Pharmacological management of behavioral symptoms associated with dementia

Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administration-approved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used off-label. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations.

Pharmacological induced target temperature management after cardiac arrest： the capsaicinoids

Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.

Non-pharmacological cognitive intervention for aging and dementia:Current perspectives

In recent years, cognitive difficulties associated with normal aging and dementia have been receiving increased attention from both public and scientific communities. With an increase in overall lifespan, promoting healthy cognition has become a priority and a necessity for minimizing and preventing individual and societal burdens associated with cognitive dysfunctions in the elderly. The general awareness concerning the efficacy of preventive(e.g., lifestyles) and palliative treatment strategies of cognitive impairments, related to either healthy or unhealthy trajectories in cognitive aging, is continuously rising. There are several therapeutic strategies which can be broadly classified as either pharmacological or non-pharmacological/psychosocial. In face of the modest evidence for success of pharmacological treatments, especially for dementia related impairments, psychosocial interventions are progressively considered as a complementary treatment. Despite the relative spread of psychosocial interventions in clinical settings, research in this area is rather scarce with evidence for success of these therapies remaining controversial. In this work we provide an evidence based perspective on cognitive intervention(s) for healthy aging, pre-dementia(mild cognitive impairment), and dementia populations. Current evidence and future directions for improving cognitive functions in the elderly are discussed as well.

Current and emerging pharmacological therapy for nonalcoholic fatty liver disease

The main treatment of patients with non-alcoholic fatty liver disease(NAFLD) is life style modification including weight reduction and dietary regimen.Majority of patients are safely treated with this management and pharmacologic interventions are not recommended. However, a subgroup of NAFLD patients with non-alcoholic steatohepatitis(NASH) who cannot achieve goals of life style modification may need pharmacological therapy. One major obstacle is measurement of histological outcome by liver biopsy which is an invasive method and is not recommended routinely in these patients. Several medications, mainly targeting baseline mechanism of NAFLD, have been investigated in clinical trials for treatment of NASH with promising results. At present, only pioglitazone acting as insulin sensitizing agent and vitamin E as an antioxidant have been recommended for treatment of NASH by international guidelines. Lipid lowering agents including statins and fibrates, pentoxifylline, angiotensin receptor blockers, ursodeoxycholic acid, probiotics and synbiotics are current agents with beneficial effects for treatment of NASH but have not been approved yet. Several emerging medications are in development for treatment of NASH. Obeticholic acid, liraglutide, elafibranor, cenicriviroc and aramchol have been tested in clinical trials or are completing trials. Here in, current and upcoming medications with promising results in clinical trial for treatment of NAFLD were reviewed.

Pain Management in Pediatric Nursing

Children often experience pain in different stage of life. After birth, newborns are exposed to many painful attempts and their anxiety levels increase with it. These painful attempts lead to metabolic or physiological problems in newborns. Excessive protein expenditure when exposed to pain for a long time, electrolyte inhalation, weakening of the immune system. Even repetitive painful procedures increase mortality and morbidity. Children experience pain due to acute onset diseases such as otitis media or pharyngitis and also in different medical interventions such vaccination, blood transfusion, vascular access, dressing change, lumber punching, or sickle cell anemia. Appropriate assessment scales should be used to treat pain effectively and adequately. Pharmacological treatment as well as non-pharmacological treatment methods has been found to be effective in the treatment of pain. Non-pharmacological methods allow your body to release natural endorphins and help to lift the pain to a minimum level or completely. In this study, current approaches and studies about pain in children will be presented. Non-pharmacological methods will be examined in more detail. Every child has right to live a painless life. It is one of the main purposes of nursing care to relieve children’s pain and improve their life quality.

Reductions in non-point source pollution through different management practices for an agricultural watershed in the Three Gorges Reservoir Area

Non-point source water pollution generated by agricultural production is considered a major environmental issue in the Three Gorges Reservoir Area （TGRA） of China. The Annualised Agricultural Non-Point Source Pollution （AnnAGNPS） model was selected to assess the impact of the application of various management treats, including seven crops, five fertilizer levels and three-group management practice scenarios, on water quality from Heigou River Watershed in TGRA. The scenario subsets include conservation tillage practice （CTP）, conservation reserve program （CRP） and conversion of cropland into forestland program （CCFP）. Results indicated that tea can not be replaced by other crops because comparatively tea resulted in a higher sediment yield. CTP with no-tillage was more effective to reduce sediment yield, but could increased nutrient loss. CRP reduced sediment yield significantly, but slightly benefited on nutrient loss. CCFP reduced not only sediment yield but also the nutrient loss significantly. The conversion of cropland with a slope greater than 10° into forestland was found to be the best scenario as the sediment yield export is less than 5 tons/ha and nutrient loss is within the permissible limit.

