Components of impactful dementia training for general hospital staff: a collective case study

Background and objectives: People with dementia occupy around one quarter of general hospital beds, with concerns consistently raised about care quality. Improving workforce knowledge, skills and attitudes is a mechanism for addressing this. However little is known about effective ways of training healthcare staff about dementia. This study aimed to understand models of dementia training most likely to lead to improved practice and better care experiences for people with dementia, and to understand barriers and facilitators to implementation. Method: A collective case study was conducted in three National Health Service Acute Hospital Trusts in England. Multiple data sources were used including interviews with training leads/facilitators, ward managers and staff who had attended training; satisfaction surveys with patients with dementia and/or carers; and observations of care using Dementia Care Mapping. Results: Interactive face-to-face training designed for general hospital staff was valued. Simulation and experiential learning methods were felt to be beneficial by some staff and stressful and distressing by others. Skilled delivery by an experienced and enthusiastic facilitator was identified as important. Staff identified learning and practice changes made following their training. However, observations revealed not all staff had the knowledge, attitudes and skills needed to deliver good care. Patient and carer satisfaction with care was mixed. A major barrier to training implementation was lack of resources. Supportive managers, organisational culture and strong leadership were key facilitators. Conclusion: Dementia training can lead to improved care practices. There are a range of key barriers and facilitators to implementation that must be considered

Fatigue reduces the complexity of knee extensor torque during fatiguing sustained isometric contractions

The temporal structure, or complexity, of muscle torque output reflects the adaptability of motor control to changes in task demands. This complexity is reduced by neuromuscular fatigue during intermittent isometric contractions. We tested the hypothesis that sustained fatiguing isometric contractions would result in a similar loss of complexity. To that end, nine healthy participants performed, on separate days, sustained isometric contractions of the knee extensors at 20% MVC to task failure and at 100% MVC for 60 s. Torque and surface EMG signals were sampled continuously. Complexity and fractal scaling were quantified by calculating approximate entropy (ApEn) and the detrended fluctuation analysis (DFA) α scaling exponent. Global, central and peripheral fatigue were quantified using maximal voluntary contractions (MVCs) with femoral nerve stimulation. Fatigue reduced the complexity of both submaximal (ApEn from 1.02 ± 0.06 to 0.41 ± 0.04, P < 0.05) and maximal contractions (ApEn from 0.34 ± 0.05 to 0.26 ± 0.04, P < 0.05; DFA α from 1.41 ± 0.04 to 1.52 ± 0.03, P < 0.05). The losses of complexity were accompanied by significant global, central and peripheral fatigue (all P < 0.05). These results demonstrate that a fatigue-induced loss of torque complexity is evident not only during fatiguing intermittent isometric contractions, but also during sustained fatiguing contractions

A collective case study of the features of impactful dementia training for care home staff

Background: Up to 80% of care home residents have dementia. Ensuring this workforce is appropriately trained is of international concern. Research indicates variable impact of training on a range of resident and staff outcomes. Little is still known about the most effective approaches to the design, delivery and implementation of dementia training. This study aimed to investigate the features and contextual factors associated with an effective approach to care home staff training on dementia. Methods: An embedded, collective case study was undertaken in three care home provider organisations who had responded to a national training audit. Data collected included individual or small group interviews with training leads, facilitators, staff attending training, managers, residents and their relatives. Observations of care practice were undertaken using Dementia Care Mapping. Training delivery was observed and training materials audited. A within case analysis of each site, followed by cross case analysis using convergence coding was undertaken. Results: All sites provided bespoke, tailored training, delivered largely using face-to-face, interactive methods, which staff and managers indicated were valuable and effective. Self-study booklets and on-line learning where were used, were poorly completed and disliked by staff. Training was said to improve empathy, knowledge about the lived experience of dementia and the importance of considering and meeting individual needs. Opportunities to continually reflect on learning and support to implement training in practice were valued and felt to be an essential component of good training. Practice developments as a result of training included improved communication, increased activity, less task-focussed care and increased resident well-being. However, observations indicated positive well-being and engagement was not a consistent experience across all residents in all sites. Barriers to training attendance and implementation were staff time, lack of dedicated training space and challenges in gaining feedback on training and its impact. Facilitators included a supportive organisational ethos and skilled training facilitation. Conclusions: Effective training is tailored to learners’, delivered face-to-face by an experienced facilitator, is interactive and is embedded within a supportive organisational culture/ethos. Further research is needed on the practical aspects of sustainable and impactful dementia training delivery and implementation in care home settings

Inspiratory muscle warm-up does not improve cycling time-trial performance

Purpose: This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance

Spatial Dynamics Of Vertical And Horizontal Intergovernmental Collaboration

Although researchers have made progress in understanding motivations behind local government collaboration, there is little research that explores the spatial dynamics of such interactions. Does the idea of collaboration travel horizontally, passed from neighbor to neighbor, or is vertical leadership from state, county, or regional actors more important in influencing local governments’ decisions to share resources and functions? What factors influence local governments’ choices to collaborate with their neighbors versus a regional entity, county, or state government? In this article, we investigate the importance of vertical and horizontal influences when local governments decide to collaborate around land use planning. Using data from a survey of Michigan local government officials, we take a spatial statistical approach to answering this question. We find widespread evidence of collaboration at multiple scales, and observe patterns of both horizontal and vertical influence. We also find that contextual factors help to explain these patterns of collaboration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112248/1/juaf12139.pd

