473 research outputs found

    A Cluster-Randomised Trial of Staff Education to Improve the Quality of Life of People with Dementia Living in Residential Care: The DIRECT Study

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    BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≀ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. CONCLUSION: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000417482

    A tribo-chemical view on astringency of plant-based food substances

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    Consumption of plant-based food products having high composition of polyphenols leads to the sensation of astringency. For sliding oral surfaces, friction is an essential property during the oral perception of roughness and dryness which are attributes associated with astringency. Different factors including the chemical composition of interacting layers, structure and operation of interfaces have an effect on the astringency development process. The manner of interactions occurring at oral interfaces suggest there is a system dependence of astringency and highlights the importance of adopting a tribosystems approach. Available measurement techniques have shown an existing relationship between salivary protein-polyphenol interaction and an astringent mouthfeel. Nevertheless, the tribo-chemistry involved in this multifaceted sensation remains largely unexplored in a comprehensive manner. In this review the underlying tribo-chemical processes useful in understanding the mechanism of astringency are highlighted and discussed considering current techniques employed to investigate astringency perception. Loss of lubrication on oral surfaces owing to the tribo-chemical interactions involving saliva and astringent plant proteins requires subsequent deformations of oral tissues which are significant enough to induce strains at mechanoreceptor locations, leading to the sensation of astringency. It is proposed that micro-scale contact modelling on the interaction of food particles/aggregates, boundary layers and oral surfaces shows potential in addressing the knowledge gap between tribo-chemical measurement techniques and panel tests, making it possible to attain a predictor for astringency.</p

    Factors Associated with Self and Informant Ratings of the Quality of Life of People with Dementia Living in Care Facilities: A Cross Sectional Study

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    There is no consensus regarding the optimal approach to assessment of the quality of life of people with dementia. We undertook the present study to describe and determine the factors associated with ratings of the quality of life of a cohort of people with dementia living in a residential care facility.351 people with dementia living in residential care facilities, and their staff and family informants participated in this cross sectional observational study. Quality of life was measured using self (Quality of Life in Alzheimer's Disease [QoL-AD] scale), and informant (QoL-AD and Alzheimer's Disease Related QoL Scale) reports. 226 people (64%) with dementia (median MMSE 17; 12-21) were able to self rate the QoL-AD scale and these subjects' ratings were compared to ratings by staff and family. Both staff and family informant ratings of the QoL-AD underestimated self ratings (mean difference -7.8, 95% CI -8.8, -6.7 for staff rated QoL-AD; and mean difference -7.2, 95% CI -8.5, -6.0 for family rated QoL-AD). Self ratings of QoL were lower among people who were restrained, had fallen or had pain. Informant ratings of the QoL of the participants with dementia were consistently and significantly lower for people with severe cognitive impairment, who had fallen, had presence of neuropsychiatric symptoms, or where care giver distress was present. Documented restraint, reported pain and neuropsychiatric symptoms were independently associated with lower self rating of the QoL-AD in multivariate models. Cognitive impairment, case conferencing, hospitalizations and neuropsychiatric symptoms were found to be independently associated with staff rated ADRQL.The majority of people with dementia living in residential care facilities can rate their own QoL. Informant ratings underestimate self ratings of QoL of people with dementia, and appear to be associated with factors which are not associated with self ratings

    Dementia in residential care: education intervention trial (DIRECT); protocol for a randomised controlled trial

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    <p>Abstract</p> <p>Background</p> <p>There is scope to improve the quality of life (QOL) of people with dementia living in residential care facilities (RCF). The DIRECT study will determine if delivery of education to General Practitioners (GPs) and care staff improves the quality of life of residential care recipients with cognitive impairment.</p> <p>Methods/Design</p> <p>A prospective randomised controlled trial conduced in residential aged care facilities in the metropolitan area of Perth, Western Australia. Participants are care facility residents, aged 65 years and older and with mini-mental state examination scores less than 25. GPs and care facility staff have been independently randomised to intervention or control groups. An education programme, designed to meet the perceived needs of learners, will be delivered to GPs and care staff in the intervention groups. The primary outcome of the study will be quality of life of the people with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) and Alzheimer Disease Related QOL Scale (ADRQL), 4 weeks and 6 months after the conclusion of the education intervention.</p> <p>Results</p> <p>Recruitment of 351 people with dementia, cared for by staff in 39 residential facilities and 55 GPs, was undertaken between May 2007 and July 2008. Collection of baseline data is complete. Education has been delivered to GPs and Care staff between September 2008 and July 2009. Follow- up data collection is underway.</p> <p>Discussion</p> <p>The study results will have tangible implications for proprietors, managers and staff from the residential care sector and policy makers. The results have potential to directly benefit the quality of life of both patients and carers.</p> <p>Trial registration</p> <p>These trial methods have been prospectively registered (ACTRN12607000417482).</p

