Germicidal efficacy of continuous and pulsed ultraviolet-C radiation on pathogen models and SARS-CoV-2.

Ultraviolet radiation's germicidal efficacy depends on several parameters, including wavelength, radiant exposure, microbial physiology, biological matrices, and surfaces. In this work, several ultraviolet radiation sources (a low-pressure mercury lamp, a KrCl excimer, and four UV LEDs) emitting continuous or pulsed irradiation were compared. The greatest log reductions in E. coli cells and B. subtilis endospores were 4.1 ± 0.2 (18 mJ cm-2) and 4.5 ± 0.1 (42 mJ cm-2) with continuous 222 nm, respectively. The highest MS2 log reduction observed was 2.7 ± 0.1 (277 nm at 3809 mJ cm-2). Log reductions of SARS-CoV-2 with continuous 222 nm and 277 nm were ≥ 3.4 ± 0.7, with 13.3 mJ cm-2 and 60 mJ cm-2, respectively. There was no statistical difference between continuous and pulsed irradiation (0.83-16.7% [222 nm and 277 nm] or 0.83-20% [280 nm] duty rates) on E. coli inactivation. Pulsed 260 nm radiation (0.5% duty rate) at 260 nm yielded significantly greater log reduction for both bacteria than continuous 260 nm radiation. There was no statistical difference in SARS-CoV-2 inactivation between continuous and pulsed 222 nm UV-C radiation and pulsed 277 nm radiation demonstrated greater germicidal efficacy than continuous 277 nm radiation. Greater radiant exposure for all radiation sources was required to inactivate MS2 bacteriophage. Findings demonstrate that pulsed irradiation could be more useful than continuous UV radiation in human-occupied spaces, but threshold limit values should be respected. Pathogen-specific sensitivities, experimental setup, and quantification methods for determining germicidal efficacy remain important factors when optimizing ultraviolet radiation for surface decontamination or other applications.

An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: The influence of attention, memory, and executive function processes on real-world prospective memory.

Studies on prospective memory (PM) predominantly assess either event- or time-based PM by implementing non-ecological laboratory-based tasks. The results deriving from these paradigms have provided findings that are discrepant with ecologically valid research paradigms that converge on the complexity and cognitive demands of everyday tasks. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality (VR) neuropsychological battery with enhanced ecological validity, was implemented to assess everyday event- and time-based PM, as well as the influence of other cognitive functions on everyday PM functioning. The results demonstrated the role of delayed recognition, planning, and visuospatial attention on everyday PM. Delayed recognition and planning ability were found to be central in event- and time-based PM respectively. In order of importance, delayed recognition, visuospatial attention speed, and planning ability were found to be involved in event-based PM functioning. Comparably, planning, visuospatial attention accuracy, delayed recognition, and multitasking/task-shifting ability were found to be involved in time-based PM functioning. These findings further suggest the importance of ecological validity in the study of PM, which may be achieved using immersive VR paradigms.

An Investigation of the Validity of the Edinburgh Social Cognition Test (ESCoT) in Acquired Brain Injury (ABI).

OBJECTIVES: Social cognition is frequently impaired following an acquired brain injury (ABI) but often overlooked in clinical assessments. There are few validated and appropriate measures of social cognitive abilities for ABI patients. The current study examined the validity of the Edinburgh Social Cognition Test (ESCoT, Baksh et al., ) in measuring social cognition following an ABI. METHODS: Forty-one patients with ABI were recruited from a rehabilitation service and completed measures of general ability, executive functions and social cognition (Faux Pas; FP, Reading the Mind in the Eyes; RME, Social Norms Questionnaire; SNQ and the ESCoT). Forty-one controls matched on age, sex and years of education also performed the RME, SNQ and ESCoT. RESULTS: A diagnosis of ABI was significantly associated with poorer performance on all ESCoT measures and RME while adjusting for age, sex and years of education. In ABI patients, the ESCoT showed good internal consistency with its subcomponents and performance correlated with the other measures of social cognition demonstrating convergent validity. Better Trail Making Test performance predicted better ESCoT total, RME and SNQ scores. Higher TOPF IQ was associated with higher RME scores, while higher WAIS-IV working memory predicted better FP performance. CONCLUSIONS: The ESCoT is a brief, valid and internally consistent assessment tool able to detect social cognition deficits in neurological patients. Given the prevalence of social cognition deficits in ABI and the marked impact these can have on an individual's recovery, this assessment can be a helpful addition to a comprehensive neuropsychological assessment.

