590 research outputs found

    What happens before, during and after crisis for someone with dementia living at home: a systematic review

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    Background People living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. Methods The protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library and references of retrieved publications, identified empirical research in English language and date range January 2000 to February 2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. Results The search identified 2755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that: for a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly. Medical treatment, community resources and psychosocial support of personal resources, decision making, relationships and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers’ and professionals’ knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. Conclusion There has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment

    Separation of river network–scale nitrogen removal among the main channel and two transient storage compartments

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    Transient storage (TS) zones are important areas of dissolved inorganic nitrogen (DIN) processing in rivers. We assessed sensitivities regarding the relative impact that the main channel (MC), surface TS (STS), and hyporheic TS (HTS) have on network denitrification using a model applied to the Ipswich River in Massachusetts, United States. STS and HTS connectivity and size were parameterized using the results of in situ solute tracer studies in first‐ through fifth‐order reaches. DIN removal was simulated in all compartments for every river grid cell using reactivity derived from Lotic Intersite Nitrogen Experiment (LINX2) studies, hydraulic characteristics, and simulated discharge. Model results suggest that although MC‐to‐STS connectivity is greater than MC‐to‐HTS connectivity at the reach scale, at basin scales, there is a high probability of water entering the HTS at some point along its flow path through the river network. Assuming our best empirical estimates of hydraulic parameters and reactivity, the MC, HTS, and STS removed approximately 38%, 21%, and 14% of total DIN inputs during a typical base flow period, respectively. There is considerable uncertainty in many of the parameters, particularly the estimates of reaction rates in the different compartments. Using sensitivity analyses, we found that the size of TS is more important for DIN removal processes than its connectivity with the MC when reactivity is low to moderate, whereas TS connectivity is more important when reaction rates are rapid. Our work suggests a network perspective is needed to understand how connectivity, residence times, and reactivity interact to influence DIN processing in hierarchical river systems

    Bodysnatching in the marketplace:Market-focused health activism and compelling narratives of dys-appearance

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    This article theorizes how market-focused health activism catalyses market change through revealing the ill-effects that consumers’ conformity with market-shaped expectations and ideals has on their bodies and embodied lives. An understanding of this activism is developed by analysing a vicarious form of ‘bodily dys-appearance’ which is used in Jamie Oliver’s televised documentary, Sugar Rush (2015), to narratively provoke corporeal anxieties among audiences. In our analysis, we borrow tropes from the science fiction film, Invasion of the Body Snatchers, to interpret themes centred on a threat, a victim and a hero. We argue that market-focused health activism problematizes the neo-liberal logic of personal responsibility and promotes market intervention as the only means to insulate and safeguard the body from harm. Where extant theorization of consumers’ antagonism towards the market hinges mostly on politically or intellectually motivated resistance, this article demonstrates how somatically oriented concerns operate alternatively to invoke activism

    Surface and hyporheic transient storage dynamics throughout a coastal stream network

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    Author Posting. © American Geophysical Union, 2010. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Water Resources Research 46 (2010): W06516, doi:10.1029/2009WR008222.Transient storage of stream water and associated solutes is expected to vary along stream networks in response to related changes in stream hydraulic conditions and morphologic gradients. These spatial changes are relevant to a wide variety of processes (e.g., biogeochemical cycling), yet data regarding these dynamics are limited and almost exclusively confined to the general storage terms of transient storage models with a single-storage zone (1-SZ). We used a transient storage model with two-storage zones (2-SZ) to simulate field data from conservative solute injections conducted in a coastal stream network in Massachusetts to separately quantify surface transient storage (STS) and hyporheic transient storage (HTS). Solute tracer additions were performed at basin-wide, low-flow conditions, and results were compared with respect to stream size. Strong positive relationships with reach contributing area indicated that the size of the main channel and the size and residence time in surface and hyporheic storage zones all increased from small to large streams. Conversely, longitudinal dispersion and the storage zone exchange coefficients had no consistent trends downstream. The influence of storage exchange on median transport time ( FMED200F_{MED}^{200}) was consistently large for STS and negligible for HTS. When compared to 1-SZ model estimates, we found that the general 1-SZ model storage terms did not consistently describe either STS or HTS exchange. Overall our results indicated that many zone-specific (STS and HTS) storage dynamics were sensitive to the combination of hydraulic and morphologic gradients along the stream network and followed positive trends with stream size.This material is based upon work supported by NSF grants DEB 06‐14350, BCS‐0709685, and OCE‐0423565

    Coherence function control of Quantum Dot Superluminescent Light Emitting Diodes by frequency selective optical feedback.

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    Low coherent light interferometry requires broad bandwidth light sources to achieve high axial resolution. Here, Superluminescent Light Emitting Diodes (SLDs) utilizing Quantum Dot (QD) gain materials are promising devices as they unify large spectral bandwidths with sufficient power at desired emission wavelengths. However, frequently a dip occurs in the optical spectrum that translates into high side lobes in the coherence function thereby reducing axial resolution and image quality. We apply the experimental technique of frequency selective feedback to shape the optical spectrum of the QD-SLD, hence optimizing the coherence properties. For well-selected feedback parameters, a strong reduction of the parasitic side lobes by a factor of 3.5 was achieved accompanied by a power increase of 40% and an improvement of 10% in the coherence length. The experimental results are in excellent agreement with simulations that even indicate potential for further optimizations

    Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic.

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    BACKGROUND: Cachexia is defined as the on-going loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. It is found in up to 80% of patients with advanced cancer and has profound psycho-social consequences for patients and their families. Previous studies demonstrate that many healthcare professionals receive little formal education in cachexia management leading them to feel that they have limited understanding of the syndrome and cannot intervene effectively. This study aims to examine the value of a dedicated cachexia clinic and its influence on staff understanding and practice. METHODS: An exploratory qualitative study was conducted. The study employed semi-structured interviews with a range of healthcare professionals responsible for designing and delivering cancer care in a large teaching hospital in Australia. This hospital had a dedicated cachexia clinic. RESULTS: In-depth interviews were conducted with 8 healthcare professionals and senior managers. Four themes were identified: formal and informal education; knowledge and understanding; truth telling in cachexia and palliative care; and, a multi-disciplinary approach. Findings show that improved knowledge and understanding across a staff body can lead to enhanced staff confidence and a willingness to address cancer cachexia and its consequences with patients and their families. CONCLUSION: Comparisons with similar previous research demonstrate the advantages of providing a structure for staff to gain knowledge about cachexia and how this can contribute to feelings of improved understanding and confidence necessary to respond to the challenge of cachexia
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