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The aim of the study was to investigate responses to dementia‐relevant words in healthy older people and to investigate changes in response over 20‐months in people with early‐stage dementia. An emotional Stroop task, using colour‐naming dementia‐relevant words, was used as an indicator of implicit awareness of dementia. Overall, 24 people with dementia and 24 healthy older people completed an emotional Stroop task (T1). People with dementia completed the same task again after 12 (T2) and 20 (T3) months. For people with dementia emotional Stroop performance was contrasted with ratings of explicit awareness based on a detailed interview at T1 and at T2. For healthy older people and people with dementia response times to dementia‐relevant words were significantly longer than those for neutral words. The effect was absent for people with dementia at T3. This decline in the emotional Stroop effect was not associated with cognitive decline as measured by the MMSE. Ratings of explicit awareness showed no significant change over time. There was no association between explicit awareness and implicit awareness. Implicit awareness of the condition is evident in early‐stage dementia and can be elicited even where there is reduced explicit awareness. The emotional Stroop effect for dementia‐relevant words in people with dementia appears to decline over time, independently of changes in MMSE score, suggesting that implicit awareness fades as time progresses. [ABSTRACT FROM AUTHOR]

As the world faces an escalating energy crisis, the necessity of adopting alternative energy sources becomes increasingly evident. Despite challenges, the imperative to prioritise these eco‐friendly alternatives remains paramount in paving the way for a more sustainable and resilient future for our planet and its inhabitants. The pursuit of sustainable energy sources has brought the oxygen reduction reaction (ORR) into the spotlight as a crucial cathodic reaction in energy‐converting systems, notably fuel cells (FCs). These FCs hold tremendous promise in providing an eco‐friendly and efficient energy supply. However, the widespread implementation of FCs is hindered by their reliance on expensive and scarce noble metal catalysts, such as platinum (Pt), which pose economic and environmental challenges. Hence, this work reports the preparation, characterisation (FTIR, XPS, SEM and EDX) and application of four composites based on doped‐carbon materials (CM) and on the Wells‐Dawson POM salt K6⋅α‐[P2W12Mo6O62] ⋅ 19H2O (P2W12Mo6@MWCNT_N8, P2W12Mo6@MWCNT_N6, P2W12Mo6@MWCNT_S6, and P2W12Mo6@GF_S6) as ORR electrocatalysts in alkaline medium (pH=13). The successful doping of the carbon materials with nitrogen (N) and sulphur (S) and the incorporation of the polyoxometalate were verified through comprehensive structural characterisation. Overall, P2W12Mo6@MWCNT_N8 exhibited favourable onset potentials of 0.84 V vs. RHE, highlighting its high catalytic activity. Additionally, the catalyst showed excellent tolerance to methanol crossover, retaining 91 % of initial current, which is crucial for practical fuel cell applications. Furthermore, the P2W12Mo6@MWCNT_N8 catalyst showed commendable stability, retaining 81 % of its initial current after 36000 seconds at an operating potential of E=0.46 V vs. RHE. These encouraging results denote the significant potential of this electrocatalyst in advancing sustainable energy conversion technologies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Impaired cognition and instrumental activities of daily living (iADL) are key diagnostic features of dementia; however, few studies have compared trajectories of cognition and iADL. METHODS: Participants from the IDEAL study comprised 1537, 1183, and 851 people with dementia, and 1277, 977, and 749 caregivers at baseline, 12 and 24 months, respectively. Addenbrooke's Cognitive Examination‐III and Functional Activities Questionnaire were used to measure cognition and iADL, respectively. Scores were converted to deciles. RESULTS: Self‐rated iADL declined on average by ‐0.08 (‐0.25, 0.08) decile points per timepoint more than cognition. Informant‐rated iADL declined on average by ‐0.31 (‐0.43, ‐0.18) decile points per timepoint more than cognition. DISCUSSION: Cognition and self‐rated iADL declined at a similar rate. Informant‐rated iADL declined at a significantly greater rate than cognition. Therefore, either cognition and perceived iADL decline at different rates or informants overestimate increasing iADL difficulties compared to both cognition and self‐ratings. Highlights: Self‐ratings of the degree of functional difficulties were consistent with cognitionDecline in self‐rated everyday activities was consistent with cognitive declineInformant‐ratings of everyday activities declined more than cognition [ABSTRACT FROM AUTHOR]

Background: The perspectives of people with moderate‐to‐severe dementia are rarely directly elicited in research studies. Objectives: This systematic review will explore methods and approaches for including the perspectives and preferences of people with moderate‐to‐severe dementia in research. Methods: AgeLine, CINAHL, Embase, PsycINFO, PubMed, Social Policy and Practice and Web of Science were searched until June 16 2022. Study quality was assessed using the 16‐item Quality Assessment Tool. We described specific communication tools, reviewed the evidence for their effectiveness and considered their strengths and limitations. We examined the more general communication skills and techniques applied to support the use of these tools using thematic synthesis. The review protocol was registered with PROSPERO CRD42019130386 and the review was conducted and reported according to PRISMA guidelines. Results: Seven studies reported in 11 publications were included. In these studies five specific communication tools were used: Talking Mats, Augmentative and Alternative Communication Flexiboard, generic photographs in combination with a preference placement board, consultation ballot and personalised communication prescriptions. Each tool identified had advantages and disadvantages depending on dementia severity, verbal or physical ability, expense, researcher training requirements and ease of use. Thematic synthesis identified five general approaches to optimising communication that were employed to support use of the tools: ensuring conversations are individual and person‐centred, managing external influences, engaging others, creating structure and facilitation skills. Conclusion: All tools had some utility and there was no clear evidence to support the recommendation of any one specific tool; therefore, researchers are advised to select the tool most appropriate to their context. Implications for Practice: The findings offer general guidance for researchers and practitioners on how to facilitate communication with people with moderate‐to‐severe dementia. [ABSTRACT FROM AUTHOR]

Objective: Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data.Methods: Data were collected between September 2020 and April 2021 in England and Wales. Carers were identified from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort and data were collected either through the telephone, video conferencing, or an online questionnaire. Responses from 242 carers were compared against benchmark data from the IDEAL cohort collected pre-pandemic. Analyses were conducted for the full sample of carers and spousal/partner carers only.Results: In total 48.8% of carers thought their healthcare needs were negatively affected during the pandemic. Compared with pre-pandemic data carers were more lonely and experienced less life satisfaction. There was little impact on carers' experience of caregiving, although carers felt trapped in their caregiving role. Carers were more optimistic and had higher social contact with relatives. There were changes in the methods carers used for contacting relatives and friends. Most carers coped very or fairly well during the pandemic. There was little difference in the experiences of spousal/partner carers and the full sample.Conclusions: After a long period of providing care under pandemic conditions carers require additional support. This support needs to be focused on alleviating feelings of loneliness and increasing life satisfaction. Services need to consider how to improve access to health care, particularly resuming face-to-face appointments. [ABSTRACT FROM AUTHOR]