Learning with friends and strangers: partner familiarity does not improve collaborative learning performance in younger and older adults.

Collaborative learning with a familiar partner can reduce age-related differences in learning and memory compared to learning alone. This study compares younger and older adults' learning with familiar and unfamiliar partners to determine whether familiarity is beneficial for collaborative learning. Twenty-four younger adults aged 18-28 years and 24 older adults aged 60-80 years participated in familiar and unfamiliar pairs. Participants were asked to arrange abstract tangram shapes in a specific order on a grid over multiple trials; the directors' tangram cards were arranged in a specific order on the grid and this order was communicated to the matcher. Older adults initially took longer to complete the task, using more words to correctly arrange the tangrams. Over multiple trials, a learning effect was observed in both groups, although older adults did not perform with similar efficiency to younger adults. Familiarity had no effect on performance. These findings suggest that the familiarity of a partner does not affect learning outcomes in younger or older adults when learning in a social context. Collaborative learning may be beneficial for older adults, even if they do not know their learning partner, which may have implications for adult education and lifelong learning.

Development of a Nuclear Magnetic Resonance Method and a Near Infrared Calibration Model for the Rapid Determination of Lipid Content in the Field Pea (Pisum sativum).

Pisum sativum is a leguminous crop suitable for cultivation worldwide. It is used as a forage or dried seed supplement in animal feed and, more recently, as a potential non-traditional oilseed. This study aimed to develop a low-cost, rapid, and non-destructive method for analyzing pea lipids with no chemical modifications that would prove superior to existing destructive solvent extraction methods. Different pea accession seed samples, prepared as either small portions (0.5 mm2) of endosperm or ground pea seed powder for comparison, were subjected to HR-MAS NMR analyses and whole seed samples underwent NIR analyses. The total lipid content ranged between 0.57-3.45% and 1.3-2.6% with NMR and NIR, respectively. Compared to traditional extraction with butanol, hexane-isopropanol, and petroleum ether, correlation coefficients were 0.77 (R2 = 0.60), 0.56 (R2 = 0.47), and 0.78 (R2 = 0.62), respectively. Correlation coefficients for NMR compared to traditional extraction increased to 0.97 (R2 = 0.99) with appropriate correction factors. PLS regression analyses confirmed the application of this technology for rapid lipid content determination, with trends fitting models often close to an R2 of 0.95. A better robust NIR quantification model can be developed by increasing the number of samples with more diversity.

Cold Ethanol Extraction of Cannabinoids and Terpenes from Cannabis Using Response Surface Methodology: Optimization and Comparative Study.

Efficient cannabis biomass extraction can increase yield while reducing costs and minimizing waste. Cold ethanol extraction was evaluated to maximize yield and concentrations of cannabinoids and terpenes at different temperatures. Central composite rotatable design was used to optimize two independent factors: sample-to-solvent ratio (1:2.9 to 1:17.1) and extraction time (5.7 min-34.1 min). With response surface methodology, predicted optimal conditions at different extraction temperatures were a cannabis-to-ethanol ratio of 1:15 and a 10 min extraction time. With these conditions, yields (g 100 g dry matter-1) were 18.2, 19.7, and 18.5 for -20 °C, -40 °C and room temperature, respectively. Compared to the reference ground sample, tetrahydrocannabinolic acid changed from 17.9 (g 100 g dry matter-1) to 15, 17.5, and 18.3 with an extraction efficiency of 83.6%, 97.7%, 102.1% for -20 °C, -40 °C, and room temperature, respectively. Terpene content decreased by 54.1% and 32.2% for extraction at -20 °C and room temperature, respectively, compared to extraction at -40 °C. Principal component analysis showed that principal component 1 and principal component 2 account for 88% and 7.31% of total variance, respectively, although no significant differences in cold ethanol extraction at different temperatures were observed.

