Imaginative anticipation: Towards a theology of care for those with dementia

Dementia is a degenerative disease which appears to take away personhood and identity and calls into question how we understand what it means to be a person. My argument is that how people with dementia are seen and imagined is key both to the understanding of their value and the care that is offered. The aim of this study is to determine how the Christian ethos of Methodist Homes (MHA) influences the care of people with dementia in order to develop a general theology of care from within practical theology. The thesis explores the ways in which the Methodist emphases of social justice and prevenient grace offer a basis for dementia care, and how MHA has drawn on its origins within the Methodist Church to develop an ethos of care that places respect for the person with dementia at the centre. This concern for those with dementia is then surveyed and the themes of respect and relationality emerge offering the potential for human becoming. Within MHA the care offered is based on a person-centred model. In order to discover how the Christian ethos of the organisation influences care this thesis explores patterns of delivering care in three homes of each of three types; well-established, recently-acquired and new-build. In each home the views of the staff were surveyed. Three in-depth interviews were conducted when questions were asked in order to understand their perception of the person with dementia. The interviews uncovered what carers regarded as good care and when care did not meet the needs, and why they believed that happened. Browning’s ‘strategic practical theology’ was used to evaluate these findings from within a Christian context to examine the influence of MHA’s ethos on the care offered. The core value chosen as the most important for care was ‘respect’; and while the care offered across all types was ‘person-centred’ the way it was delivered varied. The culture of MHA that gave rise to the values is investigated, along with the challenge of retaining ‘mutuality’ as an ideal as the needs of older people changed. The themes that emerged were those around quality of life and the things that enable the change in thinking from basic ‘caring’ to ‘caring for the person’ as the person is seen in a different way. Dementia is sometimes called the ‘theological disease’, and this understanding of dementia and the person is explored to discern what can be offered from theology to the best ideals of care in order to provide true person-centred care that is respectful of the person. I argue from within practical theology that a new way of seeing the person with dementia is needed in order to anticipate the possibility for human flourishing that is possible in a person, even in dementia. And that, offered with respect, good person-centred dementia-care can be a sign of the Kingdom. Part 1 of the D.Prof. comprises four sections in which I explore dementia from within practical theology; how it impacts on personhood, how I, as a practitioner within Methodist Homes (MHA), could enable others to offer care of the whole person; and how the carers’ understanding of the person makes a difference. In the first section, the literature was surveyed in order to discover the historical development of the term dementia. Until the middle of the twentieth century, there was little care as the condition was not named. But then drugs were discovered that could control unsocial behaviour, and the medical model of care developed. However, a new culture of care developed (person-centred care), because of the better understanding of the social nature of the disease. From within the context of theology, I explored how personhood can be understood within dementia and how, even in dementia, it might be possible to grow into the fullness of Christ as spirituality is enhanced. The second section was in the form of a publishable article which explored how it might be possible to evaluate spiritual care within a dementia-care setting. This took the form of a case study in which I worked with staff in a home that had difficulty evidencing spiritual care. It raised issues about the nature of care and assessment of spiritual care, as well as the rationale behind, and the delivery of, that care. What developed used the biblical concept of ‘fruits of the spirit’ as a way of recognising spiritual dis-ease as it is these qualities which enable inspiration, reverence, awe, meaning and purpose even in those who have no religious beliefs. The model used to offer this care was through the 3 R’s of reflection, relationship and restoration. Section three, reflective-practice section, emerged out of my practice as a chaplaincy adviser for MHA, in which I reflected critically on the contexts and understanding of the manager and chaplain, and how a chaplaincy manual was developed. The ability of the chaplain to work effectively and enable good spiritual care in the home, depended on the relationship between the manager and chaplain. By exploring the culture of both manager and chaplain, a way to enable good communication was discovered. The role of pastoral care and how it is seen within an organisation, that must have a professional management, was investigated and ways suggested for mutual understanding using the chaplaincy manual. The last section examined whether the Christian ethos of MHA encouraged a model of person-centred care. I suggested that a way of making sense of the data is by using types to describe personhood and how that can be made visible by their care. Considering the way that therapeutic interventions (reminiscence therapy, reality orientation, validation therapy, drug therapy) were used offered a way to enable the ethos of the home to be seen more clearly. Central to theological anthropology is the concept of the person which includes an ethical dimension. MHA has the strap line, ‘care informed by Christian concern’, so the study investigated whether this Christian ethos is lived out in the care offered. These aspects of study have led me to begin this thesis to research how care is delivered and what carers understand to be appropriate care. An appreciation of the context in which this care takes place also highlighted a need to conduct a theological exploration of the nature of the person with dementia

