Complementary Medicine in Nursing Homes - Results of a Mixed Methods Pilot Study

Background ‘Kneipp Therapy’ (KT) is a form of Complementary and Alternative Medicine (CAM) that includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities, and healthy eating. Since 2007, some nursing homes for older adults in Germany began to integrate CAM in the form of KT in care. The study investigated how KT is used in daily routine care and explored the health status of residents and caregivers involved in KT. Methods We performed a cross-sectional pilot study with a mixed methods approach that collected both quantitative and qualitative data in four German nursing homes in 2011. Assessments in the quantitative component included the Quality of Life in Dementia (QUALIDEM), the Short Form 12 Health Survey (SF-12), the Barthel-Index for residents and the Work Ability Index (WAI) and SF-12 for caregivers. The qualitative component addressed the residents’ and caregivers’ subjectively experienced changes after integration of KT. It was conceptualized as an ethnographic rapid appraisal by conducting participant observation and semi-structured interviews in two of the four nursing homes. Results The quantitative component included 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (all female, 42.0 ± 11.7 years). Residents were multimorbid (8 ± 3 diagnoses), and activities of daily living were restricted (Barthel-Index 60.6 ± 24.4). The caregivers’ results indicated good work ability (WAI 37.4 ± 5.1), health related quality of life was superior to the German sample (SF-12 physical CSS 49.2 ± 8.0; mental CSS 54.1 ± 6.6). Among both caregivers and residents, 89% considered KT to be positive for well-being. The qualitative analysis showed that caregivers perceived emotional and functional benefits from more content and calmer residents, a larger variety in basic care practices, and a more self-determined scope of action. Residents reported gains in attention and caring, and recognition of their lay knowledge. Conclusion Residents showed typical characteristics of nursing home inhabitants. Caregivers demonstrated good work ability. Both reported to have benefits from KT. The results provide a good basis for future projects, e.g. controlled studies to evaluate the effects of CAM in nursing homes.

Computer-based summative assessment of clinical reasoning in clerkships: A mixed-method comparison of key feature problems with case-based multiple choice questions

Background: It is yet unclear if there are differences between using electronic key feature problems (KFPs) or electronic case-based multiple choice questions (cbMCQ) for the assessment of clinical decision making. Summary of Work: Fifth year medical students were exposed to clerkships which ended with a summative exam. Assessment of knowledge per exam was done by 6-9 KFPs, 9-20 cbMCQ and 9-28 MC questions. Each KFP consisted of a case vignette and three key features (KF) using “long menu” as question format. We sought students’ perceptions of the KFPs and cbMCQs in focus groups (n of students=39). Furthermore statistical data of 11 exams (n of students=377) concerning the KFPs and (cb)MCQs were compared. Summary of Results: The analysis of the focus groups resulted in four themes reflecting students’ perceptions of KFPs and their comparison with (cb)MCQ: KFPs were perceived as (i) more realistic, (ii) more difficult, (iii) more motivating for the intense study of clinical reasoning than (cb)MCQ and (iv) showed an overall good acceptance when some preconditions are taken into account. The statistical analysis revealed that there was no difference in difficulty; however KFP showed a higher discrimination and reliability (G-coefficient) even when corrected for testing times. Correlation of the different exam parts was intermediate. Conclusions: Students perceived the KFPs as more motivating for the study of clinical reasoning. Statistically KFPs showed a higher discrimination and higher reliability than cbMCQs. Take-home messages: Including KFPs with long menu questions into summative clerkship exams seems to offer positive educational effects.

Promoting mixed stands through conversion treatments. Effect of holm oak coppices thinning on black pine regeneration

