Decision aids for respite service choices by carers of people with dementia: development and pilot RCT

<p>Abstract</p> <p>Background</p> <p>Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care.</p> <p>Methods</p> <p>A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later.</p> <p>Results</p> <p>The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants.</p> <p>Conclusions</p> <p>While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN32163031">ISRCTN32163031</a></p

Water Supply Planning: Middle Illinois Assessment of Water Resources for Water Supply-Final Report

Illinois Department of Natural Resourcespublished or submitted for publicationis peer reviewedOpe

Water supply planning: Kankakee watershed assessment of water resources for water supply

This report examines the impacts of current and future demands on water supplies for the Kankakee Watershed Water Supply Planning Subregion (WSPR) in northeastern Illinois, an area comprising most of Kankakee and Iroquois Counties and portions of Ford, Will, Vermilion, and Grundy Counties that intersects the Kankakee River watershed boundary. Initial water demand scenarios were developed for a three-county region (Ford, Iroquois, and Kankakee) out to 2060 for five major water sectors, including thermoelectric power generation, public supply, self-supplied domestic, self-supplied industrial and commercial (IC), and self-supplied irrigation, livestock, and environmental (ILE), and are described in a companion report (Meyer et al., 2019). Total water usage in 2010 was estimated to be 39 million gallons per day (mgd), with two sectors, public supply and ILE, accounting for more than 80 percent of the demand in the region. Most of the ILE demand was for crop irrigation. Self-supplied IC accounted for 13 percent and the domestic sector 6 percent of the usage. Significant water resources are available to meet demands in the Kankakee WSPR, including both groundwater and surface water. Two major aquifer systems occur in the region: (1) productive sand and gravel aquifers, primarily in the south where the Mahomet Aquifer is encountered; and (2) weathered Silurian-Devonian dolomite, which is the most productive aquifer system in the region. Both the dolomite and Mahomet Aquifers are overlain by clay over most of the watershed, limiting leakage from shallower sources. The deeper Cambrian-Ordovician sandstones are generally too saline in this area to use as a water supply, although they are heavily used just outside of the watershed boundary in Will, Kendall, and Grundy Counties. Although the aquifers are generally thought to be adequate to meet most expected future demands, there are some sensitive areas that should be monitored closely. The most important area appears to be southeastern Kankakee and northeastern Iroquois Counties, where demands for irrigation water are highest on account of sandy soils. These demands are met from the dolomite aquifers and have been shown to result in dewatering of the dolomite during the irrigation season.Water quality in the Silurian-Devonian dolomite aquifer system is generally good. At a few locations, nitrate and chloride concentrations are elevated, but at concentrations below their respective drinking water standards. Water moves relatively rapidly from land surface into the Silurian-Devonian dolomite aquifer where it is near land surface, especially in the northern half of the region; aquifer protection activities should be a priority in these areas. The primary surface water sources in the Kankakee WSPR are the Kankakee and Iroquois Rivers. Currently there are four entities withdrawing water from the Kankakee River in the planning region: Aqua Illinois-Kankakee Division, which supplies the city of Kankakee, the city of Wilmington, Exelon Dresden Station, and Exelon Braidwood Generation Station.Although the Kankakee River has reliable water for meeting current power generation and public water supply needs, the cooling water withdrawals from the river could be limited on account of protected minimum flows and water temperature criteria. Therefore, both Dresden and Braidwood plants have a considerable storage capacity in their cooling ponds to buffer the impact of the minimum flow restriction. With increasing water demand and potential climate change, the frequency and duration of the minimum flow restriction may be increased in the 2 future. Both power plants using the Kankakee River for cooling water may rely on storage water more frequently.Water demand from within the watershed is not expected to increase dramatically in the future. However, large portions of Will County are at risk to dewatering of the Cambrian-Ordovician sandstone aquifers. As a result, communities within these at-risk areas are seeking alternate water supplies in anticipation of these impacts. One possible option is the Kankakee River. As part of the process of exploring alternative supplies, both Joliet and Godley have requested withdrawing a large amount of water from the lower reach of the Kankakee River. The communities served by this water lie primarily outside of the watershed, so both withdrawal and consumptive use of Kankakee River water could increase substantially. Unlike within the watershed, water demand for these communities outside of the watershed is expected to increase. Another unknown is how water demand will be met in the future by industries along the Des Plaines River. Many of these industries also rely on the at-risk sandstone aquifers, so the long-term viability of their sandstone wells is contingent on decisions by communities.The major concern with increasing water demand on the Kankakee River is the minimum flow restriction and how to supplement the river water when it is not available during drought conditions, especially when the water is diverted out of the watershed, as the wastewater may not be returned to the river. Other backup supplies are of limited availability in areas of sandstone risk, as currently the sandstone aquifers are likely to be the only viable backup option; however, there are questions about its viability under increasing demand. Off-channel storages and/or abandoned storage pits could also be explored to provide additional backup supply.As a result, conjunctive water management that accounts for impacts on both river and groundwater supplies will be essential moving forward. Water users within the Kankakee River watershed should be cognizant of this potential future demand on the river. Available flow on the Kankakee River during low-flow periods may be contingent on whether the communities in Will County also tap into it as a water supply, so water planners currently using or anticipating growth in use of the Kankakee River water should stay informed on planning decisions outside of the region. Sandstone users considering using the Kankakee River as a backup supply are also currently working with the ISWS to evaluate the viability of the Kankakee River as a backup supply under low-flow scenarios on the Kankakee River. This is critically important because of the rapid response of the sandstone aquifer when demands change.Illinois Department of Natural Resourcespublished or submitted for publicationis peer reviewedOpe

