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The purpose of the STAR 2019 Working Group was to build on findings from the initial STAR report to further clarify the expectations, limitations, perceptions, and utility of alloimmune assays that are currently in use or in development for risk assessment in the setting of organ transplantation. The goal was to determine the precision and clinical feasibility/utility of such assays in evaluating both memory and primary alloimmune risks. The process included a critical review of biologically driven, state-of-the-art, clinical diagnostics literature by experts in the field and an open public forum in a face-to-face meeting to promote broader engagement of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics membership. This report summarizes the literature review and the workshop discussions. Specifically, it highlights (1) available assays to evaluate the attributes of HLA antibodies and their utility both as clinical diagnostics and as research tools to evaluate the effector mechanisms driving rejection; (2) potential assays to assess the presence of alloimmune T and B cell memory; and (3) progress in the development of HLA molecular mismatch computational scores as a potential prognostic biomarker for primary alloimmunity and its application in research trial design.

Purpose: The purpose of this study was to investigate Black-White differences associated with hearing loss among older adults living in the United States. Method: Secondary data analysis was conducted using the 2017 American Community Survey (ACS) with a replication analysis of the 2016 ACS. The ACS is an annual nationally representative survey of Americans living in community settings and institutions. The sample size of older Americans (age 65+ years) in 2017 was 467,789 non-Hispanic Whites (NHWs) and 45,105 non-Hispanic Blacks (NHBs). In the 2016 ACS, there were 459,692 NHW and 45,990 NHB respondents. Measures of hearing loss, age, race/ethnicity, education level, and household income were based on self-report. Data were weighted to adjust for nonresponse and differential selection probabilities. Results: The prevalence of hearing loss was markedly higher among older NHWs (15.4% in both surveys) in comparison with NHBs (9.0% in 2017 and 9.4% in 2016, both ethnic differences p < 0.001). In the 2017 ACS, the age- and sex-adjusted odds of hearing loss were 69% higher for NHWs compared with NHBs, which increased to 91% higher odds when household income and education level were also taken into account (OR = 1.91; 95% confidence interval [CI; 1.85, 1.97]). Findings from the 2016 ACS were very similar (e.g., 65+ fully adjusted OR = 1.81; 95% CI [1.76, 1.87]). Conclusions: NHWs have a much higher prevalence and almost double the odds of hearing loss compared with NHBs. Unfortunately, the ACS survey does not allow us to explore potential causal mechanisms behind this association.

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69+-14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Abstract Training to enhance healthcare practitioners’ capabilities in engaging people in sensitive and end-of life-related conversations is in demand. However, evaluations have either not measured, or found very limited impact on actual practice and patient experience. Training effectiveness is improved when it is based on in-depth evidence, reflects the complexity of real-life interactions, and instils principles adaptable to everyday practice. A relatively new source of in-depth evidence and practice-relevant insights on healthcare interactions is conversation analytic research, a form of observational analysis of real-life interactions. However, conversation analytic research findings have largely been disseminated by and for scientists, rather than clinicians and trainers. We used conversation analytic evidence to develop resources for use by healthcare trainers. The aim was to increase training’s evidence-base and authenticity. We further aimed to develop resources applicable to working with learners ranging from novices to advanced practitioners. Methods: Using an intervention development approach, we created online video-clips and supplementary written materials for professionals who deliver training, supervision, and support in healthcare communication for staff and students. The materials were reviewed by an advisory group comprising clinicians, lay consultees, educators, and researchers, and piloted by trainers in UK universities, NHS organisations and independent hospices. We refined materials based on their feedback. Results: The resulting ‘RealTalk’ resources focus on practices for communicating with patients and their companions about end-of-life and prognosis. Two core training modules were developed, each comprising several patient case studies featuring video-clips from real-life healthcare consultations. The clips featured practices that patients and experienced practitioners use in approaching end-of-life matters. The case studies also included evidence-based descriptions of observable practices and the principles underlying these, alongside transcripts and case synopses. Conclusions: RealTalk training resources aim to facilitate evidence-based, experiential and reflective learning, focusing on communication challenges, practices and principles for end-of-life-related interactions. The resources are designed for use by trainers for delivering all levels of training, from introductory to advanced, in both formal and informal training settings. Our development process may serve as a blueprint for the production of future evidence-based training resources based on conversation analytic research.

