Cluster randomized controlled trial of an aged care specific leadership and management program to improve work environment, staff turnover, and care quality

OBJECTIVE To evaluate the effectiveness of a leadership and management program in aged care. DESIGN Double-blind cluster randomized controlled trial. SETTING Twelve residential and community-aged care sites in Australia. PARTICIPANTS All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). INTERVENTION A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. MAIN OUTCOME MEASURES The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. RESULTS At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52; P = .01); and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56; P = .001) as well as individual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety. CONCLUSIONS While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost

Darcin: a male pheromone that stimulates female memory and sexual attraction to an individual male's odour

<p>Abstract</p> <p>Background</p> <p>Among invertebrates, specific pheromones elicit inherent (fixed) behavioural responses to coordinate social behaviours such as sexual recognition and attraction. By contrast, the much more complex social odours of mammals provide a broad range of information about the individual owner and stimulate individual-specific responses that are modulated by learning. How do mammals use such odours to coordinate important social interactions such as sexual attraction while allowing for individual-specific choice? We hypothesized that male mouse urine contains a specific pheromonal component that invokes inherent sexual attraction to the scent and which also stimulates female memory and conditions sexual attraction to the airborne odours of an individual scent owner associated with this pheromone.</p> <p>Results</p> <p>Using wild-stock house mice to ensure natural responses that generalize across individual genomes, we identify a single atypical male-specific major urinary protein (MUP) of mass 18893Da that invokes a female's inherent sexual attraction to male compared to female urinary scent. Attraction to this protein pheromone, which we named darcin, was as strong as the attraction to intact male urine. Importantly, contact with darcin also stimulated a strong learned attraction to the associated airborne urinary odour of an individual male, such that, subsequently, females were attracted to the airborne scent of that specific individual but not to that of other males.</p> <p>Conclusions</p> <p>This involatile protein is a mammalian male sex pheromone that stimulates a flexible response to individual-specific odours through associative learning and memory, allowing female sexual attraction to be inherent but selective towards particular males. This 'darcin effect' offers a new system to investigate the neural basis of individual-specific memories in the brain and give new insights into the regulation of behaviour in complex social mammals.</p> <p>See associated Commentary <url>http://www.biomedcentral.com/1741-7007/8/71</url></p

Temperature Dependence of Low-Lying Electronic Excitations of LaMnO_3

We report on the optical properties of undoped single crystal LaMnO_3, the parent compound of the colossal magneto-resistive manganites. Near-Normal incidence reflectance measurements are reported in the frequency range of 20-50,000 cm-1 and in the temperature range 10-300 K. The optical conductivity, s_1(w), is derived by performing a Kramers-Kronig analysis of the reflectance data. The far-infrared spectrum of s_1(w) displays the infrared active optical phonons. We observe a shift of several of the phonon to high frequencies as the temperature is lowered through the Neel temperature of the sample (T_N = 137 K). The high-frequency s_1(w) is characterized by the onset of absorption near 1.5 eV. This energy has been identified as the threshold for optical transitions across the Jahn-Teller split e_g levels. The spectral weight of this feature increases in the low-temperature state. This implies a transfer of spectral weight from the UV to the visible associated with the paramagnetic to antiferromagnetic state. We discuss the results in terms of the double exchange processes that affect the optical processes in this magnetic material.Comment: 7 pages, 5 figure

Planet Hunters. VI: An Independent Characterization of KOI-351 and Several Long Period Planet Candidates from the Kepler Archival Data

We report the discovery of 14 new transiting planet candidates in the Kepler field from the Planet Hunters citizen science program. None of these candidates overlapped with Kepler Objects of Interest (KOIs) at the time of submission. We report the discovery of one more addition to the six planet candidate system around KOI-351, making it the only seven planet candidate system from Kepler. Additionally, KOI-351 bears some resemblance to our own solar system, with the inner five planets ranging from Earth to mini-Neptune radii and the outer planets being gas giants; however, this system is very compact, with all seven planet candidates orbiting $\lesssim 1$ AU from their host star. A Hill stability test and an orbital integration of the system shows that the system is stable. Furthermore, we significantly add to the population of long period transiting planets; periods range from 124-904 days, eight of them more than one Earth year long. Seven of these 14 candidates reside in their host star's habitable zone.Comment: 27 pages, 6 figures, 5 tables, Accepted to AJ (in press) (updated title from original astro-ph submission