The effects of conversion treatments, depending on ecological factors and silvicultural parameters (thinning intensity, thinning type and rotation, among others) have been studied during the last fifteen years in an experimental trial in Central Spain. The general climate is continental Mediterranean; soils are low depth and limy; vegetation is an homogeneous dense coppices of Quercus ilex with isolated Pinus nigra trees. The experimental design (three locations) includes different thinning intensities (from 0 to 100% of extracted basal area). Inventories have been carried out in 1994 and 2010; thinning treatments were done in 1995 and 2011. Analysis of the effects of the conversion treatment show the increment of diameter and height growth rates, the canopy recovery and the stand resprouting, finding differences in these effects between thinning treatments. Besides the induced changes at holm oak stand, the application of conversion treatment clearly changed the woodland dynamics. Fifteen years after the thinnings, floristic composition varied and an abundant pine regeneration was installed in the woodland. In this work we describe the changes between inventories in tree species composition and diameter distribution, specially in the case of black pine. The conversion treatment caused changes in forest dynamics in the short term, increasing biodiversity and diversifying the forest structure. The fast installation of Pinus regeneration suggests the potential of the zone for the establishment of multipurpose mixed Quercus-Pinus stands in wide areas where Quercus species were favoured by human populations for firewood production. Conversion treatment of coppices, with the creation of mixed stands, constitutes a good management alternative for extensive areas and an interesting technique to adaptation to global change.

Limiting properties in the characterisation of mixed recycled aggregates for use in the manufacture of concrete

El objetivo principal de este trabajo de investigación es estudiar las propiedades del árido reciclado mixto para la fabricación de hormigón reciclado en aplicaciones no estructurales. Se ha realizado la caracterización completa de 35 muestras de áridos reciclados mixtos gruesos de distinta calidad, procedentes de 13 plantas de tratamiento diferentes de la geografía española. Se han estudiado las correlaciones que existen entre las diferentes propiedades, en particular, con la absorción de agua, el contenido de sulfatos y la composición. Se propone una clasificación de los áridos reciclados y se limita de forma indicativa el contenido de yeso para que una muestra de árido reciclado mixto cumpla con la limitación del 0,8% de los sulfatos solubles en ácido de la Instrucción EHE-08. Recycling of construction and demolition waste (CDW) has become a widespread concern in Spain for the last years, as a way to preserve natural resources and achieve a better control of waste disposal sites.Specific applications which make use of mixed recycled aggregates are of great importance, as this types of aggregates constitute the majority of the total production. Structural and non-structural concrete is one of the possible applications, being this the main goal of our study. This paper presents a study on the physical and chemical characteristics of mixed recycled aggregates which have been obtained from different CDW treatment plants of Spain. Correlations between the different properties were investigated in order to find criterions of acceptance for recycled aggregates to be used in concrete. The comparison between the properties offers the possibility of pre-selecting a great quantity of mixed recycled aggregates, these being suitable for either structural and non-structural concrete. The determination of water absorption and the gypsum content are good indicators in order to evaluate the quality of the mixed recycled aggregates for its application in the production of concrete.

Mixed Elements in the Boundary Theory

The development of (static and dynamics)programs with constant and linear elements has shown good behaviour. It seems so natural to combine both advantages so that the results will not be affected by local distortions. This paper will be dedicated to presenting the reserch of mixed elements and the way to solve the over-determination that appears in some cases. Although all the study has been done with the potential theory, its application to elastic problems is straightforward.

Strategies and good practice for sustainable and liveable cities of tomorrow

This contribution deals with the question, what makes cities sustainable and integrative, and suggests an approach for "liveable cities of tomorrow" designed to sustain mobility. The liveable city of tomorrow needs to meet both ecological and social requirements in an integrative approach. To design urban patterns appropriate or “sustainable mobility” based on a concept of mobility defined as the number of accessible destinations (different to that for “fossil mobility” defined as the ability to cover distances) is a key element of such an approach. Considering the limited reserves of fossil fuels and the long lifetime of the built structure, mobility needs to rely on modes independent of fossil fuels (public transport and pedestrians) to make it sustainable and the urban pattern needs to be developed appropriately for these modes. Crucial for the success of public transport is the location of buildings within the catchment area of stops. An attractive urban environment for pedestrians is characterised by short distances in a compact settlement with appropriate/qualified urban density and mixed land use as well as by attractive public space. This, complemented by an integrative urban development on the quarter level including neighbourhood management with a broad spectrum of activity areas (social infrastructure, integration of diverse social and ethnic groups, health promotion, community living, etc.), results in increased liveability. The role of information technology in this context is to support a sustainable use of the built structures by organisational instruments. Sustainable and liveable communities offer many benefits for health, safety and well-being of their inhabitants.

