Aims and objectives
The aim of this study was to identify and analyse factors influencing the use of drugs for dementia treatment in home care settings.
Background
While the number of care‐dependent ...people with dementia is growing, it is not clear whether their medication follows the state of the art, especially in home care settings where over two‐thirds of them are cared for in Germany. Although dementia is not curable, it is possible to reduce cognitive, behavioural and psychological symptoms of dementia with the appropriate use of medication. However, there is a lack of information concerning the drug treatment in home care settings.
Methods
The study was conducted as a multicentre cross‐sectional survey, including 923 participants from 102 home care institutions throughout Germany. Medical diagnosis, medication, consultations with a specialist within the previous 12 weeks of the initial assessment and additional general information were assessed following a standardised study protocol. Data were analysed using univariate and multivariate statistical methods. The manuscript was developed utilising the STROBE checklist for cross‐sectional studies.
Results
In home care, one in seven clients (14.8%) is diagnosed with some form of dementia. 52.6% (n = 72) of them were treated with dementia medication: AchEIs 16.1% (n = 22), memantine 9.5% (n = 13), antidepressants 23.4% (n = 32), antipsychotic medication 9.5% (n = 13), tranquilisers 16.8% (n = 23) and anticonvulsant drugs 6.6% (n = 9). Drug treatment for dementia was significantly associated with the consultation of a neurologist/psychiatrist in the previous 12 weeks.
Conclusions
It has been demonstrated that the use of drugs as a component of home care treatment for dementia depends on many factors and therefore varies.
Relevance to clinical practice
It can be assumed that people living with dementia in home care settings are not sufficiently supplied with medication. Their medical care can be improved by establishing interdisciplinary care involving a neurologist/psychiatrist.
Forensic anthropologists play a key role in skeletal trauma analysis and commonly use macroscopic features to distinguish between trauma types. However, this approach can be challenging, particularly ...in cases of highly comminuted or incompletely recovered fractures. Histological analysis of microscopic fracture characteristics in fractured bones may thus help provide additional information on trauma type and bone fracture biomechanics in general. This study analysed the extent of microcrack damage to osteons in long bones with blunt force trauma (BFT) and gunshot trauma (GST), from both traumatic death cases and post-mortem experimental fractures. We identified four types of osteonal damage (OD). In traumatic death cases, OD affecting the inside of the osteon and compromising the Haversian canal (type 1) was found to be indicative of BFT. Moreover, OD affecting the cement line (type 3) and interstitial lamellae (type 4) was more common in the GST samples. OD affecting the inside of the osteon without compromising the Haversian canal (type 2) was not found to be indicative of either trauma type. In cases of experimental fractures, our study revealed that post-mortem fractures in dry bone samples featured the highest amount of OD, particularly of type 4. This study also found that the experimentally produced GST featured similar OD patterns to GST death cases. These findings support our hypothesis that there are distinct osteonal damage patterns in human long bones with BFT and GST, which are of relevant value for trauma analysis in forensic anthropology.
Early dark energy (EDE) is a proposed solution to the Hubble tension in which a new cosmological field accelerates cosmic expansion prior to recombination and reduces the physical size of the sound ...horizon. In previous work, a slight preference for a nonzero EDE contribution was found in the latest Atacama Cosmology Telescope data (ACT DR4), while the Planck satellite legacy data alone do not show evidence for it. In this work, we use the most recent public data from the South Pole Telescope (SPT-3G) to constrain the parameters of the EDE scenario. We find that at the current precision level of SPT-3G, an EDE contribution to the total energy density of the universe prior to recombination of ∼10% cannot be ruled out, but that the data are also consistent with no EDE. The combination of ACT DR4 and SPT-3G with the Planck large-scale temperature anisotropy measurement shows a hint ( 2.6σ ) for nonzero EDE; however, this preference disappears when the full Planck 2018 dataset is included.
We present a simple approximation that can speed up the computation of the mode-coupling matrices, which are usually the bottleneck for computing unbiased angular power spectra, as well as their ...associated covariance matrices, of the cosmic microwave background temperature and polarization anisotropies. The approximation results in the speed-up of the MASTER algorithm by more than an order of magnitude with very little loss of precision. We demonstrate the performance on simulations of forthcoming cosmic microwave background surveys such as the Simons Observatory and CMB-S4 for a wide variety of survey window functions.
Whereas gunshot injuries in human craniums have been well studied, reliable data on fracture patterns in ballistic long bone trauma remains scarce. Further information useful for forensic trauma ...interpretation and reconstruction may be retrieved from experimentally produced gunshot fractures. In order to avoid the use of human specimens for experimental research, it is of great interest to determine whether alternative models can reproduce the ballistic fracture patterns of human long bones. To address this question, we shot seven healthy adult human femurs and humeri each, ten samples each of two different polyurethane cylinders from Synbone.sup.® and four femurs from female red deer. The specimens were embedded in ballistic gelatin and perpendicularly shot from a distance of 2 m, using a 9-mm full metal jacket projectile at an impact velocity of 360 m/s. The macroscopical appearance of the detailed fracture pattern considering entry, exit and general cortical traits as well as the bullet's energy lost upon impact were compared between the models. Despite some general similarities, neither of the two alternative models entirely reproduced the fracture patterns of human long bones. Comparing the two alternative models, the surrogate model revealed more significant differences to the human fracture than the animal model. This leads to the conclusion that the polyurethane material provides a different failure mechanism than real bone, underpinning the challenge in deploying an accurate analog.
