Planning for Dementia Care in Ireland: Conference Proceedings

The Conference, which took place on 4th June 1999 in the Royal Marine Hotel, Dun Laoghaire, marked the publication of the Councilâ?Ts latest report â?" An Action Plan for Dementia.  The Action Plan takes as its guiding principle the recognition of the individuality of the person with dementia and of his or her needs. It outlines an approach to developing available, accessible and high quality services in the context of existing resources and public expenditure constraints. Its aim is to describe a best practice model of dementia care in Ireland â?" a model which may inform and guide policy makers and others involved in planning service provision, and which may give support and assistance to those who endeavour to provide flexible services at the local level. Download the Report here

Caring places: planning for aged care and dementia 2010-2050: Alzheimer's Australia

Alzheimer’s Australia recently commissioned research group Access Economics to model different scenarios for the supply of aged care, to identify strategies to increase consumer choice and to promote service flexibility, and to identify funding options for a sustainable aged care system into the future. The report, Caring places: planning for aged care and dementia 2010-2050, found that the number of people with dementia will quadruple by 2050 to nearly 1 million.Caring places: planning for aged care and dementia 2010-2050

Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction.

Map of ecological networks for landscape planning

This paper presents a method based on a geographical information system (GIS) to model ecological networks in a fragmented landscape. The ecological networks are generated with the help of a landscape model (which integrate human activities) and with a wildlife dispersal model. The main results are maps which permit the analysis and the understanding of the impact of human activities on wildlife dispersal. Three applications in a study area are presented: ecological networks at the landscape scale, conflicting areas at the farmstead scale and ecological distance between biotopes. These applications show the flexibility of the model and its potential to give information on ecological networks at different planning scales.

Canvi de model econòmic de programari lliure per a serveis webs

Els objectius del TFM consisteixen en canviar el model de negoci de programari lliure per a serveis webs.

Towards Integrated Governance of Landscape Development : The Swiss Model of Regional Nature Parks

Coherent regulation of landscape as a resource is a major challenge. How can the development interests of some actors (eg cable car operators and property developers) be reconciled with those of others (agriculture, forestry) and with conservation of biodiversity and scenic value? To help understand how the newly introduced Regional Nature Parks (RNPs) can improve the coherence of the regulation regime in Switzerland, we highlight current direct mechanisms for regulation of landscape as a resource (bans, inventories, subsidies) as well as indirect mechanisms (taking place through the regulation of the physical basis of landscapes, eg forest, land, and water planning policies). We show that RNPs are fundamentally innovative because they make it possible to manage and coordinate indirect strategies for appropriate regulation of resources at a landscape scale. In other words, RNPs enable organization of governance of landscape as a resource in a perimeter that is not necessarily restricted to administrative boundaries.

Inventory-routing model, for a multi-period problem with stochastic and deterministic demand

The need for integration in the supply chain management leads us to considerthe coordination of two logistic planning functions: transportation andinventory. The coordination of these activities can be an extremely importantsource of competitive advantage in the supply chain management. The battle forcost reduction can pass through the equilibrium of transportation versusinventory managing costs. In this work, we study the specific case of aninventory-routing problem for a week planning period with different types ofdemand. A heuristic methodology, based on the Iterated Local Search, isproposed to solve the Multi-Period Inventory Routing Problem with stochasticand deterministic demand.

Un modèle de soins adapté aux hospitalisations psychiatriques brèves [A care model adapted to brief psychiatric hospitalizations]

Practice of psychiatric hospitalization has considerably changed: deinstitutionnalization, brief hospitalizations, opened units, partnership with patients and complementarity with community mental health services. These changes appear simultaneously in most of industrialized countries. They are the result of social changes, evolution of mental health care, and a sharper perception of deinsertion risks through long term hospitalizations. Values of psychiatric hospital were based on a closed and protective place, where community life prepared to life in the community; they are now founded on an opened place where care aims at resolving crisis and keeping closely in touch with the community. These modifications imply to rethink hospital psychiatric care and their connections with environment. This paper describe a model of care developed in a first admission psychiatric unit.

Un model d'implantació d'un sistema de gestió de la documentació administrativa: el projecte DursiGED

[cat] Aquest article descriu el procés d'implantació d'un sistema de gestió de la documentació administrativa al Departament d'Universitats, Recerca i Societat de la Informació de la Generalitat de Catalunya (actualment Departament d'Innovació, Universitats i Empresa). El projecte, anomenat DursiGED, ha inclòs l'anàlisi, el desenvolupament i la implantació dels productes i serveis necessaris per gestionar la documentació electrònica i en suport paper de manera normalitzada i d'acord amb uns paràmetres de qualitat. L'article inclou la descripció de la planificació del projecte, el procés d'implantació i seguiment, i els productes i serveis que n'han resultat.