Objectives: Awareness of difficulties shown by people with dementia is known to vary, but few studies have explored changes in awareness over time. Investigating this could further the understanding of surrounding concepts and reasons for impaired awareness. Recognising emerging or diminishing awareness could facilitate discussions about diagnosis and appropriate post-diagnostic support.Methods: Using longitudinal data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort, awareness in community-dwelling people with mild-to-moderate dementia was assessed at three timepoints over 2 years. A validated checklist was used to evaluate awareness of difficulties associated with dementia. We examined changes in awareness for people with low awareness at baseline, and used case-matching to describe differences in characteristics between people who gained awareness, and those who continued with low awareness.Results: At baseline, 83 people from a sample of 917 showed low awareness. The majority of those remaining in the study at later timepoints had gained awareness, some as late as four or more years after diagnosis. Case-matched comparisons revealed few distinguishing characteristics: cases with stable low awareness had similar or better cognitive and functional ability than those who gained and retained awareness at 12 and 24 months, but may have had more co-morbidities.Conclusions: Self-reported awareness of difficulties can change and may increase over time in people with mild-to-moderate dementia. There may be individual reasons for ongoing low awareness, not explained by cognitive or functional ability. This challenges the view that a single record of low awareness represents a fixed disease-related symptom, and highlights the complex, individual and dynamic nature of awareness. [ABSTRACT FROM AUTHOR]

Background: Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to 'live well'. However, it remains unclear to what extent these recommendations are being achieved.Methods: Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia.Results: Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status.Conclusions: Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development. [ABSTRACT FROM AUTHOR]

Key points: The focus on living well with dementia encourages a more positive and empowering approachThe right support can improve the experience of living with dementiaAn holistic approach to assessing the needs of people with dementia and identifying the factors that impact on their well‐being is essentialEnabling people to live better requires a broad approach that encompasses both health and social systems and the wider community [ABSTRACT FROM AUTHOR]

Objective: To determine whether auditory hallucinations in community-dwelling people with dementia (PwD) living in the community impacted on quality of life (QoL), subjective wellbeing and life satisfaction.Design: Cross-sectional cohort study.Settings and Participants: 1251 community-dwelling PwD and caregivers were included in this study.Measures: Neuropsychiatric Inventory Questionnaire completed by caregiver interview. Mean differences between the absence and presence of auditory hallucinations were compared to scores on three validated measures of living well: QoL in Alzheimer's disease scale (QoL-AD), World Health Organization-Five Well-being Index and Satisfaction with Life Scale. Analysis of covariance determined the confounding contributions of cognition via Mini-Mental State Examination, depression via Geriatric Depression Scale-10, caregiver stress via Relative Stress Scale and whether antipsychotic drugs were prescribed.Results: Auditory hallucinations were associated with lower scores for QoL (p < 0.001, η2  = 0.01), wellbeing (p < 0.001, η2  = 0.02) and life satisfaction (p < 0.001, η2  = 0.01). After controlling for background measures, which were potential confounds, the relationship between auditory hallucinations and QoL (p = 0.04, pη2  = 0.01) and wellbeing (p < 0.000, pη2  = 0.02) remained significant but there was no significant association with life satisfaction.Conclusion: Auditory hallucinations are associated with lower QoL and wellbeing in PwD living in the community. This has implications for targeted therapies in PwD with psychotic symptoms. [ABSTRACT FROM AUTHOR]

Background: Impairment in both cognition and instrumental activities of daily living (iADL) are key diagnostic features of dementia. Few studies have compared trajectories of cognition and iADL. By comparing trajectories of cognitive decline with both self‐rated and informant rated iADL, the study determines whether these aspects are related or decline in parallel and where there is a difference between perceptions of change. Method: Data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) study were used. The study comprises 1537, 1183, and 851 people with dementia, and 1277, 977, and 749 carers at baseline (T1), 12 months later (Time 2, T2), and 24 months later (Time 3, T3), respectively. Cognition was assessed with the Addenbrooke's Cognitive Examination‐III (ACE‐III), higher scores indicate fewer cognitive difficulties. iADL was assessed using the Functional Activities Questionnaire (FAQ), higher scores indicate more iADL difficulties. Both self‐ratings (FAQ‐S) and informant ratings (FAQ‐I) were collected. Because of the differences in the scale and distribution of FAQ and ACE‐III, scores were converted to ranks to enable comparison of trajectories between the two measures; deciles were calculated at T1 and imposed on T2 and T3 scores. Result: As ACE‐III decreased both FAQ‐S and FAQ‐I increased suggesting that people with dementia with more cognitive difficulties were rated as having greater iADL difficulties by both people with dementia themselves and their carers. FAQ‐S declined on average by ‐0.10 (‐0.26, 0.06) decile points per timepoint more than ACE‐III. As confidence intervals overlapped zero this suggests that FAQ‐S and ACE‐III ratings declined at a similar rate. FAQ‐I declined on average by ‐0.31 (‐0.43, ‐0.19) decile points per timepoint more than ACE‐III. The trajectory over the two years suggests that FAQ‐I ratings declined at a significantly greater rate than ACE‐III scores. Conclusion: Both cognition and iADL, whether self‐ or informant‐rated declined over two years. Trajectory analysis suggests that self‐rated iADL was generally concordant with cognitive decline, whereas informant‐rated iADL reflected more perceived decline than cognition. Therefore, either cognition and perceived iADL decline at different rates or informants overestimate increasing iADL difficulties compared to both cognition and self‐ratings. [ABSTRACT FROM AUTHOR]

All the title nanoclusters 1–10 with the molecular formula [(Ln2SiW10O38)4(W3O8)(OH)4(H2O)2]26− [LnIII =Sm (1), Eu (2), Gd (3), Tb (4), Dy (5), Ho (6), Er (7), Tm (8), Yb (9), and Y (10)] have been synthesized and isolated as mixed sodium and potassium salts. These nanoclusters are characterized by various analytical techniques such as FT‐IR, UV/Vis, Photoluminescence, Single crystal X‐ray diffraction, Electrochemistry, ICP‐AES and Thermogravimetric analysis, and Powder X‐ray diffraction. The {Ln8Si4W40} complexes show high efficiency and selectivity for the oxidation of thioethers using H2O2 as green oxidant. It is worth mentioning that the catalyst can be recovered even after five cycles of reaction with only a slight loss in its activity. [ABSTRACT FROM AUTHOR]

