Older People's Usage Pattern, Satisfaction with Community Facility and Well-Being in Urban Old Districts

Community facilities are an important element that supports older people's daily life and promotes their well-being. However, there is a dearth of comprehensive studies on the effect of planning and design of different types of community facilities on older people's usage patterns and satisfaction. This study aims to provide a framework to explore the relationship among the planning of community facilities, older people's usage and satisfaction level and well-being for different types of community facilities. Both spatial analysis and questionnaire survey (n = 497) methods are employed in this study. This study finds that commercial (89.34%), municipal (83.10%) and leisure (88.13%) facilities are most commonly used by older people. This study suggests that older people's frequency of visiting community facilities is mainly affected by the purpose of visiting a community facility. Planning and design quality of the community facility are found to be significantly associated with older people's satisfaction level with using a community facility. In addition, older people's higher satisfaction level and usage level of community facilities could increase their physical and psychological well-being. The findings of this study not only contribute to the knowledge gap of older people's usage and satisfaction with using community facilities but also suggest that planners should aim toward a better distribution of community facilities to improve older adults' well-being

Urinary proteomics pilot study for biomarker discovery and diagnosis in heart failure with reduced ejection fraction

Background Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF. Methods and Results Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972) discriminated between HFrEF patients (N = 94, sensitivity = 93.6%) and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%). Interestingly, HFrEF103 showed low sensitivity (12.6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin. Conclusion CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure

Having a family doctor is associated with some better patient-reported outcomes of primary care consultations

<b>Background</b> Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference.<p></p> <b>Methods</b> We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns.<p></p> <b>Results</b> One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns.<p></p> <b>Conclusion</b> People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations

Modelling long-memory volatilities with leverage effect: A-LMSV versus FIEGARCH

A new stochastic volatility model, called A-LMSV, is proposed to cope simultaneously with leverage effect and long-memory in volatility. Its statistical properties are derived and compared with the properties of the FIEGARCH model. It is shown that the dependence of the autocorrelations of squares on the parameters measuring the asymmetry and the persistence is different in both models. The kurtosis and autocorrelations of squares do not depend on the asymmetry in the A-LMSV model while they increase with the asymmetry in the FIEGARCH model. Furthermore, the autocorrelations of squares increase with the persistence in the A-LMSV model and decrease in the FIEGARCH model. On the other hand, if the correlation between returns and future volatilities is negative, the autocorrelations of absolute returns increase with the magnitude of the asymmetry in the FIEGARCH model while they decrease in the A-LMSV model. Finally, the cross-correlations between squares and original observations are, in general, larger in absolute value in the FIEGARCH model than in the A-LMSV model. The results are illustrated by fitting both models to represent the dynamic evolution of volatilities of daily returns of the S&P500 and DAX indexes.Publicad

Automation of the solution of the reverse problems of economic analysis

In this article, we consider the solution of inverse problems of economic analysis by the method of coefficients of relative importance and automation of the solution. The result of the research is the development and implementation of automation of solving the inverse problems of economic analysis, for making decisions in economic problems

康德的道德情感理論及牟宗三先生的批評與闡釋

本論文的題目為「康德的道德情感理論與牟宗三先生的批評與闡釋」。自當代新儒家牟宗三先生援引康德哲學來重新詮釋儒家哲學，中西比較哲學的討論頓時 變得活躍起來，筆者亦因讀到牟先生的著作，而對康德的哲學產生興趣。筆者以“道德情感”為比較康德與牟先生的儒學之開展，是因為注意到道德情感在 兩者哲學中的獨特位置，希望通過探討牟先生對康德的批評與闡釋，能夠指出道德情感所具有的形上意涵。通過比較康德與牟先生的道德哲學，筆者希望能 揭示兩者所採用哲學的方法以至其哲學的系統架構，從而能對兩者作恰如其分的定位

Supporting Dining Occupations for Dementia Residents in Skilled Nursing Facilities

