Connecting the person with dementia and family : a feasibility study of a telepresence robot

Background Maintenance of communication is important for people with dementia living in long-term care. The purpose of this study was to assess the feasibility of using “Giraff”, a telepresence robot to enhance engagement between family and a person with dementia living in long-term care. Methods A mixed-methods approach involving semi-structured interviews, call records and video observational data was used. Five people with dementia and their family member participated in a discussion via the Giraff robot for a minimum of six times over a six-week period. A feasibility framework was used to assess feasibility and included video analysis of emotional response and engagement. Results Twenty-six calls with an average duration of 23 mins took place. Residents showed a general state of positive emotions across the calls with a high level of engagement and a minimal level of negative emotions. Participants enjoyed the experience and families reported that the Giraff robot offered the opportunity to reduce social isolation. A number of software and hardware challenges were encountered. Conclusions Participants perceived this novel approach to engage families and people with dementia as a feasible option. Participants were observed and also reported to enjoy the experience. The technical challenges identified have been improved in a newer version of the robot. Future research should include a feasibility trial of longer duration, with a larger sample and a cost analysis.

An efficient and robust system for multi-person event detection in real world indoor surveillance scenes

Due to the popularity of security cameras in public places, it is of interest to design an intelligent system that can efficiently detect events automatically. This paper proposes a novel algorithm for multi-person event detection. To ensure greater than real-time performance, features are extracted directly from compressed MPEG video. A novel histogram-based feature descriptor that captures the angles between extracted particle trajectories is proposed, which allows us to capture motion patterns of multi-person events in the video. To alleviate the need for fine-grained annotation, we propose the use of Labelled Latent Dirichlet Allocation, a “weakly supervised” method that allows the use of coarse temporal annotations which are much simpler to obtain. This novel system is able to run at approximately ten times real-time, while preserving state-of-theart detection performance for multi-person events on a 100-hour real-world surveillance dataset (TRECVid SED).

Person-Centred Approaches to Private Housing for People with Disability : Impediments, Difficulties and Opportunities

Objective The main objective of the project was to explore the barriers and obstacles impeding a person-centred approach to planning and private housing for people with disability. Method Methodologically, the project involved explanation building using a multiple case study approach supported by a contextual study. It focussed initially on three organisations and their attempts to integrate innovative and what they regarded as person-centred models of housing into the private housing market for people with disability. It also included a fourth case highlighting the experiences of individuals with disability in accessing suitable and affordable housing. Results Using an ecological framework, the project found that: • Challenges exist within systems (such as the macro cultural, economic, regulatory systems through to local community, family and intra personal systems) as well as with interaction between systems • Reaching across systems is a key role for organisations and individuals but is very challenging with distance from the individual as well as from the policy/funding/service systems being a key aspect of the nature and extent by which they are challenged • In the case of housing for people with disability a ‘disability space’ is assumed and maintained disparately within each system and is separate from the ‘mainstream space’ with the established policy, legal, funding structures making it difficult to move between the two spaces. Conclusions Based on these findings, the project makes recommendations for government, community organisations, the housing industry, people with disability and their families and support networks, as well as for future research. An overarching recommendation is the need to address housing stock availability and suitability by adopting a mainstream approach rather than a disability-first/disability-specific approach.

Impact of simulated hyperopia on academic-related performance in children

Purpose: To investigate the impact of simulated hyperopia and sustained near work on children’s ability to perform a range of academic-related tasks. Methods: Fifteen visually normal children (mean age: 10.9 ± 0.8 years; 10 males and 5 females) were recruited. Performance on a range of standardised academic-related outcome measures was assessed with and without 2.50 D of simulated bilateral hyperopia (administered in a randomised order), before and after 20 minutes of sustained near work, at two separate testing sessions. Academic-related measures included a standardised reading test (the Neale Analysis of Reading Ability), visual information processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children) and a reading-related eye movement test (the Developmental Eye Movement test). Results: Simulated bilateral hyperopia and sustained near work each independently impaired reading, visual information processing and reading-related eye movement performance (p<0.001). A significant interaction was also demonstrated between these factors (p<0.001), with the greatest decrement in performance observed when simulated hyperopia was combined with sustained near work. This combination resulted in performance reductions of between 5% and 24% across the range of academic-related measures. A significant moderate correlation was also found between the change in horizontal near heterophoria and the change in several of the academic-related outcome measures, following the addition of simulated hyperopia. Conclusions: A relatively low level of simulated bilateral hyperopia impaired children’s performance on a range of academic–related outcome measures, with sustained near work further exacerbating this effect. Further investigations are required to determine the impact of correcting low levels of hyperopia on academic performance in children.

