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Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.
The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.
The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n = 2), occupational therapists (n = 3) and dementia behavior consultants (n = 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.
A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.
Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.
Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.
Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.
The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
In this paper we undertake a quantitative analysis of the dynamic process by which ice underneath a dry porous debris layer melts. We show that the incorporation of debris-layer airflow into a theoretical model of glacial melting can capture the empirically observed features of the so-called Østrem curve (a plot of the melt rate as a function of debris depth). Specifically, we show that the turning point in the Østrem curve can be caused by two distinct mechanisms: the increase in the proportion of ice that is debris-covered and/or a reduction in the evaporative heat flux as the debris layer thickens. This second effect causes an increased melt rate because the reduction in (latent) energy used for evaporation increases the amount of energy available for melting. Our model provides an explicit prediction for the melt rate and the temperature distribution within the debris layer, and provides insight into the relative importance of the two effects responsible for the maximum in the Østrem curve. We use the data of Nicholson and Benn (2006) to show that our model is consistent with existing empirical measurements.
Driving cessation has demonstrated impacts on well-being and lifestyle. Despite the recognized reluctance of older people to plan for driving cessation, this study has identified a new group who has a stated plan to stop driving within 12 months. Although gradual reduction of driving has been documented as part of the usual driving cessation, this study explored the differences between retired drivers and those with a stated plan to retire within 12 months in sociodemographic, well-being and lifestyle outcomes.
This study extracted all baseline data from a clinical trial exploring the effectiveness of a group program for older retiring and retired drivers. Sociodemographic data included age, gender, health status, educational level, and living situation. All participants completed measures related to episodes away from home, well-being, and lifestyle. These were compared using parametric and nonparametric statistical analysis.
Participants (n = 131) included 68 retired drivers (mean age 79.8 years) and 63 retiring drivers (mean age 77.8 years). Retiring drivers engaged in more episodes away from home (p = 0.03), and more social activities (p = 0.02), used less alternative transport (p < 0.001), displayed fewer anxiety (p = 0.05), and depressive (p = 0.01) symptoms, but demonstrated lower transport and lifestyle self-efficacy (p = 0.04).
Both retired and retiring drivers require support for driving cessation and community engagement. Retiring drivers may be in a critical position to engage in driving cessation interventions to improve self-efficacy and begin adapting community mobility.
To determine trends, patient characteristics, and outcome of patients with healthcare-associated influenza in Canadian hospitals.
Prospective surveillance of laboratory-confirmed influenza among hospitalized adults was conducted from 2006 to 2012. Adults with positive test results at or after admission to the hospital were assessed. Influenza was considered to be healthcare associated if symptom onset was equal to or more than 96 hours after admission to a facility or if a patient was readmitted less than 96 hours after discharge or admitted less than 96 hours after transfer from another facility. Baseline characteristics of influenza patients were collected. Patients were reassessed at 30 days to determine the outcome.
Acute care hospitals participating in the Canadian Nosocomial Infection Surveillance Program.
A total of 570 (17.3%) of 3,299 influenza cases were healthcare associated; 345 (60.5%) were acquired in a long-term care facility (LTCF), and 225 (39.5%) were acquired in an acute care facility (ACF). There was year-to-year variability in the rate and proportion of cases that were healthcare associated and variability in the proportion that were acquired in a LTCF versus an ACF. Patients with LTCF-associated cases were older, had a higher proportion of chronic heart disease, and were less likely to be immunocompromised compared with patients with ACF-associated cases; there was no significant difference in 30-day all-cause and influenza-specific mortality.
Healthcare-associated influenza is a major component of the burden of disease from influenza in hospitals, but the proportion of cases that are healthcare associated varies markedly from year to year, as does the proportion of healthcare-associated infections that are acquired in an ACF versus an LTCF.
