54 research outputs found

    Nurse-led advance care planning with older people who have end-stage kidney disease: feasibility of a deferred entry randomised controlled trial incorporating an economic evaluation and mixed methods process evaluation (ACReDiT)

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    © 2020, The Author(s). Background: Advance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness. Methods: A deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life. Results: Recruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups. Conclusions: A trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions. Trial registration: Registered December 16, 2015. ClinicalTrials.gov Identifier: NCT02631200

    Treatment With Nilvadipine Mitigates Inflammatory Pathology and Improves Spatial Memory in Aged hTau Mice After Repetitive Mild TBI

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    Mild traumatic brain injury (mTBI) is the most common form of brain trauma worldwide. The effects of mTBI are not well-studied within the elderly population, yet older adults constitute a significant portion of all mTBI patients. Few preclinical studies have focused on the effects of mTBI, or mTBI treatments, in the aged brain, and none have explored repetitive mTBI (r-mTBI). In this study, we have administered our well-characterized 5-injury model (5 r-mTBI) to hTau mice aged 24 months to explore the neurobehavioral and neuropathological outcomes, and the effects of treatment with the dihydropyridine, Nilvadipine. Our previous studies have shown that Nilvadipine inhibits spleen tyrosine kinase (Syk), is effective at reducing inflammation, tau hyperphosphorylation, and amyloid production, and it has recently been investigated in a European Phase III clinical trial for Alzheimer’s disease (AD). In our 24-month-old r-mTBI mice, we observed increased neuroinflammation and a trend toward impaired cognitive performance compared to sham controls. Treatment with Nilvadipine mitigated the TBI-induced inflammatory response in aged r-mTBI animals and significantly improved spatial memory. To our knowledge, this is the only preclinical study focusing on the treatment of r-mTBI in aged, and these results suggest a therapeutic potential of Nilvadipine for consequences of mTBI

    Sheep Updates 2015 - Ravensthorpe

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    This session covers fourteen papers from different authors: 1. The Sheep Industry Business Innovation project, Bruce Mullan, Sheep Industry Development Director, Department of Agriculture and Food, Western Australia 2. Western Australian sheep stocktake, Kate Pritchett and Kimbal Curtis, Research Officers, Department of Agriculture and Food, Western Australia 3. Wool demand and supply - short term volatility, long term opportunities, Chris Wilcox, Principal of Poimena Analysis 4. Lifetime management for maternal ewes, Mike Hyder, Research Officer, Department of Agriculture and Food, Western Australia 5. National Livestock Identification System (NLIS) for sheep and goats - what is the NLIS database? Leigh Sonnermann, Biosecurity Officer, Department of Agriculture and Food, Western Australia 6. Myths, Facts and the role of animal welfare in farming, Lynne Bradshaw, president, RSPCA WA 7. Latest research and development on breech strike prevention, Geoff Lindon, Manager Productivity and Animal Welfare, AWI 8. Lamb Survival Initiative and 100% Club, Katherine Davies, Development Officer, Department of Agriculture and Food, Western Australia 9. How to boost your lamb survival, Joe Young, Sheep Consultant, R.B. Young and Son 10. Using genomic technology to increase genetic gain, Stephen Lee, School of Animal and Veterinary Sciences, University of Adelaide and Sheep Cooperative Research Centre (CRC) & Ian Robertson, Merinotech WA 11. Economics of feed lotting - to feed-lot or not?, Lucy Anderton, Economist, Department of Agriculture and Food, Western Australia 12. Anameka and other shrubs to fill feed gaps, Hayley Norman CSIRO & Ed Barrett-Lennard UWA & Department of Agriculture and Food, Western Australia 13. Sheep industry traineeships - encouraging a new generation of farmers, Jackie Jarvis, Consultant, Agrifood Labour & Skills 14. Opportunities and challenges facing youth in the sheep and wool industry, Ben Patrick, Yarrawonga Stu

    Sheep Updates 2015 - Katanning

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    This session covers fourteen papers from different authors: 1. The Sheep Industry Business Innovation project, Bruce Mullan, Sheep Industry Development Director, Department of Agriculture and Food, Western Australia 2. Western Australian sheep stocktake, Kate Pritchett and Kimbal Curtis, Research Officers, Department of Agriculture and Food, Western Australia 3. Wool demand and supply - short term volatility, long term opportunities, Chris Wilcox, Principal of Poimena Analysis 4. Lifetime management for maternal ewes, Mike Hyder, Research Officer, Department of Agriculture and Food, Western Australia 5. National Livestock Identification System (NLIS) for sheep and goats - what is the NLIS database? Leigh Sonnermann, Biosecurity Officer, Department of Agriculture and Food, Western Australia 6. Myths, Facts and the role of animal welfare in farming, Lynne Bradshaw, president, RSPCA WA 7. Latest research and development on breech strike prevention, Geoff Lindon, Manager Productivity and Animal Welfare, AWI 8. Lamb Survival Initiative and 100% Club, Katherine Davies, Development Officer, Department of Agriculture and Food, Western Australia 9. How to boost your lamb survival, Joe Young, Sheep Consultant, R.B. Young and Son 10. Using genomic technology to increase genetic gain, Stephen Lee, School of Animal and Veterinary Sciences, University of Adelaide and Sheep Cooperative Research Centre (CRC) & Ian Robertson, Merinotech WA 11. Economics of feed lotting - to feed-lot or not?, Lucy Anderton, Economist, Department of Agriculture and Food, Western Australia 12. Anameka and other shrubs to fill feed gaps, Hayley Norman CSIRO & Ed Barrett-Lennard UWA & Department of Agriculture and Food, Western Australia 13. Sheep industry traineeships - encouraging a new generation of farmers, Jackie Jarvis, Consultant, Agrifood Labour & Skills 14. Opportunities and challenges facing youth in the sheep and wool industry, Ben Patrick, Yarrawonga Stu

    A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland.

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    Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways-intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32-0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38-0.66) for MT in AIS patients, 0.78 (95%CI 0.67-0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99-1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities

    The Monitor project: JW 380 -- a 0.26, 0.15 Msol pre main sequence eclipsing binary in the Orion Nebula Cluster

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    We report the discovery of a low-mass (0.26 +/- 0.02, 0.15 +/- 0.01 Msol) pre-main-sequence eclipsing binary with a 5.3 day orbital period. JW 380 was detected as part of a high-cadence time-resolved photometric survey (the Monitor project) using the 2.5m Isaac Newton Telescope and Wide Field Camera for a survey of a single field in the Orion Nebula Cluster (ONC) region in V and i bands. The star is assigned a 99 per cent membership probability from proper motion measurements, and radial velocity observations indicate a systemic velocity within 1 sigma of that of the ONC. Modelling of the combined light and radial velocity curves of the system gave stellar radii of 1.19 +0.04 -0.18 Rsol and 0.90 +0.17 -0.03 Rsol for the primary and secondary, with a significant third light contribution which is also visible as a third peak in the cross-correlation functions used to derive radial velocities. The masses and radii appear to be consistent with stellar models for 2-3 Myr age from several authors, within the present observational errors. These observations probe an important region of mass-radius parameter space, where there are currently only a handful of known pre-main-sequence eclipsing binary systems with precise measurements available in the literature.Comment: 11 pages, 9 figures, accepted for publication in MNRA

    The state of the Martian climate

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    60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

    A systematic review of task- shifting for HIV treatment and care in Africa

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    BACKGROUND: Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings. METHODS: We conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts. RESULTS: We found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement. CONCLUSIONS: Task shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes
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