Fiction services

It is perhaps surprising to find a chapter on fiction services in a book primarily concerned with considering the information needs of community groups. It is certainly challenging to try and shift the emphasis when looking at community information services, that is, to focus on the 'community' rather than the 'information' aspects of the service. The aim of this chapter is to illustrate that the public library fiction services can, and do, make a positive impact on the local community, particularly, but not exclusively, on those members who have special needs

Determination of DiazaCon in Quail Feed and Quail Serum by Ion Pair Reversed-Phase Chromatography

Liquid chromatographic (LC) methods were developed for quantitating the potential avian contraceptive DiazaCon in quail feed and serum. DiazaCon was extracted from ground quail feed with basic n-butyl chloride. The n-butyl chloride extract was evaporated to dryness. The DiazaCon residues were dissolved in an aqueous methanolic ion pairing solution and quantitated by LC at 206 nm. Avian sera was combined with an equal volume of a pH 4 aqueous solution of ion pairing reagent and filtered to remove interfering proteins. DiazaCon was quantitated by LC. Mean recoveries for 500 and 2000 ppm fortified feed were 89.1 and 91.0%, respectively. The mean recovery for sera fortified at 5 levels ranging from 35 to 2000 ppm was 84.9%. Method limits of detection were approximately 14 and 13 ppm for feed and sera, respectively

Evaluation of Bird Shield as a blackbird repellent in ripening rice and sunflower fields

Chemical repellents sometimes can provide a nonlethal alternative for reducing wildlife impacts to agricultural production. In late summer and autumn 2002, we evaluated Bird Shield™ (active ingredient: methyl anthranilate, Bird Shield Repellent Corporation, Spokane, Wash.) as a blackbird (Icteridae) repellent in Missouri rice fields and North Dakota sunflower fields. We selected 5 pairs of ripening rice fields in southeastern Missouri and randomly allocated treatments (treated and control) within pairs. The repellent was aerially applied by fixed-winged aircraft at the recommended label rate and volume (1.17 L Bird Shield/ha and 46.7 L/ha, respectively); 1 field received 2X the label rate. We observed no difference in average bird activity (birds/minute) between treated and control fields over the 3-day posttreatment period (P = 0.503). We used reversed-phase liquid chromatography to quantify methyl anthranilate residues in treated fields. The maximum concentration of methyl anthranilate in rice samples was 4.71 μg/g. This concentration was below reported threshold values that irritate birds. In North Dakota we selected 6 pairs of sunflower fields used by foraging blackbirds. We randomly selected 1 field from each pair for 2 aerial applications of Bird Shield at the label-recommended rate ~1 week apart. The remaining 6 fields served as controls. Daily bird counts, starting the first day of application and continuing for 5–7 days after the second application, showed similar numbers of blackbirds within treated and control fields (P = 0.964). We observed no difference in sunflower damage within treated and control fields (P = 0.172) prior and subsequent to the treatment. Bird Shield was not effective for repelling blackbirds from ripening rice and sunflower fields

Evaluation of Bird Shield as a blackbird repellent in ripening rice and sunflower fields

