A qualitative study of the views of residents with dementia, their relatives and staff about work practice in long-term care settings

Background: Most people living in 24-hour care settings have dementia, and little is known about what makes long-term care a positive experience for them.Method: This carer-led qualitative study examined working practices in 24-hour long-term care-settings, including hospitals, nursing and residential homes, with the aim of finding out and making recommendations about such settings. Using semi-structured interviews, managers, nurses and care assistants were asked about work practices, such as how they coped with difficult behavior, about shifts, staffing levels, staff retention and training. Relatives of residents with dementia were asked about their role and perceptions of the care provided, and residents were asked for their opinions of their care.Results: Staff reported that residents presented with increasingly challenging behavior compared to the past, and that sometimes staffing levels and skills were inadequate. Of all the settings, hospitals had the most problems with staffing levels and retention, staff-relative relationships and staff support systems. Relatives saw their own role as positive. People with dementia of varying severity could usefully evaluate some of the services they received.Discussion: Dementia-specific training and education of staff in all long-term care-settings, including induction, should address the management of problem behavior in dementia and thereby improve staff fulfilment and relatives' satisfaction. The long-stay hospital may not be appropriate as a "home for life" for those with dementia, and we recommend that long-stay care settings should be able to cater flexibly for a range of resident needs

An Assessment of X-ray Pelvimetry in South West Scotland

Abstract Not Provided

Modeling user mobility via user psychological and geographical behaviors towards point of-interest recommendation

© Springer International Publishing Switzerland 2016. The pervasive employments of Location-based Social Network call for precise and personalized Point-of-Interest (POI) recommendation to predict which places the users prefer. Modeling user mobility, as an important component of understanding user preference, plays an essential role in POI recommendation. However, existing methods mainly model user mobility through analyzing the check-in data and formulating a distribution without considering why a user checks in at a specific place from psychological perspective. In this paper, we propose a POI recommendation algorithm modeling user mobility by considering check-in data and geographical information. Specifically, with check-in data, we propose a novel probabilistic latent factor model to formulate user psychological behavior from the perspective of utility theory, which could help reveal the inner information underlying the comparative choice behaviors of users. Geographical behavior of all the historical check-ins captured by a power law distribution is then combined with probabilistic latent factor model to form the POI recommendation algorithm. Extensive evaluation experiments conducted on two real-world datasets confirm the superiority of our approach over state-of-the-art methods

Practical solutions for sampling alternatives in large-scale models

Many large-scale real-world transport applications have choice sets that are so large as to make model estimation and application computationally impractical. The ability to estimate models on subsets of the alternatives is thus of great appeal, and correction approaches have existed since the late 1970s for the simple multinomial logit (MNL) model. However, many of these models in practice rely on nested logit specifications, for example, in the context of the joint choice of mode and destination. Recent research has put forward solutions for such generalized extreme value (GEV) structures, but these structures remain difficult to apply in practice. This paper puts forward a simplification of the GEV method for use in computationally efficient implementations of nested logit. The good performance of this approach is illustrated with simulated data, and additional insights into sampling error are also provided with different sampling strategies for MNL

962-61 Late Redistribution T1-201/Stress Tc-99m Sestamibi Separate Acquisition Dual Isotope Myocardial Perfusion SPECT: A Feasibility Study

Rest TI201(TI)/stress Tc-sestamibi dual isotope SPECT (DIMPS) is an efficient myocardial perfusion protocol. Patients with rest defects, however, frequently require late TI redistribution imaging the next day. Thus, we recently implemented a modified DIMPS (M-DIMPS), with 3.5 mCi TI injected at rest the night before stress testing. On the day of stress testing, 12–18 hr redistribution TI (late TI) SPECT was performed prior to stress sestamibi study. To assess image quality of late TI, we prospectively studied 107 patients who underwent M-DIMPS. For purposes of comparison between conventional DIMPS and M-DIMPS, a subset (group A, n=41) also had rest TI(25sec/stop, 60 stops) the night before M-DIMPS. Late TI used 30sec/stop. Prereconstruction processing used a 20 Butterworth filter (cut-off: 0.5/order 10 for rest TI, 0.35/order 10 for late TI). Comparisons were made for cardiac counts (counts/pixel) and quantitative heart to background ratio (H/B ratio). Image quality was assessed visually using a 5 point score (0=unacceptable, 4=excellent), based on the evaluation of image uniformity, defect clarity, left ventricular border definition and the apparent H/B ratio, Comparisons between rest TI and late TI in 41 group A patients yielded quantitative H/B ratio of 1.63±0.39 and 1.49±0,31 (p=0.002), and total myocardial counts of 41.4±18.1 and 29.3±11.6 (p<0.001), respectively. Image quality agreement between rest TI and late TI was 90%, with 31 concordant good to excellent and 6 concordant fair studies. Analysis of the 107 late TI studies by patient weight revealed:<150 Ibs (n = 31)150–200 Ibs (n = 60)>200 Ibs (n = 16)pcardiac counts30.4±9.628.9±13.828.9±7.5nsH/B ratio1.49±0.241.46±0.321.42±0.25nsquality = 3 or 490%90%63%<0.05**> 200lbs vs. the other two weight categoriesConclusionAlthough quantitatively different, late TI has acceptable count statistics and comparable visual image quality to rest TI, establishing the feasibility of late TI/stress Tc-sestamibi dual isotope SPECT in non-obese (<200 Ibs) patients. The protocol allows for final reporting on the same day as stress testing, potentially decreasing the length of hospitalization