The effect of two lacunary Keggin polyoxometalates (K7[PW11O39].14H2O and K9[AlW11O39].15H2O) on the corrosion inhibition of XC38 steel in 0.1 M NaCl was investigated. Electrochemical methods (polarization curves and electrochemical impedance spectroscopy) showed that the presence of controlled amounts of these compounds improved protection of the steel against corrosion. These results were supported by surface analysis, where only a minor amount of rust was produced on metal surface in the presence of polyoxometalates (POMs). The lacunary POMs were more efficient compared to their saturated species, highlighting the key role played by the lacuna on the inhibition process. Efficiency of POMs (both saturated and lacunary) was explained by their ability to increase the Fe(II)/Fe(III) molar ratio in greenish protective oxide layer formed upon steel oxidation. The mechanism proposed clearly explains the higher efficiency observed with lacunary POMs, in relation to their ability to react with free Fe(III) to yield a substituted structure. [ABSTRACT FROM AUTHOR]

Objective: To establish the prevalence and determinants of loneliness among people living with dementia.Methods: Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined the prevalence and predictors of loneliness in 1547 people with mild-to-moderate dementia. Loneliness was assessed using the six-item De Jong Gierveld loneliness scale.Results: About 30.1% of people with dementia reported feeling moderately lonely and 5.2% severely lonely. Depressive symptoms and increased risk of social isolation were associated with both moderate and severe loneliness. Those living alone were more likely to experience severe loneliness as were those reporting poorer quality of life. Marital status was not associated with loneliness nor were dementia diagnosis or cognitive function.Conclusions: This is one of the few large-scale studies to explore the prevalence of and determinants of loneliness among people living with dementia. Social isolation, depression and living alone were associated with experiencing loneliness. Longitudinal studies are needed to determine the directionality of these associations. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well-being, and satisfaction with life, conceptualised as reflecting capability to "live well" in people with dementia.Methods/design: Participants were 1496 people with mild-to-moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total self-rated and informant-rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress.Results: Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self-ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self-ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings.Conclusions: People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments. [ABSTRACT FROM AUTHOR]

The ability to inhibit irrelevant information is essential for coping with the demands of everyday life. Inhibitory deficits are present in all stages of dementia and commonly observed in people with Parkinson's disease (PwPD). Inhibition is frequently tested with the Stroop test, but this may lack ecological validity. This study investigates inhibitory control in people with Alzheimer's disease dementia (PwD) and PwPD using the Hayling Sentence Completion Test (HSCT), which aspires to be a more ecologically valid task. A total of 117 people completed the HSCT, a test where participants have to complete a sentence with an unrelated word. The sample comprised 30 PwD, 33 PwPD, and 54 healthy older controls. We compared response times and the number and type of errors across the three groups. Completion time in Part B (Inhibition) did not distinguish between PwD, PwPD, and controls when controlling for the initiation speed, but a higher proportion of Category A errors (producing a word that fits the sentence when instructed otherwise) was a unique characteristic of inferior performance in PwD and PwPD. While not part of the standard test scoring protocol, controlling for the initiation speed and distinguishing between speed and accuracy in test performance appear to be essential for accurate evaluation of the inhibitory control in HSCT in older people. The findings suggest that the HSCT may be sensitive to verbal suppression deficits and may provide insight into inhibitory control in PwD and PwPD. [ABSTRACT FROM AUTHOR]

Background: Effects of brain pathology or ageing on cognitive function are moderated by an individual's ability to optimise or maximise the use of the brain's resources to perform tasks, and is a concept known as cognitive reserve. In dementia, cognitive reserve may reflect the capacity to provide a buffer against effects of dementia‐related brain pathology, resulting in a delay in signs and symptoms of dementia. Studies have found that a higher level of education may not only lead to a delay in the onset of dementia, but impact on the rate of cognitive decline following a diagnosis. Here we investigate whether a latent measure of cognitive reserve at diagnosis impacts on cognitive function or quality of life in the years following a diagnosis. Method: We used longitudinal data from 1545 individuals with mild‐to‐moderate dementia participating in the IDEAL study. Assessments took place on entry, and at 12 and 24 months. A latent measure of cognitive reserve was created based on education, social class and engagement in social and cognitive activities. Latent growth curve models were used to look for associations of cognitive reserve at diagnosis with cognitive function and quality of life in the years following diagnosis. Result: A higher cognitive reserve was associated with higher cognitive function at the time of diagnosis, but following diagnosis individuals with a higher cognitive reserve had a faster rate of decline in cognitive function. Whilst higher cognitive reserve was associated with a higher quality of life at the time of diagnosis, there was no association between cognitive reserve and change in quality of life in the years following diagnosis. Conclusion: Those with a higher cognitive reserve at baseline are more likely to decline in cognitive function at a greater rate following diagnosis suggesting that it may be possible to identify individuals who may decline more quickly based on their education, social class and social and cognitive activities later in life. [ABSTRACT FROM AUTHOR]

Background: The heterogeneity of symptoms across dementia subtypes may influence the capability of people with dementia to 'live well'. We investigated how quality of life varies across dementia subtypes and over time. Method: We assessed 1749 individuals with mild‐to‐moderate dementia on entry to the IDEAL or IDEAL‐2 studies and followed them up at 12, 24, 48, 72 and 96 months. We used mixed effects models to examine whether quality of life varied by dementia subtype at the time of diagnosis and how quality of life trajectories changed over time. Result: 52.4% of participants had a diagnosis of Alzheimer's disease, 10.2% vascular dementia, and 19.8% mixed Alzheimer's and vascular dementia. Of the rarer subtypes, 5.7% had frontotemporal dementia, 4.2% had Parkinson's disease dementia and 5.3% had dementia with Lewy bodies, with 2.4% having other/mixed dementias. The strongest associations between dementia subtype and quality of life were seen at the time of diagnosis. Compared to individuals with Alzheimer's disease, people with Parkinson's disease dementia (‐4.89, 95% CI ‐6.60 ‐ ‐3.17) and dementia with Lewy bodies (‐4.90, 95% CI ‐6.38 ‐ ‐3.42) had relatively poor quality of life. People with vascular dementia (‐2.45, 95% CI ‐3.55 ‐ ‐1.35) and mixed Alzheimer's and vascular dementia (‐1.70, 95% CI ‐2.47 ‐ ‐0.92) had somewhat poorer quality of life, but the difference was less marked. There was no difference between people with Alzheimer's disease and people with frontotemporal dementia (‐0.39, 95% CI ‐1.73 – 0.95). There was little change in quality of life over time and we found no differences in quality of life trajectories according to dementia subtype. Conclusion: At the time of diagnosis, quality of life already differs according to dementia subtype, and this pattern is maintained over time. People with Parkinsonian dementias in particular may need extra support with the challenges they face. [ABSTRACT FROM AUTHOR]

