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Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program.
Design:
Pre–post interventional mixed methods study.
Setting:
Online videoconference group program for carers across the UK held in 2021.
Participants:
Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators.
Intervention:
The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions.
Measurements:
We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2.
Results:
Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression.
Conclusion:
The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.
Cognitive impairments are well-established features of psychotic disorders and are present when individuals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population.
Aims
To investigate whether omega-3 polyunsaturated fatty acid (n−3 PUFA) supplementation improves cognitive functioning among individuals at ultra-high risk for psychosis.
Method
Data (N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n−3 PUFA levels predicted change in cognitive performance.
Results
The placebo group showed a modest greater improvement over time than the omega-3 supplementation group for motor speed (ηp2 = 0.09) and BACS composite score (ηp2 = 0.21). After repeating the analyses without individuals who transitioned, motor speed was no longer significant (ηp2 = 0.02), but the composite score remained significant (ηp2 = 0.02). Change in erythrocyte n-3 PUFA levels did not predict change in cognitive performance over 6 months.
Conclusions
We found no evidence to support the use of omega-3 supplementation to improve cognitive functioning in ultra-high risk individuals. The biomarker analysis suggests that this finding is unlikely to be attributed to poor adherence or consumption of non-trial n−3 PUFAs.
Poor transition planning contributes to discontinuity of care at the child–adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC).
Methods
A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial.
Results
The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was −1.11 points (95% confidence interval −2.07 to −0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17–€65 per service user).
Conclusions
MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.
A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.
Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed.
Methods
A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience.
Results
During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy.
Conclusion
Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.
Suicide risk is high in the 30 days after discharge from psychiatric hospital, but knowledge of the profiles of high-risk patients remains limited.
Aims
To examine sex-specific risk profiles for suicide in the 30 days after discharge from psychiatric hospital, using machine learning and Danish registry data.
Method
We conducted a case–cohort study capturing all suicide cases occurring in the 30 days after psychiatric hospital discharge in Denmark from 1 January 1995 to 31 December 2015 (n = 1205). The comparison subcohort was a 5% random sample of all persons born or residing in Denmark on 1 January 1995, and who had a first psychiatric hospital admission between 1995 and 2015 (n = 24 559). Predictors included diagnoses, surgeries, prescribed medications and demographic information. The outcome was suicide death recorded in the Danish Cause of Death Registry.
Results
For men, prescriptions for anxiolytics and drugs used in addictive disorders interacted with other characteristics in the risk profiles (e.g. alcohol-related disorders, hypnotics and sedatives) that led to higher risk of postdischarge suicide. In women, there was interaction between recurrent major depression and other characteristics (e.g. poisoning, low income) that led to increased risk of suicide. Random forests identified important suicide predictors: alcohol-related disorders and nicotine dependence in men and poisoning in women.
Conclusions
Our findings suggest that accurate prediction of suicide during the high-risk period immediately after psychiatric hospital discharge may require a complex evaluation of multiple factors for men and women.
A common feature of successful ancient states was the role of elites in maintaining and regulating socioeconomic structures and, in particular, emphasising their own social difference. The Wari (AD 600–1000) are considered the earliest expansive state in South America, and excavations have demonstrated the rich variety of exotic goods imported from across the region into the polity's heartland. Here, the authors argue that the importation of raw materials, plants, animals and people from distant regions was crucial for defining and sustaining Wari social differentiation and ideology. They emphasise the importance of studying material provenance and their archaeological contexts in order to understand the role of exotic goods in legitimising ruling groups in ancient states.
Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.
Method
Bamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.
Results
There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).
Conclusion
Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.
Five rice (Oryza sativa L.) cultivars were evaluated in the greenhouse for tolerance to fenoxaprop {(±)-2-[4-[(6-chloro-2-benzoxazolyl)oxy]phenoxy]propanoic acid}. Rice was more tolerant to fenoxaprop when flooded at 7 days after spraying, based on trends in reduction of weight of seedling topgrowth. ‘Lebonnet’ was the only cultivar that responded differently when five cultivars were compared. In the field, rice yield was not adversely affected by fenoxaprop applied at 168 g ai/ha and flooded 1 to 10 days after treatment, but yield increased as the time interval between application of 336 g ai/ha and flooding increased. Yield data suggested that flooding should be delayed at least 5 days when rice is treated with the high rate. The cultivar ‘Newbonnet’ was slightly less tolerant than 'Starbonnet’ in the field.
