, 2000, 2013), slope_2019 and convexity_2019 as predictive variables. To estimate the surface albedo all across Hurd Peninsula extending linear models using QGis. Also, we calculated the DTM of 1957-2019 altitude changes in meters (Minimum=-32.694, Maximum=53.188, Mean=7.959, StdDev=10.526), which shows strong correlation with albedo of all open sky tracks. We interpreted these results in relation to the density, structure and state of metamorphism of the snow cover that could represent the layer of snow that affects the albedo in Hurd Peninsula glaciers. The preliminary results seem to indicate that the surface melting intra-annual variability of the Hurd Peninsula glaciers, registered in the glacier surfaces geomorphology, exerts a strong influence on the current albedo.

Background: Over- and potentially inappropriate prescribing of psychotropic medications is a major public health concern among people with dementia. Objective: Describe the CHemical Restraints avOidance MEthodology (CHROME) criteria and evaluate its effects on psychotropic prescribing and quality of life (QoL). Methods: Observational, prospective, two-wave study conducted in two nursing homes. A multicomponent program to eliminate chemical restraints and attain quality prescription of psychotropic medications was implemented. CHROME’s diagnostic criteria comprise constellations of behavioral and psychological symptoms of dementia under six primary syndromic diagnoses. Since pharmacologic treatment is aimed at only one syndrome, polypharmacy is avoided. Psychotropic prescription, QoL, neuropsychiatric symptoms (NPS), and other clinical measurements were collected before and one year after the intervention. Results are presented for all residents (n = 171) and for completer subjects (n = 115). Results: Mean age (SD) of the residents was 87.8 (5.7), 78.9% were women, and 68.5% suffered advanced dementia. Psychotropic prescriptions decreased from 1.9 (1.1) to 0.9 (1.0) (p

A variety of medical and social factors have contributed over the last decades to the overuse of psychotropic drugs in people with dementia. One social factor is probably the frequent failure to provide adequate person-centered care, be it in the community or in institutional settings. This unfortunate reality has been reacted upon with numerous guidelines to reduce prescriptions of the most dangerous drugs (e.g., neuroleptics). Each psychotropic drug prescription can in principle be assessed around three dimensions: (a) adequate, (b) inadequate, and (c) chemical restraint. The CHemical Restraints avOidance MEthodology (CHROME) defined chemical restraint as any prescription based on organizational convenience, rather than justified with medical diagnosis. Two validation studies revealed that one of the main medical reasons of over- and miss-prescriptions was symptom-based prescription. By switching to syndrome-based prescription, a large proportion of drugs could be de-prescribed and some re-adjusted or kept. Paucity of research and weakness of data are not conclusive about the adequacy of specific drugs for the myriad of cases presented by patients with dementia and comorbid conditions. Clinical practice, however, leads us to believe that even under optimal care conditions, psychotropics might still contribute to quality of life if based on an adequate diagnosis. This article explains the rationale that underlies a syndromic approach aimed at optimizing psychotropic treatment in people with dementia whose significant suffering derives from their thought, affective, or behavioral problems. The results of previous validation studies of this new methodology will be discussed and conclusions for future results will be drawn.

OBJECTIVES: Although research shows that nursing home staff experience significant levels of stress and burnout, studies analyzing the relationship of psychosocial variables on their feelings of anxiety are scarce. This study aims to analyze the relationship between psychosocial variables and levels of anxiety among staff. METHOD: Participants were 101 nursing home professionals. In addition to anxiety, socio-demographic variables, depersonalization, burden, relationship with families of the residents, and guilt about the care offered to the residents were assessed. A hierarchical regression analysis was carried out to analyze the contribution of the assessed variables to staff anxiety levels. RESULTS: The obtained model explained 57% of the variance in anxious symptomatology. Guilt about the care offered and poor quality of the relationship with residents’ family were associated with anxiety. Further, working at nursing homes where the staff report higher levels of anxiety symptoms, the presence of depersonalization and burden were also associated with anxiety. CONCLUSION: The findings suggest that in addition to work-related variables (burden and burnout), problems with family members and guilt about the care offered are relevant variables for understanding staff’s anxious symptomatology. CLINICAL IMPLICATIONS: Interventions that address issues of guilt about the quality of care, and problematic relationships with family members of residents, may have potential to reduce staff anxiety and promote their well-being.

