Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

Clinical characteristics of patients with epilepsy in a specialist neuropsychiatry service

Neuropsychiatry services provide specialist input into the assessment and management of behavioral symptoms associated with a range of neurological conditions, including epilepsy. Despite the centrality of epilepsy to neuropsychiatry and the recent expansion of neuropsychiatry service provision, little is known about the clinical characteristics of patients with epilepsy who are routinely seen by a specialist neuropsychiatry service. This retrospective study filled this gap by retrospectively evaluating a naturalistic series of 60 consecutive patients with epilepsy referred to and assessed within a neuropsychiatry setting. Fifty-two patients (86.7%) had active epilepsy and were under the ongoing care of the referring neurologist for seizure management. The majority of patients (N = 42; 70.0%) had a diagnosis of localization-related epilepsy, with temporal lobe epilepsy as the most common epilepsy type (N = 37; 61.7%). Following clinical assessment, 39 patients (65.0%) fulfilled formal diagnostic criteria for at least one psychiatric disorder; nonepileptic attack disorder (N = 37; 61.7%), major depression (N = 23; 38.3%), and generalized anxiety disorder (N = 16; 26.7%) were the most commonly diagnosed comorbidities. The clinical characteristics of patients seen in specialist neuropsychiatry settings are in line with the results from previous studies in neurology clinics in terms of both epilepsy and psychiatric comorbidity. Our findings confirm the need for the development and implementation of structured care pathways for the neuropsychiatric aspects of epilepsy, with focus on comorbid nonepileptic attacks and affective and anxiety symptoms. This is of particular importance in consideration of the impact of behavioral symptoms on patients' health-related quality of life.

Making the organization fly:organizational identification and citizenship in full-service and low-cost airlines

Recently, the service industry has seen a low-cost sector emerge alongside the traditional full-service sector. We explored whether these business models have different implications for employee cooperation, one factor that plays an important role in organizational functioning. Drawing on the social identity perspective, we argue that employees will identify less strongly with the lower-status, low-cost organizations, reducing their intrinsic motivation for such cooperation. We tested these relationships among employees in Thailand's airline industry. In line with expectations, flight attendants working for low-cost airlines (N = 77) perceived their organizations to have lower status than those working for the full-service airlines (N = 77), and this was associated with reduced organizational identification. This in turn predicted lower levels of organizational citizenship behaviour and a stronger desire for organizational exit. © 2010 Hogrefe Publishing.

A racionális kisvállalati gazdálkodás tényezői, 2006-2010 (Factors in rational operation of small business, 2006-2010)

A tanulmány a hazai kis- és középvállalati szektorban 2006-ban elvégzett, majd 2010-ben megismételt kérdőíves felmérések eredményei alapján igyekszik bemutatni a racionális vállalati gazdálkodás sajátosságait. Vizsgálatunk fő kérdése, hogy e szektor vállalkozásainak gazdálkodását milyen tényezők teszik ésszerűvé, s hogy a 2006-2010 között eltelt időszakban milyen változások figyelhetők meg a gazdálkodói magatartásuk alakulásában. Eredményeink alapján megállapíthatjuk, hogy a mai napig megtalálhatók a kisvállalkozói - háztartási szemléletű, megélhetésorientált - gazdálkodás nyomai, de a racionális gazdálkodás általunk használt mutatói szerint e vállalkozások körében szakszerűbbé vált a gazdálkodás. Ebben a folyamatban szerepet játszott a gazdasági válság, amely által előidézett helyzethez kénytelenek voltak alkalmazkodni a kis- és közepes vállalkozások: felismerték, hogy célravezetőbb a hatékonyság és a költségek szempontjából a racionális pénzpiaci magatartás követése, s ezzel összhangban a válság miatti zavarok elhárítására kiadáscsökkentő eszközök alkalmazása. A kis- és közepes vállalkozások gazdálkodásával kapcsolatos racionális döntések előmozdításában elsősorban a korszerű pénzügyi ismereteknek és a szakmai tudásnak van szerepe. / === / The study seeks to identify the attributes of rational business operation, using a questionnaire survey of small and medium-sized firms made in 2006 and a repeat of it in 2010. The main questions addressed are what factors contribute to rational operation in the firms in the sector and what changes over the 2006-10 period can be discerned in business behaviour. The findings show that traces of small business-style operation (a household or livelihood orientation) could still be found, but the indicators of rationality employed in the survey show that the operation of the firms became more rational. A role in the process was played by the economic crisis, which forced small and medium-sized businesses to adapt: they recognized that it was better from the point of view of efficiency and costs to follow rational money-market behaviour, and in line with that, use spending-reduction tools to evade the disturbances of the crisis. The main factors behind the shift towards rational decision-making in the running of small and medium-sized firms are up-to-date financial information and professional expertise.