Sustainable Management of Rice Insect Pests by Non-Chemical-Insecticide Technologies in China

Chemical pesticides play crucial roles in the management of crop diseases and pests. However, excessive and irrational use of pesticides has become a major concern and obstacle to sustainable agriculture. As a result, the quality and security of agricultural products are reduced, and the ecological and environmental integrities are threatened. Recently, environment-friendly pest management measures have been introduced and adopted to manage rice insect pests and reduce the use of insecticides. This paper reviewed the advancements in development and application of non-chemical technologies for insect pest management during rice production in China.

Strategies for Informatization Construction of Continuing Education Management in Higher Vocational Colleges:Taking Pharmacology Courses as an Example

In the era of rapid development of informatization,the informatization construction of national higher vocational colleges has been in the period of application deepening.China's education system is deepening to the development of mass education,and higher vocational colleges'adult continuing education plays a great role for the realization of education popularization.With the continuous expansion of continuing education enrollment scale,the diversified development of education mode,the higher complexity of continuing education management and the increase of management workload,the traditional management method has gradually become unapplicable.Higher vocational colleges can greatly improve the management level by promoting the informatization of education management according to their own professional or regional advantages.

Non-operative management of isolated liver trauma

Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

Population distribution and threats to sustainable management of selected non-timber forest products in tropical lowland rainforests of south western Nigeria

Uncontrolled harvesting of non-timber forest products （NTFPs） poses a serious risk of extermination to several of these species in Nigeria. Yet, there is a paucity of information on the distribution, population status and sustainable management of NTFPs in most of the tropical lowland rainforests. We, therefore, assessed the population, distribution and threats to sustainable management of NTFPs within the tropical lowland rainforests of Omo and Shasha Forest Reserves, south western Nigeria. Data were obtained through inventory surveys on five top priority species including： bush mango （Irvingia gabonensis （Aubry-Lecomte ex O’Rorke） Baill）, African walnut （Tetracarpidium conophorum （Mull. Arg.） Hutch. ＆ Dalziel syn. Plukenetia conophora）, chew-stick （Massularia acuminata （G. Don） Bullock）, fever bark （Annickia chlorantha Setten ＆ P.J.Maas syn. Enantia chloranta） and bush pepper （Piper guineense Schumach. ＆ Thonn.）. Purposive and stratified random sampling techniques were used for the inventory. Each forest reserve was stratified into three, viz： less disturbed natural forest （for areas that have been rested for at least ten years）, recently disturbed natural forest （for areas that have suffered one form of human perturbation or the other in the last five years）, and plantation forest （for areas carrying forest plantation）. Data were collected from eighteen 10 m × 500 m belt transects located in the above strata. The species were generally fewer in both plantation and recently disturbed natural forest than the less disturbed natural forest, suggesting that forest disturbances （habitat modification） for other uses may have an effect on the occurrence and densities of the NTFPs. Exceptions to this trend were found for P. guineense and T. conophorum, which were fairly common in both plantation and recently disturbed natural forest. Among three tree NTFP species （i.e. I. gabonensis, M. acuminata and A. chlorantha）, only I. gabonensis showed a significant difference in overall DBH size classes for both reserves （t=？2.404; df =21; p=0.026）. Three tree NTFP species in both reserves further showed differences from the regular patterns of distribution of trees. The fairly regular reverse J-shaped size class distribution observed for M. acuminata in the study sites, however, suggests a recuperating population. In general, destructive harvesting of species, logging operations, low population size, narrow distribution ranges and habitat degradation are the major threats to the population of NTFPs in the study area. The implications of our findings for sustainable management of NTFPs in the study area are discussed and recommendations are made for a feasible approach towards enhancing the status of the species.