Objectives: Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations.Methods: The analysis was based on a large cohort study of 1547 community-dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well-being were measured as indices of "living well." Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer.Results: Negative dose-response relationships between deprivation and measures of quality of life (-2.12; 95% CI: -3.52, -0.73), life satisfaction (-1.27; 95% CI: -2.70, 0.16), and well-being (-5.24; 95% CI: -10.11, -0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference.Conclusions: The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer. [ABSTRACT FROM AUTHOR]

Abstract: Tolerance may lessen when wildlife adversely impacts people. Models from psychology can help elucidate how people make judgments, why they act accordingly, and whether beliefs and norms influence support for policy and intervention. Working in a globally important region for tigers, we estimated hunting prevalence for this endangered species and three sympatric taxa using methods for asking sensitive questions. We also investigated the relative strength of ethnicity and social‐psychological predictors in influencing intention to hunt. Men's behavioral intention and perceptions differed by species: proconservation values were most prevalent for tiger, weakest for wild boar. Perceived behavioral control was the strongest predictor of hunting‐intention; affect and injunctive norms were also important. The prominence of affect in determining intention suggests increasing environmental knowledge is unlikely to curb hunting. However, existing norms could be leveraged to incentivize behaviorchange. Integrating behavior‐change models into conservation science is crucial where strategies require changes in people's actions. [ABSTRACT FROM AUTHOR]

Objective: To examine the appropriateness and feasibility of cognitive rehabilitation for people with dementias associated with Parkinson's in a pilot randomised controlled study.Methods: This was a single-blind pilot randomised controlled trial of goal-oriented cognitive rehabilitation for dementias associated with Parkinson's. After goal setting, participants were randomised to cognitive rehabilitation (n = 10), relaxation therapy (n = 10), or treatment-as-usual (n = 9). Primary outcomes were ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes included quality of life, mood, cognition, health status, everyday functioning, and carers' ratings of goal attainment and their own quality of life and stress levels. Assessments were at 2 and 6 months following randomisation.Results: At 2 months, cognitive rehabilitation was superior to treatment-as-usual and relaxation therapy for the primary outcomes of self-rated goal attainment (d = 1.63 and d = 1.82, respectively) and self-rated satisfaction with goal attainment (d = 2.04 and d = 1.84). At 6 months, cognitive rehabilitation remained superior to treatment-as-usual (d = 1.36) and relaxation therapy (d = 1.77) for self-rated goal attainment. Cognitive rehabilitation was superior to treatment as usual and/or relaxation therapy in a number of secondary outcomes at 2 months (mood, self-efficacy, social domain of quality of life, carers' ratings of participants' goal attainment) and at 6 months (delayed recall, health status, quality of life, carer ratings of participants' goal attainment). Carers receiving cognitive rehabilitation reported better quality of life, health status, and lower stress than those allocated to treatment-as-usual.Conclusions: Cognitive rehabilitation is feasible and potentially effective for dementias associated with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of functional ability in people with early-stage dementia (PwD) is an important area of study because it forms part of the diagnostic process and may help in monitoring disease progression. Most researchers and clinicians rely on informant ratings rather than observing actual functional performance or employing self-ratings. There has however been little research to verify whether informant ratings of functioning are accurate, and there has been even less research investigating the accuracy of self-ratings of functional ability in PwD. No study has used the performance-monitoring metacognitive approach to investigate awareness of functional ability.Methods: Thirty-seven people with early-stage dementia completed an objective functional assessment and provided self-ratings before and after completing each section of the objective test. Informants provided ratings of functioning and burden. Scores were converted to percentages to allow for direct comparison.Results: Objectively assessed functional ability significantly correlated with self-ratings and informant ratings. Self-ratings did not correlate with informant ratings. For converted scores, self-ratings were more similar than informant ratings to the objectively assessed mean scores. Burden was unrelated to functional assessments after correcting for multiple comparisons.Conclusions: Self-rated functional ability was more accurate than informant ratings when compared with objectively assessed ability, with informants tending to significantly underestimate the functional ability of PwD. The findings call into question the likelihood that informants will provide accurate ratings of functional ability and suggests that self-ratings may offer a more accurate estimate of functional ability. Self-ratings made by PwD should be more widely employed in clinical and research settings. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: People with dementia differ in degree of awareness of difficulties. Awareness can influence well‐being, communication and relationships, and impact on personal safety and decision‐making in everyday and clinical situations. Evaluating awareness could facilitate person‐centered care. A scoping review identified the lack of a brief, multidimensional clinical tool. We aimed to develop and test a new awareness interview for clinical use. Method: Measure development was informed by scoping review findings, available evidence about awareness phenomena in dementia, and considerations of suitability for remote as well as in‐person administration. Some items were drawn from existing validated measures, covering awareness of functional ability, memory, and socio‐emotional functioning, and new items were developed to assess awareness of medication management and mobility, providing a profile of awareness across these domains. Scoring was based on calculation of discrepancies between self‐rating and either informant ratings or objective memory task performance, as well as self‐reported acknowledgement of specific symptoms. The interview was tested for feasibility and acceptability in a remotely‐administered pilot study. The interview was administered to 31 community‐dwelling people with mild‐to‐moderate dementia recruited in England in 2020‐2021, via telephone or Zoom video‐call. A caregiver, acting as an informant, completed a corresponding questionnaire in advance. Cognitive ability of the participant with dementia was assessed with the Montreal Cognitive Assessment‐5 minute protocol (MoCA‐5 min). Structured and open‐ended feedback was obtained from participants and caregivers Result: The interview was completed by 29 participants with MoCA‐5 min scores ranging from 9.5 to 29.Two participants with lower MoCA‐5 min scores were unable to complete the interview. Remote administration was straightforward with few challenges, taking on average under 11 minutes. Awareness profiles showed a spectrum of awareness across domains. Feedback indicated that interview questions were acceptable and understandable, but certain aspects, such as the memory task, could be somewhat upsetting as they highlighted current difficulties. Conclusion: The new Healthcare Awareness Profile Interview (HAPI) shows potential as an evidence‐based brief clinical tool for assessing awareness in people with mild‐to‐moderate dementia. Following discussions with clinical advisory and patient and public involvement groups, a final version will be prepared for a larger validation study. [ABSTRACT FROM AUTHOR]

