Healthcare Staffs’ Experiences and Perceptions of Caring for People with Dementia in the Acute Setting: Qualitative Evidence Synthesis

Background Dementia is a global issue, with increasing prevalence rates impacting on health services internationally. People with dementia are frequently admitted to hospital, an environment that may not be suited to their needs. While many initiatives have been developed to improve their care in the acute setting, there is a lack of cohesive understanding of how staff experience and perceive the care they give to people with dementia in the acute setting. Objectives The aim of this qualitative synthesis was to explore health care staffs’ experiences and perceptions of caring for people with dementia in the acute setting. Qualitative synthesis can bring together isolated findings in a meaningful way that can inform policy development. Settings A screening process, using inclusion/exclusion criteria, identified qualitative studies that focused on health care staff caring for people with dementia in acute settings. Participants Twelve reports of nine studies were included for synthesis. Data extraction was conducted on each report by two researchers. Methods Framework synthesis was employed using VIPS framework, using Values, Individualised, Perspective and Social and psychological as concepts to guide synthesis. The VIPS framework has previously been used for exploring approaches to caring for people with dementia. Quality appraisal was conducted using Critical Appraisal Skills Programme (CASP) and NVivo facilitated sensitivity analysis to ensure confidence in the findings. Results Key themes, derived from VIPS, included a number of specific subthemes that examined: infrastructure and care pathways, person-centred approaches to care, how the person interacts with their environment and other patients, and family involvement in care decisions. The synthesis identified barriers to appropriate care for the person with dementia. These include ineffective pathways of care, unsuitable environments, inadequate resources and staffing levels and lack of emphasis on education and training for staff caring for people with dementia. Conclusions This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.

Serous cystadenofibroma of the Fallopian tube. Case report and literature review

Introduction. Cystadenofibromas of the Fallopian tube are very rare benign tumors of the female genital tract. These tumours are usually asymptomatic and are found incidentally. Case report. We describe a Fallopian serous cystadenofibroma in a 50 year-old woman operated for uterine leiomyoma. The histopathologic finding revealed a cystic lesion connected to the salpinx. The cyst was composed of connective stroma lined by epithelial cuboidal cells, without pleomorfism or detectable mitoses. Pseudopapillary structures were observed in the lumen of the cyst. The patient is well on follow-up. Conclusion. The origin of serous cystadenofibroma of the Fallopian tube is not clear. The tumor is considered an embryologic remnant rather than a proliferating neoplastic process. These tumours seem to have a benign course and a malignant potential has not been described.

Price transmission dynamics between ADRs and their underlying foreign security: The case of Banco de Colombia S.A.- Bancolombia.

This paper analyzes the dynamics ofthe American Depositary Receipt (ADR) of a Colombian bank (Bancolombia) in relation to its pricing factors (underlying (preferred) shares price, exchange rate and the US market index). The aim is to test if there is a long-term relation among these variables that would imply predictability. One cointegrating relation is found allowing the use of a vector error correction model to examine the transmission of shocks to the underlying prices, the exchange rate, and the US market index. The main finding of this paper is that in the short run, the underlying share price seems to adjust after changes in the ADR price, pointing to the fact that the NYSE (trading market for the ADR) leads the Colombian market. However, in the long run, both, the underlying share price and the ADR price, adjust to changes in one another.

Resting energy expenditure, macronutrient utilization, and body composition in term infants after corrective surgery of major congenital anomalies: a case-study

Introduction - Knowledge on the metabolic changes and nutritional needs during the postsurgical anabolic phase in infants is scarce. This analysis explores the associations of resting energy expenditure (REE) and macronutrient utilization with body composition of full-term infants, during catch-up growth after corrective surgery of major congenital anomalies. Methods - A cohort of full-term appropriate for-gestational-age neonates subjected to corrective surgery of major congenital anomalies were recruited after gaining weight for at least one week. REE and macronutrient utilization, measured by respiratory quotient (RQ), were assessed by indirect calorimetry using the Deltatrac II Metabolic Monitor ®. Body composition, expressed as fat-free mass (FFM), fat mass (FM) and adiposity defined as percentage of FM (% FM), was measured by air displacement plethysmography using the Pea Pod ®. Results - Four infants were included at 3 to 5 postnatal weeks. Recommended energy and macronutrient intakes for healthy term infants were provided. Through the study, the median (min-max) REE (Kcal/Kg FFM/d) was 70.8 (60.6-96.1) and RQ was 0.99 (0.72-1.20). Steady increases in both body weight and FFM were associated with initial decrease in FM and adiposity followed by their increase. Low RQ preceded decrease in adiposity. Conclusion - The marked adiposity depletion, not expected during steady weight gain in the postsurgical period, prompts us to report this finding. The subsequent adiposity catch-up was associated with relatively high REE and RQ, suggesting preferential oxidation of carbohydrates and preservation of lipids for fat storage.

