Physicians' and Nurses' Perceived Usefulness and Acceptability of a Family Information Booklet about Comfort Care in Advanced Dementia

Background: Families of patients with advanced dementia need to be informed about the course of the dementia and comfort care. Conditional for health care providers educating families is their knowledge and comfort in family education. Methods: Perceived usefulness and acceptability of a Canadian family booklet explaining possible complications and comfort care in dementia was assessed by physicians and nurses caring for dementia patients in 14 nursing homes in Lombardy, Italy and 21 in the Netherlands. The practitioners received a questionnaire and translated versions adapted to local practice where needed. In 10 of 21 Dutch homes, physicians evaluated only the original Canadian version in English. A 15-item scale assessed the booklet's acceptability, for example, to inform families, or for educational purposes. Perceived usefulness referred to proportion of families of dementia patients for whom the booklet would be useful. A total of 168 evaluations were available for multivariable regression analyses. Results: The practitioners anticipated that the booklet would be useful for most families. Evaluation of the Dutch translation of the booklet was similar to the English version. Country (Netherlands) and profession (nurses) were independently associated with better acceptability. Usefulness was perceived as better by Italian respondents and nurses, but only in analyses unadjusted for the higher educational needs of these respondents. Conclusion: Overall, the concept of written information on comfort care was appreciated by practitioners of European countries differing in attitudes toward end-of-life care. A booklet may help practitioners, and in particular nurses, in providing comfort care for dementia patients and their families. © Copyright 2011, Mary Ann Liebert, Inc. 2011.

Plasma Homocysteine Is Not Subject to Seasonal Variation.

Background: Studies investigating the relationship between plasma total homocysteine (tHcy) and vascular disease usually rely on a single measurement. Little information is available, however, on the seasonal variability of plasma tHcy. The aim of this study was to investigate the seasonal variation in fasting plasma tHcy and related B-vitamin intake and status in a group of people who did not consume fortified foods or take B-vitamin supplements. Methods: In this longitudinal study, a group of 22 healthy people were followed for 1 year. A fasting blood sample and dietary information were collected from each individual every 3 months, i.e., at the end of each season. Results: There was no significant seasonal variation in plasma tHcy or in B-vitamin intake or status with the exception of red cell folate (significantly lower in spring compared with autumn or winter) and serum folate (significantly lower in spring compared with the other seasons). Although the between-person variation in plasma tHcy was high (47%), the within-person variation was low (11%). This low variation, combined with the low methodologic imprecision of 3.8%, yielded a high reliability coefficient for plasma tHcy (0.97). Conclusions: Although there was a small seasonal variation in folate status, there was no corresponding seasonal variation in plasma tHcy. The high reliability coefficient for plasma tHcy suggests that a single measurement is reflective of an individual’s average plasma tHcy concentration, thus indicating its usefulness as a potential predictor of disease. This, however, needs to be confirmed in different subgroups of the population.

Mire ontogeny, environmental and climate change inferred from fossil beetle successions from Hatfield Moors, eastern England

Results of a fossil Coleoptera (beetle) fauna from a fen edge sequence from Hatfield Moors, Humberhead Levels, are presented. Mire ontogeny inferred from this location and others are discussed, particularly in the light of previous palynological and plant macrofossil investigations. Peat initiation across most of the site centres around 3000 cal BC, characterised by a Calluna-Eriophorum heath with areas of Pinus-Betula woodland. The onset of peat accumulation on the southern margins of the site was delayed until 1520-1390 cal BC and appears to overlap closely with a recurrence surface at a pollen site (HAT 2) studied by Brian Smith (1985, 2002) dated to 1610-1440 cal BC, suggesting that increased surface wetness may have caused mire expansion at this time. The faunas illustrate the transition from eutrophic and mesotrophic fen to ombrotrophic raised mire, although the significance of both Pinus- and Calluna-indicating species through the sequence suggests that heath habitats may have continued to be important. Elsewhere, this earlier phase of rich fen is lacking and mesotrophic mire developed immediately above nutrient poor sands, with ombrotrophic conditions indicated soon after. Correspondence analysis of the faunas provides valuable insights into the importance of sandy heath habitats on Hatfield Moors. The continuing influence of the underlying coversands suggests these may have been instrumental in mire ontogeny. The research highlights the usefulness of using Coleoptera to assess mire ontogeny, fluctuations in site hydrology and vegetation cover, particularly when used in conjunction with other peatland proxies. The significance of a suite of extinct beetle species is discussed with reference to forest history and climate change.

