Home hemodialysis : a successful option for obese and bariatric people with end-stage kidney disease

The increasing prevalence of obesity in developed countries is reflected in the chronic kidney disease, dialysis, and transplant populations. The added risk factor of obesity increases the risk of vascular events, inflammation, insulin resistance, blood pressure, dyslipidemia, and mortality risk. Nephrology center policies may exclude obese people from transplantation programs resulting in many years of dialysis. The case of a 215-kg Australian male who has successfully dialyzed at home for more than 8 years will be used to illustrate the important considerations and clinical support that these people require for successful home dialysis treatment. The aim of this paper is to report on a program that has successfully trained 23 obese (body mass index >30) people who commenced on home hemodialysis between 2001 and 2009. Body weight ranged between 94.0 and 215 kg (mean 126, SD 26.19) and body mass index ranged between 34.9 and 71 (mean 43.38, SD 9.99) at the start of home training. During the 8.5 years of follow-up, average time on home dialysis was 43.7 months. Home hemodialysis is a feasible treatment for obese people to facilitate longer and more frequent dialysis, resulting in improved hemodynamic stability and improved quality of life. For obese people with end-stage kidney disease, home hemodialysis has shown to be cost-effective and can result in greater treatment efficacy than in-center hospital dialysis.

Talking books for children's home use in a minority Indigenous Australian language context

Members of the Kunibidji community are the traditional owners of the lands and seas around Maningrida, a remote community in Northern Australia. Most of the 200 members of the Kunibidji Community speak Ndjebbana as their first language. This study reports on the complexities of transforming technology to provide Kunibídji children with access to digital texts at home. The printed Ndjebbana texts that were kept at school were transformed to Ndjebbana talking books displayed on touch screen computers in the children's homes. Some results of the children's interaction around these touch screens are presented as well as some quantitative results of the computer viewing in the homes. The processes of rejecting technological determinism, upholding linguistic human rights of speakers of minority languages and viewing technology as practice rather than a set of artefacts are discussed in this paper. The results of this study highlight the need for speakers of minority Indigenous Australian languages to have access to texts in their threatened languages on technologies at home.

Nursing home administrators’ perspectives on a study feedback report : a cross sectional survey

Background
This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey.
Methods
A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings.
Results
Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information.
Conclusions
Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.

Robotics to enable older adults to remain living at home

Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1) what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2) what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.

Everyone’s life is so different : the experiences of young Australian adults who return home

The article focuses on the experiences of young Australian adults who return to their parent's homes. It cites several factors that lead young people to return home such as unemployment, divorce and parenthood. It uses qualitative interviews of 22- to 30-year-olds as basis of young adults' experiences. It argues that the decision of returning home is not a failure, but a positive choice in living arrangement.

Undergraduate electronics students' use of home experiment kits for distance education

Laboratory practicals form an essential component in any electronics or electrical engineering course. Many students choose to study engineering by means of distance education. Providing such students with effective and manageable practical experience has always been a significant challenge for those involved in providing distance education. Our university has employed an experimental electronics kit for teaching laboratory skills to distance-education students over the past several years. The chief limitation of the early kit was the inability to use it for performing AC experiments without an additional AC signal generator and an oscilloscope. We now supply distance-education students with the original components pack, and an additional “HELP” kit which contains the signal generator, PC-oscilloscope, a basic multimeter, logic probe, software and documentation. The combined kits allow these students to perform basic DC and AC electronics experiments at home in both freshman and sophomore electronics courses. A more recent development is introducing a small robot platform intended to enhance the student experience and interest in electronics and mechatronics, while still covering the basic skills necessary for the engineer-in-training. Distance-education students receive an updated experimental kit containing the robot, other equipment and components to allow them to complete a fuller suite of practical exercises in electronics in their first two years of study. Within this paper, we present these developments in our HELP kit and also make comparisons between on-campus and off-campus performance.

Assessing the impact of diabetes on the quality of life of older adults living in a care home : validation of the ADDQoL senior

Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior†.

Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.