Selling customer value in B2B markets - Case KONE JumpLift

Skepticism of promised value-added is forcing suppliers to provide tangible evidence of the value they can deliver for the customers in industrial markets. Despite this, quantifying customer benefits is being thought as one of the most difficult part in business-to-business selling. The objective of this research is to identify the desired and perceived customer benefits of KONE JumpLift™ and improve the overall customer value quantification and selling process of the solution. The study was conducted with a qualitative case analysis including 7 interviews with key stakeholders from three different market areas. The market areas were chosen based on where the offering has been utilized and the research was conducted by five telephone and two email interviews. The main desired and perceived benefits include many different values for example economical, functional, symbolic and epistemic value but they vary on studied market areas. The most important result of the research was finding the biggest challenges of selling the offering which are communicating and proving the potential value to the customers. In addition, the sales arguments have different relative importance in studied market areas which create challenges for salespeople to sell the offering effectively. In managerial level this means need for investing into a new sales tool and training the salespeople.

Non-Celiac Gluten Sensitivity and Autoimmunity. A Case Report

Introduction, objective: To present a case report in which the finding of non-coeliac gluten sensitivity was decisive for the treatment of a complex autoimmune disease. Materials and methods: A 43-year-old woman with polyarthritis, psoriatic features, anti-SSA/Ro and anti-cyclic citrullinated peptide antibodies, with refractory course, was evaluated for gluten sensitivity despite negative serology for coeliac disease. Results: The patient carried the HLA DQ2 haplotype and duodenal biopsy showed lymphocytic enteritis. A gluten-free diet resolved the clinical picture and permitted tapering of immunosuppressive therapy. Conclusion: Non-coeliac gluten sensitivity can be associated with autoimmunity despite the absence of the specific autoantibodies of coeliac disease.

Structured cases in case-based reasoning: re-using and adapting cases for time-tabling problems

In this paper, we present a case-based reasoning (CBR) approach solving educational time-tabling problems. Following the basic idea behind CBR, the solutions of previously solved problems are employed to aid finding the solutions for new problems. A list of feature-value pairs is insufficient to represent all the necessary information. We show that attribute graphs can represent more information and thus can help to retrieve re-usable cases that have similar structures to the new problems. The case base is organised as a decision tree to store the attribute graphs of solved problems hierarchically. An example is given to illustrate the retrieval, re-use and adaptation of structured cases. The results from our experiments show the effectiveness of the retrieval and adaptation in the proposed method.

Structured decision making as a tool for facilitating stakeholder engagement in non-renewable resource management: using the case study of hydraulic fracturing in the Green Point Shale formation in western Newfoundland

This thesis examines the importance of effective stakeholder engagement that complies with the doctrines of social justice in non-renewable resources management decision-making. It uses hydraulic fracturing in the Green Point Shale Formation in Western Newfoundland as a case study. The thesis uses as theoretical background John Rawls’ and David Miller’ theory of social justice, and identifies the social justice principles, which are relevant to stakeholder engagement. The thesis compares the method of stakeholder engagement employed by the Newfoundland and Labrador Hydraulic Fracturing Review Panel (NLHFRP), with the stakeholder engagement techniques recommended by the Structured Decision Making (SDM) model, as applied to a simulated case study involving hydraulic fracturing in the Green Point Shale Formation. Using the already identified social justice principles, the thesis then developed a framework to measure the level of compliance of both stakeholder engagement techniques with social justice principles. The main finding of the thesis is that the engagement techniques prescribed by the SDM model comply more closely with the doctrines of social justice than the engagement techniques applied by the NLHFRP. The thesis concludes by recommending that the SDM model be more widely used in non- renewable resource management decision making in order to ensure that all stakeholders’ concerns are effectively heard, understood and transparently incorporated in the nonrenewable resource policies to make them consistent with local priorities and goals, and with the social justice norms and institutions.

