A qualitative study into the use of formal services for dementia by carers from culturally and linguistically diverse (CALD) communities.

BACKGROUND: People with dementia and their family carers need to be able to access formal services in the community to help maintain their wellbeing and independence. While knowing about and navigating one's way through service systems is difficult for most people, it is particularly difficult for people from culturally and linguistically diverse (CALD) communities. This study addresses a lack of literature on the use of formal services for dementia by people from CALD backgrounds by examining the experiences and perceptions of dementia caregiving within four CALD communities - Italian, Chinese, Spanish and Arabic-speaking - in south western Sydney, Australia. METHODS: The study used a qualitative design and the methods included focus groups with family carers and one-to-one interviews with bilingual/bicultural community workers, bilingual general practitioners and geriatricians. A total of 121 family carers participated in 15 focus groups and interviews were held with 60 health professionals. All fieldwork was audiotaped, transcribed and subjected to thematic analysis. RESULTS: People from CALD communities are often unfamiliar with the concept of formal services and there may be strong cultural norms about maintaining care within the family, rather than relying on external services. CALD communities often have limited knowledge of services. There is a preference for services that will allow families to keep their relative at home, for safety as well as cultural reasons, and they are particularly reluctant to use residential care. While there is a preference for ethno-specific or multicultural services, mainstream services also need to ensure they are more flexible in providing culturally appropriate care. Positive outcomes occur when ethno-specific services work in partnership with mainstream programs. Dementia service providers need to develop a trusting relationship with their local CALD communities and promote their services in a way that is understandable and culturally acceptable to members of these communities. CONCLUSIONS: While members of CALD communities may have difficulties accessing formal services, they will use them if they are culturally and linguistically appropriate and can meet their needs. There are a number of ways to improve service provision to CALD communities and the responsibility for this needs to be shared by a range of stakeholders

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

BACKGROUND: Clinical decision-making is influenced by many factors, including clinicians' perceptions of the certainty around what is the best course of action to pursue. OBJECTIVE: To characterise the documentation of working diagnoses and the associated level of real-time certainty expressed by clinicians and to gauge patient opinion about the importance of research into clinician decision certainty. METHOD: This was a single-centre retrospective cohort study of non-consultant grade clinicians and their assessments of patients admitted from the emergency department between 01 March 2019 and 31 March 2019. De-identified electronic health record proformas were extracted that included the type of diagnosis documented and the certainty adjective used. Patient opinion was canvassed from a focus group. RESULTS: During the study period, 850 clerking proformas were analysed; 420 presented a single diagnosis, while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign and 16 (4%) were laboratory-result-defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. The patient focus group were unanimous in their support of this research. CONCLUSION: The documentation of working diagnoses is highly variable among non-consultant grade clinicians. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses. IMPLICATIONS: Increased standardisation of documentation will help future studies to better analyse and quantify diagnostic certainty in both single and multiple working diagnoses. This could lead to subsequent examination of their association with important process or clinical outcome measures

Hybrid organic-inorganic supramolecular hydrogel reinforced with CePO4 nanowires

We report a method to enhance the stiffness in the rheological yield strain of cucurbit[8]uril (CB[8])-based hydrogels by introducing inorganic nanowires (NWs) into the supramolecular networks. The supramolecular hydrogel is comprised of methylviologen-functionalised poly(vinyl alcohol) (PVA-MV), hydroxyethyl cellulose with naphthyl moieties (HEC-Np) and CB[8] macrocyclic hosts. The gel structure can be effectively enhanced by the framework supporting effects of cerous phosphate NWs and additional hydrogen bonding interactions between the NWs and the PVA-MV/HEC-Np polymers. The high aspect ratio NWs there serve as a “skeleton” for the network providing extra physical crosslinks, resulting in a single continuous phase hybrid supramolecular network with improved strength, presenting a general approach to reinforce soft materials

Hysteresis response of daytime net ecosystem exchange during drought

Continuous measurements of net ecosystem CO<sub>2</sub> exchange (NEE) using the eddy-covariance method were made over an agricultural ecosystem in the southeastern US. During optimum environmental conditions, photosynthetically active radiation (PAR) was the primary driver controlling daytime NEE, accounting for as much as 67 to 89% of the variation in NEE. However, soil water content became the dominant factor limiting the NEE-PAR response during the peak growth stage. NEE was significantly depressed when high PAR values coincided with very low soil water content. The presence of a counter-clockwise hysteresis of daytime NEE with PAR was observed during periods of water stress. This is a result of the stomatal closure control of photosynthesis at high vapor pressure deficit and enhanced respiration at high temperature. This result is significant since this hysteresis effect limits the range of applicability of the Michaelis-Menten equation and other related expressions in the determination of daytime NEE as a function of PAR. The systematic presence of hysteresis in the response of NEE to PAR suggests that the gap-filling technique based on a non-linear regression approach should take into account the presence of water-limited field conditions. Including this step is therefore likely to improve current evaluation of ecosystem response to increased precipitation variability arising from climatic changes

Orbitally excited and hybrid mesons from the lattice

We discuss in general the construction of gauge-invariant non-local meson operators on the lattice. We use such operators to study the $P$- and $D$-wave mesons as well as hybrid mesons in quenched QCD, with quark masses near the strange quark mass. The resulting spectra are compared with experiment for the orbital excitations. For the states produced by gluonic excitations (hybrid mesons) we find evidence of mixing for non-exotic quantum numbers. We give predictions for masses of the spin-exotic hybrid mesons with $J^{PC}=1^{-+},\ 0^{+-}$, and$2^{+-}$.Comment: 31 pages, LATEX, 8 postscript figures. Reference adde

Microdosing and other phase 0 clinical trials: facilitating translation in Drug Development

Increasing costs of drug development and ethical concernsabout the risks of exposing humans and animals to novelchemical entities favor limited exposure clinical trials suchas microdosing and other phase 0 trials. An increasing bodyof research supports the validity of extrapolation from thelimited drug exposure of phase 0 approaches to the full,therapeutic exposure. An increasing number of applicationsand design options demonstrate the versatility and exibilitythese approaches offer to drug developers

Quenched QCD with O(a) improvement: I. The spectrum of light hadrons

We present a comprehensive study of the masses of pseudoscalar and vector mesons, as well as octet and decuplet baryons computed in O(a) improved quenched lattice QCD. Results have been obtained using the non-perturbative definition of the improvement coefficient c_sw, and also its estimate in tadpole improved perturbation theory. We investigate effects of improvement on the incidence of exceptional configurations, mass splittings and the parameter J. By combining the results obtained using non-perturbative and tadpole improvement in a simultaneous continuum extrapolation we can compare our spectral data to experiment. We confirm earlier findings by the CP-PACS Collaboration that the quenched light hadron spectrum agrees with experiment at the 10% level.Comment: 36 pages, 7 postscript figures, REVTEX; typo in Table XVIII corrected; extended discussion of finite-size effects in sections III and VII; version to appear in Phys. Rev.