The relationship between clinical outcomes and quality of life for residents of aged care facilities

Objectives It is widely assumed improving care in residential facilities will improve quality of life (QoL), but little research has explored this relationship. The Clinical Care Indicators (CCI) Tool was developed to fill an existing gap in quality assessment within Australian residential aged care facilities and it was used to explore potential links between clinical outcomes and QoL. Design and Setting Clinical outcome and QoL data were collected within four residential facilities from the same aged care provider. Subjects Subjects were 82 residents of four facilities. Outcome Measures Clinical outcomes were measured using the CCI Tool and QoL data was obtained using the Australian WHOQOL‑100. Results Independent t‑test analyses were calculated to compare individual CCIs with each domain of the WHOQOL‑100, while Pearson’s product moment coefficients (r) were calculated between the total number of problem indicators and QoL scores. Significant results suggested poorer clinical outcomes adversely affected QoL. Social and spiritual QoL were particularly affected by clinical outcomes and poorer status in hydration, falls and depression were most strongly associated with lower QoL scores. Poorer clinical status as a whole was also significantly correlated with poorer QoL. Conclusions Hydration, falls and depression were most often associated with poorer resident QoL and as such appear to be key areas for clinical management in residential aged care. However, poor clinical outcomes overall also adversely affected QoL, which suggests maintaining optimum clinical status through high quality nursing care, would not only be important for resident health but also for enhancing general life quality.

Performance enhancement: A whole of person approach to first year dance students’ transition into tertiary training

The transition into university presents very particular challenges for students. The First Year Experience (FYE) is a transitional liminal phase, fraught with uncertainty, ripe with potential. The complexity inherent in this initial phase of tertiary education is well documented and continues to be interrogated. Providing timely and effective support and interventions for potentially at-risk first year students as they transition into tertiary study is a key priority for universities across the globe (Gale et al., 2015). This article outlines the evolution of an established and highly successful Transitional Training Program (TTP) for first year tertiary dance students, with particular reference to the 2015 iteration of the program. TTP design embraces three dimensions: physical training in transition, learning in transition, and teaching for transition, with an emphasis on developing and encouraging a mindset that enables information to be transferred into alternative settings for practice and learning throughout life. The aim of the 2015 TTP was to drive substantial change in first year Dance students’ satisfaction, connectedness, and overall performance within the Bachelor of Fine Arts (BFA) Dance course, through the development and delivery of innovative curriculum and pedagogical practices that promote the successful transition of dance students into their first year of university. The program targeted first year BFA Dance students through the integration of specific career guidance; performance psychology; academic skills support; practical dance skills support; and specialized curricula and pedagogy.

Caregiving at the end of life:perspectives from spousal caregivers and care recipients.

OBJECTIVE: The purpose of this study is to examine the perspectives of both the spousal caregiver and care recipient on the caregiving experience in home-based palliative care. METHODS: A qualitative research strategy involving home-based face-to-face interviews with older palliative care patients and their spousal caregivers was used to examine the caregiving experience. RESULTS: Ten spousal caregivers and care recipient dyads participated in the study. Most informal caregivers viewed caregiving as an extension of the family relationship where caregiving responsibilities evolved over time. Spousal caregivers identified many negative reactions to caregiving, such as fatigue or weariness, depression, anger and sadness, financial stresses, and lack of time. Care recipients acknowledged the emotional and financial strain and expressed concern for their spouses. Both caregivers and care recipients were appreciative of home care services although they identified the need for additional services. They also identified difficulties in communication with formal providers and poor coordination of care among the various services. Both caregivers and care recipients disclosed some challenges with informal supports, but on the whole felt that their presence was positive. Additional positive aspects of caregiving reported by spouses included strengthened relationship with their spouse and discovering emotional strength and physical abilities in managing care. SIGNIFICANCE OF RESULTS: Health care and social service professionals need to recognize and understand both caregiver and care recipient perspectives if they are to successfully meet the needs of both members of the dyad.