An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11&nbsp;months but was extended in a minority of cases up to 7&nbsp;years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1&nbsp;month) was favoured by age &lt;60&nbsp;years (p&nbsp;&lt;&nbsp;0.005), no previous observation (p&nbsp;&lt;&nbsp;0.0002), duration less than 3&nbsp;months (p&nbsp;&lt;&nbsp;0.0001), absence of CSCR in the fellow eye (p&nbsp;=&nbsp;0.04), leakage outside of the arcade (p&nbsp;=&nbsp;0.05) and fluid height &gt;500&nbsp;\u3bcm (p&nbsp;=&nbsp;0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1&nbsp;month was favoured by first episode (p&nbsp;=&nbsp;0.04), height of subretinal fluid &gt;500&nbsp;\u3bcm (p&nbsp;&lt;&nbsp;0.0001) and short duration of observation (p&nbsp;=&nbsp;0.02). Finally, there was no statistically significant difference among the treatments at 12&nbsp;months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification

Urban futures and the code for sustainable homes

Copyright © 2012 ICE Publishing Ltd. Permission is granted by ICE Publishing to print one copy for personal use. Any other use of these PDF files is subject to reprint fees.A 6?6 ha (66 000 m2) regeneration site, commonly referred to as Luneside East, is to be turned from a run down, economically under-achieving area of Lancaster, UK, into a new, distinctive, vibrant, sustainable quarter of the city. As a result several aspects of water planning for 350 new homes and 8000 m2 of workspace needed to be considered before any infrastructure investment was undertaken. This included assessment of the future capacity requirements (i.e. inflows and outflows) for water infrastructure (i.e. mains water supply, wastewater disposal, rainwater storage and stormwater disposal) much of which will be located underground. This paper looks at the implications of various water management strategies on the Luneside East site (e.g. water-efficient appliances, greywater recycling and rainwater harvesting) in line with current policy measures that focus on technology changes alone (e.g. the code for sustainable homes). Based on these findings this paper outlines some basic implications for technological resilience discussed in the context of four ‘world views’ – that is, the urban futures scenarios considered in this special issue. Conclusions are drawn as to how far this can take engineers, planners and developers in understanding and planning for resilient water infrastructure within a development like Luneside East

