The Development and Validation of the Dementia Quality of Life Scale for Older Family Carers (DQOL-OC)

Background: Family carers are considered to be the most important resource available to support people with dementia. The number of older people who are carers is increasing in the United Kingdom, and little is known about how caregiving affects their quality of life (QoL). The World Health Organization has established the importance of measuring individuals’ QoL and of developing and using age-specific QoL tools. However, to date no dementia- and age-specific QoL scale has been developed for use with older family carers. Aim: This PhD study aimed to develop and evaluate the psychometric properties of the ‘Dementia Quality of Life Scale for Older Family Carers’ (DQoL-OC), a dementia- and age-specific scale for the evaluation of QoL of older family carers. This tool might provide more robust QoL outcomes than scales currently being used with this particular population, helping to improve the quality of the evidence that results from studies and interventions aimed at evaluating and enhancing the QoL of these individuals. Methods: This is a sequential exploratory mixed-methods research. The DQoL-OC items were identified in four focus groups with 19 older family carers in Nottinghamshire. Data were transcribed verbatim and analysed by two researchers independently, using Interpretative Phenomenological Analysis. Inter-coder reliability was established using the Cohen’s kappa coefficient. A set of 89 items assessed using a five-point rating scale was generated and evaluated for content and face validity by a panel of six experts. The modified version of the DQoL-OC containing 100 items was then tested with a non-probabilistic sample of 182 older family carers in the UK who were providing care at home for family members with dementia. A battery of additional scales was administered to establish convergent construct validity: the Satisfaction with Life Scale; the WHOQOL-AGE QoL Scale; Perceived Health Status Visual Analogue Scale; and Overall Perceived Health-Related Quality of Life Visual Analogue Scale. The QoL model was identified using Exploratory Factor Analysis. Eighteen participants took part in the test-retest reliability, and the two measurement sets were correlated using Intraclass Correlation. Cronbach’s alpha was used to measure internal consistency reliability. The Pearson coefficient was used to provide evidence of convergent construct validity and the Spearman’s rho coefficient was used to correlate the DQoL-OC with other sociodemographic and caregiving variables. Results: Thirty-three themes emerged from focus groups and were collated into three superordinate themes: aspects of care and caregiving; feelings and concerns; and satisfaction with life and with caregiving. Very good inter-coder reliability was established (r=0.839). The psychometric study demonstrated that a one-factor solution containing 22 items best represented the new QoL model. Excellent test retest reliability (lower bound r=0.835; <0.0001) and internal consistency (α=0.936) scores were obtained. Convergent construct validity was established for all tested scales (<0.0001). Significantly lower levels of QoL were found in female older carers, those who perceived their relatives with dementia as being at the earlier stages of the disease and with unstable dementia symptoms, those providing care more hours per day and more days per week, and those in younger-old age. Conclusion: This study allowed the exploration of a broad range of aspects that are of particular importance for the QoL of older family carers of people with dementia. The DQoL-OC was considered by participants to be a relevant and useful measure of QoL. DQoL-OC is a valid and reliable 22-item tool assessed using 1 to 5 rating scales, which may be useful in clinical practice and in research in order to improve the QoL of older family carers of people with dementia. These findings will inform future health and social care practice with regards to improving life quality for this overlooked sector of the population

The Development and Validation of the Dementia Quality of Life Scale for Older Family Carers (DQOL-OC)

