Improving caregivers experience: enhancing end-of-life care for residents

Background: Global demographic changes are resulting in an ageing population with increasingly complex needs and comorbidities. The nursing home sector will increasingly play a critical role in the care of people at the end of life. Education for staff in this sector is variable in nature, with little evidence of its impact on practice. Practice development aims to enhance person-centred and evidence-informed cultures. Aim: To develop and evaluate participants’ palliative and end-of-life care knowledge, enabling them to develop and transform care practices in the homes. Methods: A practice development programme for registered nurses and care assistants in two nursing homes was undertaken. Evaluation data were collected at the start of the programme and six months after its completion, via focus groups, self-assessment, record reviews, reflective diaries, one-to-one manager interviews, and evaluations and notes from meetings and sessions. Data also informed activities within the programme and its evaluation. A creative hermeneutic approach was adopted for overall data analysis. Findings: The findings confirm the strength of adopting a practice development approach to underpin a staff education programme. Integrating registered nurses and care assistants in the learning environment enhanced working relationships and translated to a more healthful workplace culture and enhanced person-centred end-of-life care. Implications for practice: • Integrating practice development into staff education for nursing home staff is an effective means of developing their knowledge and skills and seeing this integrated into practice • As global demographics change, this sector will play a major role in end-of-life care, so a more systematic approach to the development of nursing home staff is required to enhance person-centred end-of-life care in this secto

Co-Prescribing Naloxone Policy for Chronic Pain Patients on Opioid Therapy

Opioid misuse and overdose related deaths are an escalating problem in the nation that crosses all gender, age, sociologic, economic, and race barriers. A private practice clinic treating chronic pain with opioid medication was the focus for a co-prescribing naloxone policy implementation. Over half of the patient sample was male, with an average age range of 51 to 60 years old and having obtained some level of college education. The purpose of the policy was to provide patient education regarding the risks of opioid medication, naloxone education, and to improve provider barriers in prescribing naloxone. The policy addressed this by removing the burden of risk stratification and applying the universal precautions model from infectious disease to chronic pain patients receiving opioid medications. Ultimately, the increased patient education did not have a significant impact on the number of patients choosing to fill the naloxone prescription. Future practice may include further examination of the patient barriers to filling the naloxone prescription and or including this in the narcotic contract to receive opioid medications to treat chronic pain.D.N.P

Place-based mapping with electric-acoustic stimulation

The goals of this dissertation were to understand the influence of electric frequency-to-place mismatches on the speech recognition of listeners of electric-acoustic stimulation (EAS) and whether listeners would experience better speech recognition with maps derived from a strict place-based mapping as compared to alternative mapping procedures. Current default EAS mapping procedures do not account for the individual variation in electrode array placement relative to cochlear tonotopicity, resulting in electric frequency-to-place mismatches. The strict place-based mapping procedure assigns the electric filter frequencies to match the cochlear place frequencies for electrodes in the low-to-mid frequency region and distributes the remaining high-frequency information across electrodes in the basal region. The rationales for this procedure are that eliminating mismatches will improve speech recognition since 1) critical speech information is provided by the mid-frequencies and 2) better spectral resolution of low-frequency cues may support better performance in noise. EAS simulation studies find acute masked speech recognition is significantly better with strict place-based maps as compared to maps with spectral shifts. For the present work, the first experiment evaluated the effectiveness of the strict place-based mapping procedure to an alternative full-frequency place-based mapping procedure using simulations of short electrode arrays at shallow angular insertion depths. Recipients of short arrays (e.g., ≤ 24 mm) may experience limited benefit with strict place-based maps since speech information below the frequency of the most apical electrode is discarded. The full-frequency place-based map would provide more low-frequency information yet present spectral shifts for the electrodes below the 1 kHz cochlear region. For the EAS simulations, performance with the strict map remained stable across cases, while performance with the full-frequency map improved with decreases in AID. The second experiment assessed the pattern of speech recognition acclimatization for EAS users listening with either a strict place-based map or default map. Poorer performance was observed for EAS users with larger magnitudes of electric mismatch out to 6-months post-activation. Taken together, the results from this dissertation suggest that eliminating electric frequency-to-place mismatches such as with the strict place-based mapping procedure supports better early speech recognition for EAS users than alternative mapping procedures.Doctor of Philosoph