Objective: Active lifelong cognitive lifestyles increase cognitive reserve and have beneficial effects on global cognition, cognitive decline and dementia risk in Parkinson's disease (PD). Executive function is particularly impaired even in early PD, and this impacts on quality of life. The effects of lifelong cognitive lifestyle on executive function in PD have not been studied previously. This study examined the association between lifelong cognitive lifestyle, as a proxy measure of cognitive reserve, and executive function in people with PD.Methods: Sixty-nine people diagnosed with early PD without dementia were recruited as part of the Bilingualism as a protective factor in Age-related Neurodegenerative Conditions study. Participants completed a battery of tests of executive function. The Lifetime of Experiences Questionnaire was completed as a comprehensive assessment of lifelong cognitive lifestyle. Non-parametric correlations compared clinical measures with executive function scores. Cross-sectional analyses of covariance were performed comparing the performance of low and high cognitive reserve groups on executive function tests.Results: Correlational analyses showed that better executive function scores were associated with younger age, higher levodopa dose and higher Lifetime of Experiences Questionnaire scores. Higher cognitive reserve was associated with better motor function, but high and low cognitive reserve groups did not differ in executive function.Conclusions: Cognitive reserve, although associated with global cognition, does not appear to be associated with executive function. This differential effect may reflect the specific cognitive profile of PD. The long-term effects of cognitive reserve on executive function in PD require further exploration. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Water temperature is an important factor determining estuarine species habitat conditions. Water temperature is mainly governed by advection (e.g., from rivers) and atmospheric exchange processes varying strongly over time (day-night, seasonally) and the spatial domain. On a long time scale, climate change will impact water temperature in estuarine systems due to changes in river flow regimes, air temperature, and sea level rise. To determine which factors govern estuarine water temperature and its sensitivity to changes in its forcing, we developed a process-based numerical model (Delft3D Flexible Mesh) and applied it to a well-monitored estuarine system (the San Francisco Estuary) for validation. The processbased approach allows for detailed process description and a physics-based analysis of governing processes. The model was calibrated for water year 2011 and incorporated 3-D hydrodynamics, salinity intrusion, water temperature dynamics, and atmospheric coupling. Results show significant skill in reproducing temperature observations on daily, seasonal, and yearly time scales. In North San Francisco Bay, thermal stratification is present, enhanced by salinity stratification. The temperature of the upstream, fresh water Delta area is captured well in 2-D mode, although locally--on a small scale--vertical processes (e.g., stratification) may be important. The impact of upstream river temperature and discharge and atmospheric forcing on water temperatures differs throughout the Delta, possibly depending on dispersion and residence times. Our modeling effort provides a sound basis for future modeling studies including climate change impact on water temperature and associated ecological modeling, e.g., clam and fish habitat and phytoplankton dynamics. [ABSTRACT FROM AUTHOR]

Background: Although awareness is known to vary in people with dementia, little is known about longitudinal trajectories of awareness of condition in people with mild‐to‐moderate dementia. Exploring this could help understand the concepts around awareness, and reasons for apparent impaired awareness, relevant to person‐centered care. Method: We used longitudinal data from the IDEAL programme for 917 community‐dwelling people diagnosed with mild‐to‐moderate dementia. Using a validated checklist, we assessed awareness of personal difficulties associated with dementia at three timepoints over two years. Changes in awareness from baseline were examined. Focusing on people with low awareness at baseline, we used case‐matching to compare characteristics between people who gained awareness over time, and those who continued with low awareness. Result: At baseline, 83 people showed low awareness of personal dementia‐related difficulties. Following up this group, after attrition we examined data for 49 people at T2 and 25 people at T3. Most people remaining in the study had gained awareness at T2 and T3. Gains were seen up to four or more years after diagnosis. Five people continued to deny any of the common difficulties associated with dementia at all timepoints. These five reported slightly more comorbid conditions than matched cases. Few other distinguishing features were evident but in comparison, the people who came to acknowledge difficulties showed greater deterioration in cognitive and functional ability by T3. Conclusion: Over time, self‐reported awareness of dementia‐related difficulties can change in people with mild‐to‐moderate dementia. Awareness gains, seen in most people remaining in the study at T2 and T3, may have been prompted by deteriorating abilities. Reasons for ongoing low awareness were difficult to establish and may relate to individual circumstances including comorbidity. This highlights the individual complexity and dynamic nature of awareness in dementia and challenges the concept of impaired awareness as a fixed disease‐related condition. [ABSTRACT FROM AUTHOR]

The observation of a bilingual advantage in executive control tasks involving inhibition and management of response conflict suggests that being bilingual might contribute to increased cognitive reserve. In support of this, recent evidence indicates that bilinguals develop Alzheimer's disease ( AD) later than monolinguals, and may retain an advantage in performance on executive control tasks. We compared age at the time of receiving an AD diagnosis in bilingual Welsh/ English speakers ( n = 37) and monolingual English speakers ( n = 49), and assessed the performance of bilinguals ( n = 24) and monolinguals ( n = 49) on a range of executive control tasks. There was a non-significant difference in age at the time of diagnosis, with bilinguals being on average 3 years older than monolinguals, but bilinguals were also significantly more cognitively impaired at the time of diagnosis. There were no significant differences between monolinguals and bilinguals in performance on executive function tests, but bilinguals appeared to show relative strengths in the domain of inhibition and response conflict. Bilingual Welsh/ English speakers with AD do not show a clear advantage in executive function over monolingual English speakers, but may retain some benefits in inhibition and management of response conflict. There may be a delay in onset of AD in Welsh/ English bilinguals, but if so, it is smaller than that found in some other clinical populations. In this Welsh sample, bilinguals with AD came to the attention of services later than monolinguals, and reasons for this pattern could be explored further. [ABSTRACT FROM AUTHOR]

Research on genetic counselor professional development would characterize typical developmental processes, inform training and supervision, and promote life-long development opportunities. To date, however no studies have comprehensively examined this phenomenon. The aims of this study were to investigate the nature of professional development for genetic counselors (processes, influences, and outcomes) and whether professional development varies across experience levels. Thirty-four genetic counselors participated in semi-structured telephone interviews exploring their perspectives on their professional development. Participants were sampled from three levels of post-degree genetic counseling experience: novice (0-5 years), experienced (6-14 years), and seasoned (>15 years). Using modified Consensual Qualitative Research and grounded theory methods, themes, domains, and categories were extracted from the data. The themes reflect genetic counselors' evolving perceptions of their professional development and its relationship to: (a) being a clinician, (b) their professional identity, and (c) the field itself. Across experience levels, prevalent influences on professional development were interpersonal (e.g., experiences with patients, genetic counseling colleagues) and involved professional and personal life events. Common developmental experiences included greater confidence and less anxiety over time, being less information-driven and more emotion-focused with patients, delivering 'bad news' to patients remains challenging, and individuals' professional development experiences parallel genetic counseling's development as a field. With a few noteworthy exceptions, professional development was similar across experience levels. A preliminary model of genetic counselor professional development is proposed suggesting development occurs in a non-linear fashion throughout the professional lifespan. Each component of the model mutually influences the others, and there are positive and negative avenues of development. [ABSTRACT FROM AUTHOR]