Simulated astigmatism impairs academic-related performance in children

Purpose: Astigmatism is an important refractive condition in children. However, the functional impact of uncorrected astigmatism in this population is not well established, particularly with regard to academic performance. This study investigated the impact of simulated bilateral astigmatism on academic-related tasks before and after sustained near work in children. Methods: Twenty visually normal children (mean age: 10.8 ± 0.7 years; 6 males and 14 females) completed a range of standardised academic-related tests with and without 1.50 D of simulated bilateral astigmatism (with both academic-related tests and the visual condition administered in a randomised order). The simulated astigmatism was induced using a positive cylindrical lens while maintaining a plano spherical equivalent. Performance was assessed before and after 20 minutes of sustained near work, during two separate testing sessions. Academic-related measures included a standardised reading test (the Neale Analysis of Reading Ability), visual information processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children) and a reading-related eye movement test (the Developmental Eye Movement test). Each participant was systematically assigned either with-the-rule (WTR, axis 180°) or against-the-rule (ATR, axis 90°) simulated astigmatism to evaluate the influence of axis orientation on any decrements in performance. Results: Reading, visual information processing and reading-related eye movement performance were all significantly impaired by both simulated bilateral astigmatism (p<0.001) and sustained near work (p<0.001), however, there was no significant interaction between these factors (p>0.05). Simulated astigmatism led to a reduction of between 5% and 12% in performance across the academic-related outcome measures, but there was no significant effect of the axis (WTR or ATR) of astigmatism (p>0.05). Conclusion: Simulated bilateral astigmatism impaired children’s performance on a range of academic–related outcome measures irrespective of the orientation of the astigmatism. These findings have implications for the clinical management of non-amblyogenic levels of astigmatism in relation to academic performance in children. Correction of low to moderate levels of astigmatism may improve the functional performance of children in the classroom.

Steady state visually evoked potential correlates of static and dynamic emotional face processing

While the neural regions associated with facial identity recognition are considered to be well defined, the neural correlates of non-moving and moving images of facial emotion processing are less clear. This study examined the brain electrical activity changes in 26 participants (14 males M = 21.64, SD = 3.99; 12 females M = 24.42, SD = 4.36), during a passive face viewing task, a scrambled face task and separate emotion and gender face discrimination tasks. The steady state visual evoked potential (SSVEP) was recorded from 64-electrode sites. Consistent with previous research, face related activity was evidenced at scalp regions over the parieto-temporal region approximately 170 ms after stimulus presentation. Results also identified different SSVEP spatio-temporal changes associated with the processing of static and dynamic facial emotions with respect to gender, with static stimuli predominately associated with an increase in inhibitory processing within the frontal region. Dynamic facial emotions were associated with changes in SSVEP response within the temporal region, which are proposed to index inhibitory processing. It is suggested that static images represent non-canonical stimuli which are processed via different mechanisms to their more ecologically valid dynamic counterparts.

Nutritional challenges for the family caregiver and person with dementia dyad

ABSTRACT Background: The majority of people with dementia live at home until quite late in the disease trajectory, supported by family caregivers who typically take increasing responsibility for providing nutrition. Caregiving is highly stressful and thus both dyad partners are at risk of nutritional issues. Objective: This study evaluated the nutritional status of both dyad members and the associations between these. Design Descriptive, correlational Setting Community Participants 26 dyads of persons with dementia and caregivers Measurements: The nutritional status of each dyad member was evaluated at home using a comprehensive battery of measures including the Mini-Nutritional Assessment, Corrected Arm Muscle Area and a 3-day food diary. Stage of dementia and functional eating capacity was measured for the person with dementia. Caregivers completed a brief burden scale. Results: Of those with dementia (n = 26), a large proportion had nutritional issues (one was malnourished and another 16 were at risk). Six of the caregivers were at risk of malnutrition. In addition, fifteen of the people with dementia did not meet their recommended daily energy requirements. A moderate and significant positive correlation between functional eating skills and nutritional status (MNA score) among participants with dementia was found (r =.523, n = 26, p.006). Conclusion: These findings suggest that a dyadic perspective of nutritional status provides important insights into risk in this vulnerable group. Specifically, monitoring of the functional eating independence skills of the person with dementia is critical, along with assisting caregivers to be aware of their own eating patterns and intake.

Do we need a law to help people try experimental drugs?