Transformation into Platform - How can an organisation move from a single-sided business to platforms? A case study at Lyyti

The research studies the transformation from a single-sided offering to a multi-sided platform. The study aims to define platforms and their benefits, creating a theoretical framework by applying change management models with the platform theory, and by finding critical change points of the transformation. The empirical research was done by utilizing action research. The researcher worked as project manager in the case company, and studied the transformation project by working actively and leading the project team. The result of the project was a study of how the company would be able to manage the transformation. The results clearly showed that the company didn’t have the capabilities to finish the transformation. As a conclusion, the study showed that the critical change points that led to the project failure were, that the project was managed with insufficient change managerial efforts, which later resulted as lack of commitment to re-allocating the resources to complete the transformation. Many of the critical change points were results of combined change managerial and platform-related issues.

FTIR, a potential tool to dementia diagnosis trough analysis of plasma

Nowadays it is still difficult to perform an early and accurate diagnosis of dementia, therefore many research focus on the finding of new dementia biomarkers that can aid in that purpose. So scientists try to find a noninvasive, rapid, and relatively inexpensive procedures for early diagnosis purpose. Several studies demonstrated that the utilization of spectroscopic techniques, such as Fourier Transform Infrared Spectroscopy (FTIR) and Raman spectroscopy could be an useful and accurate procedure to diagnose dementia. As several biochemical mechanisms related to neurodegeneration and dementia can lead to changes in plasma components and others peripheral body fluids, blood-based samples and spectroscopic analyses can be used as a more simple and less invasive technique. This work is intended to confirm some of the hypotheses of previous studies in which FTIR was used in the study of plasma samples of possible patient with AD and respective controls and verify the reproducibility of this spectroscopic technique in the analysis of such samples. Through the spectroscopic analysis combined with multivariate analysis it is possible to discriminate controls and demented samples and identify key spectroscopic differences between these two groups of samples which allows the identification of metabolites altered in this disease. It can be concluded that there are three spectral regions, 3500-2700 cm -1, 1800-1400 cm-1 and 1200-900 cm-1 where it can be extracted relevant spectroscopic information. In the first region, the main conclusion that is possible to take is that there is an unbalance between the content of saturated and unsaturated lipids. In the 1800-1400 cm-1 region it is possible to see the presence of protein aggregates and the change in protein conformation for highly stable parallel β-sheet. The last region showed the presence of products of lipid peroxidation related to impairment of membranes, and nucleic acids oxidative damage. FTIR technique and the information gathered in this work can be used in the construction of classification models that may be used for the diagnosis of cognitive dysfunction.

Development of business processes and sales reporting - Case recovered paper

The purpose of this research is to discover development points for business processes and sales reporting in the recovered paper sourcing organization. The processes under development are both sales and sourcing processes that were determined by the commissioning company. All of these processes have in common that there are used sales orders to organize the money flows correctly. Although the main objective is to source only recovered paper, the sourcing also brings by-products that cannot be utilized and are thus sold. As the purpose of the sales function is to only support the sourcing strategy, it should be organized as efficiently as possible. Investigating the current status of the processes and finding development points help in building proposals for enhanced process descriptions. In order that sales function could be analyzed, should the sales reporting be accurate and present the needed key figures. The current status of the processes as well as the possible problems and development ideas were researched with the help of interviews. Best practices could also be brought from other business lines in the commissioning company. The theory part was build according to relevant literature and scientific articles. The research indicates, that processes have shaped differently in sourcing organization’s business units. Local infrastructure and legislation sets certain limitations to the sourcing of recovered paper, and these circumstances cannot be changed. Customer-supplier power relations also affect to the formulation of business processes. In order to steer the processes, there has to be more internal controls. Still, the enterprise resource planning system also sets boundaries how the processes can be made more efficient.