Genetic counselors routinely engage with patients and families who grapple with questions of meaning while making decisions about genetic risk. Research and theory demonstrate genetic counselors gain important personal insights through their work and develop professionally from self-reflective practice regarding their beliefs and values. Data are lacking, however, about the nature of the meaning genetic counselors bring to their profession and how they directly experience and/or navigate issues of meaning within clinical practice over time. Accordingly, a national sample ( N = 298) of practicing genetic counselors completed a brief survey assessing their demographic characteristics and willingness to participate in a semi-structured telephone interview exploring their views on meaning as they relate to their clinical work and professional development. Sixty-eight individuals of varied experience levels were interviewed about: 1) how they define a meaningful life for themselves; 2) lifetime sources of influence on their sense of meaning; 3) how they experience meaning within both personal and professional contexts; 4) work-related contexts that reaffirm and challenge their sense of meaning; and 5) how their sense of meaning has changed over time. Twenty-five interviews were analyzed using Consensual Qualitative Research methods, at which point, data saturation was reached. Five themes, 32 domains, and 29 categories were extracted. Common findings include: importance of satisfying relationships; helping others; personal fulfillment; personal and patient experiences of illness and loss; religious and/or spiritual foundations; value conflicts; competing obligations; challenges to meaning; development of empathy; resiliency; and increased humility. Results suggest the importance of professional venues for discussions of meaning (e.g., genetic counseling program curricula, continuing education, and peer supervision/consultation). Additional findings, practice implications, and research recommendations are presented. [ABSTRACT FROM AUTHOR]

This study comprises an initial empirical description of personal and professional characteristics of master genetic counselors-those considered to be experts in the profession. Fifteen peer-nominated genetic counselors, actively engaged in providing clinical services to patients, participated in semi-structured telephone interviews exploring their personal qualities, inspirations, and perspectives on professional development of expertise. Analysis using modified Consensual Qualitative Research methods yielded 7 domains and 33 categories. Findings indicate master genetic counselors have a strong passion for and dynamic commitment to the profession. They also have insatiable curiosity and are life-long learners who are reflective, self-aware, confident, and recognize their limitations. They are authentic and genuine, and consider their personality to be their counseling style. They form collaborative and interactive relationships with patients based on trust, and they have nuanced attunement to the complexity and multiple levels of the counseling process. Master genetic counselors have deep empathy and are inspired by patients and colleagues, and they derive personal meaning from their work. They are affected emotionally by their work, but effectively manage the emotional impact. They view their professional development as ongoing, influenced by colleagues, patients, mentoring, multicultural considerations, and their own family of origin. They also believe professional development of expertise occurs through critical reflection upon the experiences one accrues. Additional findings and their relationship to theory and research, study strengths and limitations, implication for training and practice, and research recommendation are discussed. [ABSTRACT FROM AUTHOR]

The study investigated different types of awareness of memory dysfunction in dementia, specifically judgements concerning memory task performance or appraisal of everyday memory functioning and also exploring the neuropsychological correlates of such awareness. This was investigated in 76 people with dementia, comprising 46 patients with Alzheimer's disease ( AD) and 30 patients with vascular dementia (VaD). The Memory Awareness Rating Scale (Clare et al., 2002, Neuropsychol Rehabil, 12, 341-362) was used, which includes an Objective-Judgement Discrepancy ( OJD) technique involving comparison of subjective evaluation of performance on specific memory tasks with actual performance, and a Subjective Rating Discrepancy ( SRD) technique, which compares self versus informant judgement of everyday memory function. The AD and VaD groups showed lower awareness than a normal control group for both types of measures, the AD group showing less awareness than the VaD group on the OJD measure. Regression analyses supported associations for both groups between memory impairment and the OJD measure and between naming impairment and the SRD measure. The findings are discussed in terms of neurocognitive theories accounting for loss of awareness in dementia. [ABSTRACT FROM AUTHOR]

Supervision plays a vital role in genetic counselor training, yet models describing genetic counseling supervision processes and outcomes are lacking. This paper describes a proposed supervision model intended to provide a framework to promote comprehensive and consistent clinical supervision training for genetic counseling students. Based on the principle 'form follows function,' the model reflects and reinforces McCarthy Veach et al.'s empirically derived model of genetic counseling practice - the 'Reciprocal Engagement Model' (REM). The REM consists of mutually interactive educational, relational, and psychosocial components. The Reciprocal Engagement Model of Supervision (REM-S) has similar components and corresponding tenets, goals, and outcomes. The 5 REM-S tenets are: Learning and applying genetic information are key; Relationship is integral to genetic counseling supervision; Student autonomy must be supported; Students are capable; and Student emotions matter. The REM-S outcomes are: Student understands and applies information to independently provide effective services, develop professionally, and engage in self-reflective practice. The 16 REM-S goals are informed by the REM of genetic counseling practice and supported by prior literature. A review of models in medicine and psychology confirms the REM-S contains supervision elements common in healthcare fields, while remaining unique to genetic counseling. The REM-S shows promise for enhancing genetic counselor supervision training and practice and for promoting research on clinical supervision. The REM-S is presented in detail along with specific examples and training and research suggestions. [ABSTRACT FROM AUTHOR]

The United Nations recently listed illegal wildlife trade as a serious crime because of the escalating demand for highly prized species, such as tiger and rhinoceros, and the failure to effectively control the trade. In turn, this places greater urgency on reducing supply by securing source populations of these species. Yet, whether law enforcement strategies designed to mitigate poaching are succeeding remains poorly understood, despite the millions of dollars invested annually in this mainstay conservation strategy., Here, we assess the performance of one of Asia's longest running law enforcement programmes, from Kerinci Seblat National Park in Sumatra, by investigating whether forest ranger patrols reduced the occurrence of snare traps set for tiger and its ungulate prey base; local informant reports on poaching influenced ranger patrol success; and the resulting population trends of target species changed in response to these conservation actions., A total of 4433 snare traps were removed during 642 foot patrols conducted from 2000 to 2010. Controlling for the influence of varying detection probabilities, as well as accessibility and other possible determinants of illegal hunting, revealed that sites with a greater frequency of patrols, rather than the combined distance walked, had a lower occurrence of snare traps in succeeding years., Patrols conducted on the basis of local informant 'tip-offs' were significantly more likely to detect snare traps than routine patrols, with reports increasing detections by over 40%., There were no significant changes in the occupancy status of the tiger prey base from 2004 to 2011, suggesting that it remained stable during this period. The relatively good condition of prey and predator populations in Kerinci Seblat National Park was further supported by the results of an independent survey conducted in 2008-2009 which revealed a widespread tiger occurrence., Synthesis and applications. Our results not only demonstrate the effectiveness of the Kerinci Seblat law enforcement strategy in protecting wildlife, but highlight the benefits from cultivating a network of reliable informants. The study also represents a critical step in helping these urgently needed conservation assessments to become common place in the fight to save flagship species. [ABSTRACT FROM AUTHOR]

