Does the Well-Being of Individuals with Down Syndrome and Dementia Improve When Using Life Story Books and Rummage Boxes? A Randomized Single Case Series Experiment.

BACKGROUND: This study investigated whether a personalized life story book and rummage box enhanced well-being and led to changes in behaviour for people with Down syndrome (DS) who have dementia. MATERIALS AND METHODS: A randomized single case series design was used with five participants who had DS and a diagnosis of dementia. Participants were invited to take part in three conditions at random (i) life story book, (ii) rummage box and (iii) no-intervention condition. RESULTS: The two reminiscence conditions were significantly associated with enhanced well-being as compared to the no-intervention condition. However, for one participant, the life story book was associated with significantly higher well-being, while for another participant, the rummage box was associated with significantly higher well-being, suggesting some participants may prefer one method over another. CONCLUSIONS: Personalized life story books and rummage boxes are associated with higher levels of well-being for people with DS and dementia.

An exploration of the experience of self in the social world for men following traumatic brain injury.

This study explores the lived experience of male survivors of traumatic brain injury (TBI) in relation to perceived changes in their personal and social identity. The aim was to provide an understanding of the individuals' sense of self and sources of emotional distress and growth following injury. Semi-structured interviews were conducted with nine male survivors of TBI (aged 22-59 years). These men were 17 months to 21 years post-injury and were recruited through a UK holistic neuropsychological rehabilitation centre. Transcripts of their accounts were analysed using thematic analysis. Identified dominant themes related to the men's described experience of changes in self relating to their social world, were titled: "abnormality", "hidden", "the old-me-new-me" and "others treat me differently". In response to these emotional experiences the themes of "self-criticism", "need to be as others want me to be" and "withdrawal" emerged. The identified themes are considered alongside the alternative narrative of "positive growth" in relation to current understanding of identity and "self-conscious" emotions. Future research and clinical implications are suggested.

Service use, drop-out rate and clinical outcomes: a comparison between high and low intensity treatments in an IAPT service.

BACKGROUND: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher "step-up" rates between low and high intensity treatments. AIMS: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. METHOD: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. RESULTS: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. CONCLUSIONS: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

A service evaluation of the Solihull Approach training and practice.

The Solihull Approach (SA) is a conceptual framework concerned with parent-child relationships. Across the UK, training in the SA expanded from health visitors (HVs) to various practitioners in health, social care, education and voluntary sectors. A substantial amount of research had provided evidence for the effectiveness of the SA with HVs. The present study developed Ottmann's themes into an 18-item questionnaire. This measure was then administered to a large and varied sample of SA-trained professionals. Scores were compared across HVs and family support workers. The two groups described the SA training as useful to their work with clients as well as within their multidisciplinary teams. Participants identified the crucial role of managerial support, supervision and consultation in implementing the training in practice. Results are discussed with relation to the SA theory.

Randomized phase II placebo-controlled trial of maintenance therapy using the oral triple angiokinase inhibitor BIBF 1120 after chemotherapy for relapsed ovarian cancer.

PURPOSE: Inhibiting angiogenesis is one of the most promising avenues for new therapies for ovarian cancer. We investigated the efficacy and safety of a novel agent, BIBF 1120, a triple angiokinase inhibitor, after chemotherapy for relapsed disease. PATIENTS AND METHODS: We conducted a randomized, double-blind, controlled phase II trial in 83 patients who had just completed chemotherapy for relapsed ovarian cancer, with evidence of response, but at high risk of further early recurrence. The patients were randomly assigned to receive maintenance therapy using BIBF 1120 250 mg or placebo, twice per day, continuously for 36 weeks. End points were progression-free survival (PFS), toxicity, and overall survival. RESULTS: Thirty-six-week PFS rates were 16.3% and 5.0% in the BIBF 1120 and placebo groups, respectively (hazard ratio, 0.65; 95% CI, 0.42 to 1.02; P = .06). Four patients continued on BIBF 1120, including two patients for another year or more. The proportion of patients with any grade 3 or 4 adverse events was similar between the groups (34.9% for BIBF 1120 v 27.5% for placebo; P = .49; mostly grade 3). However, more patients on BIBF 1120 experienced diarrhea, nausea, or vomiting (mainly grade 1 or 2 and no grade 4). There was a higher rate of grade 3 or 4 hepatotoxicity in patients on BIBF 1120 (51.2%) compared with patients on placebo (7.5%; P < .001), but this was rarely of clinical significance, and patients continued with the trial treatment. A single-level dose reduction to 150 mg was made in 15 patients, all on active drug. CONCLUSION: BIBF 1120 is well tolerated and associated with a potential improvement in PFS. The observed treatment effect is sufficient to justify further study within a large phase III trial.

