Care and Capability:Understanding Quality of Life in Older Adults Living at Home

The central aim of this thesis is to gain a better understanding about what is important for the quality of life (QoL) of older adults living at home receiving professional care services, and how to assess outcomes of this care in terms of QoL. Specifically, this thesis focuses on how the Adult Social Care Outcomes Toolkit (ASCOT) can be used for determining QoL of older adults in the Netherlands. The ASCOT is an instrument developed in the UK that was designed to evaluate outcomes of social care services by capturing information about an individual’s QoL in eight domains: control over daily life, personal cleanliness and comfort, food and drink, personal safety, social participation and involvement, occupation, accommodation cleanliness and comfort and dignity. The ASCOT is inspired by the Capability Approach (CA). In CA, a distinction is made between capabilities - the things a person has, and functionings - the things a person does. When someone has a capability, they can choose to use it or not. Someone who has access to food can choose to eat but can also consciously refrain from eating, for example in the case of a hunger strike. Central to this are both having access to possibilities, and the freedom to use them or not. . Older adults increasingly live at home and, in this setting, may be confronted with difficulties in their daily life affecting their QoL, for instance a decrease in mobility. The opportunities to engage in various activities and autonomy, i.e. control over one’s life, often decrease because of these difficulties. Care services can support older adults in dealing with challenges and maintaining a preferred level of functioning, contributing to their QoL. The ASCOT is introduced as an instrument to measure outcomes of care for older adults living at home, focusing on the perspective of the care receiver. Four questions are formulated that are the focus of this thesis: 1) How can the ASCOT be understood from the philosophical perspective of the CA? 2) What are important aspects of QoL from the perspective of older adults living at home? 3) How can care services contribute to QoL in older adults living at home? 4) How can important aspects of QoL from the perspective of older adults living at home be addressed in QoL instruments? Within this thesis, different methodologies are combined to answer these questions, in line with and inspired by an empirical ethics approach. In this way, the question how to define QoL in older adults is explored drawing on the strengths of both philosophical and empirical analysis. We conclude that there is a need for a broad QoL tool to evaluate care in older adults living at home. The ASCOT is such a tool. It operationalizes the core assumptions of the capability approach, translating this approach in a practical instrument. From the point of view of older adults, some important domains are missing in the ASCOT. These domains have been included in an extension of the ASCOT, i.e. the EQLT. The domains identified in the EQLT should not be used as tick boxes, but should serve as issues to be discussed in a conversation between clients and care providers. Further implementation of the ASCOT and the EQLT is recommended, not only in professional care, but also in informal care in the community

Opolnomočenje nadzornikov za odgovorno raziskovalno ravnanje pri nadzoru prek spletnega tečaja: pilotna študija

Supervision and mentoring are highly relevant aspects of research integrity. Codes of Conduct, such as the ALLEA code of conduct, stipulate the relevance of training researchers how to conduct research well and about the role supervision plays in preventing unacceptable research practices. The Dutch Code of Conduct, for example, explicitly states that universities are responsible for facilitating training about research integrity. We developed a course for supervisors to address their responsibility and role in training early career researchers in research integrity. This contribution describes what evidence base was used to design this course and how the course is experienced by supervisors who participated in its piloting in early 2022. A total of 147 subscribed to the course in the testing phase, and seventeen participants obtained a certificate. The main lessons from the experiences with this course and the literature are 1) to tailor supervisor courses to the small amounts of time that supervisors can schedule to take these courses and to adjust the content and assignments to their needs, 2) to make online courses very attractive, but that need to be combined with 3) a face-to-face meeting to motivate them to finish the course in time and it might help to enable shared reflection by sharing personal experiences. (DIPF/Orig.

Human influence

Human interventions influence drought propagation and low flow in a number of ways. Abstraction decreases low flow and makes hydrological drought events more severe; water transfers do the opposite. Reservoirs change water availability in time, and, dependent on the reservoir management, low flow can be increased and hydrological drought shifted in time. Land surface changes affect evapotranspiration, infiltration and surface runoff processes, influencing the timing and severity of hydrological drought. Qualitative methods (e.g., interviews, surveys) and socio-hydrological models can give valuable insights into the complexity of human-water interactions. Socio-hydrological models can also be used to explore feedbacks of water management scenarios. To quantify of the effect of natural and human drivers several approaches using observations, modelling or a combination of both can be used. Here, we demonstrate the use of these approaches to selected case studies around the world and show that the human influence on low flow and hydrological drought can be both aggravating and alleviating

Planning and Development of Social Services for Persons with Disabilities

Soziale Dienste zur Unterstützung von Menschen mit Behinderungen haben sich in den letzten Jahren dynamisch entwickelt und unterliegen auch aktuell einem erheblichen Veränderungsdruck. Die Forschungsarbeiten, die in diesem Band versammelt sind, haben die Entwicklung hin zu einer inklusionsorientierten Unterstützung in zahlreichen Projekten auf unterschiedlichen Ebenen aktiv begleitet.Social services to support persons with disabilities have developed dynamically in recent years and are currently subject to considerable pressure to change. The research work collected in this volume has actively accompanied the development towards inclusion-oriented support in numerous projects at different levels

Massive stars in extremely metal-poor galaxies: a window into the past

Cosmic history has witnessed the lives and deaths of multiple generations of massive stars, all of them invigorating their host galaxies with ionizing photons, kinetic energy, fresh material, and stellar-mass black holes. Ubiquitous engines as they are, astrophysics needs a good understanding of their formation, evolution, properties and yields throughout the history of the Universe, and with decreasing metal content mimicking the environment at the earliest epochs. Ultimately, a physical model that could be extrapolated to zero metallicity would enable tackling long-standing questions such as “What did the first, very massive stars of the Universe look like?” or “What was their role in the re-ionization of the Universe?” Yet, most of our knowledge of metal-poor massive stars is drawn from one single point in metallicity. Massive stars in the Small Magellanic Cloud (SMC, ∼1/5Z⊙ ) currently serve as templates for low-metallicity objects in the early Universe, even though significant differences with respect to massive stars with poorer metal content have been reported. This White Paper summarizes the current knowledge on extremely (sub-SMC) metal poor massive stars, highlighting the most outstanding open questions and the need to supersede the SMC as standard. A new paradigm can be built from nearby extremely metal-poor galaxies that make a new metallicity ladder, but massive stars in these galaxies are out of reach to current observational facilities. Such a task would require an L-size mission, consisting of a 10m-class space telescope operating in the optical and the ultraviolet ranges. Alternatively, we propose that ESA unites efforts with NASA to make the LUVOIR mission concept a reality, thus continuing the successful partnership that made the Hubble Space Telescope one of the greatest observatories of all time

Hydrology needed to manage droughts: the 2015 European case

Hydrology needed to manage droughts: the 2015 European cas

Twenty-three unsolved problems in hydrology (UPH) – a community perspective

This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come

Social Transfer of Pathogenic Fungus Promotes Active Immunisation in Ant Colonies

Social contact with fungus-exposed ants leads to pathogen transfer to healthy nest-mates, causing low-level infections. These micro-infections promote pathogen-specific immune gene expression and protective immunization of nest-mates

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe