Defining the outcomes of community care: the perspectives of older people with dementia and their carers

There is growing recognition of the need for outcome measures which reflect the aims of services for people with dementia. The development and application of existing outcome measures has often marginalised people with dementia. ‘Experts’ and carers have been viewed as primary sources when identifying relevant outcomes or domains of quality of life, and proxy respondents have often been responsible for rating outcomes on the resulting measures. This paper reports a small consultation with people with dementia and their carers to identify the desired outcomes of community care. While there was considerable overlap in the outcomes identified by people with dementia and their carers, a number of limitations of relying solely on carers as proxy respondents were identified. A key outcome, which has been relatively neglected in previous work, was maximising a sense of autonomy. A range of outcomes related to the ways in which services are delivered were also identified. Future evaluative studies should encompass both quality-of-life outcomes and service-process outcomes (the impacts of the ways in which services are delivered) in addition to other outcome measures relevant to the aims and objectives of the service

The politics of commitment : The early new left in Britain 1956-1962.

SIGLELD:D48886/84 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

Background. Bloodstream infections (BSIs) cause considerable morbidity and mortality. The  epidemiology of bacterial infections differs in community and hospital settings. Regular surveillance and  reporting of pathogens and antimicrobial susceptibility can assist in appropriate management of BSIs.Objectives. To describe the distribution of organisms and of antibiotic susceptibility among isolates from blood cultures at a tertiary academic hospital during a 1-year period, stratifying by place of infection  acquisition.Methods. This was a retrospective descriptive study of bloodstream isolates from cultures from adults (>13 years of age) routinely submitted between 1 October 2011 and 30 September 2012 to the clinical  laboratory at Groote Schuur Hospital, Cape Town, South Africa. Community-acquired infections were compared with healthcare-acquired infections, defined as infections developing at least 48 hours after admission or within 3 months of admission to a healthcare facility. Frequencies and proportions of  infecting organisms are presented, along with susceptibility results for selected pathogens. The hospital-acquired isolates were stratified by ward (emergency, general medical or general surgical ward or intensive care unit (ICU)) to determine organism frequency and susceptibility patterns by hospital ward.Results. Among adults, 740 non-duplicate pathogens were isolated from BSIs. Nearly three-quarters of infections were healthcare acquired. Enterobacteriaceae and non-fermentative Gram-negative bacilli were predominant among healthcare-acquired pathogens (39.2% and 28.5%, respectively), while   Enterobacteriaceae and Gram-positive organisms were the most common among community-acquired pathogens (39.2% and 54.3%, respectively). The majority of community-acquired Enterobacteriaceae were highly susceptible to antibiotics (gentamicin 95.6%, ceftriaxone 96.1% and ciprofloxacin 92.2%),  whereas 64.6% of healthcare-associated isolates were susceptible to gentamicin, 58.5% to ceftriaxone and 70% to ciprofloxacin. All community-acquired Staphylococcus aureus isolates v. 52.4% of   healthcare-acquired isolates were susceptible to cloxacillin. The susceptibility of healthcare-acquired Pseudomonas aeruginosa and Acinetobacter baumanii complex isolates was <80% to all antibiotics with the exception of colistin. Klebsiella spp., S. aureus and Escherichia coli were the commonest causes of healthcareacquired infections in all areas outside of the ICUs, whereas Acinetobacter was common in the  ICUs and rare in all other areas.Conclusion. The distinction between community- and healthcare-acquired infections is critical in antibiotic selection because narrowspectrum agents can be utilised for community-acquired infections. The considerable antibiotic resistance of healthcare-acquired pathogens highlights the importance of infection prevention and control. This type of surveillance could be incorporated into routine laboratory practice

A methodology for quality control in cell nucleus segmentation

In order to achieve the very high accuracy rates required in unsupervised automated biomedical applications, it is often necessary to complement a successful segmentation algorithm with a robust error checking stage. The better the segmentation strategy, the less severe the error checking decisions need to be and the fewer correct segmentations that are discarded. These issues are dealt with in this paper in order to achieve 100% accuracy on a data set of 19946 cell nucleus images using an established segmentation scheme with a success rate of 99.47%. The method is based upon measuring changes in the final segmentation contour as the one parameter that governs its behaviour is varied. 1. Introduction remove potential artefacts based on shape and appearance that was capable of detecting some of the incorrectly segmented nuclei [9]. Nordin describes an algorithm that is able to report a failure at various levels of segmentation, as well as a separate artefact rejection stage [11]. McKenna used a neural network to preselect potential nuclei in scenes for subsequent segmentation. It was pointed out that a post-processing stage would also be necessary to filter out 'erroneously detected objects'[10]. A common trait in these techniques is the use of a separate process to view the output of the segmentation and to use shape and appearance measurements to classify the results as 'pass' (looks like a cell) or 'fail' (doesn't look like a cell). We have proposed a segmentation scheme that not only employs an algorithm with much better performance than previously reported [3], but also enables a confidence measure in the resulting segmentation to be given