Five years' experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-dose-rate brachytherapy: results from a single institution.

PURPOSE: To assess the clinical outcomes after concurrent cisplatin chemotherapy and radiotherapy (RT) followed by high-dose-rate brachytherapy for locally advanced carcinoma of the cervix and perform a multivariate analysis of the prognostic factors. METHODS AND MATERIALS: The outcomes were analyzed for all women treated between 1999 and 2004 with concurrent cisplatin chemotherapy and RT followed by high-dose-rate brachytherapy. Kaplan-Meier analysis was used for overall survival (OS), local control (LC), and distant control (DC). The Cox proportional hazards model was used to perform multivariate analysis of the prognostic variables. RESULTS: The standard regimen comprised whole pelvic external RT 45 Gy in 25 fractions with concurrent weekly cisplatin 40 mg/m(2), followed by four high-dose-rate brachytherapy insertions of 6 Gy. Patients with radiologically enlarged para-aortic lymph nodes underwent extended-field RT. Of 92 patients, the OS rate was 72% at 2 years and 55% at 5 years. The LC rate was 76% at 2 years and 67% at 5 years. The DC rate was 68% at 2 years and 48% at 5 years. The most important prognostic factor for OS, LC, and DC was the pretreatment hemoglobin. For OS, the tumor size and the presence of enlarged lymph nodes were also important. For LC, the number of brachytherapy insertions was important; and for DC, the number of chemotherapy treatments was important. Of the patients, 4% experienced late Grade 3 or 4 toxicity. CONCLUSION: The results of our study have shown that the regimen is effective, with acceptable long-term side effects. In this cohort, the most important prognostic factor was the pretreatment hemoglobin level, a disease-related factor. However, more effective systemic treatments are needed.

The evolution of fidelity in sensory systems.

We investigate the effect that noise has on the evolution of measurement strategies and competition in populations of organisms with sensory systems of differing fidelities. We address two questions motivated by experimental and theoretical work on sensory systems in noisy environments: (1) How complex must a sensory system be in order to face the need to develop adaptive measurement strategies that change depending on the noise level? (2) Does the principle of competitive exclusion for sensory systems force one population to win out over all others? We find that the answer to the first question is that even very simple sensory systems will need to change measurement strategies depending on the amount of noise in the environment. Interestingly, the answer to the second question is that, in general, at most two populations with different fidelity sensory systems may co-exist within a single environment.

The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review.

AIM: This systematic review examines how specific coping strategies are associated with psychological and physical outcomes in rheumatoid arthritis. BACKGROUND AND METHODS: Rheumatoid arthritis is a long-term condition that people cope with but it is unclear whether specific coping strategies have an effect on mood and function. Therefore a systematic review was undertaken of the coping with arthritis literature and 174 studies were initially included. Further examination determined that 31 studies (11 longitudinal and 20 cross sectional) were finally included in the review. The 31 studies were clinically and methodologically diverse; therefore the analysis of results was a qualitative synthesis. Coping strategies that contributed to the prediction of outcomes were allocated to a new structure for the classification of coping. RESULTS: The results demonstrated there was not sufficient, consistent evidence to support the overall view that individual coping strategies contributed to longitudinal outcomes in rheumatoid arthritis. However, major differences in the design of included studies may have hindered the comparison of results. There was some evidence from longitudinal studies that patients who used resting, inactivity, etc. (helplessness category) experienced negative outcomes. Avoidance (escape) was the most common overall category associated with predominantly negative outcomes in both cross-sectional and longitudinal studies. CONCLUSIONS: There was generally limited evidence to suggest an association between coping strategies and outcomes but the design of studies and the lack of clarity about coping strategies were identified as problems. This study used a new framework for the conceptualisation of coping strategies, thus contributing to further examining the utility of coping strategies and contributing to their redefinition. RELEVANCE TO CLINICAL PRACTICE: The use of helplessness (inactivity and passive coping) and escape/avoidant coping strategies, including denial and wishful thinking, could be identified and addressed by nurses and other health professionals to reduce the associated negative outcomes.

A mobile phone as a memory aid for individuals with traumatic brain injury: a preliminary investigation.

