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Family carers of people living with dementia often need support with making decisions about care. Many find end-of-life care decisions particularly difficult. The aim of this article is to present an evidence- and theoretical-based process for developing a decision aid to support family carers of people with dementia towards the end-of-life.
Following a systematic process, we developed a decision aid using coproduction methods and matrices to synthesize data from a systematic review and qualitative interviews with people living with dementia and family carers. Data were presented to coproduction workshops of people living with dementia, family carers, practitioners and professionals. Development was guided by the Ottawa Decision Support Framework and a modified Interprofessional Shared Decision-Making model.
The decision aid covers four decision areas (1) changes in care; (2) eating and drinking difficulties; (3) everyday well-being; and (4) healthcare, tests and medication. We present an interactive decision aid, using a variety of approaches including written text, Frequently Asked Questions, top tips and illustrative quotes from people living with dementia and family carers.
This is the first decision aid that focusses on multiple decisions towards the end-of-life in dementia care. The process offers a template for others to develop decision aids or similar interventions, and how to include people living with dementia in coproduction.
Family carers provided feedback on data collection, data analysis and the decision aid, and one is a coauthor. People living with dementia and family carers were integral to the coproduction workshops.
Family carers provided feedback on data collection, data analysis and the decision aid, and one is a coauthor. People living with dementia and family carers were integral to the coproduction workshops.
To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019.
Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis.
We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities.
Our data indicate that active M.leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.
Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.The correct targeting and insertion of tail-anchored (TA) integral membrane proteins is critical for cellular homeostasis. TA proteins are defined by a hydrophobic transmembrane domain (TMD) at their C-terminus and are targeted to either the ER or mitochondria. Derived from experimental measurements of a few TA proteins, there has been little examination of the TMD features that determine localization. As a result, the localization of many TA proteins are misclassified by the simple heuristic of overall hydrophobicity. ABT-199 molecular weight Because ER-directed TMDs favor arrangement of hydrophobic residues to one side, we sought to explore the role of geometric hydrophobic properties. By curating TA proteins with experimentally determined localizations and assessing hypotheses for recognition, we bioinformatically and experimentally verify that a hydrophobic face is the most accurate singular metric for separating ER and mitochondria-destined yeast TA proteins. A metric focusing on an 11 residue segment of the TMD performs well when classifying human TA proteins. The most inclusive predictor uses both hydrophobicity and C-terminal charge in tandem. This work provides context for previous observations and opens the door for more detailed mechanistic experiments to determine the molecular factors driving this recognition.Most of Earth's terrestrial carbon is stored in the soil and can be released as carbon dioxide (CO2 ) when disturbed. Although humans are known to exacerbate soil CO2 emissions through land-use change, we know little about the global carbon footprint of invasive species. We predict the soil area disturbed and resulting CO2 emissions from wild pigs (Sus scrofa), a pervasive human-spread vertebrate that uproots soil. We do this using models of wild pig population density, soil damage, and their effect on soil carbon emissions. Our models suggest that wild pigs are uprooting a median area of 36,214 km2 (mean of 123,517 km2 ) in their non-native range, with a 95% prediction interval (PI) of 14,208 km2 -634,238 km2 . This soil disturbance results in median emissions of 4.9 million metric tonnes (MMT) CO2 per year (equivalent to 1.1 million passenger vehicles or 0.4% of annual emissions from land use, land-use change, and forestry; mean of 16.7 MMT) but that it is highly uncertain (95% PI, 0.3-94 MMT CO2 ) due to variability in wild pig density and soil dynamics. This uncertainty points to an urgent need for more research on the contribution of wild pigs to soil damage, not only for the reduction of anthropogenically related carbon emissions, but also for co-benefits to biodiversity and food security that are crucial for sustainable development.
To determine the effects of percutaneous mitral annuloplasty on symptoms, walk distance and left ventricular (LV) structure and function in patients with mild or moderate secondary mitral regurgitation (SMR).
This was a pooled analysis of patients (n= 68) who, despite guideline-directed medical therapy had symptomatic heart failure (HF) with mild (n= 25) or moderate (n= 43) SMR treated with percutaneous mitral annuloplasty as part of the TITAN, TITAN II, or REDUCE-FMR trials. Primary outcomes were changes in symptoms, 6-min walk distance, and quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) after 1year. Secondary analyses included changes in LV structure and function. At 1 year, New York Heart Association class status was maintained (48%) or improved (46%) in most patients, mean KCCQ scores increased from baseline by 10units [95% confidence interval (CI) 3 to17; P< 0.01] and mean 6-min walk test distance increased by 34 m (95% CI 12 to 57; P< 0.01). SMR grade improved in 25% of patients and was maintained in 58% of patients with changes in mean regurgitant volume of -7mL (95% CI -11 to -3; P< 0.