Background: Leukocyte and platelet-rich fibrin (L-PRF) may be considered a co-adjuvant intervention that may play a key role in blood coagulation and tissue repair after nail surgeries. The aim of ...this study was to determine the effectiveness of L-PRF versus nitrofurazone on the post-surgical bleeding and wound cicatrization period in patients with bilateral onychocryptosis during surgeries of chemical matrixectomies with 88% phenol solution. Methods: A randomized single-blind clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2016-002048-18. Twenty healthy participants with bilateral onychocryptosis (n = 40) were recruited and bilaterally received both protocols for both halluces. Patients with a mean age mean of 45.55 ± 12.19 years attended a specialized foot and ankle surgery clinic. Both halluces of each patient were randomized and allocated to receive L-PRF (experimental group; n = 20 halluces) or nitrofurazone (control group; n = 20 halluces) interventions in conjunction with surgery of chemical matrixectomies with 88% phenol solution for bilateral ingrown of toenail border (medial and lateral). Patients were blinded to their intervention in each hallux. The primary outcome measurement was post-surgical bleeding. The secondary outcome measurements were post-surgical pain intensity, inflammation, infection, analgesic intake, and wound cicatrization period. Results: Statistically significant differences (p < 0.001) were found between both groups showing a reduction for wound cicatrization period and post-surgical bleeding for the L-PRF intervention with respect to nitrofurazone treatment. The rest of the outcome measurements did not show any statistically significant differences (p > 0.05). Conclusions: L-PRF rather than nitrofurazone in conjunction with chemical matrixectomies performed with 88% phenol solution reduced the wound cicatrization period and bleeding after nail surgery. Thus, L-PRF may be considered a first-line co-adjuvant intervention for patients who suffer from nail problems, such as onychocryptosis, that require surgical procedures.
Planck's Cosmic Microwave Background temperature and polarization observations are the premier dataset for constraining cosmological models. Cosmic variance limited temperature at large and ...intermediate scales today dominates the constraints; polarization provides additional constraining power and further scrutiny of the models. To complete this picture from Planck, ground-based experiments, such as the Atacama Cosmology Telescope (ACT) and the South Pole Telescope (SPT) continue to add temperature and polarization measurements at small scales, allowing for the extraction of competitive cosmological constraints from the $TE$ and $EE$ power spectra. Matching at the same time all these stringent probes is a key challenge and validation step for any cosmological model. In particular, $\Lambda$CDM requires a tight consistency between the temperature and polarization measurements. In this paper, we present a number of methods to identify and quantify possible inconsistencies between temperature and polarization, we apply them to the latest Planck, ACT and SPT data and find no evidence for a deviation from $\Lambda$CDM. Application of these methods will have increased importance for future, more constraining CMB data.
When dealing with badly preserved cadavers or skeletal human remains, the assessment of death circumstances remains challenging. When forensic evidence cannot be taken from the skin and soft tissue, ...the information may only be deduced from more resistant elements such as bone. Compared to cranial gunshot injuries, reliable data on ballistic long bone trauma remains scarce. This study aims to define ballistic fracture characteristics in human long bones. The shaft of 16 femurs and 13 humeri from body donors was perpendicularly shot with a 9-mm Luger full metal jacket bullet at an impact velocity of 360 m/s from a distance of 2 m. Some bones were embedded in Clear Ballistics Gel®, and some were shot without soft tissue simulant in order to better visualise the fracture propagation on the high-speed camera. The fractures were examined macroscopically and compared between the sample groups. We consistently found comminuted fractures with a stellate pattern. Fracture details were classified into entrance, exit and general characteristics. For some traits, we detected different occurrence values in the group comparison. The results indicate that some of the traits depend on bone properties such as shaft diameter, bone length and cortical thickness. The presence of ballistic gel also influenced some fracture traits, emphasising the relevance of soft tissue simulant in osseous gunshot experiments. This study revealed new insights in the detailed fracture pattern of human long bones. These may serve as guidelines for the identification and reconstruction of gunshot trauma in human long bones.
Whereas gunshot injuries in human craniums have been well studied, reliable data on fracture patterns in ballistic long bone trauma remains scarce. Further information useful for forensic trauma ...interpretation and reconstruction may be retrieved from experimentally produced gunshot fractures. In order to avoid the use of human specimens for experimental research, it is of great interest to determine whether alternative models can reproduce the ballistic fracture patterns of human long bones. To address this question, we shot seven healthy adult human femurs and humeri each, ten samples each of two different polyurethane cylinders from Synbone
®
and four femurs from female red deer. The specimens were embedded in ballistic gelatin and perpendicularly shot from a distance of 2 m, using a 9-mm full metal jacket projectile at an impact velocity of 360 m/s. The macroscopical appearance of the detailed fracture pattern considering entry, exit and general cortical traits as well as the bullet’s energy lost upon impact were compared between the models. Despite some general similarities, neither of the two alternative models entirely reproduced the fracture patterns of human long bones. Comparing the two alternative models, the surrogate model revealed more significant differences to the human fracture than the animal model. This leads to the conclusion that the polyurethane material provides a different failure mechanism than real bone, underpinning the challenge in deploying an accurate analog.
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