A Non-Invasive Skin Treatment Combining LED with Pharmacologic and Ultrasonic Technologies for Facial Rejuvenation

Background: Non-invasive facial treatments have the ability to rejuvenate the facial profile when specific pharmacologic agents and modalities are prescribed and used in combination taking into consideration each patient’s unique skin type and condition. RATIONALE Epinova is a non-invasive skin treatment that combines the correct concentrations and combinations of topicals and modalities to elicit facial rejuvenation with no down-time or side effects. Purpose: This paper focuses on facial rejuvenation improvements combining the RATIONALE Essential Six skincare system (RATIONALE, Victoria, Australia) to protect and repair the skin with the RATIONALE Epinova facial treatment every 4-6 weeks—which uses non-invasive technologies and professional strength active ingredients to deliver visible changes to skin tone and texture. Methods: Subjects underwent a RATIONALE consultation, including taking a skin history and skin imaging, followed by a data analysis and diagnosis of skin condition and prescription of a customized RATIONALE treatement (Epinova), including appropriate pharmacologic agents and treatment with personalized photo/sono therapeutic devices. Results: Subjects reported increased skin hydration, tactile improvements, skin firmness and visible radiance following the RATIONALE Epinova treatment. Further investigations will be initiated to explore the potential for longer term improvements, including connenctive tissue deposition, reduction of erythema etc. Treatments should be performed every 4-6 weeks for patients under 40 and every 3-4 weeks for patients over 40, to support cell differentiation, migration and desquamation to achieve non-invasive facial rejuvenation. Conclusion: This study demonstrated that the synergy of pharmacologic, LED light therapy and ultrasonic technologies when prescribed and administered by a trained skin therapist, can lead to a visible improvement in the signs of facial ageing and photodamage, restoring the appearance of healthy, radiant skin. .

Study on syndrome differentiation based on pharmacology of syndrome management system-a case of Qi and Yin deficiency syndrome

Taking the Qi and Yin deficiency syndrome as an example,the research method of pharmacology of syndrome management system was proposed.By means of text mining,systematic pharmacology and target analysis,to attempt to reveal the essence of the corresponding syndrome by studying the drugs and targets of Qi and Yin deficiency.Fourteen Chinese herbs treating Qi and Yin deficiency were retrieved and used more than 30 times,and 9,317 related targets were predicted.The common targets of action were 85.Topological analysis was carried out by using degree centrality,closeness centrality and betweenness centrality to confirm that estrogen receptor(ESR1),tumor necrosis factor(TNF),D(2)dopamine receptor(DRD2),vitamin D3 receptor(VDR),glucocorticoid receptor(NR3C1),acetylcholinesterase(ACHE)and endothelin-1(EDN1)were highly correlated with Qi and Yin deficiency syndrome.Through the target to find Qi and Yin deficiency syndrome corresponding to 17 categories of diseases.A new idea was provided for studying the biological essence of TCM clinical syndrome differentiation.

Non-pharmacological intervention for posterior cortical atrophy

Posterior cortical atrophy(PCA) is a rare neurodegene-rative condition characterized by progressive visual-perceptual deficits. Although the neurocognitive profile of PCA is a growing and relatively well-established field, non-pharmacological care remains understudied and to be widely established in clinical practice. In the present work we review the available literature on non-pharmacological approaches for PCA, such as cognitive rehabilitation including individual cognitive exercises and compensatory techniques to improve autonomy in daily life, and psycho-education aiming to inform people with PCA about the nature of their visual deficits and limits of cognitive rehabilitation. The reviewed studies represented a total of 7 patients. There is a scarcity of the number of studies, and mostly consisting of case studies. Results suggest non-pharmacological intervention to be a potentially beneficial approach for the partial compensation of deficits, improvement of daily functionality and improvement of quality of life. Clinical implications and future directions are also highlighted for the advancement of the field, in order to clarify the possible role of non-pharmacological interventions, and its extent, in PCA.

