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Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers.
Caregivers of people with dementia living at home or in a care home.
In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%).
Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales (“personal sacrifice burden”; “heartfelt sadness”; “worry and felt isolation”).
Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower “heartfelt sadness.”
We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers’ social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979).
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
In the southeastern United States, growers often double-crop soft red winter wheat with peanut. In some areas, tobacco is also grown as a rotational crop. Pyrasulfotole is a residual POST-applied herbicide used in winter wheat, but information about its effects on rotational crops is limited. Winter wheat planted in autumn 2014 was treated at Feekes stage 1 or 2 with pyrasulfotole at 300 or 600 g ai ha−1. Wheat was terminated by glyphosate at Feekes stage 3 to 4. Peanut was planted via strip tillage, while tobacco was transplanted into prepared beds after minimal soil disturbance. Peanut exhibited no differences in stand establishment, growth, or yield, and tobacco stand, growth, and biomass yields were not different from the nontreated control for any pyrasulfotole rate or treatment timing.
Prevalence of blaKPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.
Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.
Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.
Infect Control Hosp Epidemiol 2015;36(10):1148–1154
To determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children.
Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes.
Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children.
Among 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0·020, P=0·19), BMI (β=0·028, P=0·03) and TBFM (β=0·017, P=0·20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0·097, P<0·001), BMI (β=0·074, P<0·001) and TBFM (β=0·065, P=0·003). The association between change in SSB and WC was weakened, but remained statistically significant after accounting for BMI (β=0·042, P=0·02) and TBFM (β=0·048, P=0·01).
Higher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.
Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.
Prospective observational study.
Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.
One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the “Four Moments for Hand Hygiene.” Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.
During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions.
Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.
Deer exclosure is an important management strategy for encouraging woodland regeneration in the presence of high numbers of Cervus elaphus L. This could pose a threat to important saxicolous lichen communities as a result of competition from bryophytes and other vegetation. This investigation compared the bryophyte and lichen communities associated with siliceous rock outcrops and boulders inside and outside a number of exclosures in wet heath vegetation at the Gruinard, Letterewe and Little Gruinard estates in Wester Ross. Species cover data were recorded from 6600·2×0·2 m quadrats, allocated to three different aspects of rocks, from 22 pairs of plots (placed either side of a deer fence) with randomization at each level of this hierarchy. The data were analyzed using linear mixed effects models. Mean lichen cover, diversity and species richness were significantly lower in quadrats on rocks within the exclosures. Mean bryophyte cover was significantly higher in quadrats on rocks inside the deer fence and was shown to have a highly significant negative relationship with total lichen cover. Saxicolous lichen species are particularly affected by the increase in shading and litter accumulation from the surrounding plants and the subsequent growth of bryophytes and heath vegetation on rocks within the exclosures. The results of this study have implications for the use of exclosures at locations where there are important saxicolous lichen communities.
The treatment of hip fractures is the prototype for the orthopedic management of geriatric patients. Because of the demographics of the USA (increasing age of the population), the incidence of hip fractures will increase in the next few decades, with the yearly incidence increasing to 500,000 in 2040 from 250,000 in 1990. Prevention of hip fractures is becoming increasingly important due to significant morbidity and mortality associated with a hip fracture. Modalities that have been shown to decrease the incidence of geriatric hip fractures include analysis of conditions that predispose to falls, prevention, and treatment of bone fragility, and, possibly, the use of hip protectors. Therefore, especially in patients who already have sustained a hip fracture, reviewing the patient's medications to identify those that may interfere with cognition and balance (e.g., diazepams), evaluating eyesight (poor vision may predispose to a fall), and diagnosing and treating osteoporosis may decrease the risk of subsequent hip fractures.
Classification of hip fractures
It is not the purpose of this chapter to discuss the complete classification of hip fractures and subsequent treatment; however, it is useful to describe hip fractures and the goal of surgical treatment. Femoral neck fractures occur mostly in elderly patients; displaced fractures often are treated with arthroplasty to avoid the known complications of non-union and avascular necrosis and to allow for immediate ambulation. Intertrochanteric hip fractures are almost always treated with internal fixation. This intervention provides a high union rate; with newer implants, unrestricted weightbearing is usually allowed. The goal of treatment of all geriatric hip fractures is a rapid return to the pre-injury ambulatory status, as this has been shown to decrease the morbidity of hip fractures.
We present an application of Mathematical Morphology (MM) for the classification of astronomical objects, both for star/galaxy differentiation and galaxy morphology classification. We demonstrate that, for CCD images, 99.3 ± 3.8% of galaxies can be separated from stars using MM, with 19.4 ± 7.9% of the stars being misclassified. We demonstrate that, for photographic plate images, the number of galaxies correctly separated from the stars can be increased using our MM diffraction spike tool, which allows 51.0 ± 6.0% of the high-brightness galaxies that are inseparable in current techniques to be correctly classified, with only 1.4 ± 0.5% of the high-brightness stars contaminating the population. We demonstrate that elliptical (E) and late-type spiral (Sc-Sd) galaxies can be classified using MM with an accuracy of 91.4 ± 7.8%. It is a method involving fewer ‘free parameters’ than current techniques, especially automated machine learning algorithms. The limitation of MM galaxy morphology classification based on seeing and distance is also presented. We examine various star/galaxy differentiation and galaxy morphology classification techniques commonly used today, and show that our MM techniques compare very favourably.
The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.
A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey.
National single-payer healthcare system with 152 hospitals.
Employees of the healthcare system in 2010 who responded to the survey.
Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability.
Four factors were identified related to vaccine declination and were labeled as (1) “don't care,” (2) “don't want,” (3) “don't believe,” and (4) “don't know.” Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor.
Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.