Research has demonstrated that gesture produced during conversation can provide insights into scientific thinking and can aid scientific communication in adults and school-aged children. However, to date, there has been a limited exploration into the role of gesture in supporting young children's science communication, and how this is underpinned and shaped by their sensorimotor experiences. This study examines, identifies and conceptualises ways in which children spontaneously used gesture during their interaction-orientated discourse and how this mapped to their action experiences at a water table. Findings show how gestural communication in children under 5 years of age can convey different levels of complexity related to science thinking.

Infant mental health is strongly connected to an infant's relationship with a responsive, warm, and available caregiver. However, maternal mental illness reduces a mother's ability to detect and respond to changes in her infant's expressions and communication, which may have important consequences for infant attachment and emotion regulation. The Shared Pleasure (SP) paradigm in parent-infant interactions is defined as 'the parent and the child sharing positive affect in synchrony' and is considered to be a possible screening marker for early identification of at-risk dyads. A paucity of data exists for the application of SP as a measurable paradigm in developing countries. This study aimed to evaluate the SP paradigm using women attending a tertiary psychiatric maternal mental health clinic in Cape Town, South Africa. A sample of mothers (N = 78) and young infants (2-6 months old) were assessed for SP moments using video recordings of the dyad in free play. SP moments occurred in only 20.5% of the sample. SP moments were more frequent in younger babies (under 3 months of age). There were significantly more SP moments in dyads where mothers had no mental illnesses (p = 0.021) or were married (p = 0.016). Black African mothers also experienced significantly more SP moments with their babies (p = 0.033) than their Caucasian or Mixed-ancestry counterparts. This study explored the application of the 'SP paradigm' on women with and without mental illness who attended a maternal mental health clinic. Tracking SP moments in a larger sample of culturally diverse, at-risk and, mentally-ill population of mothers and their infants offers the possibility of a simple language- and culture-free measure to identify at-risk dyads.

Background: There are limited data on factors that predict an increased risk of multiple injuries among distance runners. The objective of this study was to determine risk factors that are predictive of individual runners with a high annual multiple injury risk (MIR). Methods: A retrospective, cross-sectional study at 4 annual (2012–2015) Two Oceans 21.1 km and 56.0 km races in South Africa with 75,401 consenting race entrants. Running-related injury data were collected retrospectively through an online pre-race medical screening questionnaire. The average number of injuries for each runner every year was calculated by taking a runner's race entry history and injury history into account and categorizing entrants into 4 MIR categories (high, intermediate, low, and very low (reference)). Multiple logistic regression modeling (odds ratios) was used to determine whether the following factors were predictive of a high MIR (average > 1 injury/year): demographics, training and racing, chronic-disease history (composite chronic disease score (CCDS)), and history of allergies. Results: Of all entrants, 9.2% reported at least 1 injury, and 0.4% of entrants were in the high MIR category; the incidence rate was 2.5 injuries per 10 runner-years (95% confidence interval (95%CI): 2.4–2.7). Significant factors predictive of runners in the high MIR category were: running for > 20 years: OR = 2.0 (95%CI: 1.3–3.1; p = 0.0010); a higher CCDS: OR = 2.2 (95%CI: 2.0–2.4; p < 0.0001); and a history of allergies: OR = 2.8 (95%CI: 2.0–3.8; p < 0.0001). Conclusion: Runners who have been running recreationally for > 20 years and those with multiple chronic diseases or a history of allergies were at higher risk of multiple running-related injuries. This high-risk group can be targeted for further study and possible injury-prevention interventions.

Background: Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. Objective: To identify risk factors associated with hITBS in distance runners. Design: Descriptive cross-sectional study. Setting: 21.1 km and 56 km Two Oceans Marathon races (2012–2015). Participants: 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. Methods: Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). Results: 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. Conclusion: Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts. [ABSTRACT FROM AUTHOR]

