Characterisation of adventitious lung sounds in people with dementia

Introduction: Lower Respiratory Tract Infections (LRTIs) are highly prevalent in institutionalised people with dementia, constituting an important cause of morbidity and mortality. Computerised auscultation of Adventitious Lung Sounds (ALS) has shown to be objective and reliable to assess and monitor respiratory diseases, however its application in people with dementia is unknown. Aim: This study characterised ALS (crackles and wheezes) in institutionalised people with dementia. Methods: An exploratory descriptive study, including 6 long-term care institutions was conducted. The sample included a dementia group (DG) of 30 people with dementia and a match healthy group (HG) of 30 elderly people. Socio-demographic and anthropometric data, cognition, type and severity of dementia, cardio-respiratory parameters, balance, mobility and activities and participation were collected. Lung sounds were recorded with a digital stethoscope following Computerised Respiratory Sound Analysis (CORSA) guidelines. Crackles’ location, number (N), frequency (F), two-cycle duration (2CD), initial deflection width (IDW) and largest deflection width (LDW) and wheezes’ number (N), ratio (R) and frequency (F) were analysed per breathing phase. Statistical analyses were performed using PASW Statistics(v.19). Results: There were no significant differences between the two groups in relation to the mean N of crackles during inspiration and expiration in both trachea and thorax. DG trachea crackles had significant higher F during inspiration and lower IDW, 2CD and LDW during expiration when compared with HG. At the thorax, the LDW during inspiration was also significantly lower in the DG. A significant higher N of inspiratory wheezes was found in the HG. Both groups had a low ratio of high frequency wheezes. Conclusion: Computerised analyses of ALS informed on the respiratory system and function of people with dementia and elderly people. Hence, this could be the step towards prevention, early diagnosis and continuous monitoring of respiratory diseases in people with cognitive impairment.

Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study.

Aim: There is a scarce literature describing psychological interventions for a young, first-episode cohort who have experienced psychotic mania. This study aimed to assess whether a manualized psychological intervention could be effective in reducing symptomatology and relapse, and improve functional outcome in this population. Methods: The study was an open-label design, drawn from a larger pharmacotherapy trial. All participants in the pharmacotherapy trial were offered a manualized psychological intervention in addition to case management. Inclusion in the psychotherapy group was based on participant's choice, and on completion of four or more of the eight modules offered. All clinical files were audited to ensure accuracy of group allocation. Forty young people aged 15 to 25 years old who had experienced a manic episode with psychotic features were recruited into the study, with 20 people in the combined treatment as usual plus psychotherapy group (P+TAU), and an equal number of matched control participants who received treatment as usual (TAU) within the same service. All participants were prescribed antipsychotic and mood-stabilizing medication. Symptomatic, functional and relapse measures were taken both at baseline and at 18-month follow-up. Results: Manic symptoms improved significantly for both groups, with no differences between groups. Depression scores and overall symptom severity were significantly lower in the P + TAU group. No differences were evident between groups with regard to numbers or type of relapse. The P + TAU group had significantly better social and occupational functioning after 18 months. Conclusion: This study suggests that a manualized psychological intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional outcome following a first episode of psychotic mania.

Social rejection of minority groups and its impacts on the individual's identity and perception of the self : exploring homosexual and racial identities in James Baldwin's Giovanni's room and Just above my head