A Multi Ant Colony Optimization algorithm for a Mixed Car Assembly Line

This paper presents an ant colony optimization algorithm to sequence the mixed assembly lines considering the inventory and the replenishment of components. This is a NP-problem that cannot be solved to optimality by exact methods when the size of the problem growth. Groups of specialized ants are implemented to solve the different parts of the problem. This is intended to differentiate each part of the problem. Different types of pheromone structures are created to identify good car sequences, and good routes for the replenishment of components vehicle. The contribution of this paper is the collaborative approach of the ACO for the mixed assembly line and the replenishment of components and the jointly solution of the problem.

Prevention of development of autoimmune disease in BXSB mice by mixed bone marrow transplantation

Transplantations of fully allogeneic, autoimmune-resistant T-cell-depleted marrow (TCDM) plus syngeneic, autoimmune-prone TCDM into lethally irradiated BXSB mice were carried out to investigate the ability of the mixed bone marrow transplantation (BMT) to prevent development of autoimmune disease and, at the same time, to reconstitute fully the immunity functions of heavily irradiated BXSB recipients. Male BXSB mice were engrafted with mixed TCDM from both allogeneic, autoimmune-resistant BALB/c mice and syngeneic, autoimmune-prone BXSB mice. BMT with mixed TCDM from both resistant and susceptible strains of mice (mixed BMT) prolonged the median life span and inhibited development of glomerulonephritis in BXSB mice. BMT with mixed TCDM also prevented the formation of anti-DNA antibodies that is typically observed in male mice of this strain. Moreover, mixed BMT reconstituted primary antibody production in BXSB recipients, so that no annoying immunodeficiencies that are regularly observed in fully allogeneic chimeras were present in the recipient of the mixed TCDM. These findings indicate that transplanting allogeneic, autoimmune-resistant TCDM plus syngeneic, autoimmune-prone TCDM into lethally irradiated BXSB mice prevents development of autoimmune disease in this strain of mice. In addition, this dual BMT reconstitutes the immunity functions and avoids the immunodeficiencies that occur regularly in fully allogeneic chimeras after total-body irradiation.

The incorporation of construction and demolition wastes as recycled mixed aggregates in non-structural concrete precast pieces

Concern for the environment has lately heightened awareness about the need for recycling in the construction industry. However, some standards, such as the Spanish standard, only accept the recycling of aggregates derived from concrete, which limits the extensive use of construction and demolition waste, which are produced in much bigger volumes. The aim of this work was to explore the possibility of using recycled mixed aggregates (RMA) in the preparation of precast non-structural concretes. To that end different percentages of natural aggregate were replaced by RMA in non-structural elements (25, 50, 75 and 100%). Contents of cement, water, and the dosages commonly used by companies were unchanged by the introduction of RMA. The characterization of the prepared elements has been done using the specific tests for each type of non-structural element (terrazzo for indoor use, hollow tiles, kerbstones and paving blocks): compression and flexural strength, water absorption, dimensional tolerances, abrasion and slipping resistance. The paving blocks, kerbstones, and hollow tiles prepared were tested for 360 days. The stability of the tested properties confirmed the possibility of using these wastes on an industrial scale satisfying the standard requirements. However, the surface of terrazzo with RMA is not as good as that prepared with natural aggregate.

Long-term in vivo biostability of poly(dimethylsiloxane) / poly(hexamethylene oxide) mixed macrodiol-based polyurethane elastomers