We analyzed the photometry of 20038 cool stars from campaigns 12, 13, 14 and 15 of the K2 mission in order to detect, characterize and validate new planetary candidates transiting low-mass stars. We present a catalogue of 25 new periodic transit-like signals in 22 stars, of which we computed the parameters of the stellar host for 19 stars and the planetary parameters for 21 signals. We acquired speckle and AO images, and also inspected archival Pan-STARRS1 images and Gaia DR2 to discard the presence of close stellar companions and to check possible transit dilutions due to nearby stars. False positive probability (FPP) was computed for 22 signals, obtaining FPP < $1\%$ for 17. We consider 12 of them as statistically validated planets. One signal is a false positive and the remaining 12 signals are considered as planet candidates. 20 signals have orbital period P$_{\rm orb} < 10$ $d$, 2 have $10$ $d < $ P$_{\rm orb} < 20$ $d$ and 3 have P$_{\rm orb} > 20$ $d$. Regarding radii, 11 candidates and validated planets have computed radius R $4 R_{\oplus}$. 2 validated planets and 2 candidates are located in moderately bright stars ($m_{kep}, Comment: Accepted for publication in MNRAS

Objective:Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.Design:Observational prospective longitudinal study.Setting:Single nursing home in Las Palmas de Gran Canaria, Spain.Participants:288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.Intervention:Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.Measurements:Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).Results:For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (ppConclusions:Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

Context. Point sources are one of the main contaminants to the recovery of the cosmic microwave background signal at small scales, and their careful detection will be important for the next generation of cosmic microwave background experiments like LiteBird. Aims. We want to develop a method based on fully convolutional networks to detect sources in realistic simulations, and to compare its performance against one of the most used point source detection method in this context, the Mexican hat wavelet 2 (MHW2). The frequencies for our analysis are the 143, 217, and 353 GHz Planck channels. Methods. We produce realistic simulations of point sources at each frequency taking into account potential contaminating signals as the cosmic microwave background, the cosmic infrared background, the Galactic thermal emission, the thermal Sunyaev-Zel’dovich effect, and the instrumental and point source shot noises. We first produce a set of training simulations at 217 GHz to train the neural network that we named PoSeIDoN. Then we apply both PoSeIDoN and the MHW2 to recover the point sources in the validating simulations at all the frequencies, comparing the results by estimating the reliability, completeness, and flux density estimation accuracy. Moreover, the receiver operating characteristic (ROC) curves are computed in order to asses the methods’performance. Results. In the extra-galactic region with a 30° galactic cut, the neural network successfully recovers point sources at 90% completeness corresponding to 253, 126, and 250 mJy for 143, 217, and 353 GHz respectively. In the same validation simulations the wavelet with a 3σ flux density detection limit recovers point sources up to 181, 102, and 153 mJy at 90% completeness. To reduce the number of spurious sources, we also apply a safer 4σ flux density detection limit, the same as in the Planck catalogues, increasing the 90% completeness levels: 235, 137, and 192 mJy. In all cases PoSeIDoN produces a much lower number of spurious sources with respect to MHW2. As expected, the results on spurious sources for both techniques worsen when reducing the galactic cut to 10°. Conclusions. Our results suggest that using neural networks is a very promising approach for detecting point sources using data from cosmic microwave background experiments, providing overall better results in dealing with spurious sources with respect to the more usual filtering approaches. Moreover, PoSeIDoN gives competitive results even at the 217 GHz nearby channels where the network was not trained.