Chemical repellents sometimes can provide a nonlethal alternative for reducing wildlife impacts to agricultural production. In late summer and autumn 2002, we evaluated Bird Shield™ (active ingredient: methyl anthranilate, Bird Shield Repellent Corporation, Spokane, Wash.) as a blackbird (Icteridae) repellent in Missouri rice fields and North Dakota sunflower fields. We selected 5 pairs of ripening rice fields in southeastern Missouri and randomly allocated treatments (treated and control) within pairs. The repellent was aerially applied by fixed-winged aircraft at the recommended label rate and volume (1.17 L Bird Shield/ha and 46.7 L/ha, respectively); 1 field received 2X the label rate. We observed no difference in average bird activity (birds/minute) between treated and control fields over the 3-day posttreatment period (P = 0.503). We used reversed-phase liquid chromatography to quantify methyl anthranilate residues in treated fields. The maximum concentration of methyl anthranilate in rice samples was 4.71 μg/g. This concentration was below reported threshold values that irritate birds. In North Dakota we selected 6 pairs of sunflower fields used by foraging blackbirds. We randomly selected 1 field from each pair for 2 aerial applications of Bird Shield at the label-recommended rate ~1 week apart. The remaining 6 fields served as controls. Daily bird counts, starting the first day of application and continuing for 5–7 days after the second application, showed similar numbers of blackbirds within treated and control fields (P = 0.964). We observed no difference in sunflower damage within treated and control fields (P = 0.172) prior and subsequent to the treatment. Bird Shield was not effective for repelling blackbirds from ripening rice and sunflower fields

Salivary immunoglobulin free light chains: reference ranges and responses to exercise in young and older adults

Background: Free light chains (FLCs) have a range of biological functions and may act as a broad marker of immune suppression and activation and inflammation. Measurement of salivary FLCs may provide practical advantages in a range of clinical populations. The aim of the present study was to develop normal reference ranges of FLCs in saliva and assess the effects of acute exercise on FLC levels in younger and older adults. Methods: Saliva FLC concentrations and secretion rates were measured in young (n = 88, aged 18-36) and older (n = 53, aged 60-80) adults. To assess FLC changes in response to acute exercise, young adults completed a constant work-rate cycling exercise trial at 60% VO 2max (n = 18) or a 1 h cycling time trial (TT) (n = 10) and older adults completed an incre-mental submaximal treadmill walking exercise test to 75% HR max (n = 53). Serum FLCs were measured at baseline and in response to exercise. Results: Older adults demonstrated significantly higher levels of salivary FLC parameters compared with young adults. Median (5-95 th percentile) concentrations were 0.45 (0.004-3.45) mg/L for kappa and 0.30 (0.08-1.54) mg/L for lambda in young adults; 3.91 (0.75-19.65) mg/L for kappa and 1.00 (0.02-4.50) mg/L for lambda in older adults. Overall median concentrations of salivary kappa and lambda FLCs were 10-fold and 20-fold lower than serum, respectively. Reductions in salivary FLC concentrations and secretion rates were observed immediately post-and at 1 h post exercise, but were only significant for the older cohort; FLCs began to recover between post and 1 h post-exercise. No changes in serum FLCs were observed in response to exercise. Conclusions: The ability to assess FLCs in saliva and the reference ranges provided will likely broaden the use of this biomarker in healthy and clinical populations. The elevated salivary FLCs in older adults may relate to a deterioration of oral health and be important in the context of inflammatory processes and diseases associated with ageing. Exercise did not affect serum FLCs, but reduced salivary FLCs, most notably in older adults, which may reflect reduced transport of FLCs from serum into saliva

Investigating the utility of saliva immunoglobulins for the detection of myeloma and using myeloma proteins to clarify partition between oral and systemic immunity

OBJECTIVES Myeloma is characterised by the presence of monoclonal immunoglobulin (M-protein) and the free light chain (FLC) in blood. We investigated whether these M-proteins and FLC are detectable in myeloma patients' saliva to evaluate its utility for non-invasive screening and monitoring of haematological malignancies. METHODS A total of 57 patients with monoclonal gammopathy and 26 age-matched healthy participants provided paired serum and saliva samples for immunoglobulin characterisation and quantification. RESULTS Myeloma patients had IgG or IgA M-protein levels ranging up to five times and FLC levels up to a thousand times normal levels of polyclonal immunoglobulins. Despite these highly elevated levels, only two IgG and no IgA M-proteins or FLC could be detected in paired saliva samples. Most patients had reduced levels of serum polyclonal immunoglobulins, but all had normal levels of salivary IgA. CONCLUSIONS Immunoglobulin transfer from blood is not determined by levels in the systemic circulation and more likely dictated by periodontal inflammation and the integrity of the oral epithelium. Immunoglobulins secreted by bone marrow plasma cells do not substantially enter saliva, which represents a poor medium for myeloma diagnosis. These findings, along with normal salivary IgA levels despite systemic immunoparesis, support a strong partitioning of oral from systemic humoral immunity