The evidence-base for stroke education in care homes

<b>Summary.</b> <b>Research questions:</b> 1. What are registered care home nurses’ educational priorities regarding stroke care? 2. What are senior care home assistants’ educational priorities regarding stroke care? 3. How do care home nurses conceive stroke care will be delivered in 2010? <b>Study design:</b> This was a 2-year study using focus groups, stroke guidelines, professional recommendations and stroke literature for the development of a questionnaire survey for data collection. Workshops provided study feedback to participants. Data were collected in 2005–2006. <b>Study site:</b> Greater Glasgow NHS Health Board. <b>Population and sample:</b> A stratified random selection of 16 private, 3 voluntary and 6 NHS continuing care homes from which a sample of 115 trained nurses and 19 senior care assistants was drawn. <b>Results:</b> The overall response rate for care home nurses was 64.3% and for senior care assistants, 73.6%. Both care home nurses and senior care assistants preferred accredited stroke education. Care home nurses wanted more training in stroke assessment, rehabilitation and acute interventions whereas senior care assistants wanted more in managing depression, general stroke information and communicating with dysphasic residents. Senior care assistants needed more information on multidisciplinary team working while care home nurses were more concerned with ethical decision-making, accountability and goal setting. <b>Conclusions:</b> Care home staff need and want more stroke training. They are clear that stroke education should be to the benefit of their resident population. Guidelines on stroke care should be developed for care homes and these should incorporate support for continuing professional learning in relation to the resident who has had a stroke

Stroke education for healthcare professionals: making it fit for purpose

<b>Research questions:</b> 1. What are healthcare professionals’ (HCPs) educational priorities regarding stroke care? 2. Do stroke care priorities vary across the primary and secondary sectors? 3. How do HCPs conceive stroke care will be delivered in 2010? <b>Study design:</b> This was a two-year study using focus groups and interviews for instrument development, questionnaires for data collection and workshops to provide study feedback. Data were collected in 2005–06. <b>Study site:</b> One Scottish health board. <b>Inclusion criteria:</b> All National Health Service healthcare professionals working wherever stroke care occurred. <b>Population and sample:</b> Participants were drawn from 4 university teaching hospitals, 2 community hospitals, 1 geriatric medicine day hospital, 48 general practices (GPs), 12 care homes and 15 community teams. The sample comprised 155 doctors, 313 nurses, 133 therapists (physiotherapists, occupational therapists, speech and language therapists), and 29 ‘other HCPs’ (14 dieticians, 7 pharmacists, 2 podiatrists and 6 psychologists). <b>Results:</b> HCPs prefer face-to-face, accredited education but blended approaches are required that accommodate uni- and multidisciplinary demands. Doctors and nurses are more inclined towards discipline-specific training compared to therapists and other healthcare professionals (HCPs). HCPs in primary care and stroke units want more information on the social impact of stroke while those working in stroke units in particular are concerned with leadership in the multidisciplinary team. Nurses are the most interested in teaching patients and carers. <b>Conclusions</b> Stroke requires more specialist stroke staff, the upskilling of current staff and a national education pathway given that stroke care is most effectively managed by specialists with specific clinical skills. The current government push towards a flexible workforce is welcome but should be educationally-sound and recognise the career aspirations of healthcare professionals

Developing and validating a predictive model for stroke progression

<p><b>Background:</b> Progression is believed to be a common and important complication in acute stroke, and has been associated with increased mortality and morbidity. Reliable identification of predictors of early neurological deterioration could potentially benefit routine clinical care. The aim of this study was to identify predictors of early stroke progression using two independent patient cohorts.</p> <p><b>Methods:</b> Two patient cohorts were used for this study – the first cohort formed the training data set, which included consecutive patients admitted to an urban teaching hospital between 2000 and 2002, and the second cohort formed the test data set, which included patients admitted to the same hospital between 2003 and 2004. A standard definition of stroke progression was used. The first cohort (n = 863) was used to develop the model. Variables that were statistically significant (p < 0.1) on univariate analysis were included in the multivariate model. Logistic regression was the technique employed using backward stepwise regression to drop the least significant variables (p > 0.1) in turn. The second cohort (n = 216) was used to test the performance of the model. The performance of the predictive model was assessed in terms of both calibration and discrimination. Multiple imputation methods were used for dealing with the missing values.</p> <p><b>Results:</b> Variables shown to be significant predictors of stroke progression were conscious level, history of coronary heart disease, presence of hyperosmolarity, CT lesion, living alone on admission, Oxfordshire Community Stroke Project classification, presence of pyrexia and smoking status. The model appears to have reasonable discriminative properties [the median receiver-operating characteristic curve value was 0.72 (range 0.72–0.73)] and to fit well with the observed data, which is indicated by the high goodness-of-fit p value [the median p value from the Hosmer-Lemeshow test was 0.90 (range 0.50–0.92)].</p> <p><b>Conclusion:</b> The predictive model developed in this study contains variables that can be easily collected in practice therefore increasing its usability in clinical practice. Using this analysis approach, the discrimination and calibration of the predictive model appear sufficiently high to provide accurate predictions. This study also offers some discussion around the validation of predictive models for wider use in clinical practice.</p&gt

Do woodland birds prefer to forage in healthy Eucalyptus wandoo trees?

