Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

BACKGROUND: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. OBJECTIVE: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. METHODS: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. RESULTS: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. CONCLUSION: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.

Health literacy and the Internet: a study on the readability of Australian online health information

OBJECTIVE: Almost 80% of Australian Internet users seek out health information online so the readability of this information is important. This study aimed to evaluate the readability of Australian online health information and determine if it matches the average reading level of Australians. METHODS: Two hundred and fifty-one web pages with information on 12 common health conditions were identified across sectors. Readability was assessed by the Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE) formulas, with grade 8 adopted as the average Australian reading level. RESULTS: The average reading grade measured by F-K and SMOG was 10.54 and 12.12 respectively. The mean FRE was 47.54, a 'difficult-to-read' score. Only 0.4% of web pages were written at or below grade 8 according to SMOG. Information on dementia was the most difficult to read overall, while obesity was the most difficult among government websites. CONCLUSIONS AND IMPLICATIONS: The findings suggest that the readability of Australian health websites is above the average Australian levels of reading. A quantifiable guideline is needed to ensure online health information accommodates the reading needs of the general public to effectively use the Internet as an enabler of health literacy.

The Permian brachiopod genus Trigonotreta Koenig and its occurrence in Argentina

A review of the Permian spiriferid brachiopod genus Trigonolrela and its occurrence in the Early Permian of Argentina is provided herein. Several species are known from the Late Palaeozoic sequences of the Argentinean Precordillera. These include Trigonolrela sp. and Trigonolrela riojanensis (Lech and Acenolaza), from the Rio del Peii.on Formation (Rio Blanco Basin), Trigonolrela pericoensis (Leanza), from the Tupe Formation at the La Herradura creek locality (Paganzo Basin) and Trigonolrela sanjuanensis (Lech and Acenolaza), from Del Salto Formation (Calingasta-Uspallata Basin). These species are characterised by being small to medium sized, relatively transverse, with cardinal extremities often strongly angular. Costae are weakly bifurcated and superimposed on weakly developed lateral flank plications adjacent to the fastigium and sulcus. The Argentinean species are close to the oldest known Indian species of the genus, Trigonotreta hesdoensis (Salmi and Dutt), particularly with respect to the nature of its weakly fasciculated costae. Further study will refine the details of the relationship of the South American species with those from elsewhere in Gondwana and may permit the recognition of a distinctive lineage. The presence of the genus in Argentina in the earliest Permian is an important palaeobiogeographical observation that raises questions about the probable migration routes of the genus from the western Gondwanan South American margin to eastern Australia and India. The Precordilleran region appears to be the likely site of the first appearance of Trigonolrela. Species with relatively simple costae appeared first. These gave rise to more complex species with a more elaborate costal pattern indicating an evolutionary progression through time.

Responding to the ageing profile of emergency department patients

Background
Older people with acute superimposed on chronic health problems are becoming a core aspect of emergency department (ED) caseload. This project explored the ED experience from the perspective of older patients and their carers.

Method
A convenience sample of thirty participants was recruited across three participating EDs: tw o metropolitan and one regional. The project utilised two approaches to data collection: 1) an observation approach where a project officer observed participants from the time of ED presentation until discharge, or for up to six hours; and 2) a subsequent interview was conducted with the participant and their carer within a week of the ED presentation. Data from both sources were integrated, and independently thematically analysed by two members of the team.

Results
Thirty participants aged over 65 were recruited. Their average age was 77.1 (sd=6.7) years, 59% w ere female, and 74% were triage category 1- 3 (indicating moderate/high acuity). Participants spent on average 7 hours 47 minutes in the ED, with 50% discharged home, 43% admitted to general wards or MAPU, and 7% discharged to residential care/hospice. Key themes in the factors influencing the patient experience and examples of quality care were identified, along with opportunities to improve the capacity for EDs to be “older person friendly”, and “person-centred.” Challenges include improving the effectiveness of communication between staff and patients/carers (including issues around people from culturally and linguistically diverse backgrounds), availability of allied health professionals to assist with discharge planning, and a tendency for older people not to seek ED care until the health problem was severe. Patient exemplars highlight key themes.

Discussion and implications
Results of the project highlight positive aspects of emergency department care for older people and inform targets for improvement strategies. These can be used to drive ongoing improvements in care for older people presenting to EDs.

Inclusive schooling policy : an educational detective story?