Ce mémoire examine la question de la formation de l'identité en tant que procédure compliquée dans laquelle plusieurs éléments interviennent. L'identité d'une personne se compose à la fois d’une identité propre et d’une autre collective. Dans le cas où l’identité propre est jugée sévèrement par les autres comme étant déviante, cela poussera la personne à, ou bien maintenir une image compatible avec les prototypes sociaux ou bien résister et affirmer son identité personnelle. Mon travail montre que l'exclusion et la répression de certains aspects de l'identité peuvent causer un disfonctionnement psychique difficile à surmonter. Par contre, l'acceptation de soi et l’adoption de tous les éléments qui la constituent conduisent, certes après une longue lutte, au salut de l’âme et du corps. Le premier chapitre propose une approche psychosociale qui vise à expliquer le fonctionnement des groupes et comment l'interaction avec autrui joue un rôle décisif dans la formation de l'identité. Des éléments extérieurs comme par exemple les idéaux sociaux influencent les comportements et les choix des gens. Toutefois, cette influence peut devenir une menace aux spécificités personnelles et aux traits spécifiques. Le deuxième chapitre examine la question des problèmes qu’on risque d’avoir au cas où les traits identitaires franchiraient les normes sociales. Nous partons du problème épineux de la quête de soi dans Giovanni's Room de James Baldwin. L'homosexualité de David était tellement refusée par la société qu’elle a engendrée chez lui des sentiments de honte et de culpabilité. Il devait choisir entre le sacrifice des aspects de soi pour satisfaire les paradigmes sociaux ou bien perdre ce qu’il a de propre. David n'arrive pas à se libérer. Il reste prisonnier des perceptions rigides au sujet de la masculinité et de la sexualité. Mon analyse se focalise essentiellement sur l'examen des différents éléments théoriques qui touchent la question du sexe et de la sexualité. Le résultat est le suivant : plus les opinions dominantes sont rigides et fermes, plus elles deviennent une prison pour l’individu. Par contre, plus elles sont tolérantes et flexibles, plus elles acceptent les diversités de l'identité humaine. Dans le dernier chapitre, j'examine la question de la représentation des relations entre les caractères masculins dans Just Above My Head. L'homosexualité est présentée comme un moyen sacré pour exprimer l'amour. Les caractères révèlent leurs sentiments implicitement à travers les chants spirituel tel que le gospel ou bien explicitement à travers la connexion physique. Dans ce roman, Baldwin montre que c'est seulement grâce à la sincérité et à l'amour que l'individu peut atteindre la libération du soi.

How Minecraft Affects How Young People Learn About Computer Science

Abstract: As one of the newest art forms available to young people, gaming has become an increasing influence on young people’s education, even if not used in a classroom environment. This talk aims to explore examples of how video games have changed how young people understand and learn about certain subjects, with particular focus on how the indie title Minecraft allows them to learn about the world of Computer Science and how groups are looking to forward the cause of education though games.

Effect of joint mobilization on the H Reflex amplitude in people with spasticity

Objective: To determine the effect of ankle joint mobilization on the H reflex amplitude of thesoleus muscle in people with spasticity. Materials and methods: A quasi-experimental study withcrossover design and simple masking was conducted in 24 randomized subjects to initiate thecontrol or experimental group. Traction and rhythmic oscillation were applied for five minutesto the ankle joint. H wave amplitude changes of Hoffmann reflex (electrical equivalent of themonosynaptic spinal reflex) was assessed, stimulating the tibial nerve at the level of the poplitealfossa and recording in the soleus muscle. In each subject 12 measurements were taken: basalrate, during and after mobilization. Changes in H reflex amplitude were calculated in relationto basal measurement. For each measurement a hypothesis test was performed (Student t test).Results: In groups of patients with brain injury and incomplete spinal cord injury, a significantdifference was found between measurements of both studies, concerning variation in H reflexamplitude during the application of joint mobilization techniques, with a decrease in the experimentalgroup and an increase in the control group. In contrast, no significant differences werefound after mobilization therapy. Patients with complete spinal cord injury showed no significantdifferences in any measurements. Conclusion: We demonstrate the effectiveness of jointmobilization in the decrease of H reflex amplitude in patients with brain injury or incompletespinal cord injury during the mobilization maneuver, but no residual effect after completion ofthe trial. This research showed no evidence regarding excitability reduction in complete spinalcord injury. We suggest that therapeutic interventions to decrease muscle tone based on the jointmobilization should be reconsidered.

Improving computer interaction for older people - studying mouse clicks

Interactions using a standard computer mouse can be particularly difficult for novice and older adult users. Tasks that involve positioning the mouse over a target and double-clicking to initiate some action can be a real challenge for many users. Hence, this paper describes a study that investigates the double-click interactions of older and younger adults and presents data that can help inform the development of methods of assistance. Twelve older adults (mean age = 63.9 years) and 12 younger adults (mean age = 20.8 years) performed click and double-click target selections with a computer mouse. Initial results show that older users make approximately twice as many errors as younger users when attempting double-clicks. For both age groups, the largest proportion of errors was due to difficulties with keeping the cursor steady between button presses. Compared with younger adults, older adults experienced more difficulties with performing two button presses within a required time interval. Understanding these interactions better is a step towards improving accessibility, and may provide some suggestions for future directions of research in this area.