Species 2000 & ITIS Catalogue of Life, 2013 Annual Checklist

This release of the Catalogue of Life contains contributions from 132 databases with information on 1,352,112 species, 114,069 infraspecific taxa and also includes 928,147 synonyms and 408,689 common names covering the following groups: Viruses • Viruses and Subviral agents from ICTV_MSL UPDATED! Bacteria and Archaea from BIOS Chromista • Chromistan fungi from Species Fungorum Protozoa • Major groups from ITIS Regional, • Ciliates from CilCat, • Polycystines from WoRMS Polycystina UPDATED!, • Protozoan fungi from Species Fungorum and Trichomycetes database • Slime moulds from Nomen.eumycetozoa.com Fungi • Various taxa in whole or in part from CABI Bioservices databases (Species Fungorum, Phyllachorales, Rhytismatales, Saccharomycetes and Zygomycetes databases) and from three other databases covering Xylariaceae, Glomeromycota, Trichomycetes, Dothideomycetes • Lichens from LIAS UPDATED! Plantae (Plants) • Mosses from MOST • Liverworts and hornworts from ELPT • Conifers from Conifer Database • Cycads and 6 flowering plant families from IOPI-GPC, and 99 families from WCSP • Plus individual flowering plants families from AnnonBase, Brassicaceae, ChenoBase, Droseraceae Database, EbenaBase, GCC UPDATED!, ILDIS UPDATED!, LecyPages, LHD, MELnet UPDATED!, RJB Geranium, Solanaceae Source, Umbellifers. Animalia (Animals) • Marine groups from URMO, ITIS Global, Hexacorals, ETI WBD (Euphausiacea), WoRMS: WoRMS Asteroidea UPDATED!, WoRMS Bochusacea UPDATED!, WoRMS Brachiopoda UPDATED!, WoRMS Brachypoda UPDATED!, WoRMS Brachyura UPDATED!, WoRMS Bryozoa UPDATED!, WoRMS Cestoda NEW!, WoRMS Chaetognatha UPDATED!, WoRMS Cumacea UPDATED!, WoRMS Echinoidea UPDATED!, WoRMS Gastrotricha NEW!, WoRMS Gnathostomulida NEW!, WoRMS Holothuroidea UPDATED!, WoRMS Hydrozoa UPDATED!, WoRMS Isopoda UPDATED!, WoRMS Leptostraca UPDATED!, WoRMS Monogenea NEW!, WoRMS Mystacocarida UPDATED!, WoRMS Myxozoa NEW!, WoRMS Nemertea UPDATED!, WoRMS Oligochaeta UPDATED!, WoRMS Ophiuroidea UPDATED!, WoRMS Phoronida UPDATED!, WoRMS Placozoa NEW!, WoRMS Polychaeta UPDATED!, WoRMS Polycystina UPDATED!, WoRMS Porifera UPDATED!, WoRMS Priapulida NEW!, WoRMS Proseriata and Kalyptorhynchia UPDATED!, WoRMS Remipedia UPDATED!, WoRMS Scaphopoda UPDATED!, WoRMS Tanaidacea UPDATED!, WoRMS Tantulocarida UPDATED!, WoRMS Thermosbaenacea UPDATED!, WoRMS Trematoda NEW!, WoRMS Xenoturbellida UPDATED! • Rotifers, mayflies, freshwater hairworms, planarians from FADA databases: FADA Rotifera UPDATED!, FADA Ephemeroptera NEW!, FADA Nematomorpha NEW! & FADA Turbellaria NEW! • Entoprocts, water bears from ITIS Global • Spiders, scorpions, ticks & mites from SpidCat via ITIS UPDATED!, SalticidDB , ITIS Global, TicksBase, SpmWeb BdelloideaBase UPDATED! & Mites GSDs: OlogamasidBase, PhytoseiidBase, RhodacaridBase & TenuipalpidBase • Diplopods, centipedes, pauropods and symphylans from SysMyr UPDATED! & ChiloBase • Dragonflies and damselflies from Odonata database • Stoneflies from PlecopteraSF UPDATED! • Cockroaches from BlattodeaSF UPDATED! • Praying mantids from MantodeaSF UPDATED! • Stick and leaf insects from PhasmidaSF UPDATED! • Grasshoppers, locusts, katydids and crickets from OrthopteraSF UPDATED! • Webspinners from EmbiopteraSF UPDATED! • Bark & parasitic lices from PsocodeaSF NEW! • Some groups of true bugs from ScaleNet, FLOW, COOL, Psyllist, AphidSF UPDATED! , MBB, 3i Cicadellinae, 3i Typhlocybinae, MOWD & CoreoideaSF NEW!• Twisted-wing parasites from Strepsiptera Database UPDATED! • Lacewings, antlions, owlflies, fishflies, dobsonflies & snakeflies from LDL Neuropterida • Some beetle groups from the Scarabs UPDATED!, TITAN, WTaxa & ITIS Global • Fleas from Parhost • Flies, mosquitoes, bots, midges and gnats from Systema Dipterorum, CCW & CIPA • Butterflies and moths from LepIndex UPDATED!, GloBIS (GART) UPDATED!, Tineidae NHM, World Gracillariidae • Bees & wasps from ITIS Bees, Taxapad Ichneumonoidea, UCD, ZOBODAT Vespoidea & HymIS Rhopalosomatidae NEW!• Molluscs from WoRMS Mollusca NEW!, FADA Bivalvia NEW!, MolluscaFW NEW! & AFD (Pulmonata) • Fishes from FishBase UPDATED! • Reptiles from TIGR Reptiles • Amphibians, birds and mammals from ITIS Global PLUS additional species of many groups from ITIS Regional, NZIB and CoL China NEW!

