Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool

Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialling the CSNAT intervention, which involved two visits from care advisors (6–8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as “knowing what to expect in the future,” “knowing who to contact if concerned,” and “equipment to help care.” The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people with a motor neurone disease

Financial health indicators: an analysis of financial statement information to determine the financial health of DoD contractors

MBA Professional ReportPrior to awarding a contract, government contracting officers must be able to determine the financial health of prospective contractors. In fact, according to the Federal Acquisition Regulation (FAR) 9.104- 1(a), the very first general requirement to being considered a responsible prospective contractor is to show adequate financial resources to perform the contract or the ability to obtain financing. The purpose of this research is to identify a financial assessment framework that could assist DOD contracting officers with determining the financial health of potential DOD contractors. This research study may help DOD contracting officers determine the financial health of potential contractors prior to awarding a contract. The findings of this study provide a recommended framework that a contracting officer could follow in order to assess the financial health of a prospective contractor. The framework includes a ratio analysis using selected ratios compiled by this study, as well as a comparative analysis using industry average driven data. The framework also incorporates horizontal and vertical analyses, as well as bankruptcy and fraud analyses. The financial assessment framework created in this study is a comprehensive financial health assessment tool that can be utilized by DOD contracting officers.http://archive.org/details/financialhealthi1094551703Lieutenant Commander, United States NavyLieutenant, United States NavyLieutenant, United States NavyApproved for public release; distribution is unlimited

"It's making contacts" : notions of social capital and implications for widening access to medical education

Acknowledgements Our thanks to the Medical Schools Council (MSC) of the UK for funding Study A; REACH Scotland for funding Study B; and Queen Mary University of London, and to the medical school applicants and students who gave their time to be interviewed. Our thanks also to Dr Sean Zhou and Dr Sally Curtis, and Manjul Medhi, for their help with data collection for studies A and B respectively. Our thanks also to Dr Lara Varpio, Uniformed Services University of the USA, for her advice and guidance on collating data sets and her comments on the draft manuscript.Peer reviewedPublisher PD

Response of nuclear track detector CR-39 to low energy muons

The effectiveness of the PolyAllyl Diglycol Carbonate (PADC) etched solid state nuclear track detector (SSNTD), commonly known as CR-39, as a muon detector is assessed. CR-39 is successfully used to detect higher rest mass particles such as neutrons and protons, and is, for example, widely used in neutron dosimetry applications. CR-39 is generally accepted as being less suitable to detect lower rest mass particles such as muons, and especially electrons, due mostly to their reduced momenta and consequently, reduced stopping power. However, there has been some evidence that CR-39 may have application in the detection of cosmic ray muons. Monte Carlo simulations indicate that CR-39 can detect muons with energies up to 2.8 MeV. Experimental data to demonstrate the ability of CR-39 to detect muons was acquired using the MuSR spectrometer station at the ISIS Neutron and Muon Source. Pits deposited in CR-39 generated by positive muons from the beamline have been characterised and compared with pits deposited by protons and neutrons from other sources. The extent to which a CR-39 SSNTD can discriminate muons from particles with different momenta and rest masses is discussed

Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer

Introduction: The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome. Methods: Linked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons. Results: It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable. Conclusion: The results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required

Providing alcohol-related screening and brief interventions to adolescents through health care systems: Obstacles and solutions

Duncan Clark and Howard Moss identify obstacles to alcohol-related screening and treatment for adolescents and propose policy solutions

Recombination in West Nile Virus: minimal contribution to genomic diversity

Recombination is known to play a role in the ability of various viruses to acquire sequence diversity. We consequently examined all available West Nile virus (WNV) whole genome sequences both phylogenetically and with a variety of computational recombination detection algorithms. We found that the number of distinct lineages present on a phylogenetic tree reconstruction to be identical to the 6 previously reported. Statistically-significant evidence for recombination was only observed in one whole genome sequence. This recombination event was within the NS5 polymerase coding region. All three viruses contributing to the recombination event were originally isolated in Africa at various times, with the major parent (SPU116_89_B), minor parent (KN3829), and recombinant sequence (AnMg798) belonging to WNV taxonomic lineages 2, 1a, and 2 respectively. This one isolated recombinant genome was out of a total of 154 sequences analyzed. It therefore does not seem likely that recombination contributes in any significant manner to the overall sequence variation within the WNV genome