A shift to randomness of brain oscillations in people with autism

BACKGROUND: Resting-state functional magnetic resonance imaging (fMRI) enables investigation of the intrinsic functional organization of the brain. Fractal parameters such as the Hurst exponent, H, describe the complexity of endogenous low-frequency fMRI time series on a continuum from random (H = .5) to ordered (H = 1). Shifts in fractal scaling of physiological time series have been associated with neurological and cardiac conditions. METHODS: Resting-state fMRI time series were recorded in 30 male adults with an autism spectrum condition (ASC) and 33 age- and IQ-matched male volunteers. The Hurst exponent was estimated in the wavelet domain and between-group differences were investigated at global and voxel level and in regions known to be involved in autism. RESULTS: Complex fractal scaling of fMRI time series was found in both groups but globally there was a significant shift to randomness in the ASC (mean H = .758, SD = .045) compared with neurotypical volunteers (mean H = .788, SD = .047). Between-group differences in H, which was always reduced in the ASC group, were seen in most regions previously reported to be involved in autism, including cortical midline structures, medial temporal structures, lateral temporal and parietal structures, insula, amygdala, basal ganglia, thalamus, and inferior frontal gyrus. Severity of autistic symptoms was negatively correlated with H in retrosplenial and right anterior insular cortex. CONCLUSIONS: Autism is associated with a small but significant shift to randomness of endogenous brain oscillations. Complexity measures may provide physiological indicators for autism as they have done for other medical conditions.

Support and information needs of older and disabled older people in the UK

The aim of this study was to determine the support and information needs of older and disabled older people in the UK. Following an initial literature survey, an examination of data on enquiries made by older people to information providers, and a series of focus groups, a questionnaire was developed for a nationwide survey. Over 1630 questionnaires were completed by disabled older clients of Day Care Centres and less frail older members of social clubs. Findings showed that there is a serious shortfall in the number of older people getting the practical support that they need, and the information that enables access to this support, compared to the number that actually need help. Substantial percentages of the survey respondents experienced difficulty with everyday tasks and with accessing the information they needed. Implications for formal sources of support and information are discussed.

Can a short period of micronutrient supplementation in older institutionalized people improve response to influenza vaccine? A randomized, controlled trial

OBJECTIVES: To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Nursing and residential homes in Liverpool, United Kingdom. PARTICIPANTS: One hundred sixty-four residents aged 60 and older from 31 homes were initially randomized; of these, 119 (72.6%) completed the study. INTERVENTION: Participants were randomized to receive a micronutrient supplement providing the reference nutrient intake for all vitamins and trace elements or identical placebo. Tablets were taken over an 8-week period during September and October 2000; influenza vaccine was administered 4 weeks after their commencement. MEASUREMENTS: The hemagglutination-inhibiting antibody response as defined by a fourfold or greater titer rise over 4 weeks and assessed separately for each of the three antigens contained in the 2000/2001 influenza vaccine (A/New Caledonia/20/99 (H1N1), A/Moscow/10/99 (H3N2), B/Beijing/184/93 (B)). RESULTS: Despite a significant increase in serum concentrations of vitamins A, C, D-3, E, folate, and selenium in the supplemented group, there was no significant difference between groups (supplemented vs placebo, respectively) in the proportion of participants seroconverting to H1N1 (41% vs 49%, P=.374), H3N2 (49% vs 58%, P=.343), or B (41% vs 40%, P=.944). CONCLUSION: A micronutrient supplement providing the reference nutrient intake administered over 8 weeks had no beneficial effect on antibody response to influenza vaccine in older people living in long-term care.

Cost-benefit evaluation of routine influenza immunisation in people 65-74 years of age