Renal angiomyolipoma with renal vein thrombosis: an incidental finding

A 66-year-old female with history of endometrioid endometrial carcinoma was admitted to our institution with abdominal and pelvic pain. A CT scan revealed a mass within the right upper kidney with a tumour thrombus that extended through the right renal vein up to the point of confluence with the inferior vena cava (IVC). The imaging features of the mass strongly suggested a diagnosis of renal angiomyolipoma (AML) with renal vein thrombosis. The patient was proposed an open radical right nephrectomy with right renal thrombectomy for histopathological confirmation of the diagnosis of AML with extension to the right renal vein and preventing complications such as potentially fatal pulmonary thromboembolism. The implantation of a temporary IVC filter before surgery was recommended.

Finding the set of k-additive dominating measures viewed as a flow problem

n this paper we deal with the problem of obtaining the set of k-additive measures dominating a fuzzy measure. This problem extends the problem of deriving the set of probabilities dominating a fuzzy measure, an important problem appearing in Decision Making and Game Theory. The solution proposed in the paper follows the line developed by Chateauneuf and Jaffray for dominating probabilities and continued by Miranda et al. for dominating k-additive belief functions. Here, we address the general case transforming the problem into a similar one such that the involved set functions have non-negative Möbius transform; this simplifies the problem and allows a result similar to the one developed for belief functions. Although the set obtained is very large, we show that the conditions cannot be sharpened. On the other hand, we also show that it is possible to define a more restrictive subset, providing a more natural extension of the result for probabilities, such that it is possible to derive any k-additive dominating measure from it.

Rectal inflammatory fibroid polyp in a Nigerian: case report & brief review of literature.

Background: Inflammatory fibroid polyps are very unusual gastrointestinal tumours. Furthermore, their occurrence in the rectum is a rarity indeed. Objective: To document this very rare pathologic entity in a patient from our region of Africa and highlight some pertinent clinical and pathologic aspects of the disease. Case report: We present a 59 year old Nigerian who had neither significant previous medical history nor current complaint and had a routine colonoscopy done. The finding in the rectum was of a small polypoidal mass which was excised whole and whose histopathologic findings were consistent with a diagnosis of inflammatory fibroid polyp. Conclusion: A unique case of rectal inflammatory fibroid polyp in a Nigerian is hereby presented. This, to the best of our knowledge, is the first such documented case from our region of the world. Hence, the entity should be considered in the differential diagnosis of colonic polyps from the continent.

Efecto determinante de la motivación de viaje sobre la imagen de destino en turistas de ocio a un destino urbano: El caso de Monterrey, México. Una aproximación por medio de mínimos cuadrados parciales (PLS) = Determinant effect of travel motivation on the destination image of leisure tourist in an urban destination: the case of Monterrey, México. An approach through partial least squares (PLS)

Los turistas urbanos se caracterizan por ser uno de los segmentos de mayor crecimiento en los mercados turísticos actuales. Monterrey (México), uno de los principales destinos urbanos del país, ha apostado en la actualidad por mejorar su competitividad. Esta investigación se propuso encontrar evidencia acerca de la relación causal de la motivación de viaje sobre la imagen percibida del destino, dos variables importantes por su influencia en la satisfacción de los visitantes. Una revisión de la literatura permitió proponer constructos teóricos integrados en un instrumento para la recogida de datos vía encuesta a una muestra representativa. Por medio del método de regresión y ecuaciones estructurales por mínimos cuadrados parciales (PLS), se identificaron los componentes principales de ambas variables y se obtuvo un modelo explicativo de la imagen percibida del destino en función de la motivación de viaje. Finalmente, se emiten recomendaciones para la gestión del destino urbano en función de los resultados obtenidos. ABSTRACT: Abstract Urban tourists are recognized as one of the fastest growing segments in today’s tourism markets. Monterrey, Mexico, one of the main urban destinations in the country aims at improving its competitiveness. This research work had the purpose of finding evidence on the causal relationship between travel motivation and destination image, two important variables because of their influence on visitors’ satisfaction. A literature review enabled the proposal of a research instrument with theoretically based constructs to gather data through survey from a representative sample. Using regression and structural equations modelling by partial least squares (pls) a set of main components of both variables were identified thus enabling the obtention of a explanatory model of destination image in terms of travel motivations. Finally based on the results some recommendations of tourism management are given.