    Facing homelessness

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    In facing homelessness we face the other, and in facing the other, we face ourselves. This book contributes to an emerging body of knowledge on street homelessness in the South African context. It is meant for researchers and scholars who are committed to finding solutions for street homelessness. It offers conceptual frameworks and practical guidelines for a liberative and transformative response to homelessness. It brings together authors from a wide range of disciplines, fusing the rigour of researchers, the vision of activists and the lived experience of practitioners. In this volume, the causes of street homelessness in South Africa today, and its different faces, are traced. It critiques singular solutions, and interrogates the political, institutional and moral failures that contribute to the systemic exclusion of homeless persons and other vulnerable populations from society. It proposes rights-based interventions as part of a radical re-imagination of how street homelessness can be ended, one person and one neighbourhood at a time. The analysis by the authors steer in the direction of new ways of doing and being that could demonstrate concrete, viable and sustainable alternatives to the exclusionary realities faced by homeless persons. It argues for solution-based approaches, aimed at radical forms of social inclusion and achieved through broad-based and creative collaborations by all spheres of society. In the face and presence of street homelessness – as one expression of urban vulnerability and deep socio-economic inequality – society is confronted with a clear political, institutional, moral and personal obligation. This volume calls for a reclamation of community in its most inclusionary, life-affirming and interdependent sense, asserting that we truly are well because of others, and we are unwell if others are. It is a call to reclaim our common humanity in the context of inclusive communities where all are equally welcome and bestowed with dignity and honour

    Sequence-based prediction for vaccine strain selection and identification of antigenic variability in foot-and-mouth disease virus

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    Identifying when past exposure to an infectious disease will protect against newly emerging strains is central to understanding the spread and the severity of epidemics, but the prediction of viral cross-protection remains an important unsolved problem. For foot-and-mouth disease virus (FMDV) research in particular, improved methods for predicting this cross-protection are critical for predicting the severity of outbreaks within endemic settings where multiple serotypes and subtypes commonly co-circulate, as well as for deciding whether appropriate vaccine(s) exist and how much they could mitigate the effects of any outbreak. To identify antigenic relationships and their predictors, we used linear mixed effects models to account for variation in pairwise cross-neutralization titres using only viral sequences and structural data. We identified those substitutions in surface-exposed structural proteins that are correlates of loss of cross-reactivity. These allowed prediction of both the best vaccine match for any single virus and the breadth of coverage of new vaccine candidates from their capsid sequences as effectively as or better than serology. Sub-sequences chosen by the model-building process all contained sites that are known epitopes on other serotypes. Furthermore, for the SAT1 serotype, for which epitopes have never previously been identified, we provide strong evidence - by controlling for phylogenetic structure - for the presence of three epitopes across a panel of viruses and quantify the relative significance of some individual residues in determining cross-neutralization. Identifying and quantifying the importance of sites that predict viral strain cross-reactivity not just for single viruses but across entire serotypes can help in the design of vaccines with better targeting and broader coverage. These techniques can be generalized to any infectious agents where cross-reactivity assays have been carried out. As the parameterization uses pre-existing datasets, this approach quickly and cheaply increases both our understanding of antigenic relationships and our power to control disease

    Facing homelessness

    Get PDF
    In facing homelessness we face the other, and in facing the other, we face ourselves. This book contributes to an emerging body of knowledge on street homelessness in the South African context. It is meant for researchers and scholars who are committed to finding solutions for street homelessness. It offers conceptual frameworks and practical guidelines for a liberative and transformative response to homelessness. It brings together authors from a wide range of disciplines, fusing the rigour of researchers, the vision of activists and the lived experience of practitioners. In this volume, the causes of street homelessness in South Africa today, and its different faces, are traced. It critiques singular solutions, and interrogates the political, institutional and moral failures that contribute to the systemic exclusion of homeless persons and other vulnerable populations from society. It proposes rights-based interventions as part of a radical re-imagination of how street homelessness can be ended, one person and one neighbourhood at a time. The analysis by the authors steer in the direction of new ways of doing and being that could demonstrate concrete, viable and sustainable alternatives to the exclusionary realities faced by homeless persons. It argues for solution-based approaches, aimed at radical forms of social inclusion and achieved through broad-based and creative collaborations by all spheres of society. In the face and presence of street homelessness – as one expression of urban vulnerability and deep socio-economic inequality – society is confronted with a clear political, institutional, moral and personal obligation. This volume calls for a reclamation of community in its most inclusionary, life-affirming and interdependent sense, asserting that we truly are well because of others, and we are unwell if others are. It is a call to reclaim our common humanity in the context of inclusive communities where all are equally welcome and bestowed with dignity and honour
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