Since the publication of the Salamanca statement (UNESCO 1994), inclusive schooling has formed a growing part of the deliberations of the special education community. Inclusive schooling research in Australia in the main continues to reproduce traditions of the special education field, emphasising the dominant psychological perspectives that have been superimposed on inclusive education discourses. At the fifth International Congress of Special Education (ISEC 2000) held in Manchester, ‘the death knell of the concept of special education’ (ISEC 2000) was announced. The concept proposed by Mike Oliver, Professor of Disability Studies at the University of Greenwich, asserts an end to understandings of diversity dependent on medical, psychological and charity-based discourses. From a recent study of inclusive schooling policy, and drawing from poststructuralist methodology, I suggest an approach to research, policy development and practice that questions traditionalist theorising in the special education field. Reflecting on the implementation of the Inclusion of Students with Disabilities Policy (DECCD 1995) in the Tasmanian government school system, I outline my alignment with Oliver’s view and highlight how questions of epistemology and reconstructions of research methodologies are central to rethinking understandings of difference. I also illustrate a methodological orientation that offers possibilities for a different science to take place, thereby understanding diversity as multiple and contradictory – and beyond the single ‘detective story’ (Gough 1998) of the medical, psychological and charity-based discourses that circulate in schools as the populist conceptions of ‘inclusion’.

Forces between mica surfaces in ethylene glycol

Measurements are presented of the force as a function of separation between two molecularly smooth mica surfaces immersed in ethylene glycol, and in solutions of lithium chloride and sulfuric acid in ethylene glycol. At surface separations greater than 3 nm the measured force is in very good agreement with double-layer theory, but at smaller separations there is an oscillatory solvation force which is superimposed on the double-layer repulsion. In contrast to the case in water, the adsorption of hydrogen ions at the mica surface does not markedly affect the short-range forces.

Channel estimation for frequency-selective two-way MIMO relay systems

In this paper, we investigate the channel estimation problem for two-way multiple-input multiple-output (MIMO) relay communication systems in frequency-selective fading environments. We propose a superimposed channel training algorithm to estimate the individual channel state information (CSI) of the first-hop and second-hop links for two-way MIMO relay systems with frequency-selective fading channels. In this algorithm, a relay training sequence is superimposed on the received signals at the relay node to assist the estimation of the second-hop channel matrices. The optimal structure of the source and relay training sequences is derived to minimize the meansquared error (MSE) of channel estimation. We also derive the optimal power allocation between the source and relay training sequences. Numerical examples are shown to demonstrate the performance of the proposed algorithm.

Agent-based smart grid protection and security

The vision of a smart grid is to provide a modern, resilient, and secure electric power grid as it boasts up with a highly reliable and efficient environment through effective use of its information and communication technology (ICT). Generally, the control and operation of a smart grid which integrate the distributed energy resources (DERs) such as, wind power, solar power, energy storage, etc., largely depends on a complex network of computers, softwares, and communication infrastructure superimposed on its physical grid architecture facilitated with the deployment of intelligent decision support system applications. In recent years, multi-agent system (MAS) has been well investigated for wide area power system applications and specially gained a significant attention in smart grid protection and security due to its distributed characteristics. In this chapter, a MAS framework for smart grid protection relay coordination is proposed, which consists of a number of intelligent autonomous agents each of which are embedded with the protection relays. Each agent has its own thread of control that provides it with a capability to operate the circuit breakers (CBs) using the critical clearing time (CCT) information as well as communicate with each other through high speed communication network. Besides physical failure, since smart grid highly depends on communication infrastructure, it is vulnerable to several cyber threats on its information and communication channel. An attacker who has knowledge about a certain smart grid communication framework can easily compromise its appliances and components by corrupting the information which may destabilize a system results a widespread blackout. To mitigate such risk of cyber attacks, a few innovative counter measuring techniques are discussed in this chapter.

An extension of the flower pattern diagram for roll forming

The initial process design of a roll forming system is often based on the traditional ‘flower pattern diagram’. In this diagram, the cross sections of the strip at each roll stand are superimposed on a single plane; the diagram is a 2D representation of the 3D process. In the present work, the flower pattern is extended into three dimensions. To demonstrate the method, the forming path or trajectory of a point at the edge of the strip during forming a V-section is considered. The forming path is a surface curve that lies on a cylindrical surface having its axis along the machine axis. This surface is unwrapped to give its plane development and important features of the forming process can be determined and are readily interpreted from this plane curve. It is shown that at any stage in the process, the axial strain and the curvature of the sheet adjacent to the point are dependent on the slope of the trajectory in this plane projection. This new diagram, which apparently has not been used previously, provides a useful initial method of examining the roll forming process and optimising the flower pattern. The model is purely geometric, as is the original flower pattern approach, and does not include the effect of material behaviour. The concept is applied to several cases available in the literature. It shows that the lowest level of shape defect in the part is achieved when the trajectory of the strip edge follows the shortest line length between the start and finish of forming, leading to the least longitudinal strain introduced in the flange. This trend is in agreement with previous experimental observations, suggesting that the analytical model proposed may be applied for early process design and optimisation before time-consuming numerical analysis is performed.