Dementia Friendly Dining provides skilled nursing facilities (SNFs) with a practice guideline and training resources for caregivers. The program is informed by existing research on environmental modifications, both physical and social, to enhance the occupations of feeding, eating, and dining for individuals with dementia (IwD) in SNF settings. The physical and social environment has a significant effect in supporting the dining experience for IwD and their caregivers (Keller et al., 2015; Hung et al, 2016; Palese et al., 2018), but many facilities have not integrated physical and social modifications, creating a gap in practice. Therefore, an evidence-based dining program that addresses both the physical and social environments, and fits the cultural context of the SNF is needed in order to support dining occupations for individuals with early and middle stage dementia. The Dementia Friendly Dining program materials include: evidence tables that summarize evidence-based practices for caregiver staff and families, a toolkit of familiar and meaningful items to enhance social interactions, an interactive online training module for caregivers, and a user guide for all facility staff with recommendations on how to set-up the environment and facilitate tasks that will enrich the individual’s dining experience. A survey to assess the feasibility and usefulness of the materials was completed by the partnering facility’s rehab director, OT and SLP practitioners, and a content expert. Findings from the survey indicate the materials are feasible and would be an effective tool to implement in the New Braunfels SNF. Program modifications are suggested by the reviewers in order to promote generalization to other SNFs. In addition, programming to support individuals with middle and late stage dementia are suggested. The Dementia Friendly Dining program illustrates the valuable role OT practitioners have as direct providers and consultants in adapting the environment for an organization or population

Epidemiologic observations guiding clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction

Hypertension, obesity, and old age are major risk factors for left ventricular (LV) diastolic dysfunction (LVDD), but easily applicable screening tools for people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5-year time span mildly impaired diastolic LV function as assessed by echocardiography. In 645 white Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2005-2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e') and late (a') mitral annular peak velocities and their ratios in 2009-2013. In multivariable-adjusted analyses, per 1-standard deviation increment in HF1, e' was -0.193 cm/s lower (95% confidence interval: -0.352 to -0.033; P = .018) and E/e' 0.174 units higher (0.005-0.342; P = .043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-standard deviation increment in HF1, the adjusted odds ratio was 1.37 (confidence interval, 1.07-1.76; P = .013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (-0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ .024). In conclusion, HF1 may allow screening for LVDD over a 5-year horizon in asymptomatic people

Biomarkers to assess right heart pressures in recipients of a heart transplant: a proof-of-concept study

Background: This proof-of-concept study investigated the feasibility of using biomarkers to monitor right heart pressures (RHP) in heart transplanted (HTx) patients. Methods: In 298 patients, we measured 7.6 years post-HTx mean pressures in the right atrium (mRAP) and pulmonary artery (mPAP) and capillaries (mPCWP) along with plasma high-sensitivity troponin T (hsTnT), a marker of cardiomyocyte injury, and the multidimensional urinary classifiers HF1 and HF2, mainly consisting of dysregulated collagen fragments. Results: In multivariable models, mRAP and mPAP increased with hsTnT (per 1-SD, +0.91 and +1.26 mm Hg; P < 0.0001) and with HF2 (+0.42 and +0.62 mm Hg; P ≤ 0.035), but not with HF1. mPCWP increased with hsTnT (+1.16 mm Hg; P < 0.0001), but not with HF1 or HF2. The adjusted odds ratios for having elevated RHP (mRAP, mPAP or mPCWP ≥10, ≥24, ≥17 mm Hg, respectively) were 1.99 for hsTnT and 1.56 for HF2 (P ≤ 0.005). In detecting elevated RHPs, areas under the curve were similar for hsTnT and HF2 (0.63 vs 0.65; P = 0.66). Adding hsTnT continuous or per threshold or HF2 continuous to a basic model including all covariables did not increase diagnostic accuracy (P ≥ 0.11), whereas adding HF2 per optimized threshold increased both the integrated discrimination (+1.92%; P = 0.023) and net reclassification (+30.3%; P = 0.010) improvement. Conclusions: Correlating RHPs with noninvasive biomarkers in HTx patients is feasible. However, further refinement and validation of such biomarkers is required before their clinical application can be considered

The effect of an electronic health record system on nursing staff time in a nursing home: a longitudinal cohort study

BackgroundNursing homes are increasingly introducing electronic health record (EHR) systems into nursing practice; however, there is limited evidence about the effect of these systems on nursing staff time. Aims To investigate the effect of introducing an EHR system on time spent on activities by nursing staff in a nursing home. MethodAn observational work sampling study was undertaken with nursing staff between 2009 and 2011 at 2 months before, and at 3, 6, 12, and 23 months after implementation of an EHR system at an Australian nursing home. An observer used pre-determined tasks to record activities of the nursing staff at 9-minute intervals.ResultsThere was no significant change in registered nurses and endorsed enrolled nurses’ time on most activities after implementation. Personal carers’ time on oral-communication reduced, and time on documentation increased at most measurement periods in the first 12 months after implementation. At 23 months, time on these activities had returned to pre-implementation levels. Nursing staff time on direct care remained stable after implementation. No considerable change was observed in time spent on other activities after implementation.ConclusionFindings suggest that successful introduction of an EHR system in a nursing home may not interfere with nursing staff time on direct care duties. However, there is scope for improving the support provided by EHR systems through incorporation of functions to support collaborative nursing care