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Being a family caregiver, and in particular giving care to someone with dementia, impacts mental and physical health and potentially reduces the ability of caregivers to “live well.” This paper examines whether three key psychological resources—self-efficacy, optimism, and self-esteem—are associated with better outcomes for caregivers of people with dementia.
Design and Participants:
Caregivers of 1,283 people with mild-to-moderate dementia in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of self-efficacy, optimism, and self-esteem, and “living well” (quality of life, life satisfaction, and well-being). Multivariate linear regression was used to examine the association between psychological resources and “living well”.
Self-efficacy, optimism, and self-esteem were all independently associated with better capability to “live well” for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day).
Low self-efficacy, optimism, and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers.
This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results.
There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups.
Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time.
Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.
Pure cobalt and cobalt-nickel alloys have been plated from simple electrolytic baths with and without additive and with and without ac superimposed upon the dc plating current.
X-ray analysis reveals preferred orientation in the polycrystalline deposits generally and extreme preferred orientation (characterized by [00.2] and [11.0] fiber axes) in the case of those samples obtained with additive-free electrolyte. It is shown that a change in the pH of the bath or the addition of an ac component are equally effective in determining the type of fiber axis in the deposit. The effects on plating texture owing to the use of additive KCNS in the bath are described. Finally, the correlation between the texture and the magnetic properties of the plating Is discussed.
Blood samples from normal and Plasmodium berghei infected mice are being analyzed for trace elements by charged particle induced x-rays. Approximately 0.25 ml of the sample (whole blood, washed red cells, or plasma) is dry ashed. The ashes are mounted on a 0.003 inch Kapton foil. The analysis is performed by bombardment of the samples by a beam of 2.0 MeV protons and detection of the characteristic x-rays by a 175-eV-resolution lithium-drifted silicon detector. The data are analyzed by an on-line PDP-9 computer-based data acquisition system. Results indicate an increase in the K, Ca, Cu, and Zn per unit volume of the red cells of the malaria infected mice relative to the amounts measured for uninfected blood, and a decrease in the K, Ca, and Fe and an increase in the Cu per unit volume in the plasma of the infected mice.
We describe the motivation and design details of the ‘Phase II’ upgrade of the Murchison Widefield Array radio telescope. The expansion doubles to 256 the number of antenna tiles deployed in the array. The new antenna tiles enhance the capabilities of the Murchison Widefield Array in several key science areas. Seventy-two of the new tiles are deployed in a regular configuration near the existing array core. These new tiles enhance the surface brightness sensitivity of the array and will improve the ability of the Murchison Widefield Array to estimate the slope of the Epoch of Reionisation power spectrum by a factor of ∼3.5. The remaining 56 tiles are deployed on long baselines, doubling the maximum baseline of the array and improving the array u, v coverage. The improved imaging capabilities will provide an order of magnitude improvement in the noise floor of Murchison Widefield Array continuum images. The upgrade retains all of the features that have underpinned the Murchison Widefield Array’s success (large field of view, snapshot image quality, and pointing agility) and boosts the scientific potential with enhanced imaging capabilities and by enabling new calibration strategies.
Current policy emphasises the importance of ‘living well’ with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1–0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance. Support given by the public health department included prenatal clinical and laboratory support and the sharing of data on NYC Health+Hospitals Zika virus screening and testing rates, thus enabling this health care delivery system to make informed decisions and practices. The close coordination, collaboration, and communication between the health care delivery system and the local public health department examined in this article demonstrate the importance of working together to combat a complex public health emergency and how this relationship can serve as a guide for other jurisdictions to optimize collaboration between external partners during major outbreaks, emerging threats, and disasters that affect public health. (Disaster Med Public Health Preparedness. 2018;12:689-691)
Does treatment mode matter in studies of the effects of candidate race or ethnicity on voting decisions? The assumption implicit in most such work is that such treatment mode differences are either small and/or theoretically well understood, so that the choice of how to signal the race of a candidate is largely one of convenience. But this assumption remains untested. Using a nationally representative sample of white voting-age citizens and a modified conjoint design, we evaluate whether signaling candidate ethnicity with ethnic labels and names results in different effects than signaling candidate ethnicity with ethnically identifiable photos and names. Our results provide strong evidence that treatment-mode effects are substantively large and statistically significant. Further, these treatment-mode effects are not consistent with extant theoretical accounts. These results highlight the need for additional theoretical and empirical work on race/ethnicity treatment-mode effects.
The placenta prevents the transfer of maternal immunity to the foetus and consequently lambs are born hypoimmunocompetent. The IgG content in colostrum and its absorption into the blood stream has important consequences for lamb liveability in early life. Recent experiments carried out at this institute found that when ewes had access to a mineral block or the mineral component of this block in the form of powdered minerals in late pregnancy, the absorption of IgG by their offspring was reduced (Boland et al., 2003). Keane (2001) stated that it would appear that the lamb was pre-programmed in-utero for lowered IgG efficiency and that the problem lay with the lamb rather than to any altered characteristics of the colostrum. The aim of this experiment was to investigate the period of time necessary for high levels of mineral supplementation to the ewe to affect a reduction in IgG values in the progeny.
In recent years there has been increasing use of mineral blocks in the diets of sheep both at mating time and in pregnancy. However, recent work carried out at this institute (Joyce, 2000) found that lambs whose dams had access to mineral blocks had significantly lower IgG serum values at 24 hours than lambs whose dams had no access to mineral blocks. This experiment investigated further the effects of supplementing the pregnant ewe diet with mineral blocks on IgG absorption efficiency and on the level of faecal adhesion to the tail-end of the lambs in early life.