Üzleti teljesítménymérés a sportban, - avagy miként segítheti a sportszervezetek vezetőit a Balanced Scorecard koncepció a stratégia szerinti működésben = Measuring Business Performance in Sports - How the Balanced Scorecard approach can help sports organisations in operating along strategic objectives

Napjainkban egyre nagyobb figyelem fordul a sporttevékenység társadalmi hasznosságára, ugyanakkor számos sportszervezet a túléléséért küzd. A legtöbb sportszervezetnél a sportteljesítmény mérése dominál, s viszonylag kevés figyelmet fordítanak az üzleti teljesítmény és az ezt befolyásoló tényezők mérésére, annak ellenére, hogy a vezetők tudatában vannak a sportteljesítmény és az üzleti teljesítmény kölcsönös összefüggésével. A sportteljesítményt a fogyasztói elégedettségen keresztül bevételre kell váltani, illetve biztosítani kell a finanszírozási forrásokat (gondolhatunk akár a játékosok fizetésére) a megfelelő sportteljesítmény eléréséhez. A sportszervezetek vezetőinek át kell látniuk a sportteljesítmény és az üzleti teljesítmény összefüggéseit, és azonosítaniuk kell a kritikus értékteremtő tényezőket. Ehhez adhat egy megfelelő gondolkodási keretet a Balanced Scorecard alkalmazása. Tanulmányunkban egy rövid áttekintést adunk a Balanced Scorecard alkalmazásának előnyeiről és kihívásairól a non-profit szervezetek esetében, majd egy magyarországi kézilabda klubnál készített esettanulmány segítségével megvizsgáljuk a BSC alkalmazási lehetőségét a sportkluboknál. _____ While performance measurement in the sport industry has a traditionally strong focus on sports results, commercial success of sports clubs needs to gain more ground. Sports results should generate market revenues, by satisfying customer needs, and allow continued investment in the further improvement of sports success (i.e. more funds for player transfers and wages). Club managers need to understand the complex relationship between on-field and off-the-field success, and identify critical success factors for achieving strategic objectives. The Balanced Scorecard approach provides a plausible framework for such analysis. Our paper explains the challenges of and opportunities for implementing a Balanced Scorecard system in non-profit organisations, and provides insights into its application in professional sport through an in-depth case study of a handball club in Hungary. We conclude by providing a model for managing sports organisations in line with strategic objectives, balancing out stakeholder expectations for both sports results and commercial success.

Mi a baj a modern szervezetekkel? – Kritikai menedzsmentelméletek (What is the problem in modern organisations? – Critical Management Studies)

A nemzetközi, elsősorban európai szervezettudományban mára meghatározóvá vált a kritikai megközelítés, a hazai szakirodalomban mégis elvétve találni rá utalásokat. A szerzők írásukban tárgyalják, hogy a kritikai menedzsmentelméletek (KME) szemszögéből miként bírálható a mindenkori szervezeti gyakorlat, és miért bírálandók a főáramú menedzsmentelméletek. A tanulmány fő részében elméleti megkülönböztetéseket tesznek: egyrészt elhatárolják a kritikai megközelítést a főáramú szervezetelméletektől, másrészt több szempontból is különbséget tesznek a különféle – de egyaránt a KME alá tartozó – kritikai megközelítések között. De a kritikai szemlélethez hűen nem csak a puszta elméletismertetés volt a céljuk: e bevezetés és problémafelvető tanulmány – s a későbbiekben tervezett cikksorozat – szándékuk szerint vitaindítóként is szolgál. Abban bíznak, hogy a felvetett kérdésekről valódi, lényegi párbeszédet generálhatnak a hazai menedzsmenttudományban (kutatók, oktatók és elméletalkalmazók körében), mely kihathat a szervezeti gyakorlatra is. _____ Critical Management Studies (CMS) as a field of organization studies (OS) has become central internationally, and especially in Europe. Yet, its appearance is still very rare in the Hungarian OS literature. In this study first the authors discuss how the nowadays dominant organizational practices along with the mainstream management and organization theories are to be criticized from a Critical Management perspective. In the main section, so as to define CMS, they make important theoretical distinctions, first between CMS and mainstream organization theories (in general), and then among the different critical approaches that nevertheless all fall under the broad CMS umbrella. But, in line with a truly critical attitude, they not only go into theoretical discussions but, at least to their intention, the purpose of this introductory paper is also to addresses important problems both in the theory and the practice of organization and management. Therefore, it could serve as an opening of an important debate or dialogue in the Hungarian academic community (researchers, educators and other professionals), a theoretical discussion that could have real influence on organizational practice too.