Dilthey: The hermeneutics of life and the universal aspirations of pedagogy

Dilthey claimed that first psychology and then hermeneutics played the foundational role for his philosophy of life, whose main practical goal is to develop a pedagogy or theory of education. Pedagogy needs help from h ethics to establish its ends, and from psychology to indicate it means. This paper intends to show the relationship between Dilthey's hermeneutics of life and his pedagogy. Dilthey's philosophy of life, in so far it adopts the hermeneutical procedure, engages in the understanding of or the search for the meaning of human socio-historical creations, by adopting a special type of relationship between parts and whole. It is exactly within this hermeneutical balance that we propose to extinguish any indication of a rupture, breach, or contradiction between the quest for universal principles of human behavior and :Dilthey's defense of the impossibility of constructing human moral tasks by means of universal principles. Dilthey began his ethics lectures at the University of Berlin in 1890. These lectures, published in 1958 by Herman Nohl in volume X of Dilthey's collected works, indicate the direction of the trajectory by which formative or social ethics are consolidated as a historical solution for reaching universal principles that can guide human purposes. This trajectory is a result of the distinctively human exercise of self-reflection, by means of which we can fulfill our destiny of manifesting and exteriorizing in time the immanent energy of the absolute spirit. We wish to show that it is possible that such a pedagogy can respect its universal task of orienting the historical development of the younger generation without directing this process by means of fixed and rigid aims.

Archaeal-eubacterial mergers in the origin of Eukarya: phylogenetic classification of life.

A symbiosis-based phylogeny leads to a consistent, useful classification system for all life. "Kingdoms" and "Domains" are replaced by biological names for the most inclusive taxa: Prokarya (bacteria) and Eukarya (symbiosis-derived nucleated organisms). The earliest Eukarya, anaerobic mastigotes, hypothetically originated from permanent whole-cell fusion between members of Archaea (e.g., Thermoplasma-like organisms) and of Eubacteria (e.g., Spirochaeta-like organisms). Molecular biology, life-history, and fossil record evidence support the reunification of bacteria as Prokarya while subdividing Eukarya into uniquely defined subtaxa: Protoctista, Animalia, Fungi, and Plantae.

A metafrontier production function for estimation of technical efficiencies and technology gaps for firms operating under different technologies

This paper presents a metafrontier production function model for firms in different groups having different technologies. The metafrontier model enables the calculation of comparable technical efficiencies for firms operating under different technologies. The model also enables the technology gaps to be estimated for firms under different technologies relative to the potential technology available to the industry as a whole. The metafrontier model is applied in the analysis of panel data on garment firms in five different regions of Indonesia, assuming that the regional stochastic frontier production function models have technical inefficiency effects with the time-varying structure proposed by Battese and Coelli ( 1992).

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.

Optimisation of maintenance expenditure for buildings : refurbish or demolish

With an increase in growing number of aging public building infrastructure globally, there is an opportunity for an efficient life care management rather then mere demolition and rebuild. By carefully implementing appropriate structural engineering practices with facility management, the whole of life cycle costs for public building assets can be optimised and public money can be saved and better utilised elsewhere. A need of decision support tool/methodology which can assist asset manager make better decision among demolish, refurbish, do nothing or rebuilt option for any typical building under consideration is growing in order to optimise maintenance funds. The paper is part of research project focusing on development of such methodology known as residual service life prediction. The paper is mainly focusing on following three major aspects of public building infrastructure; first, issues and challenges in optimisation of maintenance funds, second, residual service life prediction methodology and issues and challenges in the development of such methodology. The paper concludes with the authors’ observations and further research potentials

The impact of pain on the quality of life of people with multiple sclerosis: A community survey

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.

Measuring and supporting quality of life

It is widely acknowledged that “quality of life” (QoL) is an imprecise concept, which is difficult to define (Arnold, 1991; Ball et al., 2000; Bury & Holme, 1993; Byrne & MacLean, 1997; Guse & Masesar, 1999; McDowell & Newell, 1996). McDowell and Newell (1996) described the term as “intuitively familiar” (p.382), suggesting that everyone believes that they know what it means; while, in reality its meaning differs from person to person. Recent years, have seen steadily increasing interest in the study and measurement of QoL related to human services, which reflects greater importance being attached to accountability in its widest sense. Anecdotally, many care staff will indicate that ensuring good QoL for their clients is important to them, but how can we ascertain whether we are achieving positive QoL outcomes, and given the complexities of the concept and its measurement, how can we best incorporate QoL assessment into everyday practice? This chapter will explore the issues of QoL definition and measurement, particularly as they pertain to aged care. It will consider many measurement tool options, and provide advice on how to choose an appropriate instrument for your circumstances. Issues of quality of care and their relationship to QoL will also be considered, and the chapter will conclude with a discussion on the integration of QoL assessment into practice. Because residential aged care constitutes a living environment as well as a care environment, QoL is considered particularly pertinent in this context, and as such, it will provide much of the focus for the chapter

End-of-life decision making for older people

This chapter deals with the increasing issues surrounding end-of-life decision making. As the life trajectory for older people changes, the need for open discussion about their health problems and treatment becomes more critical. Acceptance of the ageing process itself is often not easy so the matter of a good death is even more distressing for some people to consider. The vignette provides an excellent discussion on the need for open dialogue with the older person and their families, whether they are acutely ill or have chronic health problems. How a person wishes to be treated when quality of life is not going to improve, no matter what interventions are put in place, seems essential for person-centred care. The issue of competency is one that must be determined before any decision is made by any person involved in care.