Background: Little is known about the long-term acceptance and effects of cognitive and motor stimulation interventions (CMSI) in Alzheimer’s disease (AD). Objective: To evaluate a replicable CMSI program for mild cognitive impairment (MCI) and mild-to-moderate AD persons. Methods: Eighty-four non-institutionalized subjects with AD were randomized to receive either CMSI, administered by a single care provider, or standard support. Cognition, activities of daily living (ADL), mood, and study partner’s subjective burden were assessed by blinded raters. Data on institutionalization, psychiatric medications, and demise were collected by the study physicians. Random effects model and survival analyses were conducted, after 2 and 3 years of study. Results: Three-year assessments could be performed by the physician in 85% and by the blinded rater in 66% of subjects. Significant benefits were observed in basic ADL at the 2- and 3-year assessments, whereas instrumental ADL showed benefits only up to the second year of intervention (p < 0.05). Conclusion: Long-term cognitive-motor stimulation is well accepted and produces functional benefits in subjects with AD, with no extra subjective burden in the partner.

Non-pharmacological therapies (NPT) are nonchemical, theoretically based, replicable interventions that produce relevant benefits for people with dementia and their caregivers. Three types of cognition-focused NPT are distinguished: cognitive stimulation (CS), which engages people with cognitive deterioration in a range of group activities and discussions aimed at general enhancement of cognitive and social functioning; cognitive training (CT), which focuses on particular cognitive functions; and cognitive rehabilitation (CR), which involves patients and family to achieve personally relevant goals. While CS is indicated in people with mild to moderate dementia for improvement in general cognition, CR faces the challenge to deliver cost-effective programmes.

Objective Physical restraints are associated with severe side effects and suffering. A comprehensive, person-centered, methodology was implemented in 41 Spanish nursing homes to safely eliminate restraints. Methods Data were collected in 2 waves: September 2011 (at the beginning of the intervention, n = 4361) and September 2014 (n = 5051). Use of 10 different types of physical restraints was recorded, as well as frequency of psychotropic medication prescription, falls, and mortality. Results Mean age was 83.4 (SD 8.5) and 63.5% of the residents had dementia. Frequency (95% confidence interval) of people having at least 1 restraint was reduced from 18.1% (17.0–19.3) to 1.6% (1.3–2.0). Use of benzodiazepines was also reduced, with no significant changes in other psychotropic medications and mortality. The rate of total falls increased from 13.1% (12.1–14.1) to 16.1% (15.1–17.1), with no significant increase in injurious falls. Conclusion Physical restraints can almost completely be eliminated with reasonable levels of safety.

The retrogenesis model states that the progression of brain aging and Alzheimer's disease (AD) deterioration proceeds inversely to human ontogenic acquisition patterns. Our aim was to assess if the progressive decline of cognitive abilities and functional capacity in AD follows an inverse sequence of acquisition compared to normal developmental patterns. One hundred eighty one children ranging in age from 4 to 12 years and 148 adults (cognitively normal, subjects with mild cognitive impairment, and mild-moderately severe AD) were assessed with the same cognitive and functional tools. The statistical analyses showed a progressive and inverse distribution on cognitive, functional, and mental age scores when comparing results of children classified by chronological age and patients by dementia staging. The pattern of cognitive acquisition in children showed a progressive development of overall cognitive function along all age ranges, in addition to a simultaneous acquisition of instrumental and basic daily living activities in the functional domain. AD patients showed a progressive decline in cognitive and functional domains, which concurs with the sequence of impairment reported in this dementia. Our findings provide support to the inverse and progressive pattern of functional and cognitive decline observed in AD patients compared to the developmental acquisition of these capacities in children, as stated by the retrogenesis model. Nonetheless, certain differences should be considered when comparing the sequence of acquisition during ontogenic development with that of progressive loss during the course of AD. Retrogenesis may account for the progressive loss of neocortical-related functions in AD.

The purpose of this study was to describe the QoL of patients with AD (PAD) as perceived by family caregivers, and to analyze the correlates of such QoL. This study covered 92 PAD enrolled in a cognitive-motor stimulation study. The severity of cognitive impairment ranged from mild cognitive impairment to severe dementia. QoL was measured using the AD-related quality of life (ADRQL) scale. Social and clinical variables (for both PAD and caregiver) as well as other variables relating to cognition, activities of daily living (ADL), behavior, mood and caregiver burden were recorded. Spearman correlation coefficients and multivariate linear regression analysis were used to analyze the correlates of ADRQL (global score and subscores). Behavior and basic ADL were the best predictors of global QoL (coefficient of determination R(2)=0.57, p

Our top and middle management initially received thorough training in group theory and group management techniques for organizational reasons. In daily shift meetings, nurse aides (NAs) learn some of the techniques and approaches, translating part of them to work with patients. From the moment we started to focus on the day-care center patients as a group to be managed every minute, we found that disturbances decreased significantly (based on empiric assessment by staff).