To identify the risk factors associated with all medical encounters (MEs) and serious/life-threatening MEs (SLMEs) during the Comrades Marathon. Prospective cohort study, with cross-sectional analyses. During the 2014–2019 Comrades Marathon, all MEs (including SLMEs) were recorded in 103,131 starters. For both all MEs and SLMEs, the following risk factors were explored: sex, age, route ("up" vs. "down" race), previous Comrades experience (yes/no), wet-blub globe temperature (WBGT) and race pace. Incidence (per 1000 starters; 95%CI), and the incidence ratio (IR; 95%CI) are presented. For all MEs, being female was a significant risk factor (females vs. males IR = 1.47, p < 0.0001), and age was only marginally significant (p = 0.0167). Therefore factors for all MEs were adjusted for sex. Other factors significantly associated with all MEs were: higher WBGT (highest WBGT compared to lowest, IR = 1.33, p = 0.0003), race pace (highest risk for those who finish either among the first quarter [IR = 1.49] or last quarter [IR = 1.46] compared to middle pace; p < 0.0001) and the route ("down" vs. "up": IR = 1.11; p = 0.0181). Factors associated with higher risk for SLMEs were: females (IR = 1.9; p = 0.0003), "down" vs. "up" route (IR = 1.37; p = 0.0306) and race pace (slower and faster runners vs. mid (6.4–7.1 min/km) race pace category (IR > 2.1, p < 0.0001)). Intrinsic (female, faster and slower race pace) and extrinsic (higher WBGT and the "down" route) are novel risk factors associated with all MEs at this event. These can be considered by the race organizers and the medical team to develop and implement prevention strategies. [ABSTRACT FROM AUTHOR]

Worldwide studies have revealed an important issue in that an increasing percentage of students within the X-Y age group are not interested in science. Many students, especially females, have negative feelings and attitudes toward science, which discourages them from continuing with scientific inquiries. There are limited studies related to the factors predicting school students' attitude toward science; therefore, the purpose of this study is to determine the relationships among the seventh grade elementary students' attitudes toward science, their learning approaches, motivational goals, science achievement and students' nature of science (NOS) views. The questionnaires for this study were administered online to 3,598 seventh grade students in different regions and cities of Turkey. The convenience sampling method was used in this study. The correlation results revealed the positive relationship between attitude toward science and the other variables. Multiple regression analysis indicated that while students' meaningful learning, self-efficacy, and nature of science views have a positive contribution, rote learning contributed negatively to the model. The findings also showed that parents' income and education level had a significant effect on students' attitude toward science.

The aim of this research is to determine the effects of various teaching methods and activities, which are used in environmental education lessons, on the environmental literacy level of classroom pre-service teachers. This study was carried out including the classroom pre-service teachers, who took the environmental education course in the academic year of 2012-2013. In this study, an experimental design was used. The Environmental Literacy Scale and the Evaluation of the Environmental Education Outcome Scale, which was developed by the researchers, were utilized as data collection instruments. The implementations were carried out throughout the semester. During the semester, traditional teaching methods (lecture type) were used in the control group, while teaching methods in which the pre-service teachers were active in the outdoor and indoor were used in the experimental group. Regarding the quantitative data, descriptive analysis, paired-samples t-test, Independent Samples T-Test analysis were utilized. Content analysis was used for the analysis of the data obtained from the open-ended questions. The findings showed that there was a statistically significant difference in favor of the experimental group with respect to the "attitudes", "uses," and "concern" dimensions of the environmental literacy. When the pre-test and post-test results of the control group were compared within the group, no any significant difference was found. Yet, a significant difference in the dimensions of "attitudes" and "uses" was found when the pre-test and the post-test results were compared within the experimental group. The classroom pre-service teachers in the control group gave very positive feedback on the issues of "the outcomes they obtained from the environmental education course", "teaching topics related to environmental education when become teachers," and "environmental problems." Richer codes and higher frequencies were obtained from the experimental group on these categories.

Relapsed acute lymphoblastic leukaemia (ALL) is associated with resistance to chemotherapy and poor prognosis. Gain-of-function mutations in the 5'-nucleotidase, cytosolic II (NT5C2) gene induce resistance to 6-mercaptopurine and are selectively present in relapsed ALL. Yet, the mechanisms involved in NT5C2 mutation-driven clonal evolution during the initiation of leukaemia, disease progression and relapse remain unknown. Here we use a conditional-and-inducible leukaemia model to demonstrate that expression of NT5C2(R367Q), a highly prevalent relapsed-ALL NT5C2 mutation, induces resistance to chemotherapy with 6-mercaptopurine at the cost of impaired leukaemia cell growth and leukaemia-initiating cell activity. The loss-of-fitness phenotype of NT5C2+/R367Q mutant cells is associated with excess export of purines to the extracellular space and depletion of the intracellular purine-nucleotide pool. Consequently, blocking guanosine synthesis by inhibition of inosine-5'-monophosphate dehydrogenase (IMPDH) induced increased cytotoxicity against NT5C2-mutant leukaemia lymphoblasts. These results identify the fitness cost of NT5C2 mutation and resistance to chemotherapy as key evolutionary drivers that shape clonal evolution in relapsed ALL and support a role for IMPDH inhibition in the treatment of ALL.