Investigations of connections of selected fatigue-burdened joints

Соответствущие исследования были направлены на определение механических свойств мебельных соединений с выбранными вязками. Особое внимание уделяли статической прочности, деформациям под влиянием статических нагрузок и вопросам усталостной прочности, а также зависимости между статической и усталостной прочностью. Исследования охватывали группу 4 видов вязок: шиповых, нахлесточных, с открытым сквозным типом и с плоским шипом. Все вязки склеивали двумя видами клеев: глютиновым и полиуксусновиниловым. Для всех групп вязок определяли максимальное напряжение возникающее при статической нагрузке. Определяли также графическим способом зависимость деформации вязки от нагрузки в статической пробе. Целью указанных исследований была разработка основной проблемы, какой являлось определение зависимости между статической и усталостной прочностью. Эта зависимость была определена путем дисперсионного анализа для каждого вида вязки и для всей их группы с помощью общего уравнения: n=e⁻ax₁+b, где а и Ь коэффициенты с различным значением для разных вязок.The aim of the investigations was to determine mechanical properties of furniture connections of selected joints. The main attention was concentrated upon the static strength, deformation occurring under the effect of static loads and upon the problem of fatigue strength and relations between the static and fatigue strength. The investigations comprised a group of 4 joint kinds: tenon, halved, forked and dowel joints. All joints were glued with two glue kinds: glutine and poly- acetovinyl glue. Maximum tensions occurring at the static load were determined for all joint groups. Also the dependences of connection deformation on the load in a static test were determined in the graphical way. The above investigations were aimed at solution of the main problem, i.e. determination of the relationship between static and fatigue strength. This relationship was determined by means of the analysis of variance for each joint kind and for the whole group of joints by the general equation: n=e⁻ax₁+b, where a and b - coefficients of different values for particular joint kinds

Elasticity of furniture elements glue by layers

Соответствующие исследования охватывали послойно склеиваемую буковую древесину предназначенную на выбранные конструкционные мебельные элементы. Целью исследований было определение упругостных свойств этих элементов совместно с определением зависимости между модулями упругости послойно склеиваемых элементов с различным числом слоев, их толщины и направления сгиба. Для достижения указанной цели проводились теоретические исследования с последующей проверкой на основании результатов экспериментальных изысканий. Проведенные анализы показали, что модуль упругости элементов из буковой древесины склеиваемой послойно не зависит от числа слоев ни от вида используемого клея. Примерно так же представляются прочность и деформации.The respective investigations comprised the beech wood glued by layers, designed for selected constructional furniture elements. The aim of the investigations was to determine elastic properties of the wooden elements jointly with datermination of relationships between the elasticity modules of the by-layer glued elements of different number of layers, their thickness and bending direction. To attain this aim, theoretical investigations were carried out with their subselent verification on the basis of the experimental investigation results. The investigations have proved that the elasticity module of beech wood elements glued by layers does not depend on the number of layers and the glue kind used. Strength and deformations are formed similarly

Eye Movement Desensitization And Reprocessing (Emdr) As A Time-Limited Treatment Intervention For Body Image Disturbance And Self-Esteem: A Single Subject Case Study Design

This single subject case study implemented in the private practice setting examined body-image disturbance and self-esteem. Eye movement desensitization and reprocessing (EMDR) is the treatment modality. The Self-Esteem Rating Scale and the Body Image Avoidance Questionnaire are pre and post tested. A self-developed Daily Body Satisfaction Log is used throughout the 43-day observation period. Scores on subjects\u27 self-esteem and body image avoidance showed clinical improvement over the treatment period. Based on this clinical examination, eye movement desensitization and reprocessing appears to be a promising time-limited treatment intervention that merits further research for application to eating disorder symptoms such as body image disturbance and low self-esteem. Suggestions for future research are provided