The health profile of people living with Parkinson's Disease managed in a comprehensive care setting

Background: Globally there are few reports of the impairments, disabilities and medications used in people living with idiopathic Parkinson’s disease. Caregiver characteristics and caregiver burden have seldom been reported. We examined the health status in a large cohort of people living with Parkinson’s disease and their caregivers managed in a comprehensive health care setting.

Methods/Design: A prospective, cross sectional analysis of impairments, disabilities and Parkinson’s disease medication use was conducted in a sample of 100 people with Parkinson’s disease rated I-IV on the modified Hoehn & Yahr scale. Participants were recruited from the Victorian Comprehensive Parkinson Program in Melbourne, Australia. Their caregivers were invited to provide their views on the burden of care, services provided and support received.

Results: The severity of impairments and disabilities was strongly associated with disease duration (mean of 5.5 years). Those with long standing disease or more severe disease also used more Parkinson’s disease medications and participated in fewer social roles than people who were newly diagnosed or mildly affected. The severity of impairments was strongly correlated with limitations in performing activities of daily living. Limitations in performing daily activities were also found to be a significant contributing factor for health-related quality of life (PDQ-39 SI β=0.55, p=0.000; EQ-5D SI β=0.43, p=0.001). People with Parkinson’s disease lived at home with relatives. The average caregiver was a spouse or child providing approximately 3.5 hours of care per day, with the capacity to provide 9.4 hours per day and had provided care for four years. Additional support was high (63%) for 2.5 hours per day.

Conclusion: The comprehensive care setting of this cohort describes a relatively benign condition despite a wide range of disease duration and severity. This report provides a baseline with which to compare other delivery models.

To the very ground of meaning, to vary the ground of meaning

Parody may be understood as the absorption of a revolutionary impulse into the everyday production of meaning as continuous variation and soft subversion. Considered in this way, parody is transformative because it operates on the components within a system of meaning and/or the context, logic or spatial perspective that grounds the possibility of meaning. It is the conditions under which shared meaning, sense and sensation depend that I aim to unpack in order to suggest the ways in which parody can alter a person’s relationship to the world. By approaching parody as a mode of lived abstraction and as an embodied approach to affective self-organisation, body-environment co-construction and a challenge to identity, it becomes possible to move from formal concerns that have characterised parody to a set of transformative practices. Thus parody indicates where the anchors of embodied, embedded, extended, enacted and affective are dug in and hold identity and the ground of meaning in a steady state. This paper will examine how parody moves from the impulse to overthrow and invert — ‘Beneath the street, The beach’—to a collective impulse that moves the ground of meaning into a reconfigurative process that is allows totalised systems of meaning to collide and intersect. What is left is not the rubble and ruins of meaning but revitalised fragments, stems cells of meaning ready-to-be-remade.A lineage of parodic works will be paraded and discussed that directly address the tacit relation of ground, horizon, orientation and position. This parody parade will form the basis of a critique and the analysis of the ontological orientations that for example, opposing systems of perspective insert as the very ground of meaning. The implication of this line of inquiry leads to the assertion that all descriptions of the world, universe and the cosmos are parodies in search of an origin. Totalised or unified images of the ground of meaning are already parodies of a/the set of conditions by which meaning operates that also produce a trajectory that as a lived-abstraction directs or hijacks subsequent productions of meaning

Formation of defects in the graphite oxidization process: a positron study

High-resolution positron annihilation lifetime (PAL) and two-detector coincidence Doppler broadening of annihilation radiation (2D-DBAR) measurements on graphite and its oxide derivatives for defect information, differing in oxidization agents, are reported. Positron measurements were found to be very effective in the investigation of defects in graphite and its derivatives. Positrons are mainly annihilated in vacancy-like defects on the particle surface and in large open-volume holes associated with the interface of graphite and graphite oxide. Different types of defects have been detected for unexfoliated graphite oxide and exfoliated graphene oxide based on 2D-DBAR measurements, namely the vacancy cluster and vacancy-oxygen complexes. It is also interesting to observe that the calculated large open-volume diameter of graphene oxide coincides with the distance between the layers from the XRD investigation, which indicates that the annihilation of the long-lived lifetime component τ3 might take place in the area between the graphene layers; no large open-volume hole has been detected.

Long incubation bouts and biparental incubation in the nomadic Banded Stilt

Parental care strategies have been widely investigated in shorebirds that undertake long-distance regular migrations. In contrast, virtually nothing is known of the parental care of nomadic, opportunistically breeding shorebirds, although the irregular and short-lived nature of their breeding potentially accentuates the trade-offs between investment in successive clutches and between the sexes. We investigated the incubation behaviour of the nomadic, opportunistically breeding Banded Stilt (Cladorhynchus leucocephalus). Seven nests, filmed continuously with day–night cameras over 2–7 days, revealed that both sexes contributed to incubation, with males apparently the sole carer during hatching and early brood-rearing; this is a possible adaptation, which enables females to quickly produce a second clutch if favourable conditions persist. All incubator changeovers occurred after dark; incubation shifts averaged 44.8 ± 10.9 (s.e.m.) h (n = 11, 17.5–139.6 h), the longest recorded for any shorebird. Incubation constancy averaged 96.5%; this high value is possibly an adaptation to high predation and the need for rapid embryonic development in the face of ephemeral resources for breeding. Long incubation shifts may be explained by extended foraging trips to distant areas of the partially inundated salt-lake surface, where food resources had been concentrated by wind-driven water movement.

Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia

STUDY OBJECTIVES: To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. DESIGN: Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. SETTING: A pilot, population based Australian programme offering free two-view mammographic screening. PARTICIPANTS: A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. RESULTS: Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11,550. CONCLUSIONS: The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.

Patterns of connectivity and population structure of the southern calamary Sepioteuthis australis in southern Australia

The southern calamary, Sepioteuthis australis, is a commercially and recreationally important inshore cephalopod endemic to southern Australia and New Zealand. Typical of other cephalopods, S. australis has a short life span, form nearshore spawning aggregations and undergo direct development. Such life history traits may restrict connectivity between spawning grounds creating highly structured and genetically differentiated populations that are susceptible to population crashes. Here we use seven polymorphic microsatellite markers to assess connectivity and population structure of S. australis across a large part of its geographic range in Australia. Little genetic differentiation was found between sampling locations. Overall, FST was low (0.005, 95% CI≤<0.001-0.011) and we detected no significant genetic differentiation between any of the locations sampled. There was no strong relationship between genetic and geographical distance, and our neighbour joining analysis did not show clustering of clades based on geographical locations. Similarly, network analysis showed strong connectivity amongst most locations, in particular, Tasmania appears to be well connected with several other locations and may act as an important source population. High levels of gene flow and connectivity between S. australis sampling sites across Australia are important for this short-lived species, ensuring resilience against spatial and temporal mortality fluctuations.