Trends in quality of care and dying perceived by family caregivers of nursing home residents with dementia 2005-2019

Background: Dementia palliative care is increasingly subject of research and practice improvement initiatives. Aim: To assess any changes over time in the evaluation of quality of care and quality of dying with dementia by family caregivers. Design: Combined analysis of eight studies with bereaved family caregivers' evaluations 2005-2019. Setting/participants: Family caregivers of nursing home residents with dementia in the Netherlands (n = 1189) completed the End-of-Life in Dementia Satisfaction With Care (EOLD-SWC; quality of care) and Comfort Assessment in Dying (EOLD-CAD, four subscales; quality of dying) instruments. Changes in scores over time were analysed using mixed models with random effects for season and facility and adjustment for demographics, prospective design and urbanised region. Results: The mean total EOLD-SWC score was 33.40 (SD 5.08) and increased by 0.148 points per year (95% CI, 0.052-0.244; adjusted 0.170 points 95% CI, 0.055-0.258). The mean total EOLD-CAD score was 30.80 (SD 5.76) and, unadjusted, there was a trend of decreasing quality of dying over time of -0.175 points (95% CI, -0.291 to -0.058) per year increment. With adjustment, the trend was not significant (-0.070 EOLD-CAD total score points, 95% CI, -0.205 to 0.065) and only the EOLD-CAD subscale 'Well being' decreased. Conclusion: We identified divergent trends over 14 years of increased quality of care, while quality of dying did not increase and well-being in dying decreased. Further research is needed on what well-being in dying means to family. Quality improvement requires continued efforts to treat symptoms in dying with dementia.Development and application of statistical models for medical scientific researc

A review on substances and processes relevant for optical remote sensing of extremely turbid marine areas, with a focus on the Wadden Sea

The interpretation of optical remote sensing data of estuaries and tidal flat areas is hampered by optical complexity and often extreme turbidity. Extremely high concentrations of suspended matter, chlorophyll and dissolved organic matter, local differences, seasonal and tidal variations and resuspension are important factors influencing the optical properties in such areas. This review gives an overview of the processes in estuaries and tidal flat areas and the implications of these for remote sensing in such areas, using the Wadden Sea as a case study area. Results show that remote sensing research in extremely turbid estuaries and tidal areas is possible. However, this requires sensors with a large ground resolution, algorithms tuned for high concentrations of various substances and the local specific optical properties of these substances, a simultaneous detection of water colour and land-water boundaries, a very short time lag between acquisition of remote sensing and in situ data used for validation and sufficient geophysical and ecological knowledge of the area. © 2010 The Author(s)

Seasonal Variations in Flocculation and Erosion Affecting the Large-Scale Suspended Sediment Distribution in the Scheldt Estuary: The Importance of Biotic Effects

Many estuaries exhibit seasonality in the estuary-scale distribution of suspended particulate matter (SPM). This SPM distribution depends on various factors, including freshwater discharge, salinity intrusion, erodibility, and the ability of cohesive SPM to flocculate into larger aggregates. Various authors indicate that biotic factors, such as the presence of algae and their excretion of sticky transparent exopolymer particles (TEP), affect the flocculation and erosion processes. Consequently, seasonality in these biotic factors may play a role in the observed seasonality in SPM. Whereas the impact of abiotic factors on seasonality in SPM is well studied, the relative contribution of biotically induced seasonality is largely unknown. In this study, we employ two approaches to assess the aggregated importance of biotically induced seasonality in flocculation and erosion on seasonality in SPM in the Scheldt estuary. In the first approach, we focus on seasonality of in situ observations in the Scheldt estuary of turbidity, floc size, Chlorophyll-a, and TEP, showing that the abiotic parameters show seasonality, while seasonality in TEP is ambiguous. The second approach concerns a reverse engineering method to calibrate biotically affected parameters of a coupled sediment transport-flocculation model to turbidity observations, allowing us to compare the modeled SPM concentrations to the observations. Driven by seasonality in freshwater discharge, the model captures the observed seasonality in SPM without requiring biotically induced seasonality in flocculation and erosion, which is supported by the absence of seasonality in TEP.Mathematical Physic