Stanley, Mandy; Richard, Ashley; Williams, Shoshannah
Large amounts of time spent alone by older people have been associated with loneliness and poor mental and physical health. There is a paucity of research, however, that examines time alone from an occupational perspective. In this exploratory study we explored the perspectives of older people on their time spent alone. A qualitative descriptive study design was selected. With the aim of maximising variation, five participants were recruited from retirement villages and seven participants who lived independently in the community. Participants recorded time spent alone in a time diary for three days as priming for a semi-structured in-depth interview. Transcripts were analysed thematically. Three key themes were identified: 'it is a matter of getting some balance'; 'keeping busy'; and 'the nights are the worst'. The study highlights the importance older people place on the need to manage time alone so that it is a positive and nourishing experience and to avoid experiencing extended periods of boredom potentially leading to loneliness. Older people utilise occupations to keep busy and achieve an individually acceptable level of time alone. Enabling older people to balance time spent alone by addressing barriers to participation in the community in addition to finding engaging occupations to occupy time has the potential to prevent boredom, loneliness and improve wellbeing. © 2016 Occupational Therapy Australia.
Full Text Available Ismael Conejero,1,2 Emilie Olié,1–3 Philippe Courtet,1–3 Raffaella Calati1–3 1Institut National de la Santé Et de la Recherche Médicale (INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; 2Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU Montpellier, Montpellier, France; 3FondaMental Foundation, Créteil, France Abstract: Suicidal behavior in older adults (65 years old and over is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts. Keywords: suicide, attempted suicide, older adults, risk
As an older woman therapist, I find that my life experience grounds me in my work with people of all ages and backgrounds as they deal with life crises, aging issues, and loss. People with whom I work in therapy appreciate the fact that I am older and have had varied life experiences. Gender issues are still central to my work with clients whether I am working with a man or a woman. I am an integrative therapist, with a background in cognitive-behavioral therapy and gestalt therapy. Therapists need to help clients to identify less with their aging bodies and our culture's view of attractiveness, shifting instead to a paradigm that values life experience and the cultivation of wisdom. We need to find ways of embracing what we have learned about life instead of extolling youthful values. As I get older, I more fully appreciate a constructivism framework and life-cycle perspective, focusing on making sense of clients' life narratives. Storytelling and memoirs have both provided a framework for working with clients on coping with the many changes and challenges of life that bring them to therapy and added another layer to my integrative therapeutic work. © 2015 Wiley Periodicals, Inc.
Societal myths argue against active expression of sexuality in older adults, but these prejudices are unfounded. Using a deconstructionist framework, this article addresses issues surrounding sexuality in older adults. Implications for clinical practice are given.
Poortman, A.R.; van Tilburg, T.G.
In this study we apply a lifecourse perspective to an examination of older adults' attitudes about gender roles and moral issues. The study goes beyond previous research in that it examines the relationships between older adults' attitudes and: (a) experiences in the parental home, (b) people's own
Wong, Ides Y; Smith, Simon S; Sullivan, Karen A; Allan, Alicia C
Self-regulation refers to the practice of using self-imposed restrictions to protect oneself from situations that are, or are perceived to be, unsafe. Within the driving context, self-regulation refers the compensatory practices that some older adults adopt to restrict their driving to situations in which they feel safe. However, the way in which demographic, functional, and psychosocial factors, and the interactions between these factors, influence older adults' driving self-regulation is not well understood. Improving this understanding could lead to new ways of considering the mobility concerns faced by older drivers. A systematic review of the current literature was conducted to explore this issue. Twenty-nine empirical studies investigating the factors associated with older adults' self-regulatory driving behaviors were examined. The review findings were used to construct the Multilevel Older Persons Transportation and Road Safety (MOTRS) model. The MOTRS model proposes that individual and environmental factors such as age, gender, and the availability of alternative transportation predict older adults' practice of driving-related self-regulation. However, these variables influence self-regulation through psychosocial variables such as driving confidence, affective attitude, and instrumental attitude toward driving. The MOTRS model extends previous attempts to model older adults' driving by focusing on a novel target, driving self-regulation, and by including a wider range of predictors identified on the basis of the systematic literature review. This focus enables consideration of broader mobility issues and may inform new strategies to support the mobility of older adults. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Hawley-Hague, Helen; Horne, Maria; Skelton, Dawn A; Todd, Chris
Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors' experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults' uptake and adherence to exercise classes. Analysis revealed 'barriers' to uptake related to identity, choice/control, cost, and venue, and 'solutions' included providing choice/control, relating exercise to identity, a personal touch, and social support. Barriers to adherence included unrealistic expectations and social influences, and solutions identified were encouraging commitment, creating social cohesion, and an emphasis on achieving outcomes. Older adults' attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults' uptake and adherence to classes. Instructors' perspectives help us to further understand how we can design successful exercise classes.
