Long-term implementation of the Managing Agitation and Raising QUality of lifE intervention in care homes: A qualitative study

OBJECTIVES: The dementia care home workforce receive little specific training. There are successful interventions, improving care outcomes, but it is unclear whether or how to sustain these effects. The Managing Agitation and Raising Quality of Life (MARQUE) intervention aimed to train care home staffto reduce resident's agitation and improve their quality of life. It was designed for sustainability, with implementation plans agreed with managers. MARQUE improves quality of life. In this separate study, we aimed to examine implementation around two years later. METHODS: and design: We explored practice change since the intervention and considered current implementation of home specific action plans, enablers or barriers, and perceived benefits or harms of implementation using semi-structured interviews with staff working in the trial homes who received the MARQUE intervention. RESULTS: 6/10 intervention homes participated. We interviewed 25 staff, 20-30 months after the MARQUE study. In all homes, staff reported that at least one MARQUE component was sustained. Three themes emerged about sustained practice change: (i) communication, (ii) respect and understanding of roles, and (iii) ability to try new things. Notable changes included improved team working and feelings of competence, positive attitude to residents rather than blame for agitation and avoidance, and more pleasant activities. Leadership support was important. CONCLUSIONS: It is possible to sustain some change over years in care homes. This study indicates factors which help or impede. These factors individually and together could lead to long-term improved quality of life of residents in homes where it is implemented and sustained. This article is protected by copyright. All rights reserved

Fiscal year 1981 US corn and soybeans pilot preliminary experiment plan, phase 1

A draft of the preliminary experiment plan for the foreign commodity production forecasting project fiscal year 1981 is presented. This draft plan includes: definition of the phase 1 and 2 U.S. pilot objectives; the proposed experiment design to evaluate crop calendar, area estimation, and area aggregation components for corn and soybean technologies using 1978/1979 crop-year data; a description of individual sensitivity evaluations of the baseline corn and soybean segment classification procedure; and technology and data assessment in support of the corn and soybean estimation technology for use in the U.S. central corn belt

Comparing proxy rated quality of life of people living with dementia in care homes

Background: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently

The photospheric solar oxygen project: III. Investigation of the centre-to-limb variation of the 630nm [OI]-NiI blend

The solar photospheric abundance of oxygen is still a matter of debate. For about ten years some determinations have favoured a low oxygen abundance which is at variance with the value inferred by helioseismology. Among the oxygen abundance indicators, the forbidden line at 630nm has often been considered the most reliable even though it is blended with a NiI line. In Papers I and Paper II of this series we reported a discrepancy in the oxygen abundance derived from the 630nm and the subordinate [OI] line at 636nm in dwarf stars, including the Sun. Here we analyse several, in part new, solar observations of the the centre-to-limb variation of the spectral region including the blend at 630nm in order to separate the individual contributions of oxygen and nickel. We analyse intensity spectra observed at different limb angles in comparison with line formation computations performed on a CO5BOLD 3D hydrodynamical simulation of the solar atmosphere. The oxygen abundances obtained from the forbidden line at different limb angles are inconsistent if the commonly adopted nickel abundance of 6.25 is assumed in our local thermodynamic equilibrium computations. With a slightly lower nickel abundance, A(Ni)~6.1, we obtain consistent fits indicating an oxygen abundance of A(O)=8.73+/-0.05. At this value the discrepancy with the subordinate oxygen line remains. The derived value of the oxygen abundance supports the notion of a rather low oxygen abundance in the solar hotosphere. However, it is disconcerting that the forbidden oxygen lines at 630 and 636nm give noticeably different results, and that the nickel abundance derived here from the 630nm blend is lower than expected from other nickel lines.Comment: to appear in A&

Disseminating START: training clinical psychologists and admiral nurses as trainers in a psychosocial intervention for carers of people with dementia's depressive and anxiety symptoms

OBJECTIVES: To put into practice and to evaluate an initial dissemination programme for the Strategies for Relatives (START), a clinically and cost-effective manualised intervention for family carers of people with dementia. SETTING: We offered 3-hour 'train-the-trainer' sessions through the British Psychological Society and Dementia UK. PARTICIPANTS: Clinical psychologists and admiral nurses across the UK. PRIMARY AND SECONDARY OUTCOME MEASURES: After the training session, attendees completed an evaluation. Attendees were asked how they had implemented START 6 and 12 months later, and to participate in telephone interviews about their experiences of what helps or hinders implementation 1 year after training. RESULTS: We trained 134 clinical psychologists and 39 admiral nurses through 14 training sessions between October 2014 and September 2015 in nine UK locations and made materials available online. The 40 survey respondents had trained 75 other staff. By this time, 136 carers had received START across 11 service areas. Findings from 13 qualitative interviews indicated that some clinical psychologists had begun to implement START, facilitated by buy-in from colleagues, existing skills in delivering this type of intervention, availability of other staff to deliver the intervention and support from the research team. Admiral nurses did not supervise other staff and were unable to cascade the intervention. Where START has not been used, common barriers included lack of staff to deliver the intervention and family carer support not being a service priority. Participants wanted the training to be longer. CONCLUSIONS: We trained clinical psychologists and admiral nurses to deliver and implement START locally. Results from survey respondents show that it was cascaded further and used in practice in some areas, but we do not know whether START was implemented by non-respondents. Future dissemination requires management buy-in, availability of practitioners and supervisors and consideration of other ways of delivery