Background: Family carers are considered to be the most important resource available to support people with dementia. The number of older people who are carers is increasing in the United Kingdom, and little is known about how caregiving affects their quality of life (QoL). The World Health Organization has established the importance of measuring individuals’ QoL and of developing and using age-specific QoL tools. However, to date no dementia- and age-specific QoL scale has been developed for use with older family carers. Aim: This PhD study aimed to develop and evaluate the psychometric properties of the ‘Dementia Quality of Life Scale for Older Family Carers’ (DQoL-OC), a dementia- and age-specific scale for the evaluation of QoL of older family carers. This tool might provide more robust QoL outcomes than scales currently being used with this particular population, helping to improve the quality of the evidence that results from studies and interventions aimed at evaluating and enhancing the QoL of these individuals. Methods: This is a sequential exploratory mixed-methods research. The DQoL-OC items were identified in four focus groups with 19 older family carers in Nottinghamshire. Data were transcribed verbatim and analysed by two researchers independently, using Interpretative Phenomenological Analysis. Inter-coder reliability was established using the Cohen’s kappa coefficient. A set of 89 items assessed using a five-point rating scale was generated and evaluated for content and face validity by a panel of six experts. The modified version of the DQoL-OC containing 100 items was then tested with a non-probabilistic sample of 182 older family carers in the UK who were providing care at home for family members with dementia. A battery of additional scales was administered to establish convergent construct validity: the Satisfaction with Life Scale; the WHOQOL-AGE QoL Scale; Perceived Health Status Visual Analogue Scale; and Overall Perceived Health-Related Quality of Life Visual Analogue Scale. The QoL model was identified using Exploratory Factor Analysis. Eighteen participants took part in the test-retest reliability, and the two measurement sets were correlated using Intraclass Correlation. Cronbach’s alpha was used to measure internal consistency reliability. The Pearson coefficient was used to provide evidence of convergent construct validity and the Spearman’s rho coefficient was used to correlate the DQoL-OC with other sociodemographic and caregiving variables. Results: Thirty-three themes emerged from focus groups and were collated into three superordinate themes: aspects of care and caregiving; feelings and concerns; and satisfaction with life and with caregiving. Very good inter-coder reliability was established (r=0.839). The psychometric study demonstrated that a one-factor solution containing 22 items best represented the new QoL model. Excellent test retest reliability (lower bound r=0.835; <0.0001) and internal consistency (α=0.936) scores were obtained. Convergent construct validity was established for all tested scales (<0.0001). Significantly lower levels of QoL were found in female older carers, those who perceived their relatives with dementia as being at the earlier stages of the disease and with unstable dementia symptoms, those providing care more hours per day and more days per week, and those in younger-old age. Conclusion: This study allowed the exploration of a broad range of aspects that are of particular importance for the QoL of older family carers of people with dementia. The DQoL-OC was considered by participants to be a relevant and useful measure of QoL. DQoL-OC is a valid and reliable 22-item tool assessed using 1 to 5 rating scales, which may be useful in clinical practice and in research in order to improve the QoL of older family carers of people with dementia. These findings will inform future health and social care practice with regards to improving life quality for this overlooked sector of the population

A new non-Fermi liquid fixed point

We study a new exchange interaction in which the conduction electrons with pseudo spin $S_c=3/2$ interact with the impurity spin $S_I=1/2$. Due to the overscreening of the impurity spin by higher conduction electron spin, a new non-trivial intermediate coupling strength fixed point is realized. Using the numerical renormalization group (NRG), we show that the low-energy spectra are described by a non-Fermi liquid excitation spectrum. A conformal field theory analysis is compared with NRG results and excellent agreement is obtained. Using the double fusion rule to generate the operator spectrum with the conformal theory, we find that the specific heat coefficient and magnetic susceptibility will diverge as $T^{-2/3}$, that the scaling dimension of an applied magnetic field is $5/6$, and that exchange anisotropy is always relevant. We discuss the possible relevance of our work to two-level system Kondo materials and dilute cerium alloys, and we point out a paradox in understanding the Bethe-Ansatz solutions to the multichannel Kondo model.Comment: Revised. 20 page

Associação da prática de atividade física e do estado de saúde sobre a qualidade de vida de mulheres com fibromialgia

