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

Development data bases: use in Canada via MINISIS

Meeting: American Society for Information Sciences Western Canada Chapter, Annual Meeting, 14th, 22-25 Sept. 1982, Vancouver, B.C., C

Development data bases: use in Canada via MINISIS

Meeting: American Society for Information Sciences Western Canada Chapter, Annual Meeting, 14th, 22-25 Sept. 1982, Vancouver, B.C., C

Medical Device Design Education: Identifying Problems Through Observation and Hands-On Training

Experiential learning, which may include hands-on learning paired with observation and reflection, has been applied in several industries; however, the impact of experiential learning in design education is not well known. We investigated how the type of simulation-based learning could affect the acquisition of knowledge and the ability to synthesize that understanding into insights for medical design innovation. One workshop included observational learning and the other experiential learning with hands-on training. Each course included 14-16 multidisciplinary undergraduate and graduate students. During both workshops, we measured student comprehension of two procedures— infant resuscitation and management of maternal hemorrhage. We focused on the first two phases of design thinking: “Understanding” and “Defining the Problems”. Although the course focused on “medical device design”, we encouraged students to look beyond the tool to imagine how their design change could impact the entire system. We did not find a significant difference between the scores given to students in the two courses by industry experts. Although the quality of the ideas and execution were similar between both workshops, the instructors noticed that the integration of hands-on training into the second workshop created a higher level of excitement in the class. The methodology and the approach adopted may be relevant to many design problems. In order to better understand the impact of observational learning versus hands-on training, both workshops could be expanded into full quarter classes that allow students to expand their design thinking skills to prototype and test their ideas in the real world

High-precision determination of lithium and magnesium isotopes utilising single column separation and multi-collector inductively coupled plasma mass spectrometry

Li and Mg isotopes are increasingly used as a combined tool within the geosciences. However, established methods require separate sample purification protocols utilising several column separation procedures. This study presents a single-step cation-exchange method for quantitative separation of trace levels of Li and Mg from multiple sample matrices

Catalytic stereoselective [2,3]-rearrangement reactions

The authors thank the Royal Society for a University Research Fellowship (A.D.S.), the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007-20013) ERC Grant Agreement No. 279850 (J.E.T., T.H.W., K.K.), and the European Union (Marie Curie ITN ‘SuBiCat’ PITN-GA-2013-607044) (S.S.M.S.) for financial support.[2,3]-Sigmatropic rearrangement processes of allylic ylides or their equivalents can be applied to a variety of different substrates and generate products of wide interest and applicability to organic synthesis. This review describes the development and applications of stereoselective [2,3]-rearrangement reactions in which a sub-stoichiometric amount of a catalyst is used in either the formation of the reactive intermediate or the [2,3]-rearrangement step itself.PostprintPeer reviewe

DNA barcoding uncovers cryptic diversity in 50% of deep-sea Antarctic polychaetes

The Antarctic marine environment is a diverse ecosystem currently experiencing some of the fastest rates of climatic change. The documentation and management of these changes requires accurate estimates of species diversity. Recently, there has been an increased recognition of the abundance and importance of cryptic species, i.e. those that are morphologically identical but genetically distinct. This article presents the largest genetic investigation into the prevalence of cryptic polychaete species within the deep Antarctic benthos to date. We uncover cryptic diversity in 50% of the 15 morphospecies targeted through the comparison of mitochondrial DNA sequences, as well as 10 previously overlooked morphospecies, increasing the total species richness in the sample by 233%. Our ability to describe universal rules for the detection of cryptic species within polychaetes, or normalization to expected number of species based on genetic data is prevented by taxon-specific differences in phylogenetic outputs and genetic variation between and within potential cryptic species. These data provide the foundation for biogeographic and functional analysis that will provide insight into the drivers of species diversity and its role in ecosystem function

Diseño y construcción de un horno para implementarlo en la máquina para ensayos de termofluencia del laboratorio de resistencia de materiales de la ESPOCH

La máquina para ensayos de termofluencia del laboratorio de resistencia de materiales de la ESPOCH presentaba ciertas dificultades al momento de operar y realizar mantenimientos al equipo encargado de mantener la temperatura constante, por tal motivo se procedió a diseñar y construir un horno para implementar en la máquina de termofluencia. Durante el desarrollo se seleccionó los materiales más adecuados para las principales partes del horno, las cuales son: la fuente de calor, cámara de calentamiento y revestimiento aislante. A partir de esta selección se realizó un análisis térmico para determinar las temperaturas a través de la pared del horno así también como la temperatura superficial. Además, se diseñó los pasadores que soportarán la carga de tracción aplicada por la máquina, y se incluyó un análisis del cordón de soldadura para garantizar la estabilidad y soporte del peso del horno. Con este diseño se realizó la construcción y montaje del equipo con su respectiva automatización gracias a un PLC LOGO que nos permite hacer un control ON/OFF, para que la temperatura sea uniforme durante el ensayo. Comprobamos el correcto funcionamiento del equipo ensayando una probeta de acero A36 y una probeta de fundición nodular perlítica hasta llegar a su fractura. Finalmente, el horno quedó funcional y con una temperatura de trabajo de hasta 750°C. Para continuar con el mejoramiento de la máquina, se recomienda instalar un sistema de control y monitoreo virtual que permita el registro de datos como carga, temperatura y deformaciones desde cualquier parte que se disponga de un computador con servicio de internet, y de esta manera evitar la presencia del operario junto a la máquina durante todo el ensayo.The thermofluence testing machine of the ESPOCH’s materials resistance laboratory presented specific difficulties at the time of operating and maintaining the equipment in charge of managing the constant temperature. For this reason, we proceeded to design and build an over to implement in the machine of thermofluence. During the development, the most suitable materials for the main parts of the stove were selected, which are: the heat source, heating chamber, and insulating coating. From this selection, a thermal analysis was carried out to determine temperatures through the oven wall as surface temperature. Besides, the pins that will support the tensile load applied by the machine were designed, and an analysis of the weld seam was included to ensure the stability and support of the oven weight. With this design, the construction and assembly of the equipment with its automation was carried out thanks to LOGO PLC, allowing us to make an ON/OFF control. Hence, the temperature is uniform during the test. We check the correct functioning of the equipment by testing an A36 steel specimen and a nodular cast iron specimen until it reaches its fracture. Finally, the oven functional and with a working temperature of up to 750 degrees Celsius. To continue the machine’s improvement is recommended to install a virtual control and monitoring system, allowing the recording of data such as load, temperature, and deformations from any part having a computer with internet service, and thus avoid the presence of the operator next to the machine during the whole test

No. 6 - 30th Anniversary Issue

With this issue of the Occasional Papers, we celebrate the 30th anniversary of the founding of the Dean Rusk Center, which bears the name of the late School of Law faculty member who served as secretary of state under Presidents John F. Kennedy and Lyndon B. Johnson from 1961 until 1969. Our purpose in hosting the conference and lectures published in this volume was to provide a forum for developing the comprehensive new focus necessary to met the American foreign policy demands of the 21st century. In so doing, it is our intent that the advice and counsel of the former secretaries of state and speakers in this volume—each of whom has been, directly or indirectly, impacted by the life of Dean Rusk—will bring us closer to being “present at the creation” of a post-modern American foreign policy equipped to deal with the challenges ahead. We hope that this publication, under the auspices of the Center that bears his name, will have an impact that is worthy of the legacy of Dean Rusk