Recent literature on the effectiveness of donor programmes points to the importance of understanding the political context within which reforms are taking place. A body of evidence is now emerging suggesting that programmes that are more flexible and iterative are often more successful in achieving their objectives than programmes that adopt a more rigid, linear approach to reform and recent experiments with projects that “think and work politically” appear to show promising results.The characteristics of the power sector makes reform intensely political in almost all countries and donor projects have sometimes failed because of an inability to navigate the local politics of reform. This paper reviews what is known about how donors have taken politics into account in designing and implementing power sector reform programmes in Sub-Saharan Africa and South Asia. It illustrates the challenges which donors have faced with reference to case studies of donor attempts to support power sector reform in Tanzania and in the Indian state of Orissa. The paper draws on documentary evidence from the major donors to the sector in each country as well as a set of qualitative interviews with experienced project supervisors. It concludes with a set of recommendations for further research designed to provide insights on how best to design and implement power sector reform programmes given the political context in which they are working.

The purpose of this study is to investigate how the in-service science teachers' (IST) perceptions and practices about curriculum and integration of the history of science (HOS) and the nature of science (NOS) affect their science courses. For this aim, how ISTs integrated the NOS and HOS in their elementary science courses for understanding of the NOS, the results of this integration, and how the ISTs' NOS views influenced their science teaching practices were examined. In this phenomenological study purpose and criterion sampling methods were used. Nine ISTs constituted the sample of the study. A constant comparative method was utilized for the data analysis. Multiple data sources and different evaluators were used for triangulation. The current study revealed that all the teachers in the study do their best to implement the science and technological curriculum; however, the implementation of the curriculum is not at the expected level. Also our findings indicated that the teachers' views about NOS did not directly influence their educational practices. In addition, knowing how to teach NOS is an important factor for a teacher's transfer of their knowledge and understanding of NOS to their classroom, as well as the teacher's NOS views. In this process some possible problems such as creating misconceptions, not explaining the NOS aspects effectively, differences in the students' beliefs, individual differences, and problems in the classroom environment might emerge and negatively affect the teachers' integration of NOS and HOS.

Background: There are few effective interventions for dementia. Aim: To determine the clinical effectiveness and cost-effectiveness of an intervention to promote self-management, independence and self-efficacy in people with early-stage dementia. Objectives: To undertake a randomised controlled trial of the Journeying through Dementia intervention compared with usual care, conduct an internal pilot testing feasibility, assess intervention delivery fidelity and undertake a qualitative exploration of participants’ experiences. Design: A pragmatic two-arm individually randomised trial analysed by intention to treat. Participants: A total of 480 people diagnosed with mild dementia, with capacity to make informed decisions, living in the community and not participating in other studies, and 350 supporters whom they identified, from 13 locations in England, took part. Intervention: Those randomised to the Journeying through Dementia intervention (n = 241) were invited to take part in 12 weekly facilitated groups and four one-to-one sessions delivered in the community by secondary care staff, in addition to their usual care. The control group (n = 239) received usual care. Usual care included drug treatment, needs assessment and referral to appropriate services. Usual care at each site was recorded. Main outcome measures: The primary outcome was Dementia-Related Quality of Life score at 8 months post randomisation, with higher scores representing higher quality of life. Secondary outcomes included resource use, psychological well-being, self-management, instrumental activities of daily living and health-related quality of life. Randomisation and blinding: Participants were randomised in a 1 : 1 ratio. Staff conducting outcome assessments were blinded. Data sources: Outcome measures were administered in participants’ homes at baseline and at 8 and 12 months post randomisation. Interviews were conducted with participants, participating carers and interventionalists. Results: The mean Dementia-Related Quality of Life score at 8 months was 93.3 (standard deviation 13.0) in the intervention arm (n = 191) and 91.9 (standard deviation 14.6) in the control arm (n = 197), with a difference in means of 0.9 (95% confidence interval –1.2 to 3.0; p = 0.380) after adjustment for covariates. This effect size (0.9) was less than the 4 points defined as clinically meaningful. For other outcomes, a difference was found only for Diener’s Flourishing Scale (adjusted mean difference 1.2, 95% confidence interval 0.1 to 2.3), in favour of the intervention (i.e. in a positive direction). The Journeying through Dementia intervention cost £608 more than usual care (95% confidence interval £105 to £1179) and had negligible difference in quality-adjusted life-years (–0.003, 95% confidence interval –0.044 to 0.038). Therefore, the Journeying through Dementia intervention had a mean incremental cost per quality-adjusted life-year of –£202,857 (95% confidence interval –£534,733 to £483,739); however, there is considerable uncertainty around this. Assessed fidelity was good. Interviewed participants described receiving some benefit and a minority benefited greatly. However, negative aspects were also raised by a minority. Seventeen per cent of participants in the intervention arm and 15% of participants in the control arm experienced at least one serious adverse event. None of the serious adverse events were classified as related to the intervention. Limitations: Study limitations include recruitment of an active population, delivery challenges and limitations of existing outcome measures. Conclusions: The Journeying through Dementia programme is not clinically effective, is unlikely to be cost-effective and cannot be recommended in its existing format. Future work: Research should focus on the creation of new outcome measures to assess well-being in dementia and on using elements of the intervention, such as enabling enactment in the community. Trial registration: This trial is registered as ISRCTN17993825. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 24. See the NIHR Journals Library website for further project information.

