Delphi-research exploring essential components and preconditions for case management in people with dementia

<p>Abstract</p> <p>Background</p> <p>Case management programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of case management for people with dementia as well as the preconditions for an effective delivery of case management services.</p> <p>Method</p> <p>The method used to carry out the research was a modified four-phase Delphi design. First, a list of potentially essential components and preconditions for the provision of case management was drawn up on the basis of a literature review and a subsequent focus group interview. The list was then validated by experts in a first Delphi survey round, following which the researchers translated the list items into 75 statements. In the second Delphi survey, the experts rated the statements; in the third Delphi round, they rated 18 statements on which no consensus had been reached in the second round.</p> <p>Results</p> <p>The experts were able to build consensus on 61 of the 75 statements. Essential components of case management for people with dementia are: information, support and counselling, coordination of the care provided and, to a lesser extent, practical help. A patient-centred approach was found to be one of the key aspects of providing case management services. Essential preconditions are: vision, care relationship, structured methodology, integration of case management into the health care chain, and the case manager's level of training and expertise.</p> <p>Conclusions</p> <p>We recommend that, based on the essential components and preconditions referred to above, quality criteria be developed for the provision of case management for people with dementia. Furthermore, we suggest the conduct of additional research to assess the effectiveness of case management in people with dementia.</p

Confocal sputtering of conformal α-β phase W films on etched Al features

The authors report on thin-film processing improvements in the fabrication of superconducting quasiparticle-trap-assisted electrothermal-feedback transition-edge sensors used in the design of cryogenic dark matter search detectors. The work was performed as part of a detector upgrade project that included optimization of a new confocal sputtering system and development of etch recipes compatible with patterning 40 nm-thick, α-β mixed-phase W films deposited on 300–600 nm-thick, patterned Al. The authors found that their standard exothermic Al wet etch recipes provided inadequate W/Al interfaces and led to poor device performance. The authors developed a modified Al wet-etch recipe that effectively mitigates geometrical step-coverage limitations while maintaining their existing device design. Data presented here include scanning electron microscope and focused ion beam images of films and device interfaces obtained with the new Al etch method. The authors also introduce a method for quantitatively measuring the energy collection efficiency through these interfaces

Automatic Detection of Cortical Arousals in Sleep and their Contribution to Daytime Sleepiness

Cortical arousals are transient events of disturbed sleep that occur spontaneously or in response to stimuli such as apneic events. The gold standard for arousal detection in human polysomnographic recordings (PSGs) is manual annotation by expert human scorers, a method with significant interscorer variability. In this study, we developed an automated method, the Multimodal Arousal Detector (MAD), to detect arousals using deep learning methods. The MAD was trained on 2,889 PSGs to detect both cortical arousals and wakefulness in 1 second intervals. Furthermore, the relationship between MAD-predicted labels on PSGs and next day mean sleep latency (MSL) on a multiple sleep latency test (MSLT), a reflection of daytime sleepiness, was analyzed in 1447 MSLT instances in 873 subjects. In a dataset of 1,026 PSGs, the MAD achieved a F1 score of 0.76 for arousal detection, while wakefulness was predicted with an accuracy of 0.95. In 60 PSGs scored by multiple human expert technicians, the MAD significantly outperformed the average human scorer for arousal detection with a difference in F1 score of 0.09. After controlling for other known covariates, a doubling of the arousal index was associated with an average decrease in MSL of 40 seconds ($\beta$ = -0.67, p = 0.0075). The MAD outperformed the average human expert and the MAD-predicted arousals were shown to be significant predictors of MSL, which demonstrate clinical validity the MAD.Comment: 40 pages, 13 figures, 9 table

SuperCDMS Cold Hardware Design

We discuss the current design of the cold hardware and cold electronics to be used in the upcoming SuperCDMS Soudan deployment. Engineering challenges associated with such concerns as thermal isolation, microphonics, radiopurity, and power dissipation are discussed, along with identifying the design changes necessary for SuperCDMS SNOLAB. The Cryogenic Dark Matter Search (CDMS) employs ultrapure 1-inch thick, 3-inch diameter germanium crystals operating below 50 mK in a dilution cryostat. These detectors give an ionization and phonon signal, which gives us rejection capabilities regarding background events versus dark matter signals.United States. Dept. of Energy (Grant DEAC02-76SF00515)United States. Dept. of Energy (Contract DC-AC02-07CH11359)National Science Foundation (U.S.) (Awards 0705052, 0902182, 1004714 and 0802575