Objective Assessing functional ability is an important element in diagnosing and monitoring the progression of dementia, with research suggesting a link between functional ability and cognition. We investigated the predictors of total score and individual item functional ratings made by people with dementia (PwD), carers of PwD and the resulting discrepancy score. Methods People with early-stage Alzheimer's disease, vascular or mixed dementia ( n = 100) and their carers completed the Functional Activities Questionnaire. PwD also completed tests of memory, verbal executive function, language and cognitive screening, and provided ratings of mood. Carers provided a rating of stress. Results Immediate memory predicted self-rated functioning, whereas carer stress predicted informant-rated functioning. Letter fluency predicted the discrepancy between self-rated and informant-rated functioning. For self-rated functioning, the direction and pattern of the individual item predictors suggested a degree of functional awareness. Informant ratings were dominated by carer stress and, to a lesser extent, everyday memory. The discrepancy scores were also predicted by carer stress and everyday memory, but also letter fluency. Conclusions Self-rated functioning showed evidence of awareness based on the direction and pattern of significant individual item predictors. Informant ratings, however, were found to be significantly influenced by carer stress. The findings have implications for the use of perceived functional ratings in clinical and research settings. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Little evidence is available about how quality of life (QoL) changes as dementia progresses. Objectives We explored QoL trajectories over a 20-month period and examined what predicted change in QoL. Method Fifty-one individuals with a diagnosis of Alzheimer's, vascular or mixed dementia (people with dementia (PwD)) participating in the Memory Impairment and Dementia Awareness Study rated their QoL using the QoL-Alzheimer's Disease Scale at baseline and at 20-month follow-up. PwD also rated their mood and quality of relationship with the carer. In each case, the carer rated his or her level of stress and perceived quality of relationship with the PwD. Results There was no change in mean QoL score. Nearly one-third of PwD rated QoL more positively at 20-month follow-up and nearly one-third rated QoL more negatively. These changes could be regarded as reliable in one-quarter of the sample. Participants taking acetylcholinesterase-inhibiting medication at baseline were more likely to show a decline in QoL score. There were no other significant differences between those whose scores increased, decreased or stayed the same on any demographic or disease-related variables, or in mood or perceived quality of relationship with the carer. Whereas baseline QoL score was the strongest predictor of QoL at 20 months, the quality of relationship with the carer as perceived by the PwD was also independently a significant predictor. Conclusions There is a degree of individual variation in QoL trajectories. Use of acetylcholinesterase-inhibiting medication appears linked to decline in QoL score, whereas positive relationships with carers play an important role in maintaining QoL in early-stage dementia. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Mental health nursing education in Australia has undergone a significant transition in the last 50 years, influenced by national inquiries, national decisions, and international trends in nursing education. But mental health nursing education had also accumulated decades of history in each state, including sometimes unequal relations with general nursing. Complex inter- and intra-professional relationships at state level influenced this educational transition in each state, and Western Australia provides an example of this influence. Using a range of published and unpublished sources, including oral histories, this paper describes the revision of the mental health nursing curriculum in Western Australia from 1958, responses to the call for transition to the tertiary sector between 1976 and 1984, and the final transition of mental health nursing education to university level in Western Australia in 1994. Mental health nursing's educational standards improved only gradually in Western Australia from 1958 onwards, compared with professional advances in general nursing in the same period. Factors which may have held back these improvements include mental health nursing's professional conservatism, which was outpaced by general nursing's growing radicalization at the national level. A lack of professional confidence and cohesion left mental health nursing unable to respond effectively to rapid external changes in the 1960s and 1970s, and vulnerable to absorption and dominance by general nursing education programs. [ABSTRACT FROM AUTHOR]

Objective Although it is increasingly accepted that people with dementia retain a sense of self, there is a need for empirical evidence regarding the nature of the self-concept in early stage dementia, how this changes over time and how it relates to quality of life. Methods Self-concept was assessed using the short form of the Tennessee Self-concept Scale in 95 individuals with early stage dementia; 63 were reassessed after 12 months, and 45 were seen again at 20 months. Participants also completed measures of mood, cognitive functioning and quality of life. Caregivers provided proxy ratings of self-concept, completed measures of symptoms and distress at symptoms and rated their own levels of stress and well-being. Results Self-ratings of self-concept were close to the average range for the standardization sample, and the distribution did not differ significantly from expected values. Although caregiver ratings were slightly lower, discrepancies were small. There were no significant changes over time in self-ratings or informant ratings or discrepancies. At Time 1, self-ratings were predicted by anxiety, depression and memory, caregiver ratings were predicted by caregiver distress and by depression in the person with dementia and discrepancies were predicted by caregiver distress. These models remained predictive at later time points. Self-rated self-concept predicted quality of life, with the relationship only partially mediated by depression and anxiety. Conclusions Self-concept appears largely intact in early stage dementia, but in view of the association between self-concept and quality of life, a preventive approach focused on supporting self-concept may offer benefits as dementia progresses. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Insufficient attention has been paid to the influence of psychological and social factors on discrepancy-based measures of awareness. Objectives The present study tested a biopsychosocial model of awareness in early-stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness. Method Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early-stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning. Results Scores on discrepancy-based indices of awareness and on the self-ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio-demographic characteristics of PwD and carers, carer well-being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning. Conclusions The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We examined the association between cauda equina nerve root volume and sensory block height in 15 patients undergoing spinal anaesthesia with 0.5% glucose-free bupivacaine. Magnetic resonance imaging and a separate image segmentation program were used to calculate the volume of the nerve roots. Nerve root volume was also correlated with lumbosacral cerebrospinal fluid volume and with patients' physical characteristics. Nerve root volume correlated negatively with sensory block height (Spearman rho −0.61 (95% CI −0.85 to −0.14)) and body mass index (Spearman rho −0.66 (95% CI −0.87 to −0.24)) but positively with cerebrospinal fluid volume (Spearman rho 0.76 (95% CI 0.43-0.91)). Factors that are thought to influence cerebrospinal fluid volume, such as body mass index, might similarly affect the volume of the nerve roots. The size of the nerve roots may influence the spread of spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Between 1924 and 1939, over 100 immigrants were deported from Western Australian mental hospitals. These deported 'lunatics' fell within the 3-year (and later 5-year) window between arrival and becoming 'a charge on the state'. This meant that they could be deported by the Australian Commonwealth government under Section 8a of the amended Immigration Restriction Act. So who were these lunatic migrants? Were they already unwell and deliberately encouraged to migrate to Australia by unscrupulous foreign governments? Were they simply people for whom the pressures of life in an unfamiliar culture, in the middle of a global economic depression, became too much? By examining these deportees in more detail, and looking at factors such as their ethnic background and diagnosis, some underlying reasons as to why these individuals were targeted for deportation become apparent. [ABSTRACT FROM AUTHOR]