Single chain magnet behaviour in an enantiopure chiral cobalt(II)–copper(II) one-dimensional compound

The self-assembly of an enantiomerically pure, chiral dianionic oxamatocopper(II) complex with cobalt(II) ions leads to neutral oxamato-bridged heterobimetallic chains that combine chirality and slow magnetic relaxation, providing thus the first example of ‘‘chiral single chain magnets (CSCMs).Ruiz Garcia, Rafael, [email protected] ; Lloret Pastor, Francisco, [email protected]

Closed-Form Bayesian Inferences for the Logit Model via Polynomial Expansions

Articles in Marketing and choice literatures have demonstrated the need for incorporating person-level heterogeneity into behavioral models (e.g., logit models for multiple binary outcomes as studied here). However, the logit likelihood extended with a population distribution of heterogeneity doesn't yield closed-form inferences, and therefore numerical integration techniques are relied upon (e.g., MCMC methods). We present here an alternative, closed-form Bayesian inferences for the logit model, which we obtain by approximating the logit likelihood via a polynomial expansion, and then positing a distribution of heterogeneity from a flexible family that is now conjugate and integrable. For problems where the response coefficients are independent, choosing the Gamma distribution leads to rapidly convergent closed-form expansions; if there are correlations among the coefficients one can still obtain rapidly convergent closed-form expansions by positing a distribution of heterogeneity from a Multivariate Gamma distribution. The solution then comes from the moment generating function of the Multivariate Gamma distribution or in general from the multivariate heterogeneity distribution assumed. Closed-form Bayesian inferences, derivatives (useful for elasticity calculations), population distribution parameter estimates (useful for summarization) and starting values (useful for complicated algorithms) are hence directly available. Two simulation studies demonstrate the efficacy of our approach.Comment: 30 pages, 2 figures, corrected some typos. Appears in Quantitative Marketing and Economics vol 4 (2006), no. 2, 173--20

Effective risk stratification using exercise myocardial perfusion SPECT in women: Gender-related differences in prognostic nuclear testing

AbstractObjectives. This study was designed to evaluate the incremental prognostic value over clinical and exercise variables of rest thallium-201/exercise technetium-99m sestamibi single-photon emission computed tomography (SPECT) in women compared with men and to determine whether this test can be used to effectively risk stratify patients of both genders.Background. To minimize the previously described gender-related bias in the evaluation of coronary artery disease in women, there is a need to identify a noninvasive testing strategy that is able to accurately and effectively risk stratify women.Methods. We identified 4,136 consecutive patients (2,742 men, 1,394 women) who underwent dual-isotope SPECT. The incremental value of nuclear testing was determined using both a stepwise Cox proportional hazards model and Kaplan-Meier survival analysis. Receiver operating characteristic curve analysis was performed to determine test discrimination for high risk patients in men and women.Results. The patient population was followed up for 20 ± 5 months for events (cardiac death or nonfatal myocardial infarction). During this time, 63 myocardial infarctions and 32 cardiac deaths occurred in the men, and 31 myocardial infarctions and 14 cardiac deaths occurred in the women. Nuclear testing significantly stratified both men and women irrespective of their rest electrocardiogram. Cox proportional hazards analysis revealed that nuclear testing added incremental prognostic value in both men and women after inclusion of the most predictive clinical and exercise variables (overall chi-square 89 in men vs. 120 in women, p < 0.005). Kaplan-Meier survival analysis demonstrated that nuclear testing further stratified men and women with both intermediate to high and low prescan likelihoods of coronary artery disease (p < 0.005 for all). Receiver operating characteristic curve analysis demonstrated superior discrimination for the nuclear scan results in identifying high risk women than men (area under the curve: 0.84 ± 0.03 vs. 0.71 ± 0.03 in men, p < 0.0005). The odds ratio comparing event rates in patients with abnormal versus those with normal scan results was greater in women than in men, suggesting superior stratification using nuclear testing in women.Conclusions. Dual-isotope myocardial perfusion imaging yields incremental prognostic value in both men and women. This modality identifies low risk women and men equally well but relatively high risk women more accurately than relatively high risk men and, thus, is able to stratify women more effectively than men

Photophysics of cage/guest assemblies : photoinduced electron transfer between a coordination cage containing osmium(II) luminophores, and electron-deficient bound guests in the central cavity

An octanuclear cubic Os4Zn4 coordination cage, containing Os(II) tris-diimine units at four of the eight vertices which are good photoelectron donors from their 3MLCT excited state, performs photoinduced electron transfer to electron-accepting organic guests which bind in the central cavity in water via the hydrophobic effect: the resulting charge-separated states have lifetimes of ca. 200 ps and have been characterized by transient absorption spectroscopy