Efficacy of non-pharmacological interventions in controlling type 2 diabetes in patients of African descent: A systematic review

Purpose: The purpose of this review is to systematically assess the potential effectiveness of targeted educational and other non-pharmacological interventions on diabetes control in populations of African descent in developed countries. Such information can inform intervention strategies and highlight evidence-based approaches to deal with this significant problem in this population. Methods: A systematic review and a meta-analysis of random controlled trials and cohort studies evaluating the influence of education and other non-pharmacological interventions on HbA1Cconcentrations in patients of African descent with diabetes. A comprehensive search of PubMed, EMBASE, CINAHL, ZETOC, SIGLE databases was carried out. Results: Although nine studies (8 randomised controlled trials and 1 cohort study) met the inclusion criteria, relevant HbA1Cdata were available for 6 of the studies for the subsequent meta-analysis. Heterogeneity of meta-analysis was high (I2 = 92%), the random effects pooled standard mean difference favoured the intervention -0.66 (-1.15, -0.17), p = 0.009. After sensitivity analysis, I2 remained moderate to high at 69%. The random effects pooled standard mean difference continued to favour the intervention -0.48 (-0.81, -0.16), p = 0.009. Conclusion: There is evidence supporting the efficacy of educational and other non-pharmacological interventions in diabetes control in populations of African descent in English speaking developed countries. This conclusion is tempered by the significant heterogeneity of selected interventions and paucity of high quality research in the target population.

The Effectiveness of Non-Surgical Weight Management Interventions for Obesity in the UK: A Review and Meta-Regression Analysis

Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.

A Study on Compensation for Management and Protection Expenses of Non-commercial Forests

This paper analyzes the compensation nature of non-commercial forests under different ownership from two aspects, namely, whether the property right is limited and whether the management and protection expense has been incurred: there are no economic loss compensation problems caused by changes and limitation of property rights for the state-owned non-commercial forests with only the compensation on management and protection expense; but for the non-commercial forests owned by collectives or individuals, double compensation for both the economic loss and management expense exists because of limitation on the property right. In addition, an inframarginal economic analysis framework has been built for the management and protection compensation problems faced by non-commercial forests under different ownership in the perspective of the division of labor. Research results show that: the compensation standard for the management and protection expenses of non-commercial forests shall fall in between the "completely self-sufficient forestry economic structure U(Ayz)" and the "completely specialized productive structure of non-commercial forests U(B1)".

A Project Management and Decision Support System for Non-standard Equipment's Eexecuting Work

Based on the features of the non-standard equipment executing work, a project management and decision support system oriented to the non-standard equipment is developed, and the information model, function model as well as the structure framework of the system are also introduced in this paper.

Sedimentation retention basin utilization for best management practice

Approaches to the artificial impoundment and theoretical design of sedimentation retention basin are reviewed with particular attention to best management practice(BMP) to control agriculture and surface runoff. Sediments retention basins are the small version of farm pond used where a criteria of farm pond is not met. Such basin traps the pollutants and suspended solids prior to entry into streams and lakes. The study is focused with special reference to the assessment and control of non point source pollution(NPSP) from the sub basin area of Tai Lake in the Xishan County of Wuxi City of China. The author suggested two different approaches to conduct this study including theoretical design for sedimentation retention basin and computation of flow, sediment transport and deposition during the artificial impoundment of retention basin for BMP's utilization. Theoretical design will provide a useful function as a first line defense against the movement of sediments and transport of pollutants into the Tai Lake while the assessment of sediments deposition will help to make its proper use and periodic cleanup.

Exercise training in the management of patients with resistant hypertension

Hypertension is a very prevalent risk factor for cardiovascular disease. The prevalence of resistant hypertension, i.e., uncontrolled hypertension with 3 or more antihypertensive agents including 1 diuretic, is between 5% and 30% in the hypertensive population. The causes of resistant hypertension are multifactorial and include behavioral and biological factors, such as nonadherence to pharmacological treatment. All current treatment guidelines highlight the positive role of physical exercise as a non-pharmacological tool in the treatment of hypertension. This paper draws attention to the possible role of physical exercise as an adjunct non-pharmacological tool in the management of resistant hypertension. A few studies have investigated it, employing different methodologies, and taken together they have shown promising results. In summary, the available evidence suggests that aerobic physical exercise could be a valuable addition to the optimal pharmacological treatment of patients with resistant hypertension.

Liver trauma: What current management?

Background: The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years.Methods: The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed.Results: The study involved 83 patients, with a mean age of 33 years and a marked male predominance(85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries(81.9%) were of low severity(grades Ⅰ,Ⅱ,Ⅲ), while 15(18.1%) were of high severity(grade Ⅳ or greater). Fifty-six patients(67.5%) had multiple injuries. Surgical treatment was performed in 26(31.3%) patients. Non-operative management was undertaken in 57 cases(68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group.Conclusions: Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.