Structure of smAKAP and its regulation by PKA-mediated phosphorylation

The A-kinase anchoring protein (AKAP) smAKAP has three extraordinary features; it is very small, it is anchored directly to membranes by acyl motifs, and it interacts almost exclusively with the type I regulatory subunits (RI) of cAMP-dependent kinase (PKA). Here, we determined the crystal structure of smAKAP's A-kinase binding domain (smAKAP-AKB) in complex with the dimerization/docking (D/D) domain of RIα which reveals an extended hydrophobic interface with unique interaction pockets that drive smAKAP's high specificity for RI-subunits. We also identify a conserved PKA phosphorylation site at Ser66 in the AKB domain which we predict would cause steric clashes and disrupt binding. This correlates with in vivo co-localization and fluorescence polarization studies where Ser66 AKB phosphorylation ablates RI-binding. Hydrogen/deuterium exchange studies confirm that the AKB helix is accessible and dynamic. Furthermore, full-length smAKAP as well as the unbound AKB is predicted to contain a break at the phosphorylation site, and circular dichroism measurements confirm that the AKB domain loses its helicity following phosphorylation. Since the active site of PKA's catalytic subunit does not accommodate α-helices, we predict that the inherent flexibility of the AKB domain enables its phosphorylation by PKA. This represents a novel mechanism, whereby activation of anchored PKA can terminate its binding to smAKAP affecting the regulation of localized cAMP-signaling events. This article is protected by copyright. All rights reserved

An environmental evaluation of food waste downstream management options: a hybrid LCA approach

Food waste treatment methods have been typically analysed using current energy generation conditions. To correctly evaluate treatment methods, they must be compared under existing and potential decarbonisation scenarios. This paper holistically quantifies the environmental impacts of three food waste downstream management options—incineration, composting, and anaerobic digestion (AD). Methods The assessment was carried out using a novel hybrid input–output-based life cycle assessment method (LCA), for 2014, and in a future decarbonised economy. The method introduces expanded system boundaries which reduced the level of incompleteness, a previous limitation of process-based LCA. Results Using the 2014 UK energy mix, composting achieved the best score for seven of 14 environmental impacts, while AD scored second best for ten. Incineration had the highest environmental burdens in six impacts. Uncertainties in the LCA data made it difficult determine best treatment option. There was significant environmental impact from capital goods, meaning current treatment facilities should be used for their full lifespan. Hybrid IO LCA’s included additional processes and reduced truncation error increasing overall captured environmental impacts of composting, AD, and incineration by 26, 10 and 26%, respectively. Sensitivity and Monte Carlo analysis evaluate the methods robustness and illustrate the uncertainty of current LCA methods. Major implication: hybrid IO-LCA approaches must become the new norm for LCA. Conclusion This study provided a deeper insight of the overall environmental performance of downstream food waste treatment options including ecological burdens associated with capital goods. Keywords Anaerobic digestion Incineration Composting Food waste Hybrid life cycle assessment Capital good

Landholder Typologies Used in the Development of Natural Resource Management Programs in Australia - A Review

This article reviews the literature on the identification of landholder typologies that can be used to assist the design and delivery of natural resource management (NRM) programs. Australian researchers have developed typologies of landholders based on a variety of criteria. The rationale for developing landholder typologies is first discussed before reviewing the various approaches that have been used by Australian researchers and comparing their findings. The methods employed have differed according to the theories used to guide the research and the 'clients' or 'sponsors' of the research. The landholder types they describe, however, have a number of similarities. These similarities suggest that the studies have identified the same fundamental divisions in the rural community, and that it may be possible to integrate landholder typologies for a variety of NRM and non-NRM applications. It is concluded that further research could usefully investigate whether concepts of social class or sub-cultures may be appropriate to define and describe the variations in landholder types

Cryo-EM model validation recommendations based on outcomes of the 2019 EMDataResource challenge

This paper describes outcomes of the 2019 Cryo-EM Model Challenge. The goals were to (1) assess the quality of models that can be produced from cryogenic electron microscopy (cryo-EM) maps using current modeling software, (2) evaluate reproducibility of modeling results from different software developers and users and (3) compare performance of current metrics used for model evaluation, particularly Fit-to-Map metrics, with focus on near-atomic resolution. Our findings demonstrate the relatively high accuracy and reproducibility of cryo-EM models derived by 13 participating teams from four benchmark maps, including three forming a resolution series (1.8 to 3.1 Å). The results permit specific recommendations to be made about validating near-atomic cryo-EM structures both in the context of individual experiments and structure data archives such as the Protein Data Bank. We recommend the adoption of multiple scoring parameters to provide full and objective annotation and assessment of the model, reflective of the observed cryo-EM map density