The long-term biostability of a novel thermoplastic polyurethane elastomer (Elast-Eon(TM) 2 80A) synthesized using poly(hexamethylene oxide) (PHMO) and poly(dimethylsiloxane) (PDMS) macrodiols has been studied using an in vivo ovine model. The material's biostability was compared with that of three commercially available control materials, Pellethane(R) 2363-80A, Pellethane(R) 2363-55D and Bionate(R) 55D, after subcutaneous implantation of strained compression moulded flat sheet dumbbells in sheep for periods ranging from 3 to 24 months. Scanning electron microscopy, attenuated total reflectance-Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy were used to assess changes in the surface chemical structure and morphology of the materials. Gel permeation chromatography, differential scanning calorimetry and tensile testing were used to examine changes in bulk characteristics of the materials. The results showed that the biostability of the soft flexible PDMS-based test polyurethane was significantly better than the control material of similar softness, Pellethane(R) 80A, and as good as or better than both of the harder commercially available negative control polyurethanes. Pellethane(R) 55D and Bionate(R) 55D. Changes observed in the surface of the Pellethane(R) materials were consistent with oxidation of the aliphatic polyether soft segment and hydrolysis of the urethane bonds joining hard to soft segment with degradation in Pellethane(R) 80A significantly more severe than that observed in Pellethane(R) 55D. Very minor changes were seen on the surfaces of the Elast-Eon(TM) 2 80A and Bionate(R) 55D materials. There was a general trend of molecular weight decreasing with time across all polymers and the molecular weights of all materials decreased at a similar relative rate. The polydispersity ratio, M-w/M-n, increased with time for all materials. Tensile tests indicated that UTS increased in Elast-Eon(TM) 2 80A and Bionate(R) 55D following implantation under strained conditions. However, ultimate strain decreased and elastic modulus increased in the explanted specimens of all three materials when compared with their unimplanted unstrained counterparts. The results indicate that a soft, flexible PDMS-based polyurethane synthesized using 20% PHMO and 80% PDMS macrodiols has excellent long-term biostability compared with commercially available polyurethanes. (C) 2004 Elsevier Ltd. All rights reserved.

'Nothing good ever came out of Japan': Race-mixing and the limits of diaspora

This paper argues that postcolonial notions of diaspora are premised on immigrant subjectivities and standpoints which do not fully apprehend the mixed-race / bi-racial experience and the local effect of cultural hybridity in Western settings. The paper was prompted by a recent conversation with Dee, the daughter of a Japanese warbride. As a child Dee recalled being told by her friend's mother that 'nothing good ever came out of Japan'. The significance of constant interpolations into 'Asianness' by statements such as these; by the 'where do you come from?' question and by more blatant discriminations are inadequately addressed by traditional and postcolonial notions of diaspora. 'Roots' and 'routes' imagery feature prominently in discussions of diaspora and hybridity which aim to decolonise culture and identity in deconstructive moves that highlight their flexible, multiple, contractedness. While it has been argued that even these conceptualisations are problematic because they privilege orders of explanation, theory and standpoint that are forced back into line with traditional notions of discrete 'races', cultures, ethnicities and identities, cultural studies and postcolonial theorists do not appear to find this contradiction overly troubling. Lodged in bodies that do not easily conflate to neat either/or cultures, politics and genetics, race-mixing also defies and yet return us to culture and biology. However, I argue that their refractions though the same tired old orders of racial, ethnic, cultural and national differentiation prevent us from disregarding the discursive effects of racism and racialisation.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

Crack propagation in non-homogenous materials: Evaluation of mixed-mode SIFs, T-stress and kinking angle using a variant EFG method

A new variant of the Element-Free Galerkin (EFG) method, that combines the diffraction method, to characterize the crack tip solution, and the Heaviside enrichment function for representing discontinuity due to a crack, has been used to model crack propagation through non-homogenous materials. In the case of interface crack propagation, the kink angle is predicted by applying the maximum tangential principal stress (MTPS) criterion in conjunction with consideration of the energy release rate (ERR). The MTPS criterion is applied to the crack tip stress field described by both the stress intensity factor (SIF) and the T-stress, which are extracted using the interaction integral method. The proposed EFG method has been developed and applied for 2D case studies involving a crack in an orthotropic material, crack along an interface and a crack terminating at a bi-material interface, under mechanical or thermal loading; this is done to demonstrate the advantages and efficiency of the proposed methodology. The computed SIFs, T-stress and the predicted interface crack kink angles are compared with existing results in the literature and are found to be in good agreement. An example of crack growth through a particle-reinforced composite materials, which may involve crack meandering around the particle, is reported.