The role of redox signaling in the molecular mechanism of tamoxifen resistance in breast cancer.

The emergence of tamoxifen or aromatase inhibitor resistance is a major problem in the treatment of breast cancer. The molecular signaling mechanism of antiestrogen resistance is not clear. Understanding the mechanisms by which resistance to these agents arise could have major clinical implications for preventing or circumventing it. Therefore, in this dissertation we have investigated the molecular mechanisms underlying antiestrogen resistance by studying the contributions of reactive oxygen species (ROS)-induced redox signaling pathways in antiestrogen resistant breast cancer cells. Our hypothesis is that the conversion of breast tumors to a tamoxifen-resistant phenotype is associated with a progressive shift towards a pro-oxidant environment of cells as a result of oxidative stress. The hypothesis of this dissertation was tested in an in vitro 2-D cell culture model employing state of the art biochemical and molecular techniques, including gene overexpression, immunoprecipitation, Western blotting, confocal imaging, ChIP, Real-Time RT-PCR, and anchorage-independent cell growth assays. We observed that tamoxifen (TAM) acts like both an oxidant and an antioxidant. Exposure of tamoxifen resistant LCC2 cell to TAM or 17 beta-estradiol (E2) induced the formation of reactive oxidant species (ROS). The formation of E2-induced ROS was inhibited by co-treatment with TAM, similar to cells pretreated with antioxidants. In LCC2 cells, treatments with either E2 or TAM were capable of inducing cell proliferation which was then inhibited by biological and chemical antioxidants. Exposure of LCC2 cells to tamoxifen resulted in a decrease in p27 expression. The LCC2 cells exposed to TAM showed an increase in p27 phosphorylation on T157 and T187. Conversely, antioxidant treatment showed an increase in p27 expression and a decrease in p27 phosphorylation on T157 and T187 in TAM exposed cells which were similar to the effects of Fulvestrant. In line with previous studies, we showed an increase in the binding of cyclin E-Cdk2 and in the level of p27 in TAM exposed cells that overexpressed biological antioxidants. Together these findings highly suggest that lowering the oxidant state of antiestrogen resistant LCC2 cells, increases LCC2 susceptibility to tamoxifen via the cyclin dependent kinase inhibitor p27.

Pre-Disaster Risk Management in Post-Earthquake (1999) Turkey

This paper assesses the status of pre-disaster risk management in the case of Turkey. By focusing on the period following the catastrophic August 17, 1999 earthquake, the study benefits from USAID’s Disaster Risk Management Benchmarking Tool (DRMBT). In line with the benchmarking tool, the paper covers key developments in the four components of pre-disaster risk management, namely: risk identification, risk mitigation, risk transfer and disaster preparedness. In the end, it will present three major conclusions: (i) Although post-1999 Turkey has made some important progress in the pre-disaster phase of DRM, particularly with the enactment of obligatory earthquake insurance and tightened standards for building construction, the country is far away from substantial levels of success in DRM. (ii) In recent years, local governments have had been given more authority in the realm of DRM, however, Turkey’s approach to DRM is still predominantly centralized at the expense of successful DRM practices at the local level. (iii) While the devastating 1999 earthquake has resulted in advances in the pre-disaster components of DRM; progress has been mostly in the realm of earthquakes. Turkey’s other major disasters (landslides, floods, wild fires i.e.) also require similar attention by local and central authorities.

The World in Singing Made: David Markson's "Wittgenstein's Mistress"

In line with Wittgenstein's axiom that "what the solipsist means is quite correct; only it cannot be said, but makes itself manifest," this thesis aims to demonstrate how the gulf between analytic and continental philosophy can best be bridged through the mediation of art. The present thesis brings attention to Markson's work, lauded in the tradition of Faulkner, Joyce, and Lowry, as exemplary of the shift from modernity to postmodernity, wherein the human heart is not only in conflict with itself, but with the language out of which it is necessarily constituted. Markson limns the paradoxical condition of the subject severed from intersubjectivity, and affected not only by the grief of bereavement, which can be defined in Heideggarian terms as anxiety for the ontic negation of a being (i.e., death), but by loss, which I assert is the ontological ground for how Dasein encounters the nothing in anxiety proper.

Previous Holocaust Experiences Continue to Affect Food Attitudes in Survivors

A qualitative study was conducted to determine if Holocaust survivors’ food attitudes are influenced by their earlier experiences. The 25 survivor interviewees (14 males, 11 females) ranged in age from 71 to 85 years and resided in Miami-Dade and Broward, Florida counties. Most (56%) were interned in concentration camps during the Holocaust. Interviews were tape-recorded and later transcribed. Results showed earlier experiences influenced food attitudes. The most common themes were: 1) Difficulty throwing food away - even when spoiled; 2) Storing excess food; 3) Craving a certain food; 4) Difficulty standing in line for food; and 5) Anxiety when food is not readily available. Sub-themes included healthy eating and empathy for those currently suffering from hunger. Fourteen (56%) fast for religious holidays, but 7 (28%) said they already had “fasted enough.” Dietitians and others are encouraged to evaluate food service programs to minimize uncomfortable food-related situations for Holocaust survivors.