Globally, many forests and woodlands are in decline. The marked loss of canopy foliage typical of these declines results in reduced foraging resources (e.g. nectar, pollen, and insects) and, subsequently, can reduce habitat quality for woodland birds. In south-west Western Australia, patches of Eucalyptus wandoo woodlands have shown a decline in condition since at least 2002. We investigated how changes in E. wandoo condition affect the woodland bird community. Foraging activities of three bird species were recorded for 20 sites in Dryandra State Forest and Wandoo Conservation Park either by conducting watches on focal trees ('sitting' method), or following individuals through the woodland ('following' method). Condition assessments of trees used by the birds were compared with those for trees available at the study site. Weebills (Smicrornis brevirostris; canopy insectivore) displayed preference for healthy trees (low amounts of canopy dieback), whereas rufous treecreepers (Climacteris rufa; bark-foraging insectivore) preferred trees with a higher proportion of dead branches. Yellow-plumed honeyeaters (Lichenostomus ornatus; insectivore/nectarivore) foraged in older, larger E. wandoo trees having full canopies with few signs of tree decline. Tree declines, such as that happening in E. wandoo, alter the foraging resources and habitat available to woodland birds

Novel resources: opportunities for and risks to species conservation

During the Anthropocene, ongoing rapid environmental changes are exposing many species to novel resources. However, scientists’ understanding of what novel resources are and how they impact species is still rudimentary. Here, we used a resource‐based approach to explore novel resources. First, we conceptualized novel resource use by species along two dimensions of novelty: namely, ecosystem novelty and resource novelty. We then examined characteristics that influence a species’ response to a novel resource and how novel resources can affect individuals, populations, species, and communities. In addition, we discuss potential management complications associated with novel resource use by threatened species. As conservation and management embrace global environmental change, it is critical that ecologists improve the current understanding of the opportunities and risks that novel resources present to species conservation

Gauge vs. Gravity mediation in models with anomalous U(1)'s

In an attempt to implement gauge mediation in string theory, we study string effective supergravity models of supersymmetry breaking, containing anomalous gauge factors. We discuss subtleties related to gauge invariance and the stabilization of the Green-Schwarz moduli, which set non-trivial constraints on the transmission of supersymmetry breaking to MSSM via gauge interactions. Given those constraints, it is difficult to obtain the dominance of gauge mediation over gravity mediation. Furthermore, generically the gauge contributions to soft terms contain additional non-standard terms coming from D-term contributions. Motivated by this, we study the phenomenology of recently proposed hybrid models, where gravity and gauge mediations compete at the GUT scale, and show that such a scenario can respect WMAP constraints and would be easily testable at LHC.Comment: 40 pages, 5 figure

F-theory, GUTs, and the Weak Scale

In this paper we study a deformation of gauge mediated supersymmetry breaking in a class of local F-theory GUT models where the scale of supersymmetry breaking determines the value of the mu term. Geometrically correlating these two scales constrains the soft SUSY breaking parameters of the MSSM. In this scenario, the hidden SUSY breaking sector involves an anomalous U(1) Peccei-Quinn symmetry which forbids bare mu and B mu terms. This sector typically breaks supersymmetry at the desired range of energy scales through a simple stringy hybrid of a Fayet and Polonyi model. A variant of the Giudice-Masiero mechanism generates the value mu ~ 10^2 - 10^3 GeV when the hidden sector scale of supersymmetry breaking is F^(1/2) ~ 10^(8.5) GeV. Further, the B mu problem is solved due to the mild hierarchy between the GUT scale and Planck scale. These models relate SUSY breaking with the QCD axion, and solve the strong CP problem through an axion with decay constant f_a ~ M_(GUT) * mu / L, where L ~ 10^5 GeV is the characteristic scale of gaugino mass unification in gauge mediated models, and the ratio \mu / L ~ M_(GUT)/M_(pl) ~ 10^(-3). We find f_a ~ 10^12 GeV, which is near the high end of the phenomenologically viable window. Here, the axino is the goldstino mode which is eaten by the gravitino. The gravitino is the LSP with a mass of about 10^1 - 10^2 MeV, and a bino-like neutralino is (typically) the NLSP with mass of about 10^2 - 10^3 GeV. Compatibility with electroweak symmetry breaking also determines the value of tan(beta) ~ 30 +/- 7.Comment: v3: 94 pages, 9 figures, clarification of Fayet-Polonyi model and instanton corrections to axion potentia

Analytical Results for Individual and Group Selection of Any Intensity

The idea of evolutionary game theory is to relate the payoff of a game to reproductive success (= fitness). An underlying assumption in most models is that fitness is a linear function of the payoff. For stochastic evolutionary dynamics in finite populations, this leads to analytical results in the limit of weak selection, where the game has a small effect on overall fitness. But this linear function makes the analysis of strong selection difficult. Here, we show that analytical results can be obtained for any intensity of selection, if fitness is defined as an exponential function of payoff. This approach also works for group selection (= multi-level selection). We discuss the difference between our approach and that of inclusive fitness theory