Microwave- and Ultrasound-Assisted Extraction of Cannabinoids and Terpenes from Cannabis Using Response Surface Methodology.

Limited studies have explored different extraction techniques that improve cannabis extraction with scale-up potential. Ultrasound-assisted and microwave-assisted extraction were evaluated to maximize the yield and concentration of cannabinoids and terpenes. A central composite rotatable design was used to optimize independent factors (sample-to-solvent ratio, extraction time, extraction temperature, and duty cycle). The optimal conditions for ultrasound- and microwave-assisted extraction were the sample-to-solvent ratios of 1:15 and 1:14.4, respectively, for 30 min at 60 °C. Ultrasound-assisted extraction yielded 14.4% and 14.2% more oil and terpenes, respectively, compared with microwave-assisted extracts. Ultrasound-assisted extraction increased cannabinoid concentration from 13.2−39.2%. Considering reference ground samples, tetrahydrocannabinolic acid increased from 17.9 (g 100 g dry matter−1) to 28.5 and 20 with extraction efficiencies of 159.2% and 111.4% for ultrasound-assisted and microwave-assisted extraction, respectively. Principal component analyses indicate that the first two principal components accounted for 96.6% of the total variance (PC1 = 93.2% and PC2 = 3.4%) for ultrasound-assisted extraction and 92.4% of the total variance (PC1 = 85.4% and PC2 = 7%) for microwave-assisted extraction. Sample-to-solvent ratios significantly (p < 0.05) influenced the secondary metabolite profiles and yields for ultrasound-assisted extracts, but not microwave-assisted extracts.

Validation of the Virtual Reality Everyday Assessment Lab (VR-EAL): An Immersive Virtual Reality Neuropsychological Battery with Enhanced Ecological Validity.

OBJECTIVE: The assessment of cognitive functions such as prospective memory, episodic memory, attention, and executive functions benefits from an ecologically valid approach to better understand how performance outcomes generalize to everyday life. Immersive virtual reality (VR) is considered capable of simulating real-life situations to enhance ecological validity. The present study attempted to validate the Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive VR neuropsychological battery, against an extensive paper-and-pencil neuropsychological battery. METHODS: Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive VR and a paper-and-pencil testing session. Bayesian Pearson's correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare VR and paper-and-pencil testing in terms of administration time, similarity to real-life tasks (i.e., ecological validity), and pleasantness. RESULTS: VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants' reports indicated that the VR-EAL tasks were significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time. CONCLUSION: The VR-EAL appears as an effective neuropsychological tool for the assessment of everyday cognitive functions, which has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness.

An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: the effects of delay and task type on everyday prospective memory.

Recent research has focused on assessing either event- or time-based prospective memory (PM) using laboratory tasks. Yet, the findings pertaining to PM performance on laboratory tasks are often inconsistent with the findings on corresponding naturalistic experiments. Ecologically valid neuropsychological tasks resemble the complexity and cognitive demands of everyday tasks, offer an adequate level of experimental control, and allow a generalisation of the findings to everyday performance. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality neuropsychological battery with enhanced ecological validity, was implemented to comprehensively assess everyday PM (i.e., focal and non-focal event-based, and time-based). The effects of the length of delay between encoding and initiating the PM intention and the type of PM task on everyday PM performance were examined. The results revealed that everyday PM performance was affected by the length of delay rather than the type of PM task. The effect of the length of delay differentially affected performance on the focal, non-focal, and time-based tasks and was proportional to the PM cue focality (i.e., semantic relationship with the intended action). This study also highlighted methodological considerations such as the differentiation between functioning and ability, distinction of cue attributes, and the necessity of ecological validity.