This study analyzed the association between physical activity, health status and life quality among women with fibromyalgia. Cross-sectional study based on the clinical information of 177 women (42.1 ± 8.6 years old) diagnosed with fibromyalgia and assisted in rheumatology clinics of the private sector of the Unified Health System (UHS) in the city of Maringá-PR, Brazil. The instruments were the International Physical Activity Questionnaire (IPAQ), the Fibromyalgia Impact Questionnaire (FIQ) and the WHOQOL-Bref. Data analysis was conducted through Mann-Whitney test, Spearman correlation and Structural Equation Analysis (p<0.05). Results showed positive correlations between physical activity and life quality domain. Health status showed negative correlation life quality domains. Structural Equation Analysis revealed days of walking per week showed positive association with life quality domains. Model 3 showed that the impact of fibromyalgia on the health status showed a moderate negative association with life quality domains. Based on the results obtained, the conclusion is that light physical activity, characterized as walking, represents a positive factor in the domains of quality of life in women with fibromyalgia and also, the impact of this disease on the health status of the patients is associated negatively areas of quality of life.301Este estudo analisou a associação entre atividade física, estado de saúde e qualidade de vida de mulheres com fibromialgia. Estudo transversal baseado na informação clínica de 177 mulheres (42,1 ± 8,6 anos) diagnosticadas com fibromialgia e auxiliadas em clínicas de reumatologia do setor privado do Sistema Único de Saúde (SUS) na cidade de Maringá-PR, Brasil. Os instrumentos utilizados foram o Questionário Internacional de Atividade Física (IPAQ), o Questionário de Impacto da Fibromialgia (FIQ) e o WHOQOL-Bref. A análise dos dados foi realizada através do teste de Mann-Whitney, correlação de Spearman e Análise de Equações Estruturais (p <0,05). Os resultados mostraram correlações positivas entre a atividade física e o domínio da qualidade de vida. O estado de saúde apresentou correlações negativas com a qualidade de vida. A Análise de Equação Estrutural revelou que os dias de caminhada por semana se associou positivamente com domínios de qualidade de vida. O modelo 3 mostrou que o impacto da fibromialgia no estado de saúde apresentou associação negativa e moderada com os domínios de qualidade de vida. Com base nos resultados obtidos, conclui-se que a atividade física leve, caracterizada pela caminhada, representa um fator positivo nos domínios da qualidade de vida em mulheres com fibromialgia e também, o impacto desta doença sobre o estado de saúde dos pacientes está associado negativamente domínios da qualidade de vida

Kinetics of TNF-alpha and IFN-gamma mRNA expression in islets and spleen of NOD mice

Insulin-dependent diabetes mellitus is caused by autoimmune destruction of pancreatic ß cells. Non-obese diabetic (NOD) mice spontaneously develop diabetes similar to the human disease. Cytokines produced by islet-infiltrating mononuclear cells may be directly cytotoxic and can be involved in islet destruction coordinated by CD4+ and CD8+ cells. We utilized a semiquantitative RT-PCR assay to analyze in vitro the mRNA expression of TNF-alpha and IFN-gamma cytokine genes in isolated islets (N = 100) and spleen cells (5 x 10(5) cells) from female NOD mice during the development of diabetes and from female CBA-j mice as a related control strain that does not develop diabetes. Cytokine mRNAs were measured at 2, 4, 8, 14 and 28 weeks of age from the onset of insulitis to the development of overt diabetes. An increase in IFN-gamma expression in islets was observed for females aged 28 weeks (149 ± 29 arbitrary units (AU), P<0.05, Student t-test) with advanced destructive insulitis when compared with CBA-j mice, while TNF-alpha was expressed in both NOD and CBA-j female islets at the same level at all ages studied. In contrast, TNF-alpha in spleen was expressed at higher levels in NOD females at 14 weeks (99 ± 8 AU, P<0.05) and 28 weeks (144 ± 17 AU, P<0.05) of age when compared to CBA-j mice. The data suggest that IFN-gamma and TNF-alpha expression in pancreatic islets of female NOD mice is associated with ß cell destruction and overt diabetes.1347135

Estimation of kinetic parameters in a chromatographic separation model via Bayesian inference