The photospheric solar oxygen project: IV. 3D-NLTE investigation of the 777 nm triplet lines

The solar photospheric oxygen abundance is still widely debated. Adopting the solar chemical composition based on the "low" oxygen abundance, as determined with the use of three-dimensional (3D) hydrodynamical model atmospheres, results in a well-known mismatch between theoretical solar models and helioseismic measurements that is so far unresolved. We carry out an independent redetermination of the solar oxygen abundance by investigating the center-to-limb variation of the OI IR triplet lines at 777 nm in different sets of spectra with the help of detailed synthetic line profiles based on 3D hydrodynamical CO5BOLD model atmospheres and 3D non-LTE line formation calculations with NLTETD. The idea is to simultaneously derive the oxygen abundance,A(O), and the scaling factor SH that describes the cross-sections for inelastic collisions with neutral hydrogen relative the classical Drawin formula. The best fit of the center-to-limb variation of the triplet lines achieved with the CO5BOLD 3D solar model is clearly of superior quality compared to the line profile fits obtained with standard 1D model atmospheres. Our best estimate of the 3D non-LTE solar oxygen abundance is A(O) = 8.76 +/- 0.02, with the scaling factor SH in the range between 1.2 and 1.8. All 1D non-LTE models give much lower oxygen abundances, by up to -0.15 dex. This is mainly a consequence of the assumption of a $\mu$-independent microturbulence.Comment: 25 pages, 17 figures, 7 tables (Accepted for publication in A&A

Improved simulation of aerosol, cloud, and density measurements by shuttle lidar

Data retrievals are simulated for a Nd:YAG lidar suitable for early flight on the space shuttle. Maximum assumed vertical and horizontal resolutions are 0.1 and 100 km, respectively, in the boundary layer, increasing to 2 and 2000 km in the mesosphere. Aerosol and cloud retrievals are simulated using 1.06 and 0.53 microns wavelengths independently. Error sources include signal measurement, conventional density information, atmospheric transmission, and lidar calibration. By day, tenuous clouds and Saharan and boundary layer aerosols are retrieved at both wavelengths. By night, these constituents are retrieved, plus upper tropospheric, stratospheric, and mesospheric aerosols and noctilucent clouds. Density, temperature, and improved aerosol and cloud retrievals are simulated by combining signals at 0.35, 1.06, and 0.53 microns. Particlate contamination limits the technique to the cloud free upper troposphere and above. Error bars automatically show effect of this contamination, as well as errors in absolute density nonmalization, reference temperature or pressure, and the sources listed above. For nonvolcanic conditions, relative density profiles have rms errors of 0.54 to 2% in the upper troposphere and stratosphere. Temperature profiles have rms errors of 1.2 to 2.5 K and can define the tropopause to 0.5 km and higher wave structures to 1 or 2 km

Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia

OBJECTIVES: This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes. DESIGN: A systematic review of qualitative and quantitative intervention studies was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes. METHODS: We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change. RESULTS: We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care. CONCLUSIONS: Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes. TRIAL REGISTRATION NUMBER: CRD42015017621

Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial

BACKGROUND: Family carers of people with dementia frequently report acting abusively toward them and carer psychological morbidity predicts this. We investigated whether START (STrAtegies for RelaTives), a psychological intervention which reduces depression and anxiety in family carers also reduces abusive behavior in carers of people living in their own homes. We also explored the longitudinal course of carer abusive behavior over two year. METHODS: We included self-identified family carers who gave support at least weekly to people with dementia referred in the previous year to three UK mental health services and a neurological dementia service. We randomly assigned these carers to START, an eight-session, manual-based coping intervention, or treatment as usual (TAU). Carer abusive behavior (Modified Conflict Tactic Scale (MCTS) score ≥2 representing significant abuse) was assessed at baseline, 4, 8, 12, and 24 months. RESULTS: We recruited 260 carers, 173 to START and 87 to TAU. There was no evidence that abusive behavior levels differed between randomization groups or changed over time. A quarter of carers still reported significant abuse after two years, but those not acting abusively at baseline did not become abusive. CONCLUSION: There was no evidence that START, which reduced carer anxiety and depression, reduced carer abusive behavior. For ethical reasons, we frequently intervened to manage concerning abuse reported in both groups, which may have disguised an intervention effect. Future dementia research should include elder abuse as an outcome, and consider carefully how to manage detected abuse