Implementing biosecurity measures on dairy farms in Ireland

peer-reviewedDairy farms in Ireland are expanding in preparation for a new era of unrestricted milk production with the elimination of the European Union (EU) production quotas in 2015. Countries experiencing a changing agricultural demographic, including farm expansion, can benefit from documenting the implementation of on-farm biosecurity. The objectives of this study were to document and describe influences on biosecurity practices and related opinions on dairy farms. A representative response rate of 64% was achieved to a nationwide telesurvey of farmers. A 20% discrepancy was found between self-declared and truly ‘closed’ herds indicating a lack of understanding of the closed herd concept. Although >72% of farmers surveyed considered biosecurity to be important, 53% stated that a lack of information might prevent them from improving their biosecurity. Logistic regression highlighted regional, age, and farm-size related differences in biosecurity practices and opinions towards its implementation. Farmers in the most dairy cattle dense region were three times more likely to quarantine purchased stock than were their equivalents in regions where dairy production was less intense (P = 0.012). Younger farmers in general were over twice as likely as middle-aged farmers to implement biosecurity guidelines (P = 0.026). The owners of large enterprises were almost five times more likely to join a voluntary animal health scheme (P = 0.003), and were over three times more likely to pay a premium price for health accredited animals (P = 0.02) than were those farming small holdings. The baseline data recorded in this survey will form the basis for more detailed sociological and demographic research which will facilitate the targeting of future training of the farming community in biosecurity

A study of the vitamin A content of colostrum and milk of dairy cows

Typescript, etc

Treatment of bullous pemphigoid with dupilumab: A case report

Introduction: Bullous Pemphigoid (BP) is an autoimmune blistering condition that results from formation of autoantibodies against basement membrane hemidesmosome proteins, specifically BP180 and BP230. Classic BP presents as pruritic, tense blisters on the trunk and extremities, most commonly in the elderly. BP’s pathophysiology involves IL4/IL5/IL13 and eosinophils. Dupilumab is an IgG monoclonal antibody targeted at the IL4-α receptor that works to attenuate the IL4/IL13 pathway involved in T2 differentiation. Dupilumab has clinical applications for T2 mediated disease and shows promise in the therapy of BP. Case Description: We report a case of an 83-year-old Asian male who presented in the spring of 2019 with a chief complaint of blistering lesions accompanied by significant pruritus. Medical history was positive for hypertension controlled on amlodipine and losartan and hypercholesterolemia not on any medical therapy. Past medical history and family history were negative for any autoimmune or skin disorders. Tense bullae were noted in the arm, hands, thighs, feet, groin and the head. The blistering rash appeared to be urticarial lesions which were unresponsive to prednisone therapy. Hypersensitivity reaction and drug eruption were suspected. Initial biopsy revealed spongiotic dermatitis with eosinophilic spongiosis and there was suggestion of BP. A diagnosis of BP was later confirmed on a second biopsy via direct immunofluorescence. Initial treatment with oral prednisone and doxycycline 100mg bid, topical 0.1% triamcinolone bid and topical 1% silver sulfadiazine was unsuccessful. Every time prednisone was tapered the patient would have flares of new blisters. Sarna was used for managing pruritus. Mycophenolate mofetil (1g BID) and dapsone (25 mg BID and eventually 2x25mg tablets, BID) were attempted but gradually discontinued because of significant neuropathy and paresthesias. 5 rounds of Gamunex IVIG (2 gm/kg per cycle) were conducted in 2020 without significant relief. The patient also failed to respond to three rounds of rituximab therapy (1000 cc over 6 hours) that took place in the months of January, February and September of 2022. The patient was then tried on Dupilumab therapy and after a 600mg dose at day 0 and a 300 mg dose delivered two weeks later, there was a clinically significant improvement with no new flares. The patient remains on concomitant oral doxycycline (100 mg) once daily and topical 0.1% triamcinolone as needed. The patient denies any adverse drug reactions with the new addition of Dupilumab and is continuing therapy with biweekly 300 mg injections. Discussion: Bullous Pemphigoid is an autoimmune blistering disease with variable responses to standard therapies. Our case and the literature have shown promising therapeutic results with the use of Dupilumab in treatment resistant BP