We use data over an extended Q range from 0.01 to 100Å-1 from the recently commissioned NIMROD instrument at the ISIS pulsed neutron source to develop a multi-scale inverse modeling procedure which will provide insight in to the phase transformations of polymer systems. The first level of our procedure is atomistic and we use internal coordinates (bond length, bond angles and torsion angles) to define the polymer chain in full atomistic detail. Values were assigned to each internal coordinate within the chain using a stochastic Monte Carlo method in which the probabilities were drawn from distributions representing the possible range of values. Using this approach, random chain configurations could be rapidly built and the intrachain structure factor calculated utilizing a small set of parameters and compared with the experimental function. Parameters representing the probability distribution functions were systematically varied using a grid search to find the values which gave the best fit to the structure factor for Q > 3Å-1 in order to determine the details of the chain conformation in the molten phase. This process was repeated for data over the same extended Q range obtained at lower temperatures where the polymer was expected to crystallize. Polymers crystallize via chainfolded thin lamellae crystals. Such crystals give rise to an intense peak at Q ∼ 0.03Å-1. This scattering can be calculated using a lamellar stack model, coarse-grained from the single chain structure. We describe this approach using data obtained on the crystallization from the melt phase of perdeuterated polymers. The objective here is to follow the three key length scales; the chain folded lamellar thickness of ∼ 10nm, the crystal unit cell ∼ 1nm and the detail of the chain conformation is ∼ 0.1nm.
We use new neutron scattering instrumentation to follow in a single quantitative time-resolving experiment, the three key scales of structural development which accompany the crystallisation of synthetic polymers. These length scales span 3 orders of magnitude of the scattering vector. The study of polymer crystallisation dates back to the pioneering experiments of Keller and others who discovered the chain-folded nature of the thin lamellae crystals which are normally found in synthetic polymers. The inherent connectivity of polymers makes their crystallisation a multiscale transformation. Much understanding has developed over the intervening fifty years but the process has remained something of a mystery. There are three key length scales. The chain folded lamellar thickness is ∼ 10nm, the crystal unit cell is ∼ 1nm and the detail of the chain conformation is ∼ 0.1nm. In previous work these length scales have been addressed using different instrumention or were coupled using compromised geometries. More recently researchers have attempted to exploit coupled time-resolved small-angle and wide-angle x-ray experiments. These turned out to be challenging experiments much related to the challenge of placing the scattering intensity on an absolute scale. However, they did stimulate the possibility of new phenomena in the very early stages of crystallisation. Although there is now considerable doubt on such experiments, they drew attention to the basic question as to the process of crystallisation in long chain molecules. We have used NIMROD on the second target station at ISIS to follow all three length scales in a time-resolving manner for poly(e-caprolactone). The technique can provide a single set of data from 0.01 to 100Å-1 on the same vertical scale. We present the results using a multiple scale model of the crystallisation process in polymers to analyse the results.
Surveillance for pandemic H1N1 influenza was conducted between June 1, 2009, and May 31, 2010, among adults at 40 participating hospitals in the Canadian Nosocomial Infection Surveillance Program. The first wave was characterized by a higher proportion of Aboriginals and pregnant women as well as severe outcomes, compared to the second wave.
Infect Control Hosp Epidemiol 2012;33(10):1043-1046
Political cleavages are often understood as deriving from either deep-rooted social divisions or institutional incentives. Contemporary Northern Ireland provides a test of the mutability of apparently entrenched cleavages to institutional change. Research undertaken before the ceasefire in the 1990s found noticeable asymmetries in the patterns of cleavage within the unionist and nationalist blocs. Within the unionist bloc, economic ‘left–right’ issues formed the main ideological division between the two major unionist parties. This contrasted with an ethno-national source of ideological division between the two nationalist parties. However, the emergence of a consociational form of government structure since then has demonstrated the ability of institutional incentives to reform some aspects of party competition swiftly. As evidence of this, we show that between 1989 and 2004 there was little change in the sources of support for Sinn Féin relative to the SDLP, but the influence of left–right ideology within the unionist bloc was negated as the influence of ethno-nationalism dramatically increased.
General practitioners (GPs) play an integral role in addressing the psychological needs of palliative care patients and their families. This qualitative study investigated psychosocial issues faced by GPs in the management of patients receiving palliative care and investigated the themes relevant to the psychosocial care of dying patients.