OBJECTIVES: To determine the cost-effectiveness of influenza vaccination in people aged 65-74 years in the absence of co-morbidity. DESIGN: Primary research: randomised controlled trial. SETTING: Primary care. PARTICIPANTS: People without risk factors for influenza or contraindications to vaccination were identified from 20 general practitioner (GP) practices in Liverpool in September 1999 and invited to participate in the study. There were 5875/9727 (60.4%) people aged 65-74 years identified as potentially eligible and, of these, 729 (12%) were randomised. INTERVENTION: Participants were randomised to receive either influenza vaccine or placebo (ratio 3:1), with all individuals receiving pneumococcal vaccine unless administered in the previous 10 years. Of the 729 people randomised, 552 received vaccine and 177 received placebo; 726 individuals were administered pneumococcal vaccine. MAIN OUTCOME MEASURES AND METHODOLOGY OF ECONOMIC EVALUATION: GP attendance with influenza-like illness (ILI) or pneumonia (primary outcome measure); or any respiratory symptoms; hospitalisation with a respiratory illness; death; participant self-reported ILI; quality of life (QoL) measures at 2, 4 and 6 months post-study vaccination; adverse reactions 3 days after vaccination. A cost-effectiveness analysis was undertaken to identify the incremental cost associated with the avoidance of episodes of influenza in the vaccination population and an impact model was used to extrapolate the cost-effectiveness results obtained from the trial to assess their generalisability throughout the NHS. RESULTS: In England and Wales, weekly consultations for influenza and ILI remained at baseline levels (less than 50 per 100,000 population) until week 50/1999 and then increased rapidly, peaking during week 2/2000 with a rate of 231/100,000. This rate fell within the range of 'higher than expected seasonal activity' of 200-400/100,000. Rates then quickly declined, returning to baseline levels by week 5/2000. The predominant circulating strain during this period was influenza A (H3N2). Five (0.9%) people in the vaccine group were diagnosed by their GP with an ILI compared to two (1.1%) in the placebo group [relative risk (RR), 0.8; 95% confidence interval (CI) = 0.16 to 4.1]. No participants were diagnosed with pneumonia by their GP and there were no hospitalisations for respiratory illness in either group. Significantly fewer vaccinated individuals self-reported a single ILI (4.6% vs 8.9%, RR, 0.51; 95% CI for RR, 0.28 to 0.96). There was no significant difference in any of the QoL measurements over time between the two groups. Reported systemic side-effects showed no significant differences between groups. Local side-effects occurred with a significantly increased incidence in the vaccine group (11.3% vs 5.1%, p = 0.02). Each GP consultation avoided by vaccination was estimated from trial data to generate a net NHS cost of 174 pounds. CONCLUSIONS: No difference was seen between groups for the primary outcome measure, although the trial was underpowered to demonstrate a true difference. Vaccination had no significant effect on any of the QoL measures used, although vaccinated individuals were less likely to self-report ILI. The analysis did not suggest that influenza vaccination in healthy people aged 65-74 years would lead to lower NHS costs. Future research should look at ways to maximise vaccine uptake in people at greatest risk from influenza and also the level of vaccine protection afforded to people from different age and socio-economic populations.

Is influenza vaccination cost effective for healthy people between ages 65 and 74 years? A randomised controlled trial

The aim of this study was to determine the cost effectiveness of influenza vaccination for healthy people aged 65-74 years living in the UK. People without risk factors for influenza (chronic heart, lung or renal disease, diabetic, immuno-suppressed or those living in an institution) were identified from 20 general practitioner (GP) practices in Liverpool in September 1999. 729/5875 (12.4%) eligible individuals were recruited and randomised to receive either influenza vaccine or placebo (ratio 3: 1)! with all participants receiving 23-valent-pneumococcal polysaccharide vaccine unless already administered. The primary analysis was the frequency of influenza as recorded by a GP diagnosis of pneumonia or influenza like illness. In 2000, the UK vaccination policy was changed with influenza vaccine becoming available. for all people aged 65 years and over irrespective of risk. As a consequence of this policy change. the study had to be fundamentally restructured and only results obtained over a one rather than the originally planned two-year randomised controlled trial framework were used. Results from 1999/2000 demonstrated no significant difference between groups for the primary outcome (relative risk 0.8, 95%, CI 0.16-4.1). In addition. there were no deaths or hospitalisations for influenza associated respiratory illness in either group. The subsequent analysis. using both national and local sources of evidence, estimated the following cost effectiveness indicators: (1) incremental NHS cost per GP consultation avoided = pound2000; (2) incremental NHS cost per hospital admission avoided = pound61,000: (3) incremental NHS cost per death avoided = pound1.900.000 and (4) incremental NHS cost per QALY gained = pound304,000. The analysis suggested that influenza vaccination in this Population would not be cost effective. (C) 2004 Elsevier Ltd. All rights reserved.