A study to identify the motivation compelling the business traveler to choose a specific airline in the Miami to Atlanta market and to develop a marketing strategy

The purpose of this study was to determine if the business traveler's behavior is influenced by brand loyalty. This brand loyalty, which became evident through the use of a survey, was then to be thoroughly evaluated. In order for this information to be best understood and utilized as the basis of future marketing strategies, much research was undertaken and its significance explained in relation to the airline industry as it exists at present. The results and conclusions of this study indicate that the airline industry is, for the most part, taking a successful approach in attracting business travelers. These travelers' business is highly valued due to the frequency with which they pay full-fare rates. The airlines view business travelers as a potential for great profit and their actions are in line with these philosophies.

Theoretical model simulations for variations in thermal reaction norms

Thermal reaction norms for growth rates of six Emiliania huxleyi isolates originating from the central Atlantic (Azores, Portugal) and five isolates from the coastal North Atlantic (Bergen, Norway) were assessed. We used the template mode of variation model to decompose variations in growth rates into modes of biological interest: vertical shift, horizontal shift, and generalist-specialist variation. In line with the actual habitat conditions, isolates from Bergen (Bergen population) grew well at lower temperatures, and isolates from the Azores (Azores population) performed better at higher temperatures. The optimum growth temperature of the Azores population was significantly higher than that of the Bergen population. Neutral genetic differentiation was found between populations by microsatellite analysis. These findings indicate that E. huxleyi populations are adapted to local temperature regimes. Next to between-population variation, we also found variation within populations. Genotype-by-environment interactions resulted in the most pronounced phenotypic differences when isolates were exposed to temperatures outside the range they naturally encounter. Variation in thermal reaction norms between and within populations emphasizes the importance of using more than one isolate when studying the consequences of global change on marine phytoplankton. Phenotypic plasticity and standing genetic variation will be important in determining the potential of natural E. huxleyi populations to cope with global climate change.

The main criteria of biomass selection for energy generation in Brazil

The principal aim of this paper is to examine the criteria assisting in the selection of biomass for energy generation in Brazil. To reach the aim, this paper adopts case study and survey research methods to collect information from four biomass energy case companies and solicits opinions from experts. The data gathered are analysed in line with a wide range of related data, including selection criteria for biomass and its importance, energy policies in Brazil, availability of biomass feedstock in Brazil and its characteristics, as well as status quo of biomass-based energy in Brazil. The findings of the paper demonstrate that there are ten main criteria in biomass selection for energy generation in Brazil. They comprise geographical conditions, availability of biomass feedstock, demand satisfaction, feedstock costs and oil prices, energy content of biomass feedstock, business and economic growth, CO2 emissions of biomass end-products, effects on soil, water and biodiversity, job creation and local community support, as well as conversion technologies. Furthermore, the research also found that these main criteria cannot be grouped on the basis of sustainability criteria, nor ranked by their importance as there is correlation between each criterion such as a cause and effect relationship, as well as some overlapping areas. Consequently, this means that when selecting biomass more comprehensive consideration is advisable.

Guiding stakeholders to participate in Marine Strategy Framework implementation

Large marine areas and regional seas present a challenge in terms of management. They are often bordered by numerous maritime jurisdictions; with multi-use and multi-sector environments; involving varying governance arrangements; and generation of sufficient levels of data to best inform decision-makers. Marine management at the regional scale involves a range of mechanisms and approaches to ensure all relevant stakeholders have an opportunity to engage in the process; and these approaches can differ in their legal and regulatory conditions. At present, no such comparable structures exist at the transnational level for the ecosystem-based management of the Celtic Sea. Against this backdrop, a participative process, involving representatives from differing sectors of activity in the Celtic Sea spanning four Member States, was established for the purpose of identifying realistic and meaningful management principles in line with the goals of the Marine Strategy Framework Directive.

Nvidia, matrox, paper? - Undergraduate game design tools in the humanities and social sciences

Eschewing costly high-tech approaches, this paper looks at the experience of using low-tech approaches to game design assignments as problem based learning and assessment tool over a number of years in undergraduate teaching. General game design concepts are discussed, along with learning outcomes and assessment rubrics in line with Blooms Taxonomy based on evidence from students who had no prior experience of serious game play or design. Approaches to creating game design based assessments are offered.