A modelagem de processos de adsorção tem sido empregada com frequência nas indústrias químicas, petroquímicas e refinarias, por exemplo para separação e purificação de misturas em unidade de Leito Móvel Simulado (LMS). Na representação matemática do modelo, a determinação de parâmetros é um passo importante para o projeto de condições cromatográficas para a separação contínua, em processos do tipo LMS. Este trabalho tem por objetivo a análise de estimativa de parâmetros em processos de adsorção, usando um sistema cromatográfico com uma coluna, para a separação das substâncias Glicose e Frutose. Investiga-se o uso da abordagem Bayesiana, através de métodos de Monte Carlo via Cadeias de Markov (MCMC), assim como o uso da abordagem da máxima verossimilhança, utilizando duas técnicas estocásticas diferentes, o Algoritmo de Colisão de Partículas (PCA - Particle Collision Algorithm), e o Algoritmo de Otimização por Enxame de Partículas (PSO - Particle Swarm Optimization) para executar a tarefa de minimização da função objetivo. Diferentes casos são apresentados com o objetivo de analisar a significância estatística das estimativas obtidas para os parâmetros, fazendo-se uma comparação crítica entre a solução via inferência Bayesiana e via minimização da função objetivo com métodos estocásticos. Os resultados obtidos demonstram que o uso da abordagem Bayesiana fornece uma proposta vantajosa para a estimativa de parâmetros em transferência de massa, oferecendo resultados com maior riqueza de informação estatística.The modeling of adsorption processes appears quite frequently in the chemical industry, petrochemical plants and refineries, for example for separation and purification of mixtures in Simulated Moving Bed (SMB) units. In the mathematical formulation, the accurate determination of the model parameters is an important step for the design of chromatographic conditions for continuous separation in SMB processes. This work is aimed at the estimation of the model parameters in adsorption processes, using a chromatographic column for the separation of glucose and fructose. The Bayesian framework for inverse problems is investigated through the implementation of Markov Chain Monte Carlo methods (MCMC) and a critical comparison against the classical Maximum Likelihood approach, with the minimization of the objective function via two different stochastic techniques, namely the Particle Collision Algorithm (PCA), and the Particle Swarm Optimization (PSO) is performed. Different cases are presented in order to investigate the statistical significance of the estimates obtained, and perform comparisons between the solution via Bayesian inference and via the minimization of the objective function with the stochastic methods. The results demonstrate that the Bayesian approach employs less computational effort to achieve estimates with comparable statistical information.Peer Reviewe

Orelha de Elefante Mexicana (Opuntia stricta [Haw.] Haw.) spineless cactus as an option in crossbred dairy cattle diet

new genotype of spineless cactus is being used in the diets of dairy cattle that are raised in semi-arid regions. However, little is known about its nutritional value. This study aimed to evaluate the effects of replacing Miúda (Nopalea cochenillifera Salm Dyck) with Orelha de Elefante Mexicana (Opuntia stricta [Haw.] Haw.) spineless cactus, on nutrient intake and digestibility, milk yield and composition, feeding behaviour, microbial protein synthesis, nitrogen balance, and ruminal and blood parameters of dairy cows. Ten Girolando cows, 500 ± 51.6 kg bodyweight, were distributed in a double Latin square design 5 x 5. The treatments consisted of replacement levels of Miúda (MIU) by Orelha de Elefante Mexicana (OEM) at 0, 25, 50, 75, and 100%. The intake and digestibility of dry matter (DM) (14.38–12.95 kg d-1, 716.3–658.9 g d-1), organic matter (OM) (13.01–11.43 kg d-1, 747.8–704.8 g d-1), crude protein (CP) (2.02–1.61 kg d-1, 863.8–845.2 g d-1) and total digestible nutrients (TDN) (9.38–7.92 kg d-1) decreased linearly with the increase in replacement. Despite the decrease in intake and digestibility, the supply of nutrients was sufficient to maintain a milk yield of 12.5 kg d-1. The average daily weight gain decreased linearly with the increase in replacement, while protein microbial efficiency (g microbial CP kg-1 TDN intake; 91.24 to 127.44 g kg-1) increased linearly. Thus, OEM could replace 100% MIU in diets with 48% of spineless cactus, for crossbred lactating cows with 12.5 kg d-1 milk yield. Therefore, OEM is a viable new option for producing milk in smallholder livestock systems in semi-arid regions.Keywords: Alternative forage, milk yield, ruminal parameter, semi-arid, smallholder livestock syste