Frequency domain analysis for detecting pipeline leaks

The original publication can be found at http://scitation.aip.org/hyoThis paper introduces leak detection methods that involve the injection of a fluid transient into the pipeline, with the resultant transient trace analyzed in the frequency domain. Two methods of leak detection using the frequency response of the pipeline are proposed. The inverse resonance method involves matching the modeled frequency responses to those observed to determine the leak parameters. The peak-sequencing method determines the region in which the leak is located by comparing the relative sizes between peaks in the frequency response diagram. It was found that a unique pattern was induced on the peaks of the frequency response for each specific location of the leak within the pipeline. The leak location can be determined by matching the observed pattern to patterns generated numerically within a lookup table. The procedure for extracting the linear frequency response diagram, including the optimum measurement position, the effect of unsteady friction, and the way in which the technique can be extended into pipeline networks, are also discussed within the paper.Pedro J. Lee, John P. Vítkovský, Martin F. Lambert, Angus R. Simpson and James A. Ligget

Optical Conductivity of Manganites: Crossover from Jahn-Teller Small Polaron to Coherent Transport in the Ferromagnetic State

We report on the optical properties of the hole-doped manganites Nd_{0.7}Sr _{0.3}MnO_{3}, La_{0.7}Ca_{0.3}MnO_{3}, and La_{0.7}Sr_{0.3}MnO_{3}. The low-energy optical conductivity in the paramagnetic-insulating state of these materials is characterized by a broad maximum near 1 eV. This feature shifts to lower energy and grows in optical oscillator strength as the temperature is lowered into the ferromagnetic state. It remains identifiable well below Tc and transforms eventually into a Drude-like response. This optical behavior and the activated transport in the paramagnetic state of these materials are consistent with a Jahn-Teller small polaron. The optical spectra and oscillator strength changes compare well with models that include both double exchange and the dynamic Jahn-Teller effect in the description of the electronic structure.Comment: 27 pages (Latex), 6 figures (PostScript

Placebo Adherence and Its Association with Morbidity and Mortality in the Studies of Left Ventricular Dysfunction

A provocative finding from several double-blind clinical trials has been the association between greater adherence to placebo study medication and better health outcomes. We used data from the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial (SOLVD-TT) and the SOLVD Prevention Trial (SOLVD-PT) to examine whether such associations could be validated and to examine several sources of bias and potential confounding. Survival analytic methods were used to estimate the association between placebo adherence and several health outcomes, employing a number of modeling techniques to test for the existence of alternative explanations for the association. Higher adherence was defined as having taken ≥75% of prescribed study medication. Higher placebo adherence was associated with improved overall survival in both SOLVD-TT and SOLVD-PT [hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.35 to 0.79 and HR = 0.52, 95%CI: 0.38 to 0.71, respectively]. Associations were similar for fatal or non-fatal cardiovascular or coronary heart disease events. Adjustment for both modifiable and non-modifiable cardiac risk factors (including age, gender, diabetes, blood pressure, smoking, weight, alcohol use, and levels of education) had minimal effect on the strength of the association. Little evidence of bias was found as an explanation for this relationship. In these two trials, better adherence to placebo was associated with markedly superior health outcomes, including total in-study mortality and incident cardiovascular events. No important confounders were identified. These data suggest there may exist strong but unrecognized determinants of health outcomes for which placebo adherence is a marker

Tumour risks and genotype-phenotype correlations associated with germline variants in succinate dehydrogenase subunit genes SDHB, SDHC and SDHD.

BACKGROUND: Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype-phenotype correlations in a large cohort of SDHB/SDHC/SDHD mutation carriers. METHODS: A retrospective survey of 1832 individuals referred for genetic testing due to a personal or family history of phaeochromocytoma/paraganglioma. 876 patients (401 previously reported) had a germline mutation in SDHB/SDHC/SDHD (n=673/43/160). Tumour risks were correlated with in silico structural prediction analyses. RESULTS: Tumour risks analysis provided novel penetrance estimates and genotype-phenotype correlations. In addition to tumour type susceptibility differences for individual genes, we confirmed that the SDHD:p.Pro81Leu mutation has a distinct phenotype and identified increased age-related tumour risks with highly destabilising SDHB missense mutations. By Kaplan-Meier analysis, the penetrance (cumulative risk of clinically apparent tumours) in SDHB and (paternally inherited) SDHD mutation-positive non-probands (n=371/67 with detailed clinical information) by age 60 years was 21.8% (95% CI 15.2% to 27.9%) and 43.2% (95% CI 25.4% to 56.7%), respectively. Risk of malignant disease at age 60 years in non-proband SDHB mutation carriers was 4.2%(95% CI 1.1% to 7.2%). With retrospective cohort analysis to adjust for ascertainment, cumulative tumour risks for SDHB mutation carriers at ages 60 years and 80 years were 23.9% (95% CI 20.9% to 27.4%) and 30.6% (95% CI 26.8% to 34.7%). CONCLUSIONS: Overall risks of clinically apparent tumours for SDHB mutation carriers are substantially lower than initially estimated and will improve counselling of affected families. Specific genotype-tumour risk associations provides a basis for novel investigative strategies into succinate dehydrogenase-related mechanisms of tumourigenesis and the development of personalised management for SDHB/SDHC/SDHD mutation carriers

