Contrary to our hypothesis, dysfunctional coping increased when carer depressive symptoms improved. There was preliminary evidence that emotional support and acceptance-based coping increased, as positive coping increased although solution-focused coping alone did not. More research is needed to elucidate whether successful interventions work through changing coping strategies immediately and in the longer term.

BackgroundCommunity-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Case management is a popular approach to care co-ordination, but evidence to date on its effectiveness in dementia has been equivocal. Case management interventions need to be designed to overcome obstacles to care co-ordination and maximise benefit. A successful case management methodology was adapted from the United States (US) version for use in English primary care, with a view to a definitive trial. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers.MethodsCo-design of the case manager role in a single NHS provider organisation, with external peer review by professionals and carers, in an iterative technology development process.ResultsThe generic skills and personal attributes were described for practice nurses taking up the case manager role in their workplaces, and for social workers seconded to general practice teams, together with a method of assessing their learning needs. A manual of information material for people with dementia and their family carers was also created using the US intervention as its source.ConclusionsCo-design produces rich products that have face validity and map onto the complexities of dementia and of health and care services. The feasibility of the case manager role, as described and defined by this process, needs evaluation in ‘real life’ settings.

The chemical basis for commercial production and purification of nitrous oxide is outlined and discussed. Nitric oxide is the most likely toxic contaminant but the concentration in the effluent gas from a cylinder diminishes rapidly due to fractionation. Nitric oxide reacts with oxygen but the velocity of the reaction is influenced by concentration and is very slow at concentrations below about 0.1 per cent. Most methods of detection and estimation of nitric oxide depend upon prior oxidation. The reaction between nitrogen dioxide and water is complex and toxic effects result from the formation of hydrogen ions, nitric oxide, nitrate and nitrite ions.

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