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Objectives: Awareness can be defined as a response to, or evaluation of, an aspect of one's situation or internal state. Awareness becomes impaired as dementia progresses; however, the exact nature and degree of impairment in advanced dementia remains unclear. The extent to which caregivers understand or make assumptions about the level and nature of awareness in advanced dementia may have a significant impact on their ability to appropriately respond to and care for the person with dementia. This systematic review examines the literature regarding professional caregiver perceptions about awareness in advanced dementia.Design: A systematic search of online literature databases (PsychInfo, Medline, Embase, CINAHL) was conducted up to January 15, 2018, using a range of search terms related to dementia, awareness and caregiver attitudes.Results: The systematic review included a total of 10 qualitative studies that were heterogeneous in aspects of design, including analyses. Narrative synthesis was used to integrate results. Four major themes were identified from review of the papers: how professional caregivers defined awareness; professional caregiver beliefs about what influences the expression of awareness; professional caregiver beliefs around how to assess awareness in advanced dementia; and the perceived impact of episodes of increased awareness on the person with dementia and caregiver. Sub-themes were identified within each of these areas.Conclusion: This review highlights the importance of professional caregiver perceptions of awareness in advanced dementia. Supporting professional caregivers to assess and understand the nature of awareness in advanced dementia would improve their approach to care and outcomes for people with dementia. [ABSTRACT FROM AUTHOR]

Background: Interventions that improve cognitive function in Alzheimer's disease are urgently required.Aims: To assess whether a novel cognitive training paradigm based on 'chunking' improves working memory and general cognitive function, and is associated with reorganisation of functional activity in prefrontal and parietal cortices (trial registration: ISRCTN43007027).Method: Thirty patients with mild Alzheimer's disease were randomly allocated to receive 18 sessions of 30 min of either adaptive chunking training or an active control intervention over approximately 8 weeks. Pre- and post-intervention functional magnetic resonance imaging (fMRI) scans were also conducted.Results: Adaptive chunking training led to significant improvements in verbal working memory and untrained clinical measures of general cognitive function. Further, fMRI revealed a bilateral reduction in task-related lateral prefrontal and parietal cortex activation in the training group compared with controls.Conclusions: Chunking-based cognitive training is a simple and potentially scalable intervention to improve cognitive function in early Alzheimer's disease. [ABSTRACT FROM AUTHOR]

We study convective motion in vertically vibrated three-dimensional granular beds by comparing the predictions of a model based on a hydrodynamic description to Navier–Stokes order with experimental results obtained using positron emission particle tracking (PEPT). The three-dimensional conservation equations relating mass, momentum and energy are solved using the finite element (FE) method for a viscous vibrofluidized bed by using only observable system parameters such as particle number, size, mass and coefficients of restitution. The mean velocity profiles from the viscous model show reasonable agreement with the experimental results at relatively low altitudes for the range of experimental values studied, though the velocity fields at higher altitudes were systematically underestimated by the model. We confirm that the convection rolls are influenced by the sidewall coefficient of restitution and demonstrate the scaling relationships that operate, where increasing amplitude of vibration leads to a reduction in the angular velocity of the rolls. [ABSTRACT FROM PUBLISHER]

IgA and IgE activity against Teladorsagia circumcincta was investigated in a flock of Texel lambs following natural, mixed nematode infection among lambs. The distribution of IgA activity was similar to a gamma distribution whereas IgE activity was different. Box-Cox analysis demonstrated that X0.25 was a suitable transformation to normalise IgE responses. The transformed IgE activity was under moderate to strong genetic control. Nine different allergens were identified by proteomic analysis. Tropomyosin was selected for further analysis. IgE activity against tropomyosin was moderately heritable and associated with decreased egg counts and with reduced body weight at the time of sampling. [ABSTRACT FROM AUTHOR]