Analytical investigation of AlCl[3]/SO[2]Cl[2] catholyte materials for secondary fuze reserve batteries.

Exploration of the fundamental chemical behavior of the AlCl{sub 3}/SO{sub 2}Cl{sub 2} catholyte system for the ARDEC Self-Destruct Fuze Reserve Battery Project under accelerated aging conditions was completed using a variety of analytical tools. Four different molecular species were identified in this solution, three of which are major. The relative concentrations of the molecular species formed were found to depend on aging time, initial concentrations, and storage temperature, with each variable affecting the kinetics and thermodynamics of this complex reaction system. We also evaluated the effect of water on the system, and determined that it does not play a role in dictating the observed molecular species present in solution. The first Al-containing species formed was identified as the dimer [Al({mu}-Cl)Cl{sub 2}]{sub 2}, and was found to be in equilibrium with the monomer, AlCl{sub 3}. The second species formed in the reaction scheme was identified by single crystal X-ray diffraction studies as [Cl{sub 2}Al({mu}-O{sub 2}SCl)]{sub 2} (I), a scrambled AlCl{sub 3}{center_dot}SO{sub 2} adduct. The SO{sub 2}(g) present, as well as CL{sub 2}(g), was formed through decomposition of SO{sub 2}CL{sub 2}. The SO{sub 2}(g) generated was readily consumed by AlCl{sub 3} to form the adduct 1 which was experimentally verified when 1 was also isolated from the reaction of SO{sub 2}(g) and AlCl {sub 3}. The third species found was tentatively identified as a compound having the general formula {l_brace}[Al(O)Cl{sub 2}][OSCl{sub 2}]{r_brace}{sub n}. This was based on {sup 27}Al NMR data that revealed a species with tetrahedrally coordinated Al metal centers with increased oxygen coordination and the fact that the precipitate, or gel, that forms over time was shown by Raman spectroscopic studies to possess a component that is consistent with SOCl{sub 2}. The precursor to the precipitate should have similar constituents, thus the assignment of {l_brace}[Al(O)Cl{sub 2}][OSCl{sub 2}]{r_brace}{sub n}. The precipitate was further identified by solid state {sup 27}Al MAS NMR data to possess predominantly octahedral A1 metal center which implies {l_brace}[Al(O)Cl{sub 2}][OSCl{sub 2}]{r_brace}{sub n} must undergo some internal rearrangements. A reaction sequence has been proposed to account for the various molecular species identified in this complex reaction mixture during the aging process. The metallurgical welds were of high quality. These results were all visually determined there was no mechanical testing performed. However, it is recommended that the end plate geometry and weld be changed. If the present weld strength, based on .003' - .005' penetration, is sufficient for unit performance, the end plate thickness can be reduced to .005' instead of the .020' thickness. This will enable the plug to be stamped so that it can form a cap rather than a plug and solve existing problems and increase the amount of catholyte which may be beneficial to battery performance

Mutations in SLC39A14 disrupt manganese homeostasis and cause childhood-onset parkinsonism-dystonia.

Although manganese is an essential trace metal, little is known about its transport and homeostatic regulation. Here we have identified a cohort of patients with a novel autosomal recessive manganese transporter defect caused by mutations in SLC39A14. Excessive accumulation of manganese in these patients results in rapidly progressive childhood-onset parkinsonism-dystonia with distinctive brain magnetic resonance imaging appearances and neurodegenerative features on post-mortem examination. We show that mutations in SLC39A14 impair manganese transport in vitro and lead to manganese dyshomeostasis and altered locomotor activity in zebrafish with CRISPR-induced slc39a14 null mutations. Chelation with disodium calcium edetate lowers blood manganese levels in patients and can lead to striking clinical improvement. Our results demonstrate that SLC39A14 functions as a pivotal manganese transporter in vertebrates.Action Medical ResearchThis is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/ncomms1160