Objectives: UK policy priority is to support people with dementia (PLwD) to live at home for longer. Initial clinical assessment involves evaluating and managing risk to enable PLwD to live safely and well at home. Risk assessment scales are needed to identify, manage and reduce risk within contemporary dementia practice. The “Islington Dementia Navigator Risk Assessment Tool” (IDNRAT) is used by specialist and non-specialist staff to stratify the level of risk for PLwD and inform a risk management plan and the frequency of follow-up. We assessed whether IDNRAT enables risk detection and whether the risk intervention derived from it is implemented and improves the safety of people living at home with dementia.

Methods: A mixed Methods study to evaluate IDNRAT’s validity, and the feasibility and acceptability of the resulting risk management plan. We investigated the use of the IDNRAT to: (i) detect risk (concurrent validity) and measure the reliability of the tool; (ii) contribute to risk reduction (primary outcome was numbers of decisions implemented); (iii) explore patients’ and carers’ experience of risk stratification.

Results: We found risk stratification scores (n = 119) derived from IDNRAT and compared with gold standard clinical risk assessments showed concordance between clinicians’ ratings. Joint Dementia navigator and researcher interviews (n = 19) showed consistency between the different assessor scores demonstrating IDNRAT has good reliability. Care-plan data showed most participants (n = 275) scored in the low-risk band of IDNRAT (78.9%) at baseline assessment and risk severity ratings (red/amber/green) reduced over the 6–12-month time period. PLwD (n = 19) and family carers (n = 17) had differing perceptions about risk and the PLwD’s susceptibility to risk. Overall, participants found the risk assessment acceptable, were able to identify risks and felt included in decision-making processes.

Conclusions: We found that the IDNRAT used by non-specialist practitioners (dementia navigators) does enable people with dementia to live safely at home in terms of risk- identification, implemented risk enablement decisions and acceptability. IDNRAT is a valid risk assessment tool, which offers a tailored approach to the management of risk, and over 80% of care-plan decisions were implemented. This is consistent with best practice and the tool has potential for wider use.

The 10-item Autism-Spectrum Quotient (AQ10) is a self-report questionnaire used in clinical and research settings as a diagnostic screening tool for autism in adults. The AQ10 is also increasingly being used to quantify trait autism along a unitary dimension and correlated against performance on other psychological/medical tasks. However, its psychometric properties have yet to be examined when used in this way. By analysing AQ10 data from a large non-clinical sample of adults (n = 6,595), we found that the AQ10 does not have a unifactorial factor structure, and instead appears to have several factors. The AQ10 also had poor internal reliability. Taken together, whilst the AQ10 has important clinical utility in screening for diagnosable autism, it may not be a psychometrically robust measure when administered in non-clinical samples from the general population. Therefore, we caution against its use as a measure of trait autism in future research.

Bear farms, established for the extraction of bile from live bears, have unknown effects on the conservation of bears in Asia. Whilst some major bile producing countries have tightened legislation on this practice, traders have responded by establishing bile extraction facilities in countries with weaker legislation. We conducted a survey of all known facilities in Lao PDR through direct observation or examination of governmental and non-governmental records, and documented the birth and rapid growth of this industry since the first farm was established in 2000. We also obtained trading values for gall bladders from wild bears in Lao PDR from literature, databases and direct observation. The number of farmed bears tripled from 2008 to 2012. In 2012 121 Asiatic black bears Ursus thibetanus and one sun bear Helarctos malayanus were kept on 11 commercial facilities. Evidence suggests that all bears were wild caught domestically or illegally imported internationally, in violation of national and international law. Moreover, some bile from these farms was being illegally exported internationally. Farmed bile availability has apparently not diminished the demand for wild bile, as the market value has increased dramatically since 2000. We suggest that bear farming in Lao PDR may be increasing the incentive to poach wild bears.