PRIMARY OBJECTIVE: To investigate the use of a 'reminders' function on a mobile phone as a compensatory memory aid for five individuals with traumatic brain injury (TBI). RESEARCH DESIGN: A series of five single case ABAB reversal design. METHODS AND PROCEDURE: A mobile phone was given to each participant during two intervention phases. Target behaviours were recorded for the length of the study. EXPERIMENTAL INTERVENTION: The phone was programmed to prompt a number of identified target behaviours. MAIN OUTCOMES AND RESULTS: For two participants, there was an increase in the target behaviours achieved when the phone was used, with percentages rising from 51% to 95% for Participant 1 (P1) and 58% to 88% for Participant 5 (P5). The percentage of target behaviours achieved did not return to initial baseline levels when the phone was removed, indicating that the intervention may have facilitated P1 and, in particular, P5 in the learning of their routines. The participants who did not benefit from the mobile phone differed from P1 and P5 as they fell in the category of 'severe memory impairment' on the RBMT, were significantly impaired on an assessment of executive functioning (Tower Test) and required 24-hour care. CONCLUSIONS: The preliminary investigation with five participants suggests that this system may be of best use with individuals who do not require 24-hour care and do not experience severe memory and executive functioning difficulties. However, further research with a larger sample is highly recommended.

Analysis of a certain class of replicator equations.

Motivated by a problem in the evolution of sensory systems where gains obtained by improvements in detection are offset by increased costs, we prove several results about the dynamics of replicator equations with an n x n game matrix of the form: A( ij ) = a( i )b( j ) - c( i ). First, we show that, generically, for this class of game matrix, all equilibria must be on the 1-skeleton of the simplex, and that all interior solutions must limit to the boundary. Second, for the particular ordering, a1b2> ... >bn, which is most natural in the study of the evolution of sensory systems, we show that topological restrictions require a unique local attractor in every face of the simplex. We conjecture that the unique local attractor for the full simplex is, in fact, a global attractor, and prove this for n < or = 5. In a separate argument supporting the conjecture, we show that there can be no chain recurrent invariant set entirely contained in the 1-skeleton of the simplex. Finally, we discuss the special, non-generic case and give a local description of the dynamics when there is an interior equilibrium.

Prevention of ovarian cancer.

Ovarian cancer is the leading cause of death from gynaecological malignancy. The incidence is high in the Western world. The incidence of ovarian cancer is reduced by pregnancy, lactation, the oral contraceptive pill and tubal ligation. Lifestyle factors are important in the aetiology of ovarian cancer and current evidence suggests the risk can be reduced by eating a diet rich in fruit and vegetables, taking regular exercise, avoiding smoking, avoiding being overweight and avoiding long-term use of hormonal replacement therapy (HRT). Familial ovarian cancer is responsible for about 10% of ovarian cancer cases. Strategies available to high-risk women include screening (covered elsewhere) and prophylactic salpingo-oophorectomy. The precise role of chemoprevention for high-risk women in the form of the oral contraceptive pill is unclear.

Recovery of CD8+ T-cell function during systemic chemotherapy in advanced ovarian cancer.

Immunologic approaches are emerging as new treatment options in several types of cancer. However, whereas the ability of patients to develop potent CD8+ T-cell responses is crucial for efficient antitumor responses, immunocompetence and T-cell function are not tested routinely in patients entering immunotherapy. The objective of our study was to monitor T-cell function in advanced cancer and during chemotherapy. CD8+ T-cell function of 21 patients with advanced ovarian cancer (stages III-IV) was assessed by cytokine flow cytometry following stimulation of 42 PBMC samples with a panel of synthetic viral peptides in vitro, consisting of pan-Caucasian epitopes. CD8+ T-cell responses were significantly lower in patients with high levels (>200 units/mL) of Ca125 (marker of tumor load and progression) than in those with low Ca125 levels (P = 0.0013). In longitudinal studies of nine patients, chemotherapy was associated with decreasing Ca125 levels in seven cases and also with improvement or maintenance of CD8+ T-cell function in seven cases. After the full course of chemotherapy, five of nine patients in remission displayed potent CD8+ T-cell responses, whereas four of nine patients in progression displayed low or decreasing T-cell responses, pointing toward a correlation between T-cell function and clinical response. Our results show for the first time that CD8+ T-cell function is not permanently suppressed in advanced cancer and successful chemotherapy is associated with improved antigen-specific T-cell reactivity. We suggest that functional assays determining T-cell immunocompetence can be valuable tools for optimizing cancer immunotherapy for improved clinical success.