Environmental control chamber experiments showed that cotton (Gossypium hirsutum L. ‘Stoneville 213′) and soybean [Glycine max (L.) Merr. ‘Bragg’] root and shoot growth were reduced when treated with increasing rates of dinitramine (N4,N4-diethyl-α,α,α-tri-fluoro-3,5-dinitrotoluene-2,4-diamine), profluralin [N-(cyclopropylmethyl)-α,αα-trifluoro-2,6-dinitro-N-propyl-p-toluidine], and trifluralin (α,α,α-trifluoro-2,6-dintrio-N,N-dipropyl-p-toluidine). Viusal root ratings, dry root weights, and fresh and dry herbage weights were used to evaluate plant response to herbicide treatments in environmental chambers. The order of increasing GR50 values for cotton on two soils and with all response measurements, except dry root weights on one soil, was trifluralin, dinitramine, and profluralin. The order of increasing GR50 values for soybeans on two soils and with all response measurements was dinitramine, trifluralin, and profluralin.
Cotton (Gossypium hirsutum) response was evaluated when quinclorac was applied prior to cotton emergence (preemergence) and to cotton in the cotyledon and pin-head square stages in 1988, 1989, and 1990. Quinclorac applications at 9, 17, 35, 70, and 140 g ha−1 prior to cotton emergence had little effect on cotton growth, with only 140 g ha−1 causing stand reduction or stunting. Quinclorac application to cotton in the cotyledon stage caused more damage, and 70 g ha−1 caused crop injury. Greatest phytotoxicity was observed when quinclorac was applied to cotton at pin-head square, with all rates including 9 g ha−1 causing injury. Cotton injury consisted of leaf strapping and malformation of reproductive structures. Regression analysis revealed yield was reduced by quinclorac applications to cotton in the cotyledon or pin-head square stage. The approximate regression equation to predict cotton yields after pin-head square application of quinclorac was [yield] = [yield with no injury] − 10(quinclorac rate in g ha−1).
Cotton (Gossypium hirsutum L.) was grown in the presence of common cocklebur (Xanthium strumarium L. # XANST) on a Lucedale fine sandy loam. Cotton was maintained weed free or allowed to compete with common cocklebur for 0, 3, 5, 7, 9, or 11 weeks after planting. Mathematical predictions of seed cotton yield were optimum when maintained free from common cocklebur interference for 8 weeks or more after cotton emergence in 1981 and 1982, and 10 weeks or more in 1980. Common cocklebur adversely affected yield when allowed to compete longer than 4 weeks in 1981 and 1982, and 2 weeks in 1980.
Field studies were conducted from 1985 to 1989 on a Sharkey clay to examine injury to a semi-dwarf rice cultivar, ‘Lemont’, from triclopyr or triclopyr plus propanil. Triclopyr applied in the booting stage reduced yield two of three years, with the observed yield reduction possibly caused by epinasty of the rice flag leaf. Triclopyr application to three- to four-leaf rice caused hyponasty. Triclopyr did not reduce plant height, seed weight, germination, or total milling yield. Triclopyr plus propanil caused more leaf burn that triclopyr alone, but yields were not reduced compared with the untreated control. This research indicated that triclopyr and triclopyr plus propanil can be used in rice production with the semi-dwarf cultivar, Lemont, with the potential to minimize drift to non-target crops due to the greater flexibility in application timing compared with 2,4-D application.
A 2-yr field study was conducted to determine effects of posttreatment irrigation timing on pendimethalin efficacy and dissipation in turfgrass. Factors investigated included herbicide rate, formulation, and the interval between pendimethalin application and the initial posttreatment irrigation. Plots received an initial posttreatment irrigation of 1.25 cm 0, 7, 14, 21, and 28 d after treatment. Pendimethalin efficacy on smooth crabgrass was evaluated, and turfgrass foliage and the upper 2.5-cm layer of soil were periodically assayed for pendimethalin residues. Pendimethalin 1.71% granular provided better weed control than pendimethalin 60% wettable powder at all rates, irrigation events, and years. Efficacy of granular pendimethalin was not affected by a delay in posttreatment irrigation, whereas efficacy of pendimethalin in the wettable powder formulation was reduced when irrigation was applied later than the day of treatment. Chromatographic analyses indicated that an average of 54% of the applied pendimethalin (wettable powder formulation) was retained on turfgrass foliage immediately after treatment, compared to 9% for the granular formulation. Soil residue analyses confirmed that a greater proportion of applied pendimethalin reached the soil surface immediately after treatment in the granular formulation than in the wettable power formulation.
