Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial.

INTRODUCTION: In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial. METHODS: This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS). RESULTS: From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged. CONCLUSION: A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms

Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial

Introduction In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial. Methods This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS). Results From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged. Conclusion A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms

Stress Singularities in Laminated Composite Wedges.

This work primarily deals with the determination of stress singularities at the apex of both symmetric and antisymmetric N-layered composite laminate wedges, using classical lamination theory. The symmetric bending case is governed by a single differential equation, while the antisymmetric case, in which bending and inplane extension do not occur independently, involves three coupled differential equations. In each case, the governing differential equation(s) has(have) non-constant coefficients which depend on the polar coordinate (theta). Use of a finite difference scheme leads to (n + 2)-square, and (3n + 6)-square matrices for the symmetric and antisymmetric cases respectively, for the determination of the stress singularity parameter (lamda). Specializing to a seven-layered symmetric laminate and an eight-layered antisymmetric laminate, results are obtained (for graphite/epoxy T-300/5208) in both cases for various sector and ply angles, when the edges of the wedge are simply supported. In the last part of the work, a brief exploration of possible stress singularities at the apex of a two-layerd laminate, each layer being isotropic, using a more refined theory, is given.Ph.D.MechanicsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/159439/1/8314340.pd

Adapting local electronic commerce

This thesis examined how local people think of buying through national e-commerce instead of buying from international companies. And what kind of idea the locals believe shopping from national retails instead of purchasing international market. Most of the Finnish people know how to purchase electronic shopping inside of the country, but the foreigners are not well adapted, they just think international companies when they hear about e-commerce. The theoretical framework of this thesis explained the existing e- commerce market and the history of e-commerce and how the locals adapted to the current technological trends and the future tools of electronics. The aim of this thesis was to research how locals use local e-commerce retail. Secondly, the thesis was aimed to look into the E-commerce after the Covid-19 pandemic in general views. The empirical part was used as a primary source, and the theory part or literature was based on by books in the libraries, journals, internet sources that are reliable and newsworthy. The commissioner is IGLOBAL Solution Puhelinhuolto in Pietarsaari that provides e- commerce service and is one of the local retailers

Laabi labo u la! (Q.1)

Buuggani wuxuu ku saabsanyahay sheeko jacayl.Racconto d'amore.A love story.Dokumentigan waxaa dadka u soo bandhigay "The Digital Somali Library", jaamacadda "Indiana University".Documento messo a disposizione dalla Digital Somali Library, Indiana University.Document provided by the Indiana University's Digital Somali Library.Link: http://www.indiana.edu/~libsalc/african/Digital_Somali_Library/history.htm

Laabi labo u la!!

Qiso jacayl oo dhacday.Racconto d'amore realmente accaduto.A love story that really happened

Metaphyseal Sleeves for Revision Total Knee Arthroplasty:Good Short-Term Outcomes

Metaphyseal sleeve prostheses have shown promising results in the management of bone defects at revision TKA. We present a study of their use in aseptic revision TKA. Thirty-five revisions were included in 34 patients with wear or aseptic loosening indicated in 71% of cases. The majority of cases (63%) were AORI grade 2 or greater on the tibia or femur. Knee Society scores were excellent or good in 83% of patients with the same percentage having no or only mild pain. One patient suffered a sleeve-related complication with femoral condylar fractures three years postoperatively; these united with good outcomes. All radiographs were satisfactory; no patient required a further revision. We report good outcomes with the use of metaphyseal sleeves in revision TKA.</p