Predictors of future falls in Parkinson disease

Background: Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD. ----- ----- Methods: A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months. ----- ----- Results: Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability. ----- ----- Conclusions: Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.

Delegation constraint management

The paper addresses the issue of providing access control via delegation and constraint management across multiple security domains. Specifically, this paper proposes a novel Delegation Constraint Management model to manage and enforce delegation constraints across security domains. An algorithm to trace the authority of delegation constraints is introduced as well as an algorithm to form a delegation constraint set and detect/prevent potential conflicts. The algorithms and the management model are built upon a set of formal definitions of delegation constraints. In addition, a constraint profile based on XACML is proposed as a means to express the delegation constraint. The paper also includes a protocol to exchange delegation constraints (in the form of user commitments) between the involved entities in the delegation process.

On a taxonomy of delegation

Delegation, from the technical point of view, is widely considered as a potential approach in addressing the problem of providing dynamic access control decisions in activities with a high level of collaboration, either within a single security domain or across multiple security domains. Although delegation continues to attract significant attention from the research community, presently, there is no published work that presents a taxonomy of delegation concepts and models. This paper intends to address this gap by presenting a set of taxonomic criteria relevant to the concept of delegation and applies the taxonomy to a selection of significant delegation models published in the literature.

A model for constraint and delegation management

This paper introduces a model to facilitate delegation, including ad-hoc delegation, in cross security domain activities. Specifically, this paper proposes a novel delegation constraint management model to manage and track delegation constraints across security domains. An algorithm to trace the authority of delegation constraints is introduced as well as an algorithm to form a delegation constraint set and detect/prevent potential conflicts. The algorithms and the management model are built upon a set of formal definitions of delegation constraints.

On a taxonomy of delegation

Delegation, from a technical point of view, is widely considered as a potential approach in addressing the problem of providing dynamic access control decisions in activities with a high level of collaboration, either within a single security domain or across multiple security domains. Although delegation continues to attract significant attention from the research community, presently, there is no published work that presents a taxonomy of delegation concepts and models. This article intends to address this gap by presenting a set of taxonomic criteria relevant to the concept of delegation. This article also applies the taxonomy to a selection of significant delegation models published in the literature.

Sequence Changes in Six Variants of Rice Tungro Bacilliform Virus and Their Phylogenetic Relationships

The DNA of three biological variants, G1, Ic and G2, which originated from the same greenhouse isolate of rice tungro bacilliform virus (RTBV) at the International Rice Research Institute (IRRI), was cloned and sequenced. Comparison of the sequences revealed small differences in genome sizes. The variants were between 95 and 99% identical at the nucleotide and amino acid levels. Alignment of the three genome sequences with those of three published RTBV sequences (Phi-1, Phi-2 and Phi-3) revealed numerous nucleotide substitutions and some insertions and deletions. The published RTBV sequences originated from the same greenhouse isolate at IRRI 20, 11 and 9 years ago. All open reading frames (ORFs) and known functional domains were conserved across the six variants. The cysteine-rich region of ORF3 showed the greatest variation. When the six DNA sequences from IRRI were compared with that of an isolate from Malaysia (Serdang), similar changes were observed in the cysteine-rich region in addition to other nucleotide substitutions and deletions across the genome. The aligned nucleotide sequences of the IRRI variants and Serdang were used to analyse phylogenetic relationships by the bootstrapped parsimony, distance and maximum-likelihood methods. The isolates clustered in three groups: Serdang alone; Ic and G1; and Phi-1, Phi-2, Phi-3 and G2. The distribution of phylogenetically informative residues in the IRRI sequences shared with the Serdang sequence and the differing tree topologies for segments of the genome suggested that recombination, as well as substitutions and insertions or deletions, has played a role in the evolution of RTBV variants. The significance and implications of these evolutionary forces are discussed in comparison with badnaviruses and caulimoviruses.

Urban, regional, national and global knowledge capital [Guest editorial]

Purpose – The purpose of this paper is to introduce the JKM 2010 annual special issue on knowledge based development (KBD) with reference to the multi-level analysis characteristic of the field. ----- ----- Design/methodology/approach – A description of the knowledge management approach at ESOC (European Space Operations Centre of the European Space Agency) is provided first. At the core of this approach is the breakdown of knowledge in individual technical domains followed by coverage analysis and criticality assessment. Such a framework becomes the reference for best knowledge acquisition, transfer and storage locus identification and subsequent knowledge management practices and guidelines. ----- ----- Findings – KBD provides an integrated framework to account for multidisciplinary analyses and multilevel practices in knowledge capital generation, distribution and utilization. ----- ----- Originality/value – The collection of papers included in the annual special issue on KBD provides a representative, composite view of the research topics and applications concerns in the field. Involving a number of disciplines and levels of analysis, issues ranging from the technological gatekeeper to global knowledge flows show the interdependence of KBD concepts and tools.

An advanced implicit meshless approach for fractional partial differential equation in computational mechanics

Recently, the numerical modelling and simulation for fractional partial differential equations (FPDE), which have been found with widely applications in modern engineering and sciences, are attracting increased attentions. The current dominant numerical method for modelling of FPDE is the explicit Finite Difference Method (FDM), which is based on a pre-defined grid leading to inherited issues or shortcomings. This paper aims to develop an implicit meshless approach based on the radial basis functions (RBF) for numerical simulation of time fractional diffusion equations. The discrete system of equations is obtained by using the RBF meshless shape functions and the strong-forms. The stability and convergence of this meshless approach are then discussed and theoretically proven. Several numerical examples with different problem domains are used to validate and investigate accuracy and efficiency of the newly developed meshless formulation. The results obtained by the meshless formations are also compared with those obtained by FDM in terms of their accuracy and efficiency. It is concluded that the present meshless formulation is very effective for the modelling and simulation for FPDE.