Executive Functions do not Underlie Performance on the Edinburgh Social Cognition Test (ESCoT) in Healthy Younger and Older Adults.

OBJECTIVE: Current measures of social cognition have shown inconsistent findings regarding the effects of executive function (EF) abilities on social cognitive performance in older adults. The psychometric properties of the different social cognition tests may underlie the disproportional overlap with EF abilities. Our aim was to examine the relationship between social cognition and EF abilities using the Edinburgh Social Cognition Test (ESCoT; Baksh, R.A., Abrahams, S., Auyeung, B., & MacPherson, S.E. (2018). The Edinburgh Social Cognition Test (ESCoT): Examining the effects of age on a new measure of theory of mind and social norm understanding. PloS One, 13(4), e0195818.), a test assessing four different aspects of social cognition: cognitive theory of mind (ToM), affective ToM, interpersonal understanding of social norms, and intrapersonal understanding of social norms. METHOD: We administered the ESCoT, EF measures of inhibition, set shifting, updating, and a measure of processing speed to 30 younger and 31 older adults. We also administered the Visual Perspective Taking task (VPT) as a ToM test thought to be reliant on EF abilities. RESULTS: Better performance on cognitive ToM was significantly associated with younger age and slower processing speed. Better performance on affective ToM and ESCoT total score was associated with being younger and female. Better performance on interpersonal understanding of social norms was associated with being younger. EF abilities did not predict performance on any subtest of the ESCoT. In contrast, on the VPT, the relationship between age group and performance was fully or partially mediated by processing speed and updating. CONCLUSIONS: These findings show that the ESCoT is a valuable measure of different aspects of social cognition and, unlike many established tests of social cognition, performance is not predicted by EF abilities.

Cognitive Reserve Proxies Do Not Differentially Account for Cognitive Performance in Patients with Focal Frontal and Non-Frontal Lesions.

OBJECTIVE: Cognitive reserve (CR) suggests that premorbid efficacy, aptitude, and flexibility of cognitive processing can aid the brain's ability to cope with change or damage. Our previous work has shown that age and literacy attainment predict the cognitive performance of frontal patients on frontal-executive tests. However, it remains unknown whether CR also predicts the cognitive performance of non-frontal patients. METHOD: We investigated the independent effect of a CR proxy, National Adult Reading Test (NART) IQ, as well as age and lesion group (frontal vs. non-frontal) on measures of executive function, intelligence, processing speed, and naming in 166 patients with focal, unilateral frontal lesions; 91 patients with focal, unilateral non-frontal lesions; and 136 healthy controls. RESULTS: Fitting multiple linear regression models for each cognitive measure revealed that NART IQ predicted executive, intelligence, and naming performance. Age also significantly predicted performance on the executive and processing speed tests. Finally, belonging to the frontal group predicted executive and naming performance, while membership of the non-frontal group predicted intelligence. CONCLUSIONS: These findings suggest that age, lesion group, and literacy attainment play independent roles in predicting cognitive performance following stroke or brain tumour. However, the relationship between CR and focal brain damage does not differ in the context of frontal and non-frontal lesions.

Individual differences in cognitive processes underlying Trail Making Test-B performance in old age: The Lothian Birth Cohort 1936.

The Trail Making Test Part B (TMT-B) is commonly used as a brief and simple neuropsychological assessment of executive dysfunction. The TMT-B is thought to rely on a number of distinct cognitive processes that predict individual differences in performance. The current study examined the unique and shared contributions of latent component variables in a large cohort of older people. Five hundred and eighty-seven healthy, community-dwelling older adults who were all born in 1936 were assessed on the TMT-B and multiple tasks tapping cognitive domains of visuospatial ability, processing speed, memory and reading ability. Firstly, a first-order measurement model examining independent contributions of the four cognitive domains was fitted; a significant relationship between TMT-B completion times and processing speed was found (ß = -0.610, p < .001). Secondly, a bifactor model examined the unique influence of each cognitive ability when controlling for a general cognitive factor. Importantly, both a general cognitive factor (g; ß = -0.561, p < .001) and additional g-independent variance from processing speed (ß = -0.464, p < .001) contributed to successful TMT-B performance. These findings suggest that older adults' TMT-B performance is influenced by both general intelligence and processing speed, which may help understand poor performance on such tasks in clinical populations.