Fifteen general practitioners whose patient had been recently referred to the Mt. Olivet Palliative Home Care Services in Brisbane participated in an individual case review discussions guided by key questions within a semistructured format. These interviews focused on the psychosocial aspects of care and management of the referred patient, including aspects of the doctor/patient relationship, experience of delivering diagnosis and prognosis, addressing the psychological concerns of the patients' family, and the doctors' personal experiences, reactions, and responses. Qualitative analysis was conducted on the transcripts of these interviews.
The significant themes that emerged related to perceived barriers to exploration of emotional concerns, including spiritual issues, and the discussion of prognosis and dying, the perception of patients' responses/coping styles, and the GP's personal experience of the care (usually expressed in terms of identification with patient).
Significance of results:
The findings indicate the significant challenges facing clinicians in discussions with patients and families about death, to exploring the patient's emotional responses to terminal illness and spiritual concerns for the patient and family. These qualitative date indicate important tasks in the training and clinical support for doctors providing palliative care.
Up to one billion people live in areas where they may be at risk from I deficiency. Many of the debilitating effects of the deficiency may be irreversible, consequently it is essential to understand the mechanisms whereby lack of I can cause disease through decreased thyroxine and 3, 3',5-triiodothyronine (T3) synthesis. Since Se has an essential role in thyroid hormone metabolism, it has the potential to play a major part in the outcome of I deficiency. These effects of Se derive from two aspects of its biological function. First, three Se-containing deiodinases regulate the synthesis and degradation of the biologically active thyroid hormone, T3. Second, selenoperoxidases and possibly thioredoxin reductase (EC 184.108.40.206) protect the thyroid gland from H2O2 produced during the synthesis of thyroid hormones. The mechanisms whereby Se deficiency exacerbates the hypothyroidism due to I deficiency have been elucidated in animals. In contrast to these adverse effects, concurrent Se deficiency may also cause changes in deiodinase activities which can protect the brain from low T3 concentrations in I deficiency. Animals with Se and I deficiency have changes in serum thyroid hormone concentrations that are similar to those observed in patients with I deficiency disease. However such animal models show no thyroid involution, a feature which is characteristic of myxoedematous cretinism in man. These observations imply that if Se deficiency is involved in the outcome of I deficiency in human populations it is likely that other interacting factors such as goitrogens are also implicated. Nevertheless the protection of the thyroid gland from H2O2 and the regulation of tissue T3 levels are the functions of Se that are most likely to underlie the interactions of Se and I.
Motivated by the recent determination of proper motions of knots in the M87 jet by Biretta, Zhou, & Owen (1995), we have investigated the relationship between the dynamics of the jet and the kpc-scale radio and optical structure. We interpret the knots as internal shocks in the jet, and find that relativistic effects play an important role in their appearance. In particular, knot A, which appears to be almost transverse to the flow and seems to be viewed nearly edge-on, is in fact a highly oblique shock. The direction of its normal with respect to the flow lies within about 10° of the Mach angle, i.e., the angle of obliquity beyond which no shock is possible. In a frame comoving with the shock front, the incident streamlines make an angle of about 40° – 60° with respect to the shock normal. Knot A has a proper motion corresponding to only 0.51c, and the relativistic effects are modest. Its edge-on appearance is largely fortuitous. We have found, however, that relativistic effects would create a strong bias for shocks with apparent superluminal speeds to appear nearly edge-on.
A survey was made of all female admissions to the State Hospital, Carstairs, between the time of the first female admissions in 1959, and 31 December 1973. There were 66 female admissions, constituting 7·1 per cent of the total admissions over the same period. The females fall into two separate sub-groups. The first consists of persistently violent patients transferred from other hospitals, suffering from mental subnormality or personality disorder; they have a poorer prognosis than the second group, who are sent from Courts or prison because of single serious acts of violence often directed at a member of the family, and who suffer from a personality disorder or from schizophrenia. Some features of the two groups are compared and contrasted. There may be an increase in the proportion of patients in the first group being admitted to the State Hospital, and some implications of this trend are discussed.
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