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Navigating dementia care:a systematic review of young and young adult carers′ needs and support solutions
Get PDFObjectives: This systematic review aimed to explore the available support and identify the unique needs of young and young adult carers of individuals with dementia. Method: A systematic review following PRISMA guidelines was conducted. Electronic databases, including PubMed, Web of Science, PsycINFO, CINAHL, and Ovid, along with Google Scholar for grey literature, were searched. A narrative synthesis approach was used to analyse the findings of the included studies. The quality of the articles was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Seven studies met the predefined inclusion criteria and were included in the narrative synthesis. Findings revealed that young and young adult carers often lack knowledge of available support services and face challenges navigating the healthcare system. Caregiving responsibilities were found to hinder educational and career aspirations, leading to social isolation and strained relationships. The support received from family, friends, and teachers was often inconsistent and inadequate. A significant finding was the lack of differentiation between young and young adult carers in the existing research, despite their distinct social care support needs. Conclusion: The limited research highlights a critical gap in the literature regarding the support and needs of young and young adult carers of people with dementia. The lack of distinction between these two groups, who receive different social care support, emphasises the need for further research to better understand their unique experiences. There is an urgent need for targeted education and support programmes that address the distinct developmental needs and challenges of this population, promoting their well-being and safeguarding their personal and educational aspirations.</p
Comparison of muscle strength and power in the short physical performance battery for predicting negative outcomes in older adults with mobility limitations
Get PDFObjectives: The present study examined sex-specific associations between Short Physical Performance Battery (SPPB) indexes operationalized according to lower limb muscle strength and power and the occurrence of negative events in older adults with mobility limitations. Design: Secondary longitudinal analysis of a randomized controlled trial Setting: Community-Dwellers. Participants: Older adults (70+ years) with mobility limitations. Methods: Participants completed the SPPB under standardized conditions. Muscle power measures were estimated according to results of the 5-time sit-to-stand (5STS) test using validated equations. Then, four SPPB indexes were created by replacing 5STS test results with muscle power measures. Outcomes were assessed after 24 months of randomization and included mobility disability, hospitalization, and death. Results: Data from 1,422 participants were analyzed. Cox regression models revealed sex-specific associations between SPPB variants and adverse outcomes. SPPB indexes incorporating muscle strength or power were significantly associated with mobility disability in both sexes, and with hospitalization and death in women. According to Akaike's Information Criterion, muscle power-based SPPB indexes provided the best fit for predicting negative outcomes. Conclusions: Sex-specific associations exist between modified SPPB indexes and adverse outcomes in older adults with mobility limitations. Notably, SPPB variants incorporating muscle power measures demonstrated the best fit for adverse outcomes in comparison to traditional SPPB. Trial registration: ClinicalTrials.gov identifier: NCT02582138 (registration date: 2015-10-08).</p
“A biomarker-based scoring system to assess the presence of obstructive coronary artery disease in patients with myocardial infarction”
Get PDFAims: Approximately 10% of patients with myocardial infarction present with non-obstructive coronary arteries (MINOCA), whose characteristics differ from those with obstructive coronary lesions (MICAD). Inflammation plays a key role in myocardial infarction. This study aims to develop a biomarker-based index for accurate differentiation between MINOCA and MICAD. Methods: A prospective, observational cohort study including 111 patients admitted for myocardial infarction: 46 with MINOCA and 65 with MICAD. Blood samples were collected within the first 24 h to measure high-sensitivity C-reactive protein, interleukin-6, asymmetric dimethylarginine, and peak high-sensitivity troponin T. The association of these biomarkers with MICAD risk was analyzed using logistic regression. Scoring systems were developed using optimization algorithms to predict the diagnosis before coronary angiography, applied to both individual biomarkers and a combined index. Results: Patients had a mean age of 67 years (SD 13.3), with a male predominance (68.5%). Higher levels of IL-6 and high-sensitivity troponin T were significantly associated with increased MICAD risk (OR: 1.58; 95% CI: 1.01–2.46, and OR: 2.27; 95% CI: 1.61–3.26, respectively). As score increases, interleukin-6 and high-sensitivity troponin T increase the likelihood of MICAD classification, while higher asymmetric dimethylarginine levels reduce it. Each one-point increase in the combined index multiplies MICAD risk by six (OR:6.16, 95%CI: 2.72–13.95; p < 0.001). While individual indexes improved the diagnostic performance of biomarkers, the combined index demonstrated superior accuracy (AUC: 0.918). Conclusions: A biomarker-based scoring system was developed, achieving superior discriminatory capacity for differentiating MINOCA from MICAD compared to the individual analysis of biomarkers in absolute values or independent indexes.</p
Cut-off points for low relative 30-s sit-to-stand power and their associations with adverse health conditions
