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Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.
We describe the glacial geomorphology and initial geochronology of two ice-free valley systems within the Neptune Range of the Pensacola Mountains, Antarctica. These valleys are characterized by landforms associated with formerly more expanded ice sheet(s) that were at least 200 m thicker than at present. The most conspicuous features are areas of supraglacial debris, discrete debris accumulations separated from modern-day ice and curvilinear ridges and mounds. The landsystem bears similarities to debris-rich cold-based glacial landsystems described elsewhere in Antarctica and the Arctic where buried ice is prevalent. Geochronological data demonstrate multiple phases of ice expansion. The oldest, occurring > 3 Ma, overtopped much of the landscape. Subsequent, less expansive advances into the valleys occurred > 2 Ma and > ~1 Ma. An expansion of some local glaciers occurred < 250 ka. This sequence of glacial stages is similar to that described from the northernmost massif of the Pensacola Mountains (Dufek Massif), suggesting that it represents a regional signal of ice-sheet evolution over the Plio-Pleistocene. The geomorphological record and its evolution over millions of years makes the Neptune Range valleys an area worthy of future research and we highlight potential avenues for this.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model.
Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine.
There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions.
The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.
OBJECTIVES/GOALS: Our goal is to develop a non-invasive stimulation technique using magneto-electric nanoparticles (MENs) for inducing and enhancing neuronal activity with high spatial and temporal resolutions and minimal toxicity, which can potentially be used as a more effective approach to brain stimulation. METHODS/STUDY POPULATION: MENs compose of core-shell structures that are attracted to strong external magnetic field (~5000 Gauss) but produces electric currents with weaker magnetic field (~450 Gauss). MENs were IV treated into mice and drawn to the brain cortex with a strong magnetic field. We then stimulate MENs with a weaker magnetic field via electro magnet. With two photon calcium imaging, we investigated both the temporal and spatial effects of MENs on neuronal activity both in vivo and in vitro. We performed mesoscopic whole brain calcium imaging on awake animal to assess the MENs effects. Furthermore, we investigated the temporal profile of MENs in the vasculatures post-treatment and its toxicities to CNS. RESULTS/ANTICIPATED RESULTS: MENs were successfully localized to target cortical regions within 30 minutes of magnetic application. After wirelessly applying ~450 G magnetic field between 10-20 Hz, we observed a dramatic increase of calcium signals (i.e. neuronal excitability) both in vitro cultured neurons and in vivo treated animals. Whole brain imaging of awake mice showed a focal increase in calcium signals at the area where MENs localized and the signals spread to regions further away. We also found MENs stimulatory effects lasted up to 24 hours post treatment. MEN stimulation increases c-Fos expression but resulted in no inflammatory changes, up to one week, by assessing microglial or astrocytes activations. DISCUSSION/SIGNIFICANCE OF IMPACT: Our study shows, through controlling the applied magnetic field, MENs can be focally delivered to specific cortical regions with high efficacy and wirelessly activated neurons with high spatial and temporal resolution. This method shows promising potential to be a new non-invasive brain modulation approach disease studies and treatments.
Canada, like other countries around the world, has an ageing population and growing numbers of people with dementia. Although rural Canada makes up 95 per cent of the country's land mass (Moazzami, 2014), Canada is becoming increasingly urbanised as cities grow and the proportion of people living in rural areas has declined and aged (Statistics Canada, 2017a). These changes have socioeconomic impacts on rural communities, including ability to deliver health and social services for ageing rural populations. The challenges of ageing in rural communities, such as disparities in access to services (Keating et al, 2011) are compounded when living with dementia. This chapter reviews the Canadian dementia care context, issues and challenges in rural dementia care, and Canadian research addressing these issues. The chapter provides an overview of the Rural Dementia Action Research (RaDAR) programme based in Saskatchewan, Canada, which has focused on rural dementia care for over 20 years.
Dementia in Canada
The number of people over age 65 in Canada is projected to increase from 17 per cent in 2017 to 23 per cent by 2031 (Statistics Canada, 2017a). The number of people with dementia is also projected to increase, from 564,000 in 2016 to around one million by 2033 (ASC, 2016). A number of Canadian initiatives have been implemented to address growing dementia care needs. Most of the ten provinces in Canada have established dementia strategies, some as early as 2002, and a national dementia strategy was released in 2019 (Public Health Agency of Canada). A 2016 report by the Senate of Canada included 29 recommendations to inform development of the national strategy (Senate of Canada, 2016). The Alzheimer Society of Canada has published several studies of projected prevalence and monetary costs using different data sources and intervention scenarios (ASC, 2010, 2016). The Canadian Institutes of Health Research Dementia Research Strategy included C$32 million in federal funding over five years for Phase I of the Canadian Consortium on Neurodegeneration in Aging (CCNA) and C$46 million for Phase 2 (2019– 24). This network of 20 research teams involves over 350 researchers conducting research in dementia prevention, treatment and quality of life (CCNA, 2019). The Canadian Chronic Disease Surveillance System was expanded to include dementia in 2011, creating national data on dementia incidence and prevalence to support planning and evaluation of policies and services (Public Health Agency of Canada, 2017; CIHI, 2018).
Tomasello's account of the origins and nature of moral obligation rightly emphasises the key roles of social relations and a cooperative sense of “we.” However, we suggest that it overlooks the complexity of those social relations and the resulting prevalence of a divided “we” in moral social groups. We argue that the social identity dynamics that arise can lead to competing obligations in a single group, and this has implications for the evolution of obligation.
This study aimed to examine the influence of the complexity of the story-book on caregiver extra-textual talk (i.e., interactions beyond text reading) during shared reading with preschool-age children. Fifty-three mother–child dyads (3;00–4;11) were video-recorded sharing two ostensibly similar picture-books: a simple story (containing no false belief) and a complex story (containing a false belief central to the plot, which provided content that was more challenging for preschoolers to understand). Book-reading interactions were transcribed and coded. Results showed that the complex stories facilitated more extra-textual talk from mothers, and a higher quality of extra-textual talk (as indexed by linguistic richness and level of abstraction). Although the type of story did not affect the number of questions mothers posed, more elaborative follow-ups on children's responses were provided by mothers when sharing complex stories. Complex stories may facilitate more and linguistically richer caregiver extra-textual talk, having implications for preschoolers’ developing language abilities.
Contract Law: Principles and Context presents the development of contract law through a considered selection of cases that are both authoritative and used as factual examples to explain the law. The text introduces readers to the nature and range of contracts, the process for making a contract, rights and duties, adjustments to contracts, vitiating factors and unfair conduct, ending contracts, and remedies and restitution. The text considers the historical development of contracts through case law and legislation, then takes the reader to particular issues with contracts as they might arise in real life and navigates a legal pathway through them. Written in a clear and engaging style, Contract Law provides a fresh, topical and accessible account of the Australian law of contract, and is an invaluable resource for contract law students and practitioners.