Biosynthesis of spathulenol and camphor stand as a competitive route to artemisinin production as revealed by a new chemometric convergence approach based on nine locations’ field-grown Artemesia annua L.

Since isopentenyl diphosphate (IPP) and its isomer dimethylallyl diphosphate (DMAPP) are the universal precursors of both essential oil components, and the antimalarial agent artemisinin and its derivatives in Artemesia annua L., this paper aims to correlate the spotted differences in their concentrations by screening Artemesia annua L. field-grown in nine locations around the world that may reveal the role of any these compounds as precursors or competitors in the biosynthetic pathway of the sesquiterpene lactone : artemisinin. Principal component analysis (PCA) revealed that artemisinin is positively correlated to β-pinene, 1.8-cineole, sabinene hydrate, borneol and 1-octen-3-ol; but negatively to artemisinic acid and β-caryophyllene oxide. Hierarchical cluster analysis (HCA) classified locations into two distinct groups in which artemisinin concentration stood as the main driving factor to build similarities between the locations. In parallel, an improved convergence approach based on idiosyncratic similarities able to capture heterogeneity across individuals is proposed, which was able to classify compounds into four distinct clusters. Artemisinin appeared to be cross-linked to p-cymene, cis-carvyle acetate, 4-terpinene-1-ol, β-caryophyllene, β-farnesene, β-selinene, α-selinene, β-caryophyllene oxide and α-costol. It is interesting to see how camphor and spathulenol behaved as a distinct cluster group, which suggests that biosynthesis of these two compounds follows a different but a competitive pathway ; thus limiting their production could be a key to control and enhance the production of artemisinin

The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review

© the authors 2012. Background: Simulation is defined as a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. The use of simulation for educational purposes began decades ago with the use of low-fidelity simulations and has evolved at an unprecedented pace. Debriefing is considered by many to be an integral and critical part of the simulation process. However, different debriefing approaches have developed with little objective evidence of their effectiveness. Objectives: The aim of this review was to identify, appraise and synthesise the best available evidence for the effectiveness of debriefing as it relates to simulation-based learning for health professionals

Chronic disease management support in Australian workplaces—low base, rising need

© 2017 Australian Health Promotion Association Issue addressed: This study investigates the current nature, levels and perceived need for workplace support among mature age Australian workers with chronic illness. Methods: A cross-sectional population survey was conducted via a double opt-in panel sample of Australian workers aged 45 years and older with one or more of six major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). Results: Three hundred and fourteen respondents reported being in the workforce and having at least one of the chronic conditions under investigation, of which almost one third reported having more than one of the conditions. The findings reveal a number of considerable gaps in Australian workplace support for employees 45 years and older with chronic illness, including workplace flexibility, supportive policies and co-worker support. Conclusions: This research adds to a scarce existing literature base on workplace support for workers with chronic illness in Australia. Future research is needed to identify opportunities for effective public policy and implementation of workplace interventions to better support this cohort. So what?: If timely progress is not made in this area, the projected increase in the aged population and scheduled public policy changes impacting retirement age will multiply potential adverse effects on the health of employees with chronic illness and Australia's labour market productivity

Organisational interventions for promoting person-centred care for people with dementia

© 2015 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective: To determine the effectiveness of organisation-wide interventions to implement person-centred care for people with dementia, in relation to reduction of behavioural symptoms such as agitation and depression, improvement in quality of life and functional capabilities, alterations in the use of restraint (physical and/or chemical) and reduction in adverse events. Secondary objective: To identify the variety, quality, and feasibility of person-centred care approaches for people with dementia, with specific reference to organisational factors which promote and constrain the implementation of person-centred care

Exploring factors contributing to medication errors with opioids in australian specialist palliative care inpatient services: A multi-incident analysis

© 2018 Mary Ann Liebert, Inc. Background: Opioid errors have the potential to cause significant patient harm. These high-risk medications are used in high volumes in palliative care services to manage pain and other symptoms. Palliative patients are at greater risk of harm from opioid errors, as they are generally older and taking numerous medications to manage multiple comorbidities. Understanding factors contributing to opioid errors in inpatient palliative care services is a largely underexplored, yet, essential aspect of patient safety. Objective: To explore and identify the characteristics and associated contributing factors of reported opioid errors in palliative care inpatient services using a multi-incident analysis framework. Design: A multi-incident analysis of opioid errors reported over three years in two Australian specialist palliative care inpatient services. Results: A total of 78 opioid errors were reported. The majority (76%) of these errors occurred during opioid administration, primarily due to omitted dose (34%) and wrong dose (17%) errors. Eighty-five percent of reported errors reached the patient resulting in opioid underdose for over half (59%) of these patients. Over one-third (37%) of errors caused patient harm, which required clinical intervention. Error contributing factors included the following: noncompliance with policy; individual factors such as distraction; poor clinical communication systems; and workload. Conclusions: This multi-incident analysis has provided initial insights into factors contributing to opioid errors in palliative care inpatient services. Further exploration is warranted to understand palliative care clinicians' perspectives of systems, individual, and patient factors that influence safe opioid delivery processes

Effects of person-centered care at the organisational-level for people with dementia. A systematic review

