Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study

Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals. Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative

Sensitivity of wardrop equilibria

We study the sensitivity of equilibria in the well-known game theoretic traffic model due to Wardrop. We mostly consider single-commodity networks. Suppose, given a unit demand flow at Wardrop equilibrium, one increases the demand by ε or removes an edge carrying only an ε-fraction of flow. We study how the equilibrium responds to such an ε-change. Our first surprising finding is that, even for linear latency functions, for every ε> 0, there are networks in which an ε-change causes every agent to change its path in order to recover equilibrium. Nevertheless, we can prove that, for general latency functions, the flow increase or decrease on every edge is at most ε. Examining the latency at equilibrium, we concentrate on polynomial latency functions of degree at most p with nonnegative coefficients. We show that, even though the relative increase in the latency of an edge due to an ε-change in the demand can be unbounded, the path latency at equilibrium increases at most by a factor of (1 + ε) p . The increase of the price of anarchy is shown to be upper bounded by the same factor. Both bounds are shown to be tight. Let us remark that all our bounds are tight. For the multi-commodity case, we present examples showing that neither the change in edge flows nor the change in the path latency can be bounded

On the Price of Anarchy of Highly Congested Nonatomic Network Games

We consider nonatomic network games with one source and one destination. We examine the asymptotic behavior of the price of anarchy as the inflow increases. In accordance with some empirical observations, we show that, under suitable conditions, the price of anarchy is asymptotic to one. We show with some counterexamples that this is not always the case. The counterexamples occur in very simple parallel graphs.Comment: 26 pages, 6 figure

Citizen Science and Open Data: a model for Invasive Alien Species in Europe

Invasive Alien Species (IAS) are a growing threat to Europe's biodiversity. The implementation of European Union Regulation on IAS can benefit from the involvement of the public in IAS recording and management through Citizen Science (CS) initiatives. Aiming to tackle issues related with the use of CS projects on IAS topics, a dedicated workshop titled “Citizen Science and Open Data: a model for Invasive Alien Species in Europe” was organized by the Joint Research Centre (JRC) and the European Cooperation in Science and Technology (COST Association). Fifty key stakeholders from all Europe, including two Members of the European Parliament, attended the workshop. With a clear focus on IAS, the workshop aimed at addressing the following issues: a) CS and policy, b) citizen engagement, and c) CS data management. Nine short presentations provided input on CS and IAS issues. Participants discussed specific topics in several round tables (“world café” style) and reported back their conclusions to the audience and full assembly moderated discussions. Overall, the workshop enabled the sharing of ideas, approaches and best practices regarding CS and IAS. Specific opportunities and pitfalls of using CS data in the whole policy cycle for IAS were recognized. Concerning the implementation of the IAS Regulation, CS data could complement official surveillance systems, and contribute to the early warning of the IAS of Union concern after appropriate validation by the Member States’ competent authorities. CS projects can additionally increase awareness and empower citizens. Attendees pointed out the importance for further public engagement in CS projects on IAS that demonstrate specific initiatives and approaches and analyze lessons learned from past experiences. In addition, the workshop noted that the data gathered from different CS projects on IAS are fragmented. It highlighted the need for using an open and accessible platform to upload data originating from CS sources or to mirror validated data into a single, easy-to-use web service, in line with the EU Open Science Strategic Priority. The workshop provided ten key recommendations of best practices for CS projects on IAS, addressed to researchers, policy makers and implementing authorities, indicating future research and policy directions and opportunities

Identifying recombination hotspots in the HIV-1 genome

HIV-1 infection is characterised by the rapid generation of genetic diversity that facilitates viral escape from immune selection and antiretroviral therapy. Despite recombination's crucial role in viral diversity and evolution, little is known about the genomic factors that influence recombination between highly similar genomes. In this study, we use a minimally modified full length HIV-1 genome and high throughput sequence analysis to study recombination in gag and pol in T cells. We find that recombination is favoured at a number of recombination hotspots, where recombination occurs six times more frequently than at corresponding coldspots. Interestingly, these hotspots occur near important features of the HIV-1 genome, but do not occur at sites immediately around protease inhibitor or reverse transcriptase inhibitor drug resistance mutations. We show that the recombination hot and cold spots are consistent across five blood donors and are independent of co-receptor mediated entry. Finally, we check common experimental confounders and find that these are not driving the location of recombination hotspots. This is the first study to identify the location of recombination hotspots, between two similar viral genomes with great statistical power and under conditions that closely reflect natural recombination events amongst HIV-1 quasispecies