Power relations and good governance: a social network analysis of the evolution of the integrity in public office act in the Commonwealth of Dominica

La Banque mondiale propose la bonne gouvernance comme la stratégie visant à corriger les maux de la mauvaise gouvernance et de faciliter le développement dans les pays en développement (Carayannis, Pirzadeh, Popescu & 2012; & Hilyard Wilks 1998; Leftwich 1993; Banque mondiale, 1989). Dans cette perspective, la réforme institutionnelle et une arène de la politique publique plus inclusive sont deux stratégies critiques qui visent à établir la bonne gouvernance, selon la Banque et d’autres institutions de Bretton Woods. Le problème, c’est que beaucoup de ces pays en voie de développement ne possèdent pas l’architecture institutionnelle préalable à ces nouvelles mesures. Cette thèse étudie et explique comment un état en voie de développement, le Commonwealth de la Dominique, s’est lancé dans un projet de loi visant l’intégrité dans la fonction publique. Cette loi, la Loi sur l’intégrité dans la fonction publique (IPO) a été adoptée en 2003 et mis en œuvre en 2008. Cette thèse analyse les relations de pouvoir entre les acteurs dominants autour de évolution de la loi et donc, elle emploie une combinaison de technique de l’analyse des réseaux sociaux et de la recherche qualitative pour répondre à la question principale: Pourquoi l’État a-t-il développé et mis en œuvre la conception actuelle de la IPO (2003)? Cette question est d’autant plus significative quand nous considérons que contrairement à la recherche existante sur le sujet, l’IPO dominiquaise diverge considérablement dans la structure du l’IPO type idéal. Nous affirmons que les acteurs "rationnels," conscients de leur position structurelle dans un réseau d’acteurs, ont utilisé leurs ressources de pouvoir pour façonner l’institution afin qu’elle serve leurs intérêts et ceux et leurs alliés. De plus, nous émettons l’hypothèse que: d’abord, le choix d’une agence spécialisée contre la corruption et la conception ultérieure de cette institution reflètent les préférences des acteurs dominants qui ont participé à la création de ladite institution et la seconde, notre hypothèse rivale, les caractéristiques des modèles alternatifs d’institutions de l’intégrité publique sont celles des acteurs non dominants. Nos résultats sont mitigés. Le jeu de pouvoir a été limité à un petit groupe d’acteurs dominants qui ont cherché à utiliser la création de la loi pour assurer leur légitimité et la survie politique. Sans surprise, aucun acteur n’a avancé un modèle alternatif. Nous avons conclu donc que la loi est la conséquence d’un jeu de pouvoir partisan. Cette recherche répond à la pénurie de recherche sur la conception des institutions de l’intégrité publique, qui semblent privilégier en grande partie un biais organisationnel et structurel. De plus, en étudiant le sujet du point de vue des relations de pouvoir (le pouvoir, lui-même, vu sous l’angle actanciel et structurel), la thèse apporte de la rigueur conceptuelle, méthodologique, et analytique au discours sur la création de ces institutions par l’étude de leur genèse des perspectives tant actancielles que structurelles. En outre, les résultats renforcent notre capacité de prédire quand et avec quelle intensité un acteur déploierait ses ressources de pouvoir.

Do GPs Make Good Research Participants?

Background Childhood cancers cause the largest numbers of deaths by disease in children aged 0-14 years1 with more than 400 children a year dying from cancer in the UK.2 Parental preference for their child to die within the family home2 coupled with the speciality of children’s palliative care medicine being still in its infancy, highlights the importance of the GP’s role in this highly specialised area of clinical practice. An understanding of the GP’s role will help inform the development of this specialty and identify best collaborative practice. A NIHR/CAT CL funded study examined the role of the GP in paediatric oncology palliative and bereavement care from the perspective of both the GP and the bereaved parent. This presentation will detail how GPs were approached and recruited, the reasons GPs declined participation and factors influencing the actual data collection. Methods The mixed method study used both qualitative and quantitative data collection methods. Phase 1: Semi-structured interviews to explore the experiences of GPs and parents. Phase 2: Q methodology with GPs who had a child with cancer on their caseload. Q methodology is a research tool that uses statistical analysis to cluster participants’ experiences according to similarity of their viewpoint Results The method and effectiveness of recruiting GPs for both phases of the study will be presented. In addition factors influencing collecting such emotive and sensitive data will be discussed. Conclusions Researcher flexibility and perseverance in participant recruitment was rewarded by the rich data collected. Findings from this study have identified four different GP role viewpoints and have provided a new dimension in understanding GP viewpoints on their role in this arena.