Ecological impacts of time-variable exposure regimes to the fungicide azoxystrobin on freshwater communities in outdoor microcosms

This paper evaluates the effects of different time-varying exposure patterns of the strobilurin fungicide azoxystrobin on freshwater microsocosm communities. These exposure patterns included two treatments with a similar peak but different time-weighted average (TWA) concentrations, and two treatments with similar TWA but different peak concentrations. The experiment was carried out in outdoor microcosms under four different exposure regimes; (1) a continuous application treatment of 10 μg/L (CAT10) for 42 days (2), a continuous application treatment of 33 μg/L (CAT33) for 42 days (3), a single application treatment of 33 μg/L (SAT33) and (4) a four application treatment of 16 μg/L (FAT16), with a time interval of 10 days. Mean measured 42-d TWA concentrations in the different treatments were 9.4 μg/L (CAT10), 32.8 μg/L (CAT33), 14.9 μg/L (SAT33) and 14.7 μg/L (FAT16). Multivariate analyses demonstrated significant changes in zooplankton community structure in all but the CAT10 treated microcosms relative to that of controls. The largest adverse effects were reported for zooplankton taxa belonging to Copepoda and Cladocera. By the end of the experimental period (day 42 after treatment), community effects were of similar magnitude for the pulsed treatment regimes, although the magnitude of the initial effect was larger in the SAT33 treatment. This indicates that for long-term effects the TWA is more important for most zooplankton species in the test system than the peak concentration. Azoxystrobin only slightly affected some species of the macroinvertebrate, phytoplankton and macrophyte assemblages. The overall no observed ecologically adverse effect concentrations (NOEAEC) in this study was 10 µg/L

Methylation of migraine-related genes in different tissues of the rat

17β-Estradiol, an epigenetic modulator, is involved in the increased prevalence of migraine in women. Together with the prophylactic efficacy of valproate, which influences DNA methylation and histone modification, this points to the involvement of epigenetic mechanisms. Epigenetic studies are often performed on leukocytes, but it is unclear to what extent methylation is similar in other tissues. Therefore, we investigated methylation of migraine-related genes that might be epigenetically regulated (CGRP-ergic pathway, estrogen receptors, endothelial NOS, as well as MTHFR) in different migraine-related tissues and compared this to methylation in rat as well as human leukocytes. Further, we studied whether 17β-estradiol has a prominent role in methylation of these genes. Female rats (n = 35) were ovariectomized or shamoperated and treated with 17b-estradiol or placebo. DNA was isolated and methylation was assessed through bisulphite treatment and mass spectrometry. Human methylation data were obtained using the Illumina 450k genome-wide methylation array in 395 female subjects from a population-based cohort study. We showed that methylation of the Crcp, Calcrl, Esr1 and Nos3 genes is tissue-specific and that methylation in leukocytes was not correlated to that in other tissues. Interestingly, the interindividual variation in methylation differed considerably between genes and tissues. Furthermore we showed that methylation in human leukocytes was similar to that in rat leukocytes in our genes of interest, suggesting that rat may be a good model to study human DNA methylation in tissues that are difficult to obtain. In none of the genes a significant effect of estradiol treatment was observed

Hindrance of Heavy-ion Fusion at Extreme Sub-Barrier Energies in Open-shell Colliding Systems

The excitation function for the fusion-evaporation reaction 64Ni+100Mo has been measured down to a cross-section of ~5 nb. Extensive coupled-channels calculations have been performed, which cannot reproduce the steep fall-off of the excitation function at extreme sub-barrier energies. Thus, this system exhibits a hindrance for fusion, a phenomenon that has been discovered only recently. In the S-factor representation introduced to quantify the hindrance, a maximum is observed at E_s=120.6 MeV, which corresponds to 90% of the reference energy E_s^ref, a value expected from systematics of closed-shell systems. A systematic analysis of Ni-induced fusion reactions leading to compound nuclei with mass A=100-200 is presented in order to explore a possible dependence of the fusion hindrance on nuclear structure.Comment: 10 pages, 9 figures, Submitted to Phys. Rev.