Experiments were conducted for 3 yr to evaluate the effects of the ethyl ester of fenoxaprop {(±)-2-[4-[(6-chloro-2-benzoxazolyl)oxy] phenoxy] propanoic acid} on rice (Oryza sativa L. 'Starbonnet′) applied at 112 and 168 g ai/ha or as two applications of 112 g ai/ha applied 10 to 14 days apart. Fenoxaprop did not adversely affect grain yield, panicle weight, seed weight, or seed germination when applied before the booting stage of both sprinkler-irrigated and flooded rice. Rice height was sometimes reduced by treatment at earlier growth stages, but yields were not affected. With the exception of applications at early jointing (internode elongation = 6 mm) in 1983, milling yield was not adversely affected by fenoxaprop applications made prior to booting of both sprinkler-irrigated and flood-culture rice. Applications during heading adversely affected most yield parameters.
To determine the competitiveness of common cocklebur (Xanthium pensylvanicum Wallr.) with cotton (Gossypium hirsutum L. 'Stoneville 213′), experiments were conducted on a Lucedale fine sandy loam from 1978 through 1980. Common cocklebur dry weight increased with increasing density up to 16 plants/15 m of row. No further increase in dry matter occurred beyond this density. Regression analysis showed that common cocklebur produced an average of 342 kg/ha of dry weight for each plant per 15-m row. Seed-cotton yields decreased as weed density increased up to 16 common cocklebur plants/15 m of row. Regression equations revealed yield losses ranging from 72 to 115 kg/ha for hand-harvested seed cotton and 57 to 90 kg/ha for machine-harvested seed cotton for each common cocklebur plant/15 m of row. Cotton stem diameter and height were reduced by weed competition in the same manner as seed cotton yields, but reductions were not as pronounced, indicating that these parameters were not good indicators of common cocklebur competition.
A study was conducted in 1994 and 1995 at two Mississippi locations to evaluate preplant incorporated (PPI) and preemergence (PRE) applications of alachlor, clomazone, SAN 582, metolachlor, pendimethalin, and trifluralin, and postemergence (POST) applications of AC 263,222 and imazethapyr alone or followed by clethodim late postemergence (LPOST) for red rice control in soybean. Applications of 110 g ai/ha clethodim increased red rice control when following any earlier herbicide application at one location that harbored a high natural infestation. In 1 yr at one location, red rice seedhead suppression from PPI and PRE herbicide applications alone was greater than 95% due to high activity from herbicides and drought conditions during red rice seedhead development. Early postemergence (EPOST) applications of 30 g ae/ha AC 263,222 suppressed at least 95% of red rice seedheads, regardless of year, location, or clethodim LPOST application. At one location, any treatment where 110 g/ha clethodim followed an earlier herbicide application suppressed red rice seedheads at least 95%. Compared to the nontreated control, only AC 263,222 injured soybean (30%) and reduced soybean yield (200 kg/ha).
The ethyl ester of fenoxaprop {(±)-2-[4-[(6-chloro-2-benzoxazolyl)oxy] phenoxy] propanoic acid} was applied to rice (Oryza sativa L.) that was heavily infested with barnyardgrass [Echinochloa crus-galli (L.) Beauv. # ECHCG] during a 3-yr study. Applications were made to two- to three-leaf, three- to four-leaf, five- to six-leaf, or tillering barnyardgrass. Barnyardgrass control at 9 weeks after final treatment was greater than 90% for all growth stages except the 0.1 kg ai/ha rate applied to three- to four-leaf barnyardgrass in 1983. In 1984, the sequential application of fenoxaprop made at the three- to four-leaf stage controlled more than 95% when rated at 9 weeks. Rates of 0.17 and 0.2 kg ai/ha and the sequential treatment of 0.1 kg ai/ha followed by 0.1 kg ai/ha 7 to 10 days later controlled greater than 90% at 9 weeks when applied to three- to four- and five- to six-leaf barnyardgrass in 1985. In general, barnyardgrass was controlled by fenoxaprop rates greater than 0.1 kg ai/ha when applied to any growth stage evaluated up through the five- to six-leaf stage. However, acceptable control of tillering barnyardgrass was achieved in only 1 of 3 years. Yields were increased due to barnyardgrass control all years with all treatments except those applied at tillering. However, control was sufficient to increase yields over that of the check for all tillering treatments except the 0.1 kg ai/ha rate in 1984 and 1985 and the 0.17 kg ai/ha treatment in 1985.