Sixty twin- and 60 single-bearing ewes were used in a 2 X 2 X 2 factorial design incorporating nutritional and shearing-cold exposure treatment (no. =15 per subgroup) to study the effects on periparturient immunity against nematode infection. From week -8 to week -4 relative to parturition, animals grazed ryegrass-white clover pastures at allowances designed to provide either 0.8 (low allowance) or 1.2 (high allowance) of estimated metabolizable energy requirement for a ewe carrying 1.5 lambs. During week-4, half the sheep from each reproductive effort and nutritional group were shorn and exposed to artificial wind and rain for 4 h on each of 4 days consecutively. During the same week, all animals were challenged twice with 1.5 X 104 Teladorsagia circumcincta and 1.5 X 104 Trichostrongylus colubriformis infective third stage larvae to supplement the natural infection from pasture. From week -3 to week + 5 relative to parturition the sheep were run together and offered pasture at rates estimated to enable them to meet their nutrient requirement. Shearing and cold stress reduced ewe body weight (by up to 4.66 kg per sheep), and temporarily reduced the levels of IgA against T. circumcincta (by proportionately 0.24) and T. colubriformis (0.34), and raised faecal egg count (1.6 to 4.4 fold) but did not affect the parasite-specific total antibody levels in the serum. The low allowance during pregnancy was associated with a 6.09-kg decrease in ewe body weight, decrease in the levels of total antibody and of IgA against both T. circumcincta and T. colubriformis, and increased faecal egg count (by 1.5 to 10.6 fold) during pregnancy and lactation. Faecal egg count was consistently higher (up to 8.8 fold) in twin-bearing and rearing ewes than in single-bearing and rearing ewes except during the first 4 weeks of the experiment. A significant effect of litter size on antibody levels was relatively small when compared with short-term changes (reductions)... [ABSTRACT FROM AUTHOR]

We report the case of JW, a 66-year-old woman who presented with musical hallucinations and multiple etiological factors for these rare phenomena. We discuss these factors and the successful amelioration of her symptoms with lamotrigine. [ABSTRACT FROM AUTHOR]

Background: A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum., Aims: We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic., Method: We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020., Results: There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown., Conclusions: UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.

Background: The coronavirus disease 2019 (COVID-19) pandemic led to measures that reduced social contact and support. We explored whether UK residents with more frequent or supportive social contact had fewer depressive symptoms during March-August 2020, and potential factors moderating the relationship., Methods: A convenience sample of UK dwelling participants aged ⩾18 in the internet-based longitudinal COVID-19 Social Study completed up to 22 weekly questionnaires about face-to-face and phone/video social contact frequency, perceived social support, and depressive symptoms using the PHQ-9. Mixed linear models examined associations between social contact and support, and depressive symptoms. We examined for interaction by empathic concern, perspective taking and pre-COVID social contact frequency., Results: In 71 117 people with mean age 49 years (standard deviation 15), those with high perceived social support scored 1.836 (1.801-1.871) points lower on PHQ-9 than those with low support. Daily face-to-face or phone/video contact was associated with lower depressive symptoms (0.258 (95% confidence interval 0.225-0.290) and 0.117 (0.080-0.154), respectively) compared to no contact. The negative association between social relationships and depressive symptoms was stronger for those with high empathic concern, perspective taking and usual sociability., Conclusions: We found during lockdown that those with higher quality or more face-to-face or phone/video contact had fewer depressive symptoms. Contact quality was more strongly associated than quantity. People who were usually more sociable or had higher empathy had more depressive symptoms during enforced reduced contact. The results have implications for COVID-19 and potential future pandemic management, and for understanding the relationship between social factors and mental health.

Currently available treatments for Alzheimer's disease (AD) are disappointing and their modest benefits do not reflect the increased understanding of the condition that has arisen from the last 50 years of research or the huge investments made by the pharmaceutical industry and academia in developing therapies. Cholinesterase inhibitors and memantine are evidence-based symptomatic treatments that offer benefits at the margins of clinical significance, but successive failures in trials of putative disease-modifying drugs have led researchers to investigate the potential efficacy of non-drug interventions. Exercise and cognitive-based interventions have received the most attention, but we are still a long way from understanding whether any can offer real benefit to patients with AD (Huntley et al., 2015).

Background: Chunking is a powerful encoding strategy that significantly improves working memory performance in normal young people., Aims: To investigate chunking in patients with mild Alzheimer's disease and in a control group of elderly people without cognitive impairment., Method: People with mild Alzheimer's disease (n = 28) were recruited and divided according to Mini-Mental State Examination score into mild and very mild disease groups. A control group of 15 elderly individuals was also recruited. All participants performed digit and spatial working memory tasks requiring either unstructured sequences or structured sequences (which encourage chunking of information) to be recalled., Results: The control group and both disease groups performed significantly better on structured trials of the digit working memory tasks, indicating successful use of chunking strategies to improve verbal working memory performance. The control and very mild disease groups also performed significantly better on structured trials of the spatial task, whereas those with mild disease demonstrated no significant difference between the structured and unstructured spatial conditions., Conclusions: The ability to use chunking as an encoding strategy to improve verbal working memory performance is preserved at the mild stage of Alzheimer's disease, whereas use of chunking to improve spatial working memory is impaired by this stage. Simple training in the use of chunking might be a beneficial therapeutic strategy to prolong working memory functioning in patients at the earliest stage of Alzheimer's disease.