ObjectiveTo investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis.MethodsA total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences.ResultsCluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) years; p = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95); p < 0.001), and showed a better response to triptans (50.00% vs. 28.00; p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0%; p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0%; p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0%; p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) min; p=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) min; p = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0%; p< 0.001).ConclusionsCluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH.

Abstract Background Headache is the most common COVID-19-related neurological symptom. We aimed to reveal diagnostic clues of headache for COVID-19 infection and to investigate the course of primary headaches during the pandemic. Methods We developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. Findings A total of 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21 ± 11.2 years contributed to the survey. Among them, 262 participants had COVID-19 diagnosis and 126 (48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p

Abstract Background Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia. Methods The Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing). Results One hundred sixty-five candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48 to 92/100. The median score for the crisis teams was 74.5 (range 67–92), and the median score for non-crisis teams was 60 (range 48–72). Conclusions With further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future.

Abstract Background Enabling people with dementia to ‘live well’ is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures. Methods Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined. Findings Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia. Conclusion An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based ‘in-the-moment’ measurement.

Summary: Background: The objectives of this study are to assess the chest drainage volumes of patients undergoing anatomic resection of non-small cell lung carcinoma and to determine the safety and effectiveness of administering enoxaparin for thromboprophylaxis. Methods: A total of 77 patients were included in the study. A study was conducted on the first group of 42 patients in which enoxaparin prophylaxis (enoxaparin, 40 mg) was subcutaneously injected once a day for a period of three days after the patients underwent anatomic pulmonary resection between March 2016 and March 2018. An enoxaparin-free group was identified and included 35 patients who received no enoxaparin prophylaxis after undergoing anatomic pulmonary resection between February 2013 and February 2016. We compared the changes in hemoglobin (Hb) levels, postoperative 3-day drainage volume, transfusion volume, pulmonary complications and length of stay between the two groups. Results: No differences in postoperative Hb levels, chest drainage volume, transfusion volume, postoperative complications, and length of stay were observed between the two groups. Deep-vein thrombosis was noted in a patient in the enoxaparin-free group. No major bleeding was noted in either group. Conclusion: We found that for patients undergoing anatomic resection of primary lung cancer, the blood transfusion and chest drainage volumes did not differ, regardless of whether the patients were given enoxaparin. To the best of our knowledge, the impact of low-molecular-weight heparin on chest tube drainage volume for patients undergoing anatomic resection of non-small cell lung carcinoma has not been investigated before. Keywords: Enoxaparin, Chest drainage volume

Background: Hearing loss is a source of great public health concern. Previous research showed a decline in the prevalence of hearing loss among older adults. However, it is unclear whether this trend persists in recent years. Methods: The purpose of this study was to investigate the temporal trend in prevalence of hearing loss among older Americans (age 65+) between 2008 and 2017. To this end, we conducted a secondary analysis of 10 cross-sectional surveys: the 2008–2017 annual American community surveys (ACS). The ACS were conducted by the US Census through mail, internet, phone, and in-person meetings. ACS includes Americans aged 65+ living in the community and in group quarters such as nursing homes (n = 5,359,651). Annual response rates were above 89%. Whether the participant has hearing problems is assessed based on response to the ACS question “Is this person deaf or does he/she have serious difficulty hearing?”. Results: During the decade 2008–2017, the prevalence of serious hearing loss in the older American population (65+) decreased from 16.3 to 14.8% (p