Seven recommendations to make your invasive alien species data more useful

Science-based strategies to tackle biological invasions depend on recent, accurate, well-documented, standardized and openly accessible information on alien species. Currently and historically, biodiversity data are scattered in numerous disconnected data silos that lack interoperability. The situation is no different for alien species data, and this obstructs efficient retrieval, combination, and use of these kinds of information for research and policy-making. Standardization and interoperability are particularly important as many alien species related research and policy activities require pooling data. We describe seven ways that data on alien species can be made more accessible and useful, based on the results of a European Cooperation in Science and Technology (COST) workshop: (1) Create data management plans; (2) Increase interoperability of information sources; (3) Document data through metadata; (4) Format data using existing standards; (5) Adopt controlled vocabularies; (6) Increase data availability; and (7) Ensure long-term data preservation. We identify four properties specific and integral to alien species data (species status, introduction pathway, degree of establishment, and impact mechanism) that are either missing from existing data standards or lack a recommended controlled vocabulary. Improved access to accurate, real-time and historical data will repay the long-term investment in data management infrastructure, by providing more accurate, timely and realistic assessments and analyses. If we improve core biodiversity data standards by developing their relevance to alien species, it will allow the automation of common activities regarding data processing in support of environmental policy. Furthermore, we call for considerable effort to maintain, update, standardize, archive, and aggregate datasets, to ensure proper valorization of alien species data and information before they become obsolete or lost

What is the value of orthodontic treatment?

Orthodontic treatment is as popular as ever. Orthodontists frequently have long lists of people wanting treatment and the cost to the NHS in England was £258m in 2010-2011 (approximately 10% of the NHS annual spend on dentistry). It is important that clinicians and healthcare commissioners constantly question the contribution of interventions towards improving the health of the population. In this article, the authors outline some of the evidence for and against the claims that people with a malocclusion are at a disadvantage compared with those without a malocclusion and that orthodontic treatment has significant health benefits. The authors would like to point out that this is not a comprehensive and systematic review of the entire scientific literature. Rather the evidence is presented in order to stimulate discussion and debate

The multifunctional roles of vegetated strips around and within agricultural fields : A systematic map protocol.

Background: Agriculture and agricultural intensification can have significant negative impacts on the environment, including nutrient and pesticide leaching, spreading of pathogens, soil erosion and reduction of ecosystem services provided by terrestrial and aquatic biodiversity. The establishment and management of vegetated strips adjacent to farmed fields (including various field margins, buffer strips and hedgerows) are key mitigation measures for these negative environmental impacts and environmental managers and other stakeholders must often make decisions about how best to design and implement vegetated strips for a variety of different outcomes. However, it may be difficult to obtain relevant, accurate and summarised information on the effects of implementation and management of vegetated strips, even though a vast body of evidence exists on multipurpose vegetated strip interventions within and around fields. To improve the situation, we describe a method for assembling a database of relevant research relating to vegetated strips undertaken in boreo-temperate farming systems (arable, pasture, horticulture, orchards and viticulture). Methods: We will search 13 bibliographic databases, 1 search engine and 37 websites for stakeholder organisations using a predefined and tested search string that focuses on a comprehensive list of vegetated strip synonyms. Non-English language searches in Danish, Finnish, German, Spanish, and Swedish will also be undertaken using a web-based search engine. We will screen search results at title, abstract and full text levels, recording the number of studies deemed non-relevant (with reasons at full text). A systematic map database that displays the meta-data (i.e. descriptive summary information about settings and methods) of relevant studies will be produced following full text assessment. The systematic map database will be displayed as a web-based geographical information system (GIS). The nature and extent of the evidence base will be discussed

Simple elbow dislocations: a systematic review of the literature

Objective: To identify if functional treatment is the best available treatment for simple elbow dislocations. Search strategy: Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials. Selection criteria: Studies were eligible for inclusion if they were trials comparing different techniques for the treatment of simple elbow dislocations. Data analysis: Results were expressed as relative risk for dichotomous outcomes and weighted mean difference for continuous outcomes with 95% confidence intervals. Main results: This review has included data from two trials and three observational comparative studies. Important data were missing from three observational comparative studies and the results from these studies were extracted for this review. No difference was found between surgical treatment of the collateral ligaments and plaster immobilisation of the elbow joint. Better range of movement, less pain, better functional scores, shorter disability and shorter treatment time were seen after functional treatment versus plaster immobilisation

Teacher Awareness and Attitudes Regarding Adolescent Risk Behaviours : a Sample of Finnish Middle and High School Teachers

Empirical evidence has shown that youth gamble on both regulated and unregulated games, despite legislative prohibitions. This study assesses middle and high school teachers' awareness and attitudes regarding adolescent gambling and other potentially high-risk behaviours in Finland. A convenience sample of teachers (N = 157) from 13 provinces participated in the survey. The results suggest that teachers in Finland were more knowledgeable of the age limits of other adolescent high-risk behaviours than the legal age for gambling. Teachers were somewhat familiar with the behaviours and consequences associated with adolescent gambling. All other risk behaviours were perceived as being more important than gambling. Teachers' awareness about gambling prevention material in Finnish schools was limited. Results suggest that initiatives are required to enhance teachers' knowledge of adolescent problem gambling and its harmful short- and long-term consequences. School policies and guidelines including gambling behavior should be implemented in middle and high schools globally.Peer reviewe