The effect of sainfoin (Onobrychis viciifolia) hay consumption on the pathophysiology and local cellular responses of growing lambs during infection with Trichostrongylus colubriformis was investigated. Thirty-two lambs, 16 weeks of age, were allocated to 1 of 4 treatment groups (n=8) that were offered either grass (G) or sainfoin (S) hay while concurrently either infected (+), or not (-) with 12,000 L3 T. colubriformis larvae per week for 6 weeks. Liveweight gains were affected by diet (P=0.002) and reduced by infection (P<0.05). Faecal egg count was reduced in S+compared to G+ from days 35 to 42 (P=0.001); however, total egg output, worm burdens at day 42 and worm fecundity were similar between diets (P>0.05).Feeding sainfoin appeared to enhance immune cell development with tissue eosinophils, mast cells and pan T cells present in greater concentrations in S+ than in G+ animals. However, further studies are required to determine if the enhanced immune cell development is a consequence of a greater nutrient supply or a direct influence of sainfoin metabolites on local inflammatory responses to the gastrointestinal nematode T. colubriformis.

A cDNA encoding the immunogen Pso o 1 from Psoroptes ovis was obtained by polymerase chain reaction (PCR) amplification. The amplicon contained the entire coding sequence for the prepro-enzyme in an open reading frame (ORF) of 966 bp. This gene encoded a predicted protein of 322 amino acids (aa) with 64% aa identity (80% similarity) to the major house dust mite faecal allergen Der f 1. The pro-enzyme form of Pso o 1 was expressed as a recombinant protein in the Pichia pastoris-eukaryotic expression system. Maturation of the recombinant pro-enzyme by autocatalytic activation was not observed, and such maturation could not be achieved using a number of techniques known to activate recombinant Der p 1 and Der f 1 expressed in the same system. Serum raised against recombinant Pso o 1 cross-reacted with mature Der p 1 and allowed Pso o 1 to be immunolocalized to the gut of P. ovis.

cDNAs encoding the immunodominant allergens tropomyosin and paramyosin were amplified from RNA extracted from the sheep scab mite Psoroptes ovis. The tropomyosin cDNA contained an open reading frame (ORF) of 852 bp which encoded a predicted protein with 98% and 97% identity to the house dust mite allergens Der f 10 and Der p 10 respectively. The complete paramyosin ORF generated by RT-PCR was 2625 bp in length and encoded an 875aa predicted protein of 102.6 kDa with 97%, 95% and 89% identity to the paramyosins of Dermatophagoides pteronyssinus (Der p 11), Sarcoptes scabiei and Blomia tropicalis (Blo t 11) respectively. Full length tropomyosin and truncated and full-length paramyosin were expressed as recombinant proteins. IgG and IgE in sera from sheep with a 6-week duration primary infestation of P. ovis did not detect either full-length or truncated recombinant paramyosin. IgG in both infested and naïve sheep sera detected recombinant tropomyosin, suggesting cross-reactivity to tropomyosin and to other invertebrate species to which the sheep may have been exposed. Staining with antibodies directed against tropomyosin and paramyosin was observed throughout sections of P. ovis. Staining was especially prevalent in the anterior sections of the mites, possibly associated with locomotory muscles in this region.

The aim of this study was to investigate the effects of grazing different bioactive forages on acquired immunity against Teladorsagia circumcinta infection. The development of immunity was assessed by following the response of trickle-infected lambs grazing chicory (Cichorium intybus; IC), sulla (Hedysarum coronarium; IS) or grass/clover (Lolium perenne/Trifolium repens; IGC), to a single challenge infection. Parasite-naive lambs, grazing grass/clover, were also challenged with the single infection dose providing the uninfected control (UGC) group. Trickle infection significantly reduced worm establishment, inhibited larval development and increased mucosal mast cell (MMC) and globule leucocyte (GL) cells. Grazing treatment (chicory, sulla or grass/clover) significantly affected adult worm (P<0.05), late-L4 (P<0.01) and mid-L4 (P<0.01) larval-stage recoveries of the trickle-infected lambs, with IGC group always carrying higher worm burdens than either IC or IS lambs. MMC and GL cells of trickle-infected lambs were positively correlated with the proportion of early-L4 worms recovered and negatively correlated with both the proportion of adult worms recovered and the total worm establishment, suggesting that the observed effects were due to an enhanced immune response. The results suggest elevated immune responses against T. circumcincta infections in growing lambs grazing on either sulla or chicory compared to those grazing on grass/clover, probably due to differences in forage nutritional values.