Objective:To determine whether people with dementia (PwD), and carers of PwD, show a processing bias to dementia-related words in an emotional Stroop task, and if so, whether the presence of such a bias is related to level of explicit awareness of the condition. Method: Seventy-nine people with early stage Alzheimer’s disease (AD), vascular or mixed dementia, and their carers, completed an emotional Stroop task. Time taken to colour-name dementia-related and neutral words was compared within and between groups. Additionally, as a comparison, ratings of the awareness of the condition shown by PwD were made on the basis of a detailed interview with each PwD and his/her carer. Results: PwD and carers showed the same level of increase in response times to salient compared to neutral words. In the PwD this effect was unrelated to the degree of awareness that they demonstrated regarding the condition. Conclusions: The emotional Stroop effect in response to dementia-related words in PwD indicates that preserved implicit awareness of the condition can be elicited even where there is reduced explicit awareness. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Fetal hemoglobin (HbF) induction involves NO-cGMP signaling pathways.l-arginine, an NO precursor, and the phosphodiesterase (PDE) 5 inhibitor sildenafil, which potentiates cGMP, were studied in adults with sickle cell disease (SCD) who were stably on HU. Methods: Twenty four courses ofl-arginine (0.1–0.2 g/kg divided TID) or sildenafil (25–100 mg TID), assigned based on gender due to concerns about sildenafil-related priapism, were successfully completed. Biochemical assays, pulmonary pressures, and cardiopulmonary exercise capacity are reported from patients in whom serial values are available. Hematologic responses are reported in 14 subjects with HbSS who had stable baseline HbF levels. Results: l-arginine increased plasma arginine and ornithine, but not citrulline, suggesting diversion by plasma arginase from NO, and citrulline, generation. Glutathione increased only in patients onl-arginine. Sildenafil increased plasma cGMP and citrulline, but not other amino acids. Pulmonary pressures and 6-min walk distances improved only in patients on sildenafil. In subjects with stable baseline HbF levels, HbF levels changed little from a normalized baseline onl-arginine, decreasing by 2.9 ± 16.1%, n = 6; P = n.s., but increased on sildenafil, by 7.5 ± 11.7%, n = 8, P < 0.05. Absolute reticulocyte counts initially decreased in patients on sildenafil. Conclusions: l-arginine, at doses that increase plasma arginine levels, altered redox potential in red cells. The lack of clinically detectable efficacy ofl-arginine may be due to increased arginine metabolism in SCD patients. In vivo augmentation of the cyclic nucleotide pathway by PDE inhibition may induce HbF slightly, but strikingly improves hemodynamic and functional status in SCD. [ABSTRACT FROM AUTHOR]

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Pulmonary hypertension is associated with sudden death and is a risk factor for mortality in adult patients with sickle cell disease. The high mortality despite only mild-to-moderate increases in pulmonary vascular resistance remains an unresolved paradox. Accordingly, little is known about the cardiovascular effects of stressors, such as vaso-occlusive pain crisis (VOC) and exercise, which may acutely increase pulmonary pressures and impair right heart function. We therefore evaluated pulmonary artery pressures by echocardiogram in 25 patients with sickle cell disease in steady-state and during VOC, and by right heart catheterisation with exercise in a second cohort of 21 patients to determine whether pulmonary hypertension worsens during acute cardiopulmonary stress. TRV increased during VOC ( P < 0·001), and the increased pulmonary pressures during VOC were associated with decreases in haemoglobin levels ( P < 0·001), and increases in lactate dehydrogenase ( P < 0·001) and plasma haemoglobin levels ( P = 0·03). During exercise stress performed during cardiac catheterisation, mean pulmonary artery pressures ( P < 0·001) and pulmonary vascular resistance increased ( P < 0·001) in all subjects. These data suggest that acute elevations in pulmonary pressures during VOC or exercise may contribute to morbidity and mortality in patients with sickle cell disease. [ABSTRACT FROM AUTHOR]

1. Conservation managers require accurate and timely information on the occurrence, size and viability of populations, but this is often difficult for cryptic species living at low densities over large areas. This study aimed to provide such information for tigers in the 36 400-km2 Kerinci Seblat (KS) region, Sumatra, by identifying and assessing subpopulation viability under different management strategies. 2. Tiger occurrence was mapped within a geographical information system (GIS) using repeat detection–non-detection surveys to incorporate a function of detection probability into a logistic regression model. The landscape variables that influenced tiger occupancy were then used to construct a spatially explicit habitat model to identify core areas. 3. The number of tigers within each core area was estimated by calculating the area of different forest types and their respective tiger densities as determined through camera trapping. The viability of each subpopulation was then assessed under different management scenarios using a population viability analysis (PVA). 4. Tiger occurrence was negatively correlated with distance to public roads. Four core tiger areas were identified, all predominantly located within KS National Park, estimated to support subpopulations of 21, 105, 16 and three adult tigers, respectively. PVA showed that the three larger subpopulations could be demographically viable if well protected. However, if poaching removed ≥ 3 tigers per year, then only the largest subpopulation would not reach extinction within 50 years. Connectivity to this large subpopulation would ensure survival of the smaller subpopulations, through providing a source of tigers to offset poaching losses. 5. Synthesis and applications. Our key management recommendations for tigers in the Kerinci Seblat region of Sumatra stress the importance of maintaining connectivity between the smaller areas and the larger area, and minimizing poaching within these smaller areas. More widely, our research has shown the feasibility of using detection–non-detection surveys combined with spatial modelling to provide timely information for conservation management. [ABSTRACT FROM AUTHOR]