Bayesian Analysis of Cell Nucleus Segmentation by a Viterbi Search Based Active Contour

An image segmentation scheme is shown to be exceptionally successful through the application of high-level knowledge of the required image objects (cell nuclei). By tuning the algorithm's single parameter, it is shown that the performance can be maximised for the dataset, but leads to individual failures that may require alternative choices. A second stage is introduced to process each of the resulting segmentations obtained by varying the parameter over the working range. This stage gives a Bayesian interpretation of the results which indicates the probable accuracy of each of the segmentations that can then be used to make a decision upon whether to accept or reject the segmentation

Method for Accurate Unsupervised Cell Nucleus Segmentation

To achieve the extreme accuracy rates demanded by applications in unsupervised automated cytology, it is frequently necessary to supplement the primary segmentation algorithm with a segmentation quality control system. The more robust the segmentation strategy, the less severe the data pruning need be at the segmentation validation stage. These issues are addressed as we describe our cell nucleus segmentation strategy which is able to achieve 100% accurate segmentation from a data set of 19946 cell nucleus images by automatically discarding the most difficult cell images. The automatic quality checking is applied to enhance the performance of a robust energy minimisation based segmentation scheme which already achieved a 99.47% accurate segmentation rate

A One-Pass Extended Depth of Field Algorithm Based on the Over-Complete Discrete Wavelet Transform

In this paper we describe an algorithm for extended depth of field (EDF) imaging based on the over-complete discrete wavelet transform (OCDWT). We extend previous approaches by describing a, potentially real-time, algorithm that produces the EDF image after a single pass through the "stack" of focal plane images. In addition, we specifically study the effect of over-sampling on EDF reconstruction accuracy and show that a small degree of over-sampling considerably improves the quality of the EDF image

Preliminary X-ray diffraction analysis of YqjH from Escherichia coli: a putative cytoplasmic ferri-siderophore reductase

YqjH is a cytoplasmic FAD-containing protein from Escherichia coli; based on homology to ViuB of Vibrio cholerae, it potentially acts as a ferri-siderophore reductase. This work describes its overexpression, purification, crystallization and structure solution at 3.0 A resolution. YqjH shares high sequence similarity with a number of known siderophore-interacting proteins and its structure was solved by molecular replacement using the siderophore-interacting protein from Shewanella putrefaciens as the search model. The YqjH structure resembles those of other members of the NAD(P)H:flavin oxidoreductase superfamily

The Tully-Fisher relation of intermediate redshift field and cluster galaxies from Subaru spectroscopy

We have carried out spectroscopic observations in 4 cluster fields using Subaru's FOCAS multi-slit spectrograph and obtained spectra for 103 bright disk field and cluster galaxies at $0.06 \le z \le 1.20$. Seventy-seven of these show emission lines, and 33 provide reasonably-secure determinations of the galaxies' rotation velocity. The rotation velocities, luminosities, colours and emission-line properties of these galaxies are used to study the possible effects of the cluster environment on the star-formation history of the galaxies. Comparing the Tully-Fisher relations of cluster and field galaxies at similar reshifts we find no measurable difference in rest-frame $B$-band luminosity at a given rotation velocity (the formal difference is $0.18\pm0.33$mag). The colours of the cluster emission line galaxies are only marginally redder in rest-frame $B-V$ (by $0.06\pm0.04$mag) than the field galaxies in our sample. Taken at face value, these results seem to indicate that bright star-forming cluster spirals are similar to their field counterparts in their star-formation properties. However, we find that the fraction of disk galaxies with absorption-line spectra (i.e., with no current star formation) is larger in clusters than in the field by a factor of $\sim3$--5. This suggests that the cluster environment has the overall effect of switching off star formation in (at least) some spiral galaxies. To interpret these observational results, we carry out simulations of the possible effects of the cluster environment on the star-formation history of disk galaxies and thus their photometric and spectroscopic properties. Finally, we evaluate the evolution of the rest-frame absolute $B$-band magnitude per unit redshift at fixed rotation velocity.Comment: 21 pages, 13 figures, accepted for publication in MNRA