Dementia Care Mapping and Patient-Centred Care in Australian residential homes: An economic evaluation of the CARE Study, CHERE Working Paper 2008/4

Background: As the population ages, the incidence of dementia and its burden on society will increase. The economic costs of dementia are high, particularly for persons in the mid and late stages of the disease, when formal care arrangements such as nursing home placement are required. The need for care is often precipitated by the development of behavioural and psychological symptoms of dementia (BPSD) which also severely affect the quality of life of affected persons and their carers The Caring for Aged-Care REsident Study (CARES), the first randomised controlled trial to evaluate Dementia Care Mapping (DCM) and Person Centred Care (PCC), demonstrated that either of the two interventions improved outcomes compared to Usual Care (UC) on the primary outcome measure, the Cohen-Mansfield Agitation Inventory (CMAI). This study reports the results of an economic evaluation which was undertaken in conjunction with the trial. This information will provide additional information to assist policy makers in making choices between competing options. Methods: Fifteen nursing homes were randomised to one of three conditions: DCM, PCC or Usual Care (UC). The sample consisted of 360 residents with dementia. Data were collected at baseline, three months, and eight months by assessors blind to group assignment. In addition to the CMAI, data were collected about the use and costs of health care resources and pharmacological interventions. Total costs associated with each of the interventions were estimated, which were contrasted with the outcomes using standard health economics methodology. Results: Over one year, the cost per residential setting of implementing DCM and PCC relative to UC was $10,034 and$2,250 respectively. The additional cost per resident-level unit improvement in CMAI post-intervention (at follow-up) relative to UC was $48.95 ($46.89) for DCM and $8.01 ($6.43) for PCC. Compared to DCM, PCC produced a greater reduction in anxiety and agitation at a lower cost. Therefore, DCM was dominated by PCC and removed from the economic evaluation. Sensitivity analysis suggests this result is robust to changing model parameters. Conclusions: PCC provides a greater decrease in agitation and related behavioural and psychological symptoms of dementia, compared with DCM, at a lower cost and is the preferred option for cost-effectiveness. While there is no existing standard for a reasonable cost for a point improvement in CMAI, the cost per unit under PCC seems acceptable.Dementia, patient centred care

Superconducting Diamond on Silicon Nitride for Device Applications

Chemical vapour deposition (CVD) grown nanocrystalline diamond is an attractive material for the fabrication of devices. For some device architectures, optimisation of its growth on silicon nitride is essential. Here, the effects of three pre-growth surface treatments, often employed as cleaning methods of silicon nitride, were investigated. Such treatments provide control over the surface charge of the substrate through modification of the surface functionality, allowing for the optimisation of electrostatic diamond seeding densities. Zeta potential measurements and X-ray photoelectron spectroscopy (XPS) were used to analyse the silicon nitride surface following each treatment. Exposing silicon nitride to an oxygen plasma offered optimal surface conditions for the electrostatic self-assembly of a hydrogen-terminated diamond nanoparticle monolayer. The subsequent growth of boron-doped nanocrystalline diamond thin films on modified silicon nitride substrates under CVD conditions produced coalesced films for oxygen plasma and solvent treatments, whilst pin-holing of the diamond film was observed following RCA-1 treatment. The sharpest superconducting transition was observed for diamond grown on oxygen plasma treated silicon nitride, demonstrating it to be of the least structural disorder. Modifications to the substrate surface optimise the seeding and growth processes for the fabrication of diamond on silicon nitride devices

Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial

Background: Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational. We aimed to do a large, randomised comparison of person-centred care, dementia-care mapping, and usual care. Methods: In a cluster randomised controlled trial, urban residential sites were randomly assigned to person-centred care, dementia-care mapping, or usual care. Carers received training and support in either intervention or continued usual care. Treatment allocation was masked to assessors. The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory (CMAI). Secondary outcomes included psychiatric symptoms including hallucinations, neuropsychological status, quality of life, falls, and cost of treatment. Outcome measures were assessed before and directly after 4 months of intervention, and at 4 months of follow-up. Hierarchical linear models were used to test treatment and time effects. Analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12608000084381. Findings: 15 care sites with 289 residents were randomly assigned. Pairwise contrasts revealed that at follow-up, and relative to usual care, CMAI score was lower in sites providing mapping (mean difference 10·9, 95% CI 0·7-21·1; p=0·04) and person-centred care (13·6, 3·3-23·9; p=0·01). Compared with usual care, fewer falls were recorded in sites that used mapping (0·24, 0·08-0·40; p=0·02) but there were more falls with person-centred care (0·15, 0·02-0·28; p=0·03). There were no other significant effects. Interpretation: Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care. Funding: Australian Health Ministers' Advisory Council

Smart-fish system for fresh fish cold chain transportation - Overall approach and selection of sensor materials