Resurrecting the notion of journalistic objectivity : a discussion of journalistic objectivity in one-on-one interviews

A number of recent books on ethics (Hirst and Patching 2005, Tanner et al, 2005, Ward, 2006)have indicated that traditional understandings of journalism "objectivity" are in need of renovation if they are to sustain the claim as a guide to ethical action. Ward argues for the recasting of the notions of traditional objectivity to offer a "pragmatic objectivity" as an alternative and plausible underpinning to ethical journalism practice. He argues that a recast or "pragmatic objectivity" should respond to the changing rhetorical relationship between journalists and their audiences; and, in so doing, should take inspiration from attempts to be objective in other domains---professions such as law and public relations in seeking models. This paper seeks to take a step in that direction through illustrating how journalism interviews do "objectivity" through an adaptation of the principles of the "Fourth Estate" to political interviews. It turns such analysis to the ends of establishing the particular "pragmatic ethic" underpinning such practices and how journalism interviewing techniques has allowed for proactive journalists to strike a workable balance between pursuing the public interest and observing the restraining protocols of modern journalistic practice.

Developments in texture-based vector field visualisation techniques

Vector field visualisation is one of the classic sub-fields of scientific data visualisation. The need for effective visualisation of flow data arises in many scientific domains ranging from medical sciences to aerodynamics. Though there has been much research on the topic, the question of how to communicate flow information effectively in real, practical situations is still largely an unsolved problem. This is particularly true for complex 3D flows. In this presentation we give a brief introduction and background to vector field visualisation and comment on the effectiveness of the most common solutions. We will then give some examples of current development on texture-based techniques, and given practical examples of their use in CFD research and hydrodynamic applications.

The nature of caregiving in children of a parent with multiple sclerosis from multiple sources and the associations between caregiving activities and youth adjustment overtime

This study explored youth caregiving for a parent with multiple sclerosis (MS) from multiple perspectives, and examined associations between caregiving and child negative (behavioural emotional difficulties, somatisation) and positive (life satisfaction, positive affect, prosocial behaviour) adjustment outcomes overtime. A total of 88 families participated; 85 parents with MS, 55 partners and 130 children completed questionnaires at Time 1. Child caregiving was assessed by the Youth Activities of Caregiving Scale (YACS). Child and parent questionnaire data were collected at Time 1 and child data were collected 12 months later (Time 2). Factor analysis of the child and parent YACS data replicated the four factors (instrumental, social-emotional, personal-intimate, domestic-household care), all of which were psychometrically sound. The YACS factors were related to parental illness and caregiving context variables that reflected increased caregiving demands. The Time 1 instrumental and social-emotional care domains were associated with poorer Time 2 adjustment, whereas personal-intimate was related to better adjustment and domestic-household care was unrelated to adjustment. Children and their parents exhibited highest agreement on personal-intimate, instrumental and total caregiving, and least on domestic-household and social-emotional care. Findings delineate the key dimensions of young caregiving in MS and the differential links between caregiving activities and youth adjustment.

A cyclic porphyrin tetramer linked by azo and butadiyne bridges

A soluble cyclic porphyrin oligomer (CPO) consisting of four 5,10- diarylporphyrins linked by alternating azo and butadiyne bridges has been synthesised via an aminated dinickel(II) butadiyne dimer. This is the first cyclic tetramer that combines both azo and butadiyne bridges and extends the azoporphyrin family, which comprises only a very few examples. The electronic absorption spectrum of the tetramer is more similar to spectra of azoporphyrins than to those of butadiyne-linked dimers or tetramer, exhibiting a two component Soret band with a splitting of 4190 cm-1 and a strongly red-shifted Q band maximum at 735 nm.

Personalizing the design of computer-based instruction to enhance learning

This paper reports two studies designed to investigate the effect on learning outcomes of matching individuals' preferred cognitive styles to computer-based instructional (CBI) material. Study 1 considered the styles individually as Verbalizer, Imager, Wholist and Analytic. Study 2 considered the bi-dimensional nature of cognitive styles in order to assess the full ramification of cognitive styles on learning: Analytic/Imager, Analytic/ Verbalizer, Wholist/Imager and the Wholist/Verbalizer. The mix of images and text, the nature of the text material, use of advance organizers and proximity of information to facilitate meaningful connections between various pieces of information were some of the considerations in the design of the CBI material. In a quasi-experimental format, students' cognitive styles were analysed by Cognitive Style Analysis (CSA) software. On the basis of the CSA result, the system defaulted students to either matched or mismatched CBI material by alternating between the two formats. The instructional material had a learning and a test phase. Learning outcome was tested on recall, labelling, explanation and problem-solving tasks. Comparison of the matched and mismatched instruction did not indicate significant difference between the groups, but the consistently better performance by the matched group suggests potential for further investigations where the limitations cited in this paper are eliminated. The result did indicate a significant difference between the four cognitive styles with the Wholist/Verbalizer group performing better then all other cognitive styles. Analysing the difference between cognitive styles on individual test tasks indicated significant difference on recall, labelling and explanation, suggesting that certain test tasks may suit certain cognitive styles.

Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.