Assessment of immunological competence and SV40 specific recall immunity in malignant pleural mesothelioma.

Diffuse malignant pleural mesothelioma (MPM) is the third most common lung malignancy showing rising incidence with 250,000 deaths expected from it in Western Europe over the next 35 year. The tumour is generally resistant to conventional treatment and there is urgent need for novel preventative and therapeutic measures to combat this growing public threat. Finding of SV40 DNA sequences in a high proportion (40-90%) of several series of MPM cases, and suggestion of its potential co-carcinogen role provide a rationale for the development of novel anti-MPM vaccines incorporating SV40 gene sequences or antigenic determinants. As a prelude to adopting this approach, general T cell function was examined in relatively early cases of MPM presenting for biopsy or debulking surgery. CD8+ T cell responses were studied using antigenic epitopes of common viral antigens covering a broad range of haplotypes. 74.1% (20/27) of MPM patients and 80% (8/10) of the control subjects showed T cell responsiveness to the viral peptides mix, whilst a small proportion showed SV40 specific recall immunity.

Exosomes as potent cell-free peptide-based vaccine. II. Exosomes in CpG adjuvants efficiently prime naive Tc1 lymphocytes leading to tumor rejection.

Ideal vaccines should be stable, safe, molecularly defined, and out-of-shelf reagents efficient at triggering effector and memory Ag-specific T cell-based immune responses. Dendritic cell-derived exosomes could be considered as novel peptide-based vaccines because exosomes harbor a discrete set of proteins, bear functional MHC class I and II molecules that can be loaded with synthetic peptides of choice, and are stable reagents that were safely used in pioneering phase I studies. However, we showed in part I that exosomes are efficient to promote primary MHC class I-restricted effector CD8(+) T cell responses only when transferred onto mature DC in vivo. In this work, we bring evidence that among the clinically available reagents, Toll-like receptor 3 and 9 ligands are elective adjuvants capable of triggering efficient MHC-restricted CD8(+) T cell responses when combined to exosomes. Exosome immunogenicity across species allowed to verify the efficacy of good manufactory procedures-manufactured human exosomes admixed with CpG oligonucleotides in prophylactic and therapeutic settings of melanoma in HLA-A2 transgenic mice. CpG adjuvants appear to be ideal adjuvants for exosome-based cancer vaccines.

How do attitudes to illness and treatment compare with self-reported behaviour in predicting inhaler use in asthma?

AIM: To compare attitudes to illness and treatment with self-reported behaviour in predicting inhaler use in asthmatic patients. METHODS: In five practices, 45 patients had their ß-2-agonist and steroid inhalers exchanged for Ventolin and Flixotide Accuhalers™. They completed the Illness Perception Questionnaire, the Attitudes to Treatment for Asthma Questionnaire, and a self-report questionnaire at entry, after one month's run-in, and at three months. A nurse counted the number of doses used. Univariate analysis was performed with Accuhaler use over three months as the dependent variable. Independent variables included the questionnaire sub-scales and morbidity. Significant variables were entered into multiple linear regression. RESULTS: The self-report questionnaire explained 40% of the variance of steroid use. The ATAQ relief sub-scale and morbidity explained 29% of the variance of ß-2-agonist use. CONCLUSIONS: Steroid inhaler use can be partly predicted by self-reported behaviour and ß-2-agonist use by attitudes to inhaler treatment. These findings have implications for patient education.

Developing a questionnaire to measure patients' beliefs about inhaler treatment for asthma: Tests of validity and reliability.

AIM: To develop a valid and reliable questionnaire for measuring patients' beliefs about inhaler treatments for asthma. METHODS: In seven general practices, 335 patients prescribed both beclomethasone and salbutamol inhalers completed a 66-item questionnaire. Sub-scales were developed using factor analysis and a 29-item questionnaire sent to 90 patients in another practice to estimate test-retest reliability. RESULTS: Three factors explained 31.4% of the variance relating to beliefs about inhalers: preventing asthma symptoms, problems with and concerns about inhalers, and relieving asthma symptoms. Cronbach's alpha coefficients of the sub-scales were 0.71, 0.70 and 0.70 respectively. Intra-class correlation coefficients were 0.87 or more for all three sub-scales. The prevention and relief scale scores were significantly correlated with estimates of corticosteroid and ß2-agonist use. CONCLUSIONS: A valid and reliable questionnaire has been developed for measuring patients' beliefs about inhaler treatments for asthma. Its utility in predicting adherence and facilitating patient education needs to be tested.