Get PDFBackground: Despite muscle power derived from the 5-rep sit-to-stand (STS) test having been demonstrated to be a valuable biomarker in older individuals, there is limited information regarding muscle power derived from the 30-s STS test, a widely used test in the clinical setting. This study aimed (i) to compare relative 30-s STS power values between older men and women, (ii) to identify cut-off points for low relative 30-s STS power, (iii) to compare the prevalence of low relative STS power between sexes and (iv) to evaluate the association of low relative 30-s STS power with adverse conditions in older people. Methods: A total of 1475 community-dwelling older adults (65–98 years; 45% men) from the Toledo Study for Healthy Aging were included. Relative STS power was assessed using the 30-s STS test and the Alcazar's equation. Adverse health conditions considered encompassed frailty, depression, disability in basic (BADL) and instrumental activities of daily living (IADL), cognitive impairment and low habitual gait speed (HGS). Results: Relative STS power decreased linearly at an average rate of 1.0% year−1 in men and 1.5% year−1 in women. The cut-off points for low relative STS power were 2.53 and 2.01 W·kg−1 for men and women, respectively. The prevalence of low relative STS power was significantly lower in older men compared with older women (43.5% vs. 50.0%, respectively; p = 0.005). In men, low relative STS power was associated with frailty (OR [95% CI] = 4.4 [2.4–8.0]), cognitive impairment (OR [95% CI] = 1.7 [1.0–2.7]), disability in BADL (OR [95% CI] = 4.5 [1.5–13.8]) and low HGS (OR [95% CI] = 3.4 [1.9–5.9]). In women, low relative STS power was associated with frailty (OR [95% CI] = 5.2 [3.5–7.7]), disability in BADL (OR [95% CI] = 4.3 [1.8–9.9]) and IADL (OR [95% CI] = 3.1 [2.2–4.3]) and low HGS (OR [95% CI] = 6.1 [2.8–13.1]). No associations were found between low relative STS power and disability in IADL or depression in men, nor between low relative STS power and cognitive impairment or depression in women. Conclusion: Relative STS power decreased with increasing age in both men and women. The provided sex-specific cut-off points for low relative STS power using the 30-s STS test adequately identified older people with frailty and were associated with an increased risk of experiencing adverse conditions.</p
Frailty Prevalence and Characterization Among Kidney Transplant Candidates in Spain:A Multicenter Study
Get PDFFrailty is a frequent condition among kidney transplant candidates (KTc) that confers poor outcomes after transplantation. We aimed to establish frailty prevalence in a representative sample of KTc in Spain. We conducted a multicenter cross-sectional study including 1194 KTc ≥50 years. Frailty was assessed by the FRAIL scale. Mean age was 64.2 years; 38.4% were female. Median Charlson comorbidity index (CCI) was 6 [4–7] and the total number of medications was 9 [7–12]. We found that 8.2% of patients were frail and 41.5% were pre-frail. Frailty was more frequent among females (60.2% of frail vs. 32.8% of robust; p < 0.001), hemodialysis patients (74.5% of frail vs. 67.1% of robust; p = 0.02), and those with a high burden of disease (54.6% of frail patients with CCI >6 vs. 29.3% of robust; p < 0.001). The multivariable analysis confirmed that frailty was associated with the female sex (OR 3.9 [2.5–6.2]); higher CCI (>6 OR 2.9 [1.6–54]); and the number of medications (OR –per medication- 1.13 [1.07–1.2]). Almost 50% of KTc in Spain are pre-frail or frail. Frailty is more prevalent between women and patients with high comorbidity burden. Identifying those candidates at risk is essential to establish risks and implement strategies to minimize them.</p
Design of a combined heat store and heat exchanger for CAES Systems
Get PDFA combined heat store and heat exchanger unit (HSX) intended for compressed air energy storage (CAES) is presented. The unit is directly charged by the pressurised air emerging from the compression train, which removes the need for a secondary low-pressure air circuit. Salt is used as the thermal storage medium due to its good heat capacity, thermal conductivity, and its ability to accommodate the thermal expansion of the stainless-steel pipes. This paper uses a CAES system (15 MW, 12-h discharge) driven by an offshore wind turbine as a case study. There are not many commercial CAES systems in operation; however, the levelized cost of the heat storage subsystem of a CAES system (i.e. heat store, set of heat exchangers and ancillary low-pressure circuit) ranges between 45 and 48 £/MWh. Findings show that the most cost-effective design for a HSX has a capital cost of ∼£55k. This translates into a levelized cost of storage of ∼31.5 £/MWh. The roundtrip exergy efficiency of this design is 93.7 %. This accounts for heat-exergy and pressure-exergy losses; losses to ambient are not considered. A HSX unit can considerably reduce the overall cost of a CAES system.</p
Identifying typical academic language and learning development practitioner roles and specialisms: an international taxonomy
Get PDFAlthough the higher education ‘third space’ has become more widely recognised, there is still a prevailing lack of specificity in terms of many associated job roles. In contrast to librarians (CILIP, 2025), there is no formally recognised classification of types of Academic Language and/or Learning Development (ALLD) job roles. In practice, this means that ALLD practitioners with similar job titles often undertake different roles. In the absence of clearly defined job roles, the valuable contributions made by ALLD practitioners and the associated specialist skills and knowledge required are not always widely understood (Bickle, Johnson and White, 2024). This led Briggs (2025a) to propose the need to develop an ALLD role taxonomy. The current article reports results from an international study (primarily comprising of practitioners from UK, Canada, and New Zealand) that sought to establish the principal job responsibilities and specialisms synonymous with working in ALLD. Based on data from 92 respondents, it was possible to develop an ALLD practitioner taxonomy that details the most frequent area(s) of work and specialism(s) reported by ALLD practitioners. Implications for applying the taxonomy are considered from the perspectives of international and national associations, institutions, and individual practitioners
A criminal world of Carolingian priests
No full textRecent research on Carolingian reform has shown a key role for local priests, addressed by kings and bishops and then passing on admonitions and instruction to congregations throughout the Carolingian Empire. What happened, however, when such priests were themselves badly-behaved? This chapter uses specific cases of clerical misconduct, along with conciliar norms, to look at this Carolingian “criminal world.” How did the offenses reported (sexual misdemeanors, violence, and misuse of church property) relate to social changes in the Carolingian world? How did higher authorities’ attempts to deal with such men also potentially destabilize Carolingian order, creating further problems and increasing criminality?<br/
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