This paper gives and overview of Cold Chain temperature measuring solutions available on a commercial market and introduces an approach of building a smart system for fresh fish transportation, called Smart-Fish. The system measurement ability ranges beyond a temperature measurement. It also features a GPS-based tracking and may be equipped with other types of sensors. A great domain-specific applicability for real-time measures and potentially low production cost stands the system out of crowd of similar solutions. Printed electronics technologies were utilised for temperature sensor, the key element of the system. The paper describes a set of requirements, results of material tests and final selection of material for this element

An exploratory research of the usage level of e-commerce among SMEs in the west coast of Malaysia

Previous studies have indicated that e-commerce development offers a promising way for business to meet the challenges of the ever-changing environment. It provides effective and efficient ways, such as buyers can gather information rapidly about the availability of the products or services, evaluate, or negotiate with vendors. However, previous studies on Small and Medium Enterprises (SMEs) in Malaysia have shown that the application of e-commerce is still at its infancy. Thus, this study investigates the usage level of e-commerce application for the SMEs in West Coast of Sabah, Malaysia. This achieved by circulating a set of questionnaire to examine the awareness and adoption of e-commerce application by the SMEs, and recognize the impeding factors to adopt e-commerce and the perception of e-commerce benefits towards incorporating ecommerce in their business. The study found that the awareness and adoption level among the SMEs are still in its infancy, although the potential benefits were perceived to be important

Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain

Background: A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses. Methods: Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority. Results: Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts. Conclusions: Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public healt

Seminario-taller: biología de epífitas, sus funciones y servicios ecosistémicos.

Las comunidades de epífitas vasculares y no vasculares representan un componente importante en varios ecosistemas tropicales, la carga o abundancia de epífitas vasculares en el dosel del bosque puede causar altas tazas de caídas de árboles o ramas. En este estudio se compara la abundancia de epífitas en ramas caídas para cuatro sitios en Chiriquí, Panamá. En cada sitio se establecieron cuadrantes de 10 x 5 m donde se tomaron datos de abundancia en ramas caídas. Los resultados señalan que las epífitas no vasculares son más abundantes que las epífitas vasculares para todos los sitios, el índice de Shannon y Simpson demuestran que Chorro Blanco es más diverso que los demás sitios. Los análisis de similaridad (ANOSIM) y el análisis de multivariantes (PERMANOVA) indican que el sitio y la altura influyen sobre la composición de las comunidades. Grupos funcionales como los helechos, bromeliáceas, musgos, hepáticas, líquenes foliosos y fruticulosos son más abundantes para sitios de elevaciones altas. Se concluye que a medida que decrece la altitud sobre el nivel del mar, la abundancia de epífitas también lo hace. Factores como la humedad, disponibilidad de luz entre otros elementos climáticos asociados a la altitud, podrían influir significativamente sobre la diversidad de las comunidades epífitas de los diferentes sitios

Co-design of a neurodevelopment assessment scale : a study protocol

Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., ‘social validity’), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual’s unique profile in a holistic and efficient manner

Optimización Educativa de la Pliometría para Mejorar Patadas en Deportistas de Artes Marciales Mixtas.

For this investigation, a study was carried out whose purpose was to determine the incidence of a plyometric program and how it will help to improve the strength of low, medium and high kicks, it is a quasi-experimental investigation in which 11 mixed martial arts athletes participated. from the Striking Lab academy in the city of Riobamba, to whom a pre-test was applied using the My Jump 2 research instrument, which is a mobile application that measures jump height, strength, speed, power, time of contact, strength and speed profile, the same as average their strength levels in lower limbs. After the application of the plyometric program, the post-test was taken, yielding favorable results in the investigation, such as the increase in strength, power and height of the athletes. Therefore, it is concluded that well-guided training and with new forms of application, in this case, plyometric training, significantly helps lower limb strength and also strength in low, medium and high kicks. Plyometrics is a training method which helps to enhance the physical abilities of athletes regardless of the sport in which this training method is used.Para esta investigación se realizó un estudio cuyo propósito fue determinar la incidencia de un programa pliométrico y como este ayudara al mejoramiento y fuerza de patadas bajas, medias y altas, es una investigación de tipo cuasi experimental en la cual participaron 11 deportistas de artes marciales mixtas de la academia Striking Lab de la cuidad de Riobamba, a quienes se les aplico un pre-test mediante el instrumento de investigación My Jump 2, la cual es una aplicación móvil que mide la altura de salto, fuerza, velocidad, potencia, tiempo de contacto, perfil de fuerza y velocidad, misma que medio sus niveles de fuerza en miembros inferiores. Después de la aplicación del programa pliométrico se procedió a la toma del post test, arrojando resultados favorables en la investigación como fueron el aumento de la fuerza, de la potencia y de la altura de los deportistas. Por lo tanto, se concluye concluir que el entrenamiento bien guiado y con nuevas formas de aplicación en este caso un entrenamiento pliométrico ayuda de manera significativa a la fuerza en miembros inferiores y también a la fuerza en patadas bajas, medias y altas. La pliometría es un método de entrenamiento el cual ayuda a potenciar las capacidades físicas de los deportistas independientemente del deporte en el cual se utilice este método de entrenamiento