Clinical Evaluation of Silent T1-Weighted MRI and Silent MR Angiography of the Brain.

OBJECTIVE: New MRI sequences based on rapid radial acquisition have reduced gradient noise. The purpose of this study was to compare Silent T1-weighted and unenhanced MR angiography (MRA) against conventional sequences in a clinical population. MATERIALS AND METHODS: The study cohort consisted of 40 patients with suspected brain metastases (median age, 60 years; range, 23-91 years) who underwent T1-weighted contrast-enhanced MRI and 51 patients with suspected vascular lesions or cerebral ischemia (median age, 60 years; range, 16-94 years) who underwent unenhanced intracranial MRA. Three neuroradiologists reviewed the images blindly and rated several measures of image quality on a 5-point Likert scale. Reviewers recorded the number of enhancing lesions and whether Silent images were better than, worse than, or equivalent to conventional images. RESULTS: For T1-weighted MR images, ratings were slightly lower for Silent versus conventional images, except for diagnostic confidence. Although more lesions were detected on conventional images, this difference was not statistically significant; agreement was seen in 88% of cases. In 48% of cases, T1-weighted scans were deemed equivalent, but when a preference existed, it was usually for conventional images (38% vs 14%). Conventional MRA images were rated higher on all image quality metrics and were strongly preferred (reviewers preferred conventional images in 69% of cases, rated the images as equivalent in 27% of cases, and preferred Silent images in 4% of cases). In some cases, artifacts on Silent images caused reduced vessel caliber, vessel irregularities, and even absent vessels. CONCLUSION: Although conventional T1-weighted images were preferred overall, most Silent T1-weighted images were rated as equivalent to or better than conventional images and represent a potential alternative for imaging of noise-averse patients. Silent MRA scored significantly worse and could not be recommended at this time, suggesting that it requires additional refinement before routine clinical use.

Corrigendum to Correlational structure of 'frontal' tests and intelligence tests indicates two components with asymmetrical neurostructural correlates in old age Intelligence 46 (2014) 94-106.

[This corrects the article DOI: 10.1016/j.intell.2014.05.006.].

Theory of mind and the Ultimatum Game in healthy adult aging.

BACKGROUND: The Ultimatum Game assesses decision-making involved in cooperative interactions with others. However, little is known about the role that the ability to understand other people's intentions plays in these interactions. METHODS: This study examined performance on the Ultimatum Game and theory of mind (ToM) tasks in younger and older adults. RESULTS: Age differences were not found on the ToM tasks, and a lack of variability in performance prevented analyses of the relationships between performance on the Ultimatum Game and ToM. However, age differences were found on the Ultimatum Game, with older adults accepting more unfair offers. Yet, the two age groups did not differ in their appreciation of fairness, as assessed using subjective fairness ratings. CONCLUSIONS: These findings suggest that older adults are more rational in their behavior, accepting unfair offers even when they know they are unfair, as it is in their self-interest to accept small monetary values rather than nothing at all.

Survival of effector CD8+ T cells during influenza infection is dependent on autophagy.