Effects of cochlear implantation on binaural hearing in adults with unilateral hearing loss

A FDA clinical trial was carried out to evaluate the potential benefit of cochlear implant (CI) use for adults with unilateral moderate-to-profound sensorineural hearing loss. Subjects were 20 adults with moderate-to-profound unilateral sensorineural hearing loss and normal or near-normal hearing on the other side. A MED-EL standard electrode was implanted in the impaired ear. Outcome measures included: (a) sound localization on the horizontal plane (11 positions, −90° to 90°), (b) word recognition in quiet with the CI alone, and (c) masked sentence recognition with the target at 0° and the masker at −90°, 0°, or 90°. This battery was completed preoperatively and at 1, 3, 6, 9, and 12 months after CI activation. Normative data were also collected for 20 age-matched control subjects with normal or near-normal hearing bilaterally. The CI improved localization accuracy and reduced side bias. Word recognition with the CI alone was similar to performance of traditional CI recipients. The CI improved masked sentence recognition when the masker was presented from the front or from the side of normal or near-normal hearing. The binaural benefits observed with the CI increased between the 1- and 3-month intervals but appeared stable thereafter. In contrast to previous reports on localization and speech perception in patients with unilateral sensorineural hearing loss, CI benefits were consistently observed across individual subjects, and performance was at asymptote by the 3-month test interval. Cochlear implant settings, consistent CI use, and short duration of deafness could play a role in this result

The 2011 Eruption of the Recurrent Nova T Pyxidis; the Discovery, the Pre-eruption Rise, the Pre-eruption Orbital Period, and the Reason for the Long Delay

We report the discovery by M. Linnolt on JD 2455665.7931 (UT 2011 April 14.29) of the sixth eruption of the recurrent nova T Pyxidis. This discovery was made just as the initial fast rise was starting, so with fast notification and response by observers worldwide, the entire initial rise was covered (the first for any nova), and with high time resolution in three filters. The speed of the rise peaked at 9 mag/day, while the light curve is well fit over only the first two days by a model with a uniformly expanding sphere. We also report the discovery by R. Stubbings of a pre-eruption rise starting 18 days before the eruption, peaking 1.1 mag brighter than its long-time average, and then fading back towards quiescence 4 days before the eruption. This unique and mysterious behavior is only the fourth known anticipatory rise closely spaced before a nova eruption. We present 19 timings of photometric minima from 1986 to February 2011, where the orbital period is fast increasing with P/dot{P}=313,000 yrs. From 2008-2011, T Pyx had a small change in this rate of increase, so that the orbital period at the time of eruption was 0.07622950+-0.00000008 days. This strong and steady increase of the orbital period can only come from mass transfer, for which we calculate a rate of 1.7-3.5x10^-7 Mo/yr. We report 6116 magnitudes between 1890 and 2011, for an average B=15.59+-0.01 from 1967-2011, which allows for an eruption in 2011 if the blue flux is nearly proportional to the accretion rate. The ultraviolet-optical-infrared spectral energy distribution is well fit by a power law with flux proportional to nu^1.0, although the narrow ultraviolet region has a tilt with a fit of \nu^{1/3}. We prove that most of the T Pyx light is not coming from a disk, or any superposition of blackbodies, but rather is coming from some nonthermal source.Comment: ApJ submitted, 62 pages, 8 figures; much added data, updated analysi

Effects of age at cochlear implant activation on auditory skill development for children with congenital deafness

The development of auditory skills is a precursor to the development of spoken language. The purpose of this study was to investigate the impact of age at cochlear implant (CI) activation on the trajectory of auditory skill acquisition in children with congenital deafness. A retrospective review of Functional Listening Index (FLI)1 scores for children who received a CI before 3 years of age showed that children activated early, specifically before 9 months of age, demonstrated a steeper trajectory of auditory skill development and achieved the number of auditory skills expected of children with normal hearing by 2 years of age