People with life-threatening or incurable diseases may be willing to try experimental drugs and unproven treatments, but they face the risk of exploitation. Is the law the best avenue to ensure that they are protected while medical innovation is encouraged? Protection of vulnerable people is a thread running through many laws, in Australia and elsewhere. In medical law, for instance, children and people with impaired decision-making capacity warrant special attention. But what of the ordinary person diagnosed with a life-threatening disease? Such people are vulnerable to harm and potential exploitation when they seek access to innovative, experimental or unproven treatments that depart from the existing range of accepted medicine.

Searching for semantic person queries using channel representations

It is not uncommon to hear a person of interest described by their height, build, and clothing (i.e. type and colour). These semantic descriptions are commonly used by people to describe others, as they are quick to relate and easy to understand. However such queries are not easily utilised within intelligent surveillance systems as they are difficult to transform into a representation that can be searched for automatically in large camera networks. In this paper we propose a novel approach that transforms such a semantic query into an avatar that is searchable within a video stream, and demonstrate state-of-the-art performance for locating a subject in video based on a description.

Mental health facility design: The case for person-centred care

There is a schism between a growing chorus for person-centred models of care and the prevalent paradigms for the design of mental health facilities. This argument proposes that architectural solutions have traditionally been geared around staff-centred concerns like ease of patient management. It suggests that the demands for person-centred models of care are important because evidence suggests that the physical environment is a causal factor in mental illness, and that even minor concessions towards person-centred models of care consistently exert a disproportionate and sustained positive influence on the behaviour of mental health patients. While the traditional mental health unit layout is unsatisfactory for person-centred care and effective recovery, other approaches that have been well tested and found to be effective is described along with a statement about subtle details that will improve facilities for all users.

Toward the multilevel older person's transportation and road safety model: A new perspective on the role of demographic, functional, and psychosocial factors

Objectives Self-regulation refers to the practice of using self-imposed restrictions to protect oneself from situations that are, or are perceived to be, unsafe. Within the driving context, self-regulation refers the compensatory practices that some older adults adopt to restrict their driving to situations in which they feel safe. However, the way in which demographic, functional, and psychosocial factors, and the interactions between these factors, influence older adults’ driving self-regulation is not well understood. Improving this understanding could lead to new ways of considering the mobility concerns faced by older drivers. Method A systematic review of the current literature was conducted to explore this issue. Twenty-nine empirical studies investigating the factors associated with older adults’ self-regulatory driving behaviors were examined. Results The review findings were used to construct the Multilevel Older Persons Transportation and Road Safety (MOTRS) model. The MOTRS model proposes that individual and environmental factors such as age, gender, and the availability of alternative transportation predict older adults’ practice of driving-related self-regulation. However, these variables influence self-regulation through psychosocial variables such as driving confidence, affective attitude, and instrumental attitude toward driving. Discussions The MOTRS model extends previous attempts to model older adults’ driving by focusing on a novel target, driving self-regulation, and by including a wider range of predictors identified on the basis of the systematic literature review. This focus enables consideration of broader mobility issues and may inform new strategies to support the mobility of older adults.

Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments

Objectives The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). Methods A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. Results In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. Conclusions This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated.

Patients' outcomes related to person-centred nursing care in radiation oncology: A case study

Abstract Purpose The aim of this case study is to describe patients' responses to nursing care following the implementation of a person-centred model in a radiation oncology department. Method An instrumental case study design utilised surveys to collect data on a range of key patient outcomes: patient satisfaction (PSS), informational issues (RSEP), quality of life (FACT_G), comfort (RTCQ), and emotional status (HADS). This occurred at the beginning of, and twelve months following, the implementation of the new model of care. Results This study demonstrated that, although adverse effects of radiotherapy continue to affect patient well-being in the latter part of their course of radiation therapy, patients continue to be satisfied with nursing care. There were significant differences between groups in perceptions of the care environment and the use of the nurse as an acknowledged source of information are noteworthy, since these variables were key targets of the new model of care. The finding that nurses were seen by the post-implementation cohort as more likely to be a source of information is an important indicator that the nurses' presence was noted by patients, and they generally reported high levels of functioning despite undergoing a curative course of radiotherapy. Conclusion The person-centred nursing approach in the radiotherapy setting has contributed to some improvements in the provision of patient care. Aspects of this study may assist in planning further nursing interventions for patients undergoing radiotherapy for cancer, and continue to enhance the contribution of the radiation oncology nurse to improved patient outcomes.

The issue of consent: For the plaintiff or defendant to prove in trespass to person?

In White v Johnston1 the vexed question of whether it is for a plaintiff to prove lack of consent to a trespass to person or for the defendant to establish consent as defence was considered. The court also considered the principles of assessing an award of exemplary damages...