The activation and expansion of effector CD8(+) T cells are essential for controlling viral infections and tumor surveillance. During an immune response, T cells encounter extrinsic and intrinsic factors, including oxidative stress, nutrient availability, and inflammation, that can modulate their capacity to activate, proliferate, and survive. The dependency of T cells on autophagy for in vitro and in vivo activation, expansion, and memory remains unclear. Moreover, the specific signals and mechanisms that activate autophagy in T effector cells and their survival are not known. In this study, we generated a novel inducible autophagy knockout mouse to study T cell effector responses during the course of a virus infection. In response to influenza infection, Atg5(-/-) CD8(+) T cells had a decreased capacity to reach the peak effector response and were unable to maintain cell viability during the effector phase. As a consequence of Atg5 deletion and the impairment in effector-to-memory cell survival, mice fail to mount a memory response following a secondary challenge. We found that Atg5(-/-) effector CD8(+) T cells upregulated p53, a transcriptional state that was concomitant with widespread hypoxia in lymphoid tissues of infected mice. The onset of p53 activation was concurrent with higher levels of reactive oxygen species (ROS) that resulted in ROS-dependent apoptotic cell death, a fate that could be rescued by treating with the ROS scavenger N-acetylcysteine. Collectively, these results demonstrate that effector CD8(+) T cells require autophagy to suppress cell death and maintain survival in response to a viral infection.

Behavioral Symptoms of Dementia that Present Management Difficulties in Nursing Homes: Staff Perceptions and Their Concordance With Informant Scales.

The current study aimed to profile behaviors associated with dementia that pose management difficulties for staff and determine whether existing rating scales capture these reported behaviors. Staff in 17 nursing homes described the behavioral symptoms of 229 residents with predominantly moderate-severe dementia associated with management difficulties. Behaviors were categorized by an expert clinical panel and compared to items in four dementia behavior rating scales. Staff reported 59 discrete behavioral symptoms, with physically agitated, aggressive verbal, non-aggressive verbal, and aggressive physical behaviors most common, followed by resistance to care and inappropriate social and sexual behaviors. Results suggested that some scales omit important behaviors reported by staff for residents with particularly challenging behaviors. The current study highlights the clinical complexity faced by nursing home staff in managing residents with behavioral symptoms of dementia. [Journal of Gerontological Nursing, 43(1), 34-43.].

A cluster-based approach to selecting representative stimuli from the International Affective Picture System (IAPS) database.

The International Affective Picture System (IAPS; Lang, Bradley, & Cuthbert, 2008) is a stimulus database that is frequently used to investigate various aspects of emotional processing. Despite its extensive use, selecting IAPS stimuli for a research project is not usually done according to an established strategy, but rather is tailored to individual studies. Here we propose a standard, replicable method for stimulus selection based on cluster analysis, which re-creates the group structure that is most likely to have produced the valence arousal, and dominance norms associated with the IAPS images. Our method includes screening the database for outliers, identifying a suitable clustering solution, and then extracting the desired number of stimuli on the basis of their level of certainty of belonging to the cluster they were assigned to. Our method preserves statistical power in studies by maximizing the likelihood that the stimuli belong to the cluster structure fitted to them, and by filtering stimuli according to their certainty of cluster membership. In addition, although our cluster-based method is illustrated using the IAPS, it can be extended to other stimulus databases.

Volumetric and Correlational Implications of Brain Parcellation Method Selection: A 3-Way Comparison in the Frontal Lobes.

OBJECTIVE: The aims of this study were to compare distinct brain frontal lobe parcellation methods across 90 brain magnetic resonance imaging scans and examine their associations with cognition in older age. METHODS: Three parcellation methods (Manual, FreeSurfer, and Stereology) were applied to T1-weighted magnetic resonance imaging of 90 older men, aged ∼ 73 years. A measure of general fluid intelligence (gf) associated with dorsolateral frontal regions was also derived from a contemporaneous psychological test battery. RESULTS: Despite highly discordant raw volumes for the same nominal regions, Manual and FreeSurfer (but not Stereology) left dorsolateral measures were significantly correlated with gf (r > 0.22), whereas orbital and inferior lateral volumes were not, consistent with the hypothesized frontal localization of gf. CONCLUSIONS: Individual differences in specific frontal lobe brain volumes--variously measured--show consistent associations with cognitive ability in older age. Importantly, differences in parcellation protocol for some regions that may impact the outcome of brain-cognition analyses are discussed.

Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence.

BACKGROUND: Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL. METHODS: A comprehensive search of 20 years' peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review. RESULTS: Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3-4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change. CONCLUSION: In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).