The production of early-weaned lamb is a high cost production system with the major cost being the concentrate consumed by the lamb. However the transformation of concentrate to weight gain is more efficient when the concentrate is fed to the lamb directly rather than fed to the dam and the lamb avails of the mother’s milk. This type of finishing system requires a lamb with a high lean proportion in the carcass, a trait that characterises Texel cross lambs. Molasses, a by-product of the sugar processing industry, is high in soluble carbohydrates and is a common ingredient in commercial animal feed formulations. Inclusion levels in excess of 10% have been reported to cause excessive stickiness of the feed (Ewing, 1997). Molasses based diets increase propionic acid concentrations in sheep (Cortez et al., 1987), which promotes soft carcass fat (Bozzolo et al., 1990). The objective of this experiment was to determine the optimum inclusion rate of molasses in the diet of early-weaned lambs, based on growth rate, lamb cleanliness and carcass characteristics.
Lambs are born hypoimmunocompetent as the placenta prevents the transfer of maternal immunity to the foetus of the ruminant. Colostrum is the source of imunoglobulins for the young lamb and any interference with the absorption of immunoglobulins from colostrum would have important consequences for lamb liveability in early life. Recent experiments at this institute found that when ewes had access to mineral blocks in late pregnancy the absorption of immunoglobulin (IgG) by their offspring was reduced (Keane 2001). This author also stated that the lamb was preprogrammed in-utero for lowered IgG absorption efficiency. The aim of this experiment was to determine whether it was the mineral or molasses component of the mineral block which caused the reduced IgG absorption by the lamb.
High levels of mineral supplementation to ewes in late gestation results in reduced blood serum immunoglobulin G (IgG) concentration and a lowered efficiency of colostral IgG absorption at 24h post partum (Boland et al., 2003). Given that lambs are born hypogammaglobulinemic and are dependent on the absorption of immunoglobulins from colostrum for immunity in early life, this decrease in serum IgG concentration is likely to present a significant challenge to the neonatal lamb in relation to disease susceptibility. The aim of this experiment was to determine which element(s) in the mineral supplement are having the greatest effect in reducing colostral IgG absorption and if the removal of this element(s) from the formulation would result in a return to what might be considered as normal immunoglobulin absorption values.
Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research.
Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute—the Health Equity Leadership Institute (HELI)—with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research.
In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding.
HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.
To examine the choices Canadian family medicine residents make for oral anticoagulation (OAC) for patients with nonvalvular atrial fibrillation (AF).
AF increases the risk of strokes. An important consideration in AF management is risk stratification for stroke and prescription of appropriate OAC. Family physicians provide the vast majority of OAC prescriptions.
We administered a survey to residents in multiple Canadian family medicine training programmes. Questions explored the experiences and attitudes towards risk stratification and choices of OAC when presented with standardized clinical scenarios. In each scenario, a novel oral anticoagulant (NOAC) would be the preferred treatment according to the contemporary Canadian and European guidelines.
A total of 247 residents participated in the survey. Most used the congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, stroke or TIA (2 points) (81%) and congestive heart failure, hypertension, age ≥ 75 (2 points) or age 65-74 (1 point), diabetes mellitus, stroke or TIA, vascular disease including peripheral arterial disease, myocardial infarction, or aortic plaque, sex (female) (67%) risk stratification schemes while the preferred bleeding risk stratification scheme was hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalized ratio, elderly (age ≥ 65), drugs or alcohol (84%). In the clinical scenarios, residents generally preferred warfarin in favour of NOACs, independent of training level. Residents ranked the risk of adverse events and the cost to the patient as their most and least important consideration when prescribing OAC, respectively. Therefore in patients with nonvalvular AF, Canadian family medicine residents prefer warfarin in comparison with NOACs despite the latest Canadian and European guideline recommendations. This knowledge gap may be enhanced by multiple factors, including a sometimes magnified fear of adverse events and a rapidly changing landscape in stroke prophylaxis.
Introduction: Patients presenting to the Emergency Department (ED) may require clarification of their goals of care (GOC) to ensure they receive treatments aligned with their values. However, these discussions can be difficult to conduct for multiple reasons, including lack of time in a busy ED, competing priorities and a limited relationship with the patient. Few studies have examined the perceived challenges faced by Emergency Physicians in conducting GOC discussions. This study sought to contextualize and discern the barriers and facilitators to having these conversations as reported by Emergency physicians. Methods: An interdisciplinary team of Emergency Medicine, Palliative Care and Internal Medicine providers developed an online survey comprised of multiple choice, Likert-scale and open-ended questions to explore four domains of GOC discussions: training; communication; environment; and personal beliefs. Invitations and scheduled reminders were sent to 275 ED physicians at six academic sites in a Canadian urban centre, including 49 EM residents. Results: 105 (46%) staff physicians and 23 (47%) residents responded with similar representation from all sites. Differences were reported in the frequency of GOC discussions: 59% of staff physicians conduct several per month whereas 65% of residents conduct less than one per month. Most agreed that GOC discussions are within their scope of practice (92%), they feel comfortable (96%), and are adequately trained (73%) to have them; however, 66% reported difficulty initiating GOC discussions. 73% believed that admitting services should conduct GOC discussions, yet acuity was noted in the comments as a major determinant with initiating GOC discussions by ED physicians. Main barriers identified were lack of time, chaotic environment, lack of advanced directives and the inability to reach substitute decision makers. 54% of respondents indicated that the availability of 24-hour Palliative Care consults would facilitate GOC discussions in the ED. Conclusion: Emergency physicians are prepared to conduct goals of care discussions, but often believe they should instead be conducted by the patient’s admitting service. Multiple perceived barriers to goals of care discussion in the ED were identified, and a majority of respondents felt that the availability of Palliative Care in the ED may facilitate these discussions.