Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers

ImportanceThe effectiveness of different approaches to dementia care is unknown.ObjectiveTo determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes.Design, setting, and participantsRandomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023).InterventionsParticipants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144).Main outcomes and measuresPrimary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy).ResultsAmong 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29).Conclusions and relevanceIn this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain.Trial registrationClinicalTrials.gov Identifier: NCT03786471

Social Relations and Relational Incentives

This paper studies how social relationships between managers and employees affect relational incentive contracts. To this end we develop a simple dynamic principal-agent model where both players may have feelings of altruism or spite toward each other. The contract may contain two types of incentives for the agent to work hard: a bonus and a threat of dismissal. We find that good social relationships undermine the credibility of a threat of dismissal but strengthen the credibility of a bonus. Among others, these two mechanisms imply that better social relationships sometimes lead to higher bonuses, while worse social relationships may increase productivity and players' utility in equilibrium

Relationships between Supervisor Turnover Intention and Subordinate Perceived Organisational Support and Positive Mood

The current study utilised organisational support theory to consider whether supervisors' intention to leave the organisation could contribute to subordinates' perceived organisational support (POS) and positive mood. Using hierarchical linear modeling, we found that supervisors' turnover intentions were related to subordinates' POS, and subordinate POS mediated the relationship between supervisor turnover intention and positive mood. Supervisors who intend to leave may no longer feel obligated to help the organisation reach its goals. The reduced felt obligation may affect their willingness to provide aid to the subordinates below them, resulting in reduced POS and positive mood of subordinates.</span

Inhibition of fungal plant pathogens by synergistic action of chito-oligosaccharides and commercially available fungicides

Chitosan is a linear heteropolymer consisting of β 1,4-linked N-acetyl-D-glucosamine (GlcNAc) and D-glucosamine (GlcN). We have compared the antifungal activity of chitosan with DPn (average degree of polymerization) 206 and FA (fraction of acetylation) 0.15 and of enzymatically produced chito-oligosaccharides (CHOS) of different DPn alone and in combination with commercially available synthetic fungicides, against Botrytis cinerea, the causative agent of gray mold in numerous fruit and vegetable crops. CHOS with DPn in the range of 15-40 had the greatest anti-fungal activity. The combination of CHOS and low dosages of synthetic fungicides showed synergistic effects on antifungal activity in both in vitro and in vivo assays. Our study shows that CHOS enhance the activity of commercially available fungicides. Thus, addition of CHOS, available as a nontoxic byproduct of the shellfish industry, may reduce the amounts of fungicides that are needed to control plant diseases

Perceived Organizational Support: Why Caring About Employees Counts

According to organizational support theory (OST), employees develop a general perception concerning the extent to which their work organization values their contribution and cares about their well-being (perceived organizational support, or POS). We explain OST and review empirical POS findings relevant to OST's main propositions, including new findings that suggest changes to OST. Major antecedents of POS include fairness, support from leaders, and human resource practices and work conditions, especially to the extent that employees perceive these as the discretionary choices of organizations. Among more recent findings, the average level of POS has modestly increased over the past three decades in the United States. Furthermore, POS appears to have stronger positive outcomes in Eastern cultures than Western cultures. Some additional promising recent areas of research on POS include trickle-down effects, POS of groups, and POS as relevant to creativity and innovation, positive emotional outcomes, and well-being. </jats:p

Interaction process in computer-mediated and face-to-face groups

This paper presents a comparative description of interactions in computer-mediated (CMC) and face-to-face (FTF) groups. For each of six weeks 16 CMC and 14 FTF groups of students collaborated on group essay assignments. We coded all verbal messages during these essay tasks. We explored four questions: 1.) Do CMC and FTF groups differ in the frequency of interaction acts, overall and within interaction categories?; 2.) If so, which interaction categories are used more by CMC and which by FTF groups?; 3.) Do these patterns of interaction activity vary over time?; 4.) Are there systematic differences in interaction patterns over time between media? Results showed that there were substantial differences between CMC and FTF groups in both the amount and type of interaction for each of four main categories of interaction. There were substantial over-time effects, collapsed across media, for several of the categories of behavior, but there were no significant differences in the way CMC and FTF groups changed over time. Although there was extensive variation among groups within a given medium, we did find some consistent patterns of behavior for groups within each medium, some of them distinctive for the medium. Although we offer evidence for differences in interaction processes of FTF and CMC groups, we note that the conclusions one makes depends upon one's perspective about the purpose of groups

Meetings at Work

Although advances in communication technology were once expected to diminish the need for synchronous work meetings, meeting activity in organizations continues to rise. Regrettably, the time and energy employees spend in work meetings is not matched by the amount of direct attention group and organizational scholars have paid to meeting phenomena. This special issue of Small Group Research helps to address this gap by presenting empirical studies of work meetings that explore the theory and practice of work meetings. </jats:p