Mind-reading difficulties in the siblings of people with Asperger's syndrome: evidence for a genetic influence in the abnormal development of a specific cognitive domain

Background: Previous research suggests that the phenotype associated with Asperger's syndrome (AS) includes difficulties in understanding the mental states of others, leading to difficulties in social communication and social relationships. It has also been suggested that the first-degree relatives of those with AS can demonstrate similar difficulties, albeit to a lesser extent. This study examined 'theory of mind' (ToM) abilities in the siblings of children with AS relative to a matched control group. Method: 2 7 children who had a sibling with AS were administered the children's version of the 'Eyes Test'(Baron-Cohen, Wheelwright, Stone, & Rutherford, 1999). The control group consisted of 27 children matched for age, sex, and a measure of verbal comprehension, and who did not have a family history of AS/autism. Results: A significant difference was found between the groups on the Eyes Test, the 'siblings' group showing a poorer performance on this measure of social cognition. The difference was more pronounced among female siblings. Discussion: These results are discussed in terms of the familial distribution of a neuro-cognitive profile associated with AS, which confers varying degrees of social handicap amongst first-degree relatives. The implication of this finding with regard to the autism/AS phenotype is explored, with some discussion of why this neuro-cognitive profile (in combination with corresponding strengths) may have an evolutionary imperative.

Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations

Mainstream schooling is a key policy in the promotion of social inclusion of young people with learning disabilities. Yet there is limited evidence about the school experience of young people about to leave mainstream as compared with segregated education, and how it impacts on their relative view of self and future aspirations. Sixty young people with mild to moderate intellectual disabilities in their final year of secondary school participated in this study. Twenty-eight individuals came from mainstream schools and 32 attended segregated school. They completed a series of self-report measures on perceptions of stigma, social comparison to a more disabled and non-disabled peer and the likelihood involved in attaining their future goals. The majority of participants from both groups reported experiencing stigmatized treatment in the local area where they lived. The mainstream group reported significant additional stigma at school. In terms of social comparisons, both groups compared themselves positively with a more disabled peer and with a non-disabled peer. While the mainstream pupils had more ambitious work-related aspirations, both groups felt it equally likely that they would attain their future goals. Although the participants from segregated schools came from significantly more deprived areas and had lower scores on tests of cognitive functioning, neither of these factors appeared to have an impact on their experience of stigma, social comparisons or future aspirations. Irrespective of schooling environment, the young people appeared to be able to cope with the threats to their identities and retained a sense of optimism about their future. Nevertheless, negative treatment reported by the children was a serious source of concern and there is a need for schools to promote the emotional well-being of pupils with intellectual disabilities.

Interpretation of recommended risk terms: differences between doctors and lay people

Objectives: To examine doctors' (Experiment 1) and doctors' and lay people's (Experiment 2) interpretations of two sets of recommended verbal labels for conveying information about side effects incidence rates. Method: Both studies used a controlled empirical methodology in which participants were presented with a hypothetical, but realistic, scenario involving a prescribed medication that was said to be associated with either mild or severe side effects. The probability of each side effect was described using one of the five descriptors advocated by the European Union (Experiment 1) or one of the six descriptors advocated in Calman's risk scale (Experiment 2), and study participants were required to estimate (numerically) the probability of each side effect occurring. Key findings: Experiment 1 showed that the doctors significantly overestimated the risk of side effects occurring when interpreting the five EU descriptors, compared with the assigned probability ranges. Experiment 2 showed that both groups significantly overestimated risk when given the six Calman descriptors, although the degree of overestimation was not as great for the doctors as for the lay people. Conclusion: On the basis of our findings, we argue that we are still a long way from achieving a standardised language of risk for use by both professionals and the general public, although there might be more potential for use of standardised terms among professionals. In the meantime, the EU and other regulatory bodies and health professionals should be very cautious about advocating the use of particular verbal labels for describing medication side effects.

Parent and child perspectives on the nature of anxiety in children and young people with Autism Spectrum Disorders: a focus group study

Anxiety disorders are common among children and young people with Autism Spectrum Disorders (ASD). Despite growing knowledge about the prevalence, phenomenology and treatment of anxiety disorders, relatively little is understood about the nature and impact of anxiety in this group and little is known about autism-specific factors that may play a role in the increased prevalence of anxiety disorders. In this exploratory study, we report on a series of 5 focus groups with 17 parents of children and adolescents with ASD and anxiety. Across groups, parents gave strikingly similar descriptions of the triggers and behavioural signs associated with anxiety. Another consistent finding was that many parents reported that their children had great difficulty expressing their worries verbally and most showed their anxiety through changes in their behaviour. The impact of anxiety was reported to often be more substantial than the impact of ASD itself. The implications of the focus group findings are discussed in relation to existing literature.