Poly(epsilon-caprolactone) and poly(epsilon-caprolactone)-polyvinylpyrrolidone-iodine blends as ureteral biomaterials: characterisation of mechanical and surface properties, degradation and resistance to encrustation in vitro.

This study describes the physicochemical properties and in vitro resistance to encrustation of solvent cast films composed of either poly(epsilon-caprolactone) (PCL), prepared using different ratios of high (50,000) to low (4000) (molecular weight) m.wt., or blends of PCL and the polymeric antimicrobial complex, poly(vinylpyrrolidone)-iodine (PVP-I). The incorporation of PVP-I offered antimicrobial activity to the biomaterials. Films were characterised in terms of mechanical (tensile analysis, dynamic mechanical thermal analysis) and surface properties (dynamic contact angle analysis, scanning electron microscopy), whereas degradation (at 37degreesC in PBS at pH 7.4) was determined gravimetrically. The resistance of the films to encrustation was evaluated using an in vitro encrustation model. Reductions in the ratio of high:low-m.wt. PCL significantly reduced the ultimate tensile strength, % elongation at break and the advancing contact angle of the films. These effects were attributed to alterations in the amorphous content and the more hydrophilic nature of the films. Conversely, there were no alterations in Young's modulus, the viscoelastic properties and glass-transition temperature. Incorporation of PVP-I did not affect the mechanical or rheological properties of the films, indicative of a limited interaction between the two polymers in the solid state. Manipulation of the high:low m.wt. ratio of PCL significantly altered the degradation of the films, most notably following longer immersion periods, and resistance to encrustation. Accordingly, maximum degradation and resistance to encrustation was observed with the biomaterial composed of 40:60 high:low m.wt. ratios of PCL; however, the mechanical properties of this system were considered inappropriate for clinical application. Films composed of either 50:50 or 60:40 ratio of high:low m.wt. PCL offered an appropriate compromise between physicochemical properties and resistance to encrustation. This study has highlighted the important usefulness of degradable polymer systems as ureteral biomaterials

Performance Management in the UK Public Sector: addressing multiple stakeholder complexity

Purpose The aim of this paper is to explore the issues involved in developing and applying performance management approaches within a large UK public sector department using a multiple stakeholder perspective and an accompanying theoretical framework. Design/methodology/approach An initial short questionnaire was used to determine perceptions about the implementation and effectiveness of the new performance management system across the organisation. In total, 700 questionnaires were distributed. Running concurrently with an ethnographic approach, and informed by the questionnaire responses, was a series of semi-structured interviews and focus groups. Findings Staff at all levels had an understanding of the new system and perceived it as being beneficial. However, there were concerns that the approach was not continuously managed throughout the year and was in danger of becoming an annual event, rather than an ongoing process. Furthermore, the change process seemed to have advanced without corresponding changes to appraisal and reward and recognition systems. Thus, the business objectives were not aligned with motivating factors within the organisation. Research limitations/implications Additional research to test the validity and usefulness of the theoretical model, as discussed in this paper, would be beneficial. Practical implications The strategic integration of the stakeholder performance measures and scorecards was found to be essential to producing an overall stakeholder-driven strategy within the case study organisation. Originality/value This paper discusses in detail the approach adopted and the progress made by one large UK public sector organisation, as it attempts to develop better relationships with all of its stakeholders and hence improve its performance. This paper provides a concerted attempt to link theory with practice.

Applications of statistical models in proportioning medium strength self-compacting concrete

Self-compacting concrete (SCC) is generally designed with a relatively higher content of finer, which includes cement, and dosage of superplasticizer than the conventional concrete. The design of the current SCC leads to high compressive strength, which is already used in special applications, where the high cost of materials can be tolerated. Using SCC, which eliminates the need for vibration, leads to increased speed of casting and thus reduces labour requirement, energy consumption, construction time, and cost of equipment. In order to obtain and gain maximum benefit from SCC it has to be used for wider applications. The cost of materials will be decreased by reducing the cement content and using a minimum amount of admixtures. This paper reviews statistical models obtained from a factorial design which was carried out to determine the influence of four key parameters on filling ability, passing ability, segregation and compressive strength. These parameters are important for the successful development of medium strength self-compacting concrete (MS-SCC). The parameters considered in the study were the contents of cement and pulverised fuel ash (PFA), water-to-powder ratio (W/P), and dosage of superplasticizer (SP). The responses of the derived statistical models are slump flow, fluidity loss, rheological parameters, Orimet time, V-funnel time, L-box, JRing combined to Orimet, JRing combined to cone, fresh segregation, and compressive strength at 7, 28 and 90 days. The models are valid for mixes made with 0.38 to 0.72 W/P ratio, 60 to 216 kg/m3 of cement content, 183 to 317 kg/m3 of PFA and 0 to 1% of SP, by mass of powder. The utility of such models to optimize concrete mixes to achieve good balance between filling ability, passing ability, segregation, compressive strength, and cost is discussed. Examples highlighting the usefulness of the models are presented using isoresponse surfaces to demonstrate single and coupled effects of mix parameters on slump flow, loss of fluidity, flow resistance, segregation, JRing combined to Orimet, and compressive strength at 7 and 28 days. Cost analysis is carried out to show trade-offs between cost of materials and specified consistency levels and compressive strength at 7 and 28 days that can be used to identify economic mixes. The paper establishes the usefulness of the mathematical models as a tool to facilitate the test protocol required to optimise medium strength SCC.