BIB21. Cap a un nou model de biblioteques al servei de les universitats públiques de Catalunya

Els canvis que s'estan produint a les universitats provocats per l'adaptació dels estudis a l'anomenat Espai Europeu d'Educació Superior (EEES), que ha de fer-se realitat l'any 2010, representen també un gran repte per a les biblioteques universitàries, que estan treballant per adaptar els seus recursos i serveis a les noves exigències de l'educació superior. Les biblioteques han establert models organitzatius i de col·laboració que, en un entorn marcat per l'ús intensiu de les tecnologies de la informació i pel fenomen de l'èxit de cercadors com Google, han de permetre superar amb èxit reptes com ara el suport al desenvolupament dels nous plans d'estudi dissenyats per competències tot potenciant i introduint la formació dels usuaris en l'adquisició d'habilitats informacionals; el disseny de sistemes d'informació robustos que donin suport a la producció científica i acadèmica dels investigadors i dels professors i li aportin valor, mitjançant dipòsits oberts d'informació i de documentació; la personalització dels serveis o l'adaptació dels espais a un model educatiu centrat en l'aprenentatge actiu de l'estudiant. Aquest article resumeix les principals actuacions i reptes de futur que recull amb detall l'informe encarregat per l'Associació Catalana d'Universitats Públiques (ACUP) als directors de les biblioteques, en el marc de l'elaboració del futur llibre blanc de les universitats.

Tc-99m-MAA SPECT-derived tumor-to-normal liver ratios for partition model dosimetry in selective internal radiation therapy (SIRT)

Aim: When planning SIRT using 90Y microspheres, the partition model is used to refine the activity calculated by the body surface area (BSA) method to potentially improve the safety and efficacy of treatment. For this partition model dosimetry, accurate determination of mean tumor-to-normal liver ratio (TNR) is critical since it directly impacts absorbed dose estimates. This work aimed at developing and assessing a reliable methodology for the calculation of 99mTc-MAA SPECT/CT-derived TNR ratios based on phantom studies. Materials and methods: IQ NEMA (6 hot spheres) and Kyoto liver phantoms with different hot/background activity concentration ratios were imaged on a SPECT/CT (GE Infinia Hawkeye 4). For each reconstruction with the IQ phantom, TNR quantification was assessed in terms of relative recovery coefficients (RC) and image noise was evaluated in terms of coefficient of variation (COV) in the filled background. RCs were compared using OSEM with Hann, Butterworth and Gaussian filters, as well as FBP reconstruction algorithms. Regarding OSEM, RCs were assessed by varying different parameters independently, such as the number of iterations (i) and subsets (s) and the cut-off frequency of the filter (fc). The influence of the attenuation and diffusion corrections was also investigated. Furthermore, both 2D-ROIs and 3D-VOIs contouring were compared. For this purpose, dedicated Matlab© routines were developed in-house for automatic 2D-ROI/3D-VOI determination to reduce intra-user and intra-slice variability. Best reconstruction parameters and RCs obtained with the IQ phantom were used to recover corrected TNR in case of the Kyoto phantom for arbitrary hot-lesion size. In addition, we computed TNR volume histograms to better assess uptake heterogeneityResults: The highest RCs were obtained with OSEM (i=2, s=10) coupled with the Butterworth filter (fc=0.8). Indeed, we observed a global 20% RC improvement over other OSEM settings and a 50% increase as compared to the best FBP reconstruction. In any case, both attenuation and diffusion corrections must be applied, thus improving RC while preserving good image noise (COV<10%). Both 2D-ROI and 3D-VOI analysis lead to similar results. Nevertheless, we recommend using 3D-VOI since tumor uptake regions are intrinsically 3D. RC-corrected TNR values lie within 17% around the true value, substantially improving the evaluation of small volume (<15 mL) regions. Conclusions: This study reports the multi-parameter optimization of 99mTc MAA SPECT/CT images reconstruction in planning 90Y dosimetry for SIRT. In phantoms, accurate quantification of TNR was obtained using OSEM coupled with Butterworth and RC correction.