Background Psychotropic medications are very frequently used in nursing homes and have been associated with falls. Little is known on the potential differences between types and subtypes of these medications, and also regarding different prescription patterns. Methods Data from 4502 residents living in 41 nursing homes belonging to a Spanish private chain were collected during a study period of 1 month and analyzed. Frequency of injurious and noninjurious falls were investigated for the following groups of psychotropic medications: typical neuroleptics; atypical neuroleptics; antidepressants; short and middle half-life benzodiazepines (BZD); long half-life BZD; BZD (of any type) administered only if needed; other hypnotic, sedative or anxiolytic drugs; cholinesterase inhibitors, and memantine. OR (95% CI) were calculated using regression analysis adjusted for age, sex, number of medications, physical restraint, and cognitive performance. Results Mean age (SD) was 84.3 (8.6) and 73.4% of the subjects were female. Psychotropic medication was prescribed to 2987 residents (66.3%), and there were 490 falls. Total falls were associated with use of atypical neuroleptics (OR 1.50, CI 1.17‒1.94), antidepressants (OR 1.36, CI 1.03‒ 1.78), short and middle half-life BZD (OR 1.27, CI 1.00‒1.60), long half-life BZD (OR 1.65, CI 1.14‒2.38), cholinesterase inhibitors (OR 1.42, CI 1.05‒ 1.92), and memantine (OR 1.90, CI 1.32‒2.74). Injurious falls were associated with typical neuroleptics (OR 1.77, CI 0.99 ‒3.17), atypical neuroleptics (OR 1.64, CI 1.11‒ 2.44), and long half-life BZD (OR 2.57, CI 1.56‒ 4.25). The use of 2 or more psychotropics in combination was also associated with a significant increase of total falls and injurious falls. Conclusions Psychotropic medications were highly prescribed in the studied sample and were associated with falls. The most unsafe profile was detected for long half-life BZD, neuroleptics, and psychotropics in combination.

The purpose of this study was to describe and compare QoL and its determinants in two groups of patients with AD that differed in place of residence: community or nursing home. This study covered 200 patients with AD (mean age 79.3 ± 8.2 years, 74% female). Fifty-four per cent of the subjects were living in a nursing home and 46% lived at home. QoL was measured using the Alzheimer's Disease Related Quality of Life Scale (ADRQL). The ADRQL was answered by the family caregiver (community group) or the professional caregiver (nursing home group). Descriptive statistics, Chi-square test, Mann-Whitney test and multiple regression analysis were used to compare sociodemographic and clinical variables between the two study groups. The institutionalized patients were predominantly women (87.0% vs. 58.7%, p0.001), were older (84 years vs. 74 years, p0.001), and had more advanced dementia (Global Deterioration Scale (GDS)5 79.6% vs. 19.6%, p0.001). ADRQL total score was higher (i.e., better QoL) for patients living at home than for institutionalized patients (72.6 ± 19.9 vs. 64.8 ± 18.2, p0.01). Neuropsychiatric symptoms, severity of dementia, depression and functional dependence were significant predictors of worst QoL. Once those variables were controlled a marginal effect of setting on QoL was found, which favored the nursing home (β=0.20, p0.05).

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology (indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. Results: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, multicomponent interventions for the PWD, behavioral interventions, professional CG training); mood (multicomponent interventions for the PWD); QoL (multicomponent interventions for PWD and CG) and restraint prevention (professional CG training); for the CG, grade B was also reached for: CG mood (CG education, CG support, multicomponent interventions for the CG); CG psychological well-being (cognitive stimulation, multicomponent interventions for the CG); CG QoL (multicomponent interventions for PWD and CG). Conclusion: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.

Objective: To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).Methods: Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators.Results: Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017).Conclusions: A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.