© 2019 Chenoweth et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The aim of the systematic review was to determine the effectiveness of organizational-level person-centered care for people living with dementia in relation to their quality of life, mood, neuropsychiatric symptoms and function. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register databases, were searched up to June 2018 using the terms dementia OR cognitive impairment OR Alzheimer AND non-pharmacological AND personhood OR person-centered care. Reviewed studies included randomized controlled trials (RCTs), cluster-randomized trials (CRTs) and quasi-experimental studies that compared outcomes of person-centered care and usual (non-person-centered) care, for people with a diagnosis of dementia. The search yielded 12 eligible studies with a total of 2599 people living with dementia in long-term care homes, 600 receiving hospital care and 293 living in extra-care community housing. Random-effects models were used to pool adjusted risk ratios and standard mean differences from all studies; the findings were assessed followed the PRISMA guidelines and GRADE criteria. Statistical heterogeneity was assessed using the I 2 method and Chi 2 P value; studies with low statistical heterogeneity were analyzed using a random-effects model with restricted maximum likelihood estimation in R. Analyses of pre/post data within 12 months identified: a significant effect for quality of life (standardized mean difference (SMD) 0.16 and 95% CI 0.03 to 0.28; studies = 6; I 2 = 22%); non-significant effects for neuropsychiatric symptoms (SMD 0.06, 95% CI -0.08 to 0.19; studies = 4; I 2 = 0%) and well-being (SMD 0.15, 95% CI -0.15 to 0.45; studies = 4; I 2 = 77%); and no effects for agitation (SMD -0.05 (95% CI -0.17 to -0.07; studies 5; I 2 = 0%) and depression (SMD -0.06 and 95% CI -0.27 to 0.15, studies = 5; I 2 = 53%). The evidence from this review recommends implementation of person-centered care at the organizational-level to support the quality of life of people with living with dementia

The concept of selectivity control by simultaneous distribution of the oxygen feed and wall temperature in a microstructured reactor

This paper explores the feasibility of controlling the selectivity of a partial oxidation reaction by simultaneous modulation of local oxygen concentration and coolant temperature along the length of a reactor. The microstructured membrane reactor (MMR) concept consists of an oxygen-permeable membrane for distributing the oxygen feed with the coolant channel divided into zones of different temperatures. The reactor concept was explored in simulation of the selective oxidation of o-xylene to phthalic anhydride (PA). A mathematical model of the reactor was developed and optimization performed with the objective of maximising PA selectivity at the reactor outlet. Dosing of oxygen at uniform wall temperature results in PA selectivity increase by 6.3%, albeit with a reduction in o-xylene conversion of about 8% compared to a conventional fixed bed reactor. However, simultaneous modulation of both reactor wall temperatures and local oxygen concentration results in an improved conversion of o-xylene without a detrimental effect on selectivity, thus giving maximum yield of PA.S.M. Aworinde and A.M. Schweidtmann gratefully acknowledge scholarship awards received from Cambridge Trust and the Ernest-Solvay-Foundation, respectively. Work on this paper was enabled in part by the National Research Foundation, Prime Minister’s Office, Singapore, under its CREATE programme

A psychometric analysis of the Caring Assessment Tool version V

Aim The aim of this study was to examine the factor structure and construct validity of the Caring Assessment Tool version V (CAT‐V) for patients in Australian hospitals. Design Secondary analysis of CAT‐V surveys from the Australian Nursing Outcomes Collaborative (AUSNOC) data set was used. The CAT was originally developed in the United States of America. Methods The 27‐item CAT‐V was administered to patients prior to discharge from eight wards in three Australian hospitals in 2016. The psychometric properties of the CAT were evaluated using item analysis and exploratory factor analyses. Results Item analysis of surveys from 476 participants showed high levels of perceived caring behaviours and actions. Exploratory factor analysis revealed a two‐factor structure consisting of: Nurse-patient communication; and Feeling cared for. The CAT‐V is a reliable and valid instrument for measuring patients\u27 perceptions of the attitudes and actions of nurses in Australia

An observational study of older patient specialling in acute hospital settings

© 2020 John Wiley & Sons Ltd Background: During hospitalisation, older people can quickly become disoriented and agitated. In these instances, ‘specialling’, involving close monitoring and observation of the person to prevent accidents, injuries and clinical deterioration is often required. Despite the widespread practice of older patient specialling, there is no evidence of the best model, or any clear guidelines around the essential requirements for this practice. Aim: This study aimed to examine specialling practices for hospitalised older patients in acute aged care wards. Method: Quantitative and qualitative data were obtained in an observational study of specialling practices for hospitalised older patients. Two validated observational tools were used to collect data on nursing care provided during specialling and patient responses to specialling over a three-month period. Findings: A total of 58 observations were undertaken of specialling practices for 12 hospital patients aged 65 years and over in four acute aged care wards. Delirium was the most common reason for older patient specialling. Most specialling was undertaking by Assistants in Nursing. Specialling interactions and responses were mainly positive. Positive specialling practices occurred when the staff special was familiar with the older patient and the ward in which specialling occurred. Specialling practices differed in relation to, the type of care required, the presence of the patients’ personal possessions in their immediate surroundings, the presence of medical devices, patient acuity and general ward busyness. Conclusion: These findings suggest that specialling practices differ according to patient need and that the staff member\u27s familiarity with the ward and their patients are important factors in positive older patient specialling. The specialling role needs much clearer definition, including the type of educational preparation and workload support that is appropriate to ensure safe and quality care