Emission-line ratios for [N II] in gaseous nebulae and a comparison between theory and observation

R-matrix calculations of electron impact excitation rates among the 2s(2)2p(2) P-3, D-1, S-1, and 2s2p(3) S-5 levels of N II are presented. These results are used in conjunction with other recent calculations of electron impact excitation rates and Einstein A-coefficients for N II to derive the emission-line ratio: ratio diagrams and where (R-1, R-2) (R-1, R-3), where R-1 = I(5756.2 Angstrom)/I(6549.9 + 6585.2 Angstrom), R-2 = I(2143.5 Angstrom)/I(6549.9 + 6585.2 Angstrom), and R-3 = I(2139.7 Angstrom)/I(6549.9 + 658.2 Angstrom), for a range of electron temperatures (T-e = 5000-20,000 K) and electron densities (N-e = 10(2)-10(7) cm(-3)) appropriate to gaseous nebulae. These diagrams should, in principle, allow the simultaneous determination of T-e and N-e from measurements of the [N II] lines in a spectrum. Plasma parameters deduced for a sample of gaseous nebulae, using observational data obtained from ground-based telescopes plus the International Ultraviolet Explorer and Hubble Space Telescope satellites, are found to show generally excellent internal consistency and to be in good agreement with the values of T-e and N-e estimated from other line ratios. These results provide observational support for the accuracy of the theoretical ratios and hence the atomic data adopted in their derivation. Theoretical ratios are also presented for the infrared line pair R-4 = I(122 mum)/I(205 mum), and the usefulness of R-4 as an electron density diagnostic is briefly discussed.

S XI emission lines in active region spectra obtained with the Solar EUV Rocket Telescope and Spectrograph (SERTS)

Theoretical electron density sensitive emission line ratios involving a total of eleven 2s(2)2p(2)-2s2p(3) transitions in S XI between 187 and 292 Angstrom are presented. A comparison of these with solar active region observations obtained during rocket flights by the Solar EUV Rocket Telescope and Spectrograph (SERTS) reveals generally good agreement between theory and experiment. However, the 186.87 Angstrom line is masked by fairly strong Fe XII emission at the same wavelength, while 239.83 Angstrom is blended with an unknown feature, and 285.58 Angstrom is blended with possibly N IV 285.56 Angstrom. In addition, the 191.23 Angstrom line appears to be more seriously blended with an Fe XIII feature than previously believed. The presence of several new S XI lines is confirmed in the SERTS spectra, at wavelengths of 188.66, 247.14 and 291.59 Angstrom, in excellent agreement with laboratory measurements. In particular, the detection of the 2s(2)2p(2) P- 3(1) -2s2p(3) P-3(0,1) transitions at 242.91 Angstrom is the first time (to our knowledge) that this feature has been identified in the solar spectrum. The potential usefulness of the S XI line ratios as electron density diagnostics for the solar transition region and corona is briefly discussed.

Making the law accessible to non-lawyers: effects of different kinds of expertise on perceived usability of online legal information services

To help design an environment in which professionals without legal training can make effective use of public sector legal information on planning and the environment - for Add-Wijzer, a European e-government project - we evaluated their perceptions of usefulness and usability. In concurrent think-aloud usability tests, lawyers and non-lawyers carried out information retrieval tasks on a range of online legal databases. We found that non-lawyers reported twice as many difficulties as those with legal training (p = 0.001), that the number of difficulties and the choice of database affected successful completion, and that the non-lawyers had surprisingly few problems understanding legal terminology. Instead, they had more problems understanding the syntactical structure of legal documents and collections. The results support the constraint attunement hypothesis (CAH) of the effects of expertise on information retrieval, with implications for the design of systems to support the effective understanding and use of information.