Use of the swat model for hydro-sedimentologic simulation in a small rural watershed

Mathematical models have great potential to support land use planning, with the goal of improving water and land quality. Before using a model, however, the model must demonstrate that it can correctly simulate the hydrological and erosive processes of a given site. The SWAT model (Soil and Water Assessment Tool) was developed in the United States to evaluate the effects of conservation agriculture on hydrological processes and water quality at the watershed scale. This model was initially proposed for use without calibration, which would eliminate the need for measured hydro-sedimentologic data. In this study, the SWAT model was evaluated in a small rural watershed (1.19 km²) located on the basalt slopes of the state of Rio Grande do Sul in southern Brazil, where farmers have been using cover crops associated with minimum tillage to control soil erosion. Values simulated by the model were compared with measured hydro-sedimentological data. Results for surface and total runoff on a daily basis were considered unsatisfactory (Nash-Sutcliffe efficiency coefficient - NSE < 0.5). However simulation results on monthly and annual scales were significantly better. With regard to the erosion process, the simulated sediment yields for all years of the study were unsatisfactory in comparison with the observed values on a daily and monthly basis (NSE values < -6), and overestimated the annual sediment yield by more than 100 %.

USE OF SCALED SEMIVARIOGRAMS IN THE PLANNING SAMPLE OF SOIL CHEMICAL PROPERTIES IN SOUTHERN AMAZONAS, BRAZIL

The lack of information concerning the variability of soil properties has been a major concern of researchers in the Amazon region. Thus, the aim of this study was to evaluate the spatial variability of soil chemical properties and determine minimal sampling density to characterize the variability of these properties in five environments located in the south of the State of Amazonas, Brazil. The five environments were archaeological dark earth (ADE), forest, pasture land, agroforestry operation, and sugarcane crop. Regular 70 × 70 m mesh grids were set up in these areas, with 64 sample points spaced at 10 m distance. Soil samples were collected at the 0.0-0.1 m depth. The chemical properties of pH in water, OM, P, K, Ca, Mg, H+Al, SB, CEC, and V were determined at these points. Data were analyzed by descriptive and geostatistical analyses. A large part of the data analyzed showed spatial dependence. Chemical properties were best fitted to the spherical model in almost all the environments evaluated, except for the sugarcane field with a better fit to the exponential model. ADE and sugarcane areas had greater heterogeneity of soil chemical properties, showing a greater range and higher sampling density; however, forest and agroforestry areas had less variability of chemical properties.

Three-dimensional radiobiological dosimetry of kidneys for treatment planning in peptide receptor radionuclide therapy.

PURPOSE: Peptide receptor radionuclide therapy (PRRT) delivers high absorbed doses to kidneys and may lead to permanent nephropathy. Reliable dosimetry of kidneys is thus critical for safe and effective PRRT. The aim of this work was to assess the feasibility of planning PRRT based on 3D radiobiological dosimetry (3D-RD) in order to optimize both the amount of activity to administer and the fractionation scheme, while limiting the absorbed dose and the biological effective dose (BED) to the renal cortex. METHODS: Planar and SPECT data were available for a patient examined with (111)In-DTPA-octreotide at 0.5 (planar only), 4, 24, and 48 h post-injection. Absorbed dose and BED distributions were calculated for common therapeutic radionuclides, i.e., (111)In, (90)Y and (177)Lu, using the 3D-RD methodology. Dose-volume histograms were computed and mean absorbed doses to kidneys, renal cortices, and medullae were compared with results obtained using the MIRD schema (S-values) with the multiregion kidney dosimetry model. Two different treatment planning approaches based on (1) the fixed absorbed dose to the cortex and (2) the fixed BED to the cortex were then considered to optimize the activity to administer by varying the number of fractions. RESULTS: Mean absorbed doses calculated with 3D-RD were in good agreement with those obtained with S-value-based SPECT dosimetry for (90)Y and (177)Lu. Nevertheless, for (111)In, differences of 14% and 22% were found for the whole kidneys and the cortex, respectively. Moreover, the authors found that planar-based dosimetry systematically underestimates the absorbed dose in comparison with SPECT-based methods, up to 32%. Regarding the 3D-RD-based treatment planning using a fixed BED constraint to the renal cortex, the optimal number of fractions was found to be 3 or 4, depending on the radionuclide administered and the value of the fixed BED. Cumulative activities obtained using the proposed simulated treatment planning are compatible with real activities administered to patients in PRRT. CONCLUSIONS: The 3D-RD treatment planning approach based on the fixed BED was found to be the method of choice for clinical implementation in PRRT by providing realistic activity to administer and number of cycles. While dividing the activity in several cycles is important to reduce renal toxicity, the clinical outcome of fractionated PRRT should be investigated in the future.