Channel estimation for two-way MIMO relay systems in frequency-selective fading environments

© 2002-2012 IEEE. In this paper, we investigate the channel estimation problem for two-way multiple-input multiple-output (MIMO) relay communication systems in frequency-selective fading environments. We apply the method of superimposed channel training to estimate the individual channel state information (CSI) of the first-hop and second-hop links for two-way MIMO relay systems with frequency-selective fading channels. In this algorithm, a relay training sequence is superimposed on the received signals at the relay node to assist the estimation of the second-hop channel matrices. The optimal structure of the source and relay training sequences is derived to minimize the mean-squared error (MSE) of channel estimation. Moreover, the optimal power allocation between the source and relay training sequences is derived to improve the performance of channel estimation. Numerical examples are shown to demonstrate the performance of the proposed superimposed channel training algorithm for two-way MIMO relay systems in frequency-selective fading environments.

Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement

BACKGROUND: Dementia residential facilities can be described as traditional or non-traditional facilities. Non-traditional facilities aim to utilise principles of environmental design to create a milieu that supports persons experiencing cognitive decline. This study aimed to compare these two environments in rural Australia, and their influence on residents' occupational engagement. METHODS: The Residential Environment Impact Survey (REIS) was used and consists of: a walk-through of the facility; activity observation; interviews with residents and employees. Thirteen residents were observed and four employees interviewed. Resident interviews did not occur given the population diagnosis of moderate to severe dementia. Descriptive data from the walk-through and activity observation were analysed for potential opportunities of occupational engagement. Interviews were thematically analysed to discern perception of occupational engagement of residents within their facility. RESULTS: Both facilities provided opportunities for occupational engagement. However, the non-traditional facility provided additional opportunities through employee interactions and features of the physical environment. Interviews revealed six themes: Comfortable environment; roles and responsibilities; getting to know the resident; more stimulation can elicit increased engagement; the home-like experience and environmental layout. These themes coupled with the features of the environment provided insight into the complexity of occupational engagement within this population. CONCLUSION: This study emphasises the influence of the physical and social environment on occupational engagement opportunities. A non-traditional dementia facility maximises these opportunities and can support development of best-practice guidelines within this population.

Risk factors for incident delirium in an acute general medical setting: a retrospective case – control study

Aims and ObjectivesTo determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission.BackgroundIncident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients that are most susceptible to incident delirium.DesignRetrospective case-control study with two controls per case.MethodsAn audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data was collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1st January 2012 and 31st December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation.ResultsIdentified using logistic regression modelling, predisposing risk factors for incident delirium were: dementia, cognitive impairment, functional impairment, previous delirium, and fracture on admission. Precipitating risk factors for incident delirium were: use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission.ConclusionsMultiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation.Relevance to clinical practiceNurses and other health care professionals should be aware of patients that have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and prevention of delirium can contribute to improved patients safety and reduction in harm.

Multisensory environments for leisure: promoting well-being in nursing home residents with dementia

Multisensory environments such as Snoezelen^® rooms are becoming increasingly popular in health care facilities for older individuals. There is limited reliable evidence of the benefits of such innovations, and the effect they have on residents, caregivers, and visitors in these facilities. This two-stage project examined how effective two types of multisensory environments were in improving the well-being of older individuals with dementia. The two multisensory environments were a Snoezelen room and a landscaped garden. These environments were compared to the experience of the normal living environment. The observed response of 24 residents with dementia in a nursing home was measured during time spent in the Snoezelen room, in the garden, and in the living room. In the second part of the project, face-to-face interviews were conducted with six caregivers and six visitors to obtain their responses to the multisensory environments. These interviews identified the components of the environments most used and enjoyed by residents and the ways in which they could be improved to maximize well-being.

Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings

Reality Orientation (RO) was developed as a strategy to assist people with dementia to improve their orientation and everyday function. Although its efficacy has been extensively studied in long-term care facilities, its effectiveness has rarely been examined in acute care settings. The aim of this review was to examine the studies cited in systematic reviews of RO to determine the potential clinical usefulness and the feasibility of using RO in acute care settings. Based on this information, the authors make recommendations for future research in this area. The feasibility of implementing RO in acute care poses challenges because of the short time a patient is in hospital and their ability to participate given their acute medical condition. Although the efficacy and feasibility of using RO in acute care settings have not been sufficiently examined, its potential to improve care should not be ignored. A comprehensive and rigorous study is necessary to investigate the usefulness of RO in the acute care setting and to help establish clinical guidelines for dementia care in the context of acute care nursing.