Drewes, Yvonne M; Koenen, Julia M; de Ruijter, Wouter; van Dijk-van Dijk, D J Annemarie; van der Weele, Gerda M; Middelkoop, Barend J C; Reis, Ria; Assendelft, Willem J J; Gussekloo, Jacobijn
Preventive care traditionally aims to prevent diseases or injuries. For older people, different aims of prevention, such as maintenance of independence and wellbeing, are increasingly important. To explore GPs' perspectives on preventive care for older people. Qualitative study comprising six focus groups with GPs in the Netherlands. The focus-group discussions with 37 GPs were analysed using the framework analysis method. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request; when the vitality levels in older people fall, the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these perspectives, a conceptual model for preventive care was developed, which describes GPs' different perspectives toward older people who are vulnerable and those with high levels of vitality. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline). GPs' perspectives on preventive care are determined by their perception of the level of vitality of their older patients. Preventive care for older people with high levels of vitality may consist of a standardised disease-oriented approach; those who are vulnerable will need an individualised approach to prevent functional decline.
Vass, M; Hendriksen, C
and to consider different approaches when evaluating evidence of risk and benefit for the individual. Old people are facing a considerable risk of adverse drug reactions and recent initiatives, including the Continuous Medical Educational Efforts Programme, address issues of inappropriate prescribing practices...... is recommended at every encounter, and time consuming comprehensive follow-up will be demanded, 'polypharmacy consultations' surely will be built into GP contracts in the future. The authors state that a number of pharmacological regimens for older people are outperformed by non-pharmacological treatment...
Šaňáková, Šárka; Čáp, Juraj
Dignity is one of the most important values sensitively perceived by patients in nursing care. Older patients have been identified as having a high risk of losing their dignity in institutional care. To promote optimum nursing care, a deeper insight into the problem of older patients' dignity is needed. The aim was to identify, analyse and synthesise the qualitative evidence of dignity views and factors affecting it from the nurses' and older patients' perspective in the context of nursing care and to compare synthesised finding from the both perspective. A literature review of qualitative evidence was chosen as a study design. The ENTREQ statement was implemented to enhance transparency. The CASP - Qualitative checklist and the thematic synthesis for synthesised findings were used. The electronic databases Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE and PROQUEST were used to gather information for qualitative studies. A total of 306 papers were retrieved. Fourteen qualitative studies met the inclusion criteria and were included in the review after methodological quality assessment using CASP. Four main themes of dignity from nurses' perspective were synthesised: seeing the patient as a unique person, communication and privacy, involving the patient, and working culture and environment. From the patients' perspective, six main themes were synthesised: autonomy and control, privacy, relationships, care and comfort, communication and identity. The comparison shows that the key difference is that older patients highlighted the theme relationships and nurses underlined the theme working culture and environment. The model structures of the older patients' dignity from both the nurses' and patients' perspectives support the idea of a multidimensional structure of human dignity. The resulting model might be used in a nursing self-reflection, in the management of the institutions providing all-day care for the older people and in the
Full Text Available Dejana Braithwaite,1 Joshua Demb,1 Louise M Henderson2 1Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 2Department of Radiology, University of North Carolina, Chapel Hill, NC, USA Abstract: Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models. Keywords: aging, breast cancer, precision cancer screening
Exploring access to care among older people in the last phase of life using the behavioural model of health services use: a qualitative study from the perspective of the next of kin of older persons who had died in a nursing home.
Condelius, Anna; Andersson, Magdalena
There is little investigation into what care older people access during the last phase of their life and what factors enable access to care in this group. Illuminating this from the perspective of the next of kin may provide valuable insights into how the health and social care system operates with reference to providing care for this vulnerable group. The behavioural model of health services use has a wide field of application but has not been tested conceptually regarding access to care from the perspective of the next of kin. The aim of this study was to explore the care accessed by older people during the last phase of their life from the perspective of the next of kin and to conceptually test the behavioural model of health services use. The data collection took place in 2011 by means of qualitative interviews with 14 next of kin of older people who had died in a nursing home. The interviews were analysed using directed content analysis. The behavioural model of health services use was used in deriving the initial coding scheme, including the categories: utilization of health services, consumer satisfaction and characteristics of the population at risk. Utilization of health services in the last phase of life was described in five subcategories named after the type of care accessed i.e. admission to a nursing home, primary healthcare, hospital care, dental care and informal care. The needs were illuminated in the subcategories: general deterioration, medical conditions and acute illness and deterioration when death approaches. Factors that enabled access to care were described in three subcategories: the organisation of care, next of kin and the older person. These factors could also constitute barriers to accessing care. Next of kin's satisfaction with care was illuminated in the subcategories: satisfaction, dissatisfaction and factors influencing satisfaction. One new category was constructed inductively: the situation of the next of kin. A bed in a nursing
Pinter, Jule; Hanson, Camilla S; Chapman, Jeremy R; Wong, Germaine; Craig, Jonathan C; Schell, Jane O; Tong, Allison
Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs. Face-to-face semistructured interviews were conducted with 30 kidney transplant recipients aged 65-80 years from five renal units in Australia. Transcripts were analyzed thematically. Six themes were identified: restoring vitality of youth (with subthemes of revived mindset for resilience, embracing enjoyment in life, drive for self-actualization); persisting through prolonged recovery (yielding to aging, accepting functional limitations, pushing the limit, enduring treatment responsibilities); imposing sicknesses (combatting devastating comorbidities, painful restrictions, emerging disillusionment, anxieties about accumulating side effects, consuming treatment burden); prioritizing graft survival (privileged with a miracle, negotiating risks for longevity, enacting a moral duty, preserving the last opportunity); confronting health deterioration (vulnerability and helplessness, narrowing focus to immediate concerns, uncertainty of survival); and value of existence (purpose through autonomy, refusing the burden of futile treatment, staying alive by all means). Older kidney transplant recipients felt able to enjoy life and strived to live at their newly re-established potential and capability, which motivated them to protect their graft. However, some felt constrained by slow recuperation and overwhelmed by unexpected comorbidities, medication-related side effects, and health decline. Our findings suggest the need to prepare and support older recipients for self
Tarn, Derjung M; Paterniti, Debora A; Wenger, Neil S; Williams, Bradley R; Chewning, Betty A
To investigate older patient, physician and pharmacist perspectives about the role of pharmacists in pharmacist-patient interactions. Eight focus-group discussions were held in senior centres, community pharmacies and primary care physician offices. Participants were 42 patients aged 63 years and older, 17 primary care physicians and 13 community pharmacists. Qualitative analysis of the focus-group discussions was performed. Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists' ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impeded patient counselling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counselling, including lack of knowledge about medication indications and physician treatment plans. Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.
Full Text Available Time perspective is crucial for our present and future plans, and for the way we act in the present. The aim of this study was to investigate the relationship between time perspective and subjective well-being in older adults. The sample of our questionnaire study consisted of 149 older adults aged between 65 and 96 years. Time perspective was measured with the Zimbardo Time Perspective Inventory. The five time perspective dimensions were related to four specific aspects of subjective well-being (positive affect, negative affect, life satisfaction and depression. Future-oriented older persons had a more positive affect. Older adults who were positively oriented towards the past appeared to be more satisfied with life. A hedonistic view of the present was related to a high positive affect. Older persons with a Past-Negative perspective were more likely to experience negative affect and depressive feelings, along with a lower level of positive affect and satisfaction with life. The Present-Fatalistic time perspective correlated with more depressive symptoms. The findings emphasize the relevance of time perspective styles for the subjective well-being, which has specific implications for the way caregivers could interact with older adults to enhance quality of life.
Mittinty, Manasi Murthy; Marshall, Amy; Harvey, Gillian
According to the 2013 WHO Global Forum on Innovation for Ageing Populations, disabilities and morbidities associated with ageing could be minimised by accessing preventive care. One way of improving the management of multimorbidity in the older population is through the provision of 'integrated care'. Although integrated care means different things to different people, it typically symbolises continuity in care, thus preventing older patients' from falling through gaps in the health care system. Many initiatives have attempted to improve the integration of care; however, these are typically designed from a particular policy or system perspective. Relatively little is known about patient expectations and experiences of integrated care, which is vital for developing and implementing better models of care. The proposed scoping review aims to map literature on older patients'' views, expectations, experiences and perspectives of integrated care. Multiple electronic databases including PubMed, Web of Science, Embase, PsychInfo, Google Scholar, Cochrane Library, CINAHL and ProQuest Dissertations will be searched for appropriate articles between August and December 2017. Reference lists of selected articles will also be searched for similar articles. Two experienced researchers will conduct an initial search of the literature to identify relevant articles. Abstracts of the identified articles will be reviewed collectively by two researchers to identify potential further studies. Full texts of the potential studies will be sourced and screened for the inclusion criteria. Appropriate qualitative and quantitative methods will be used to extract data from each included study. The scoping review will synthesise findings from studies reporting on patients' views and expectations of integrated care. This review expects to find information relating to facilitators and barriers of integrated care from an older person's perspective. The findings from the review will be applied when
Huh, Jina; Le, Thai; Reeder, Blaine; Thompson, Hilaire J.; Demiris, George
Purpose Our purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use. Methods We conducted three focus groups with health care providers (n=10) and four focus groups with community-dwelling older adults (n=31). Results Older adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes towards wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools. Conclusions Our paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness. PMID:24041452
Buchacz, Kate; Gebo, Kelly A.; Mermin, Jonathan
HIV disease is often perceived as a condition affecting young adults. However, approximately 11% of new infections occur in adults aged 50 years or older. Among persons living with HIV disease, it is estimated that more than half will be aged 50 years or older in the near future. In this review, we highlight issues related to HIV prevention and treatment for HIV-uninfected and HIV-infected older Americans, and outline unique considerations and emerging challenges for public health and patient management in these 2 populations. PMID:22698038
Ferrari, Lea; Nota, Laura; Soresi, Salvatore
Career choices involve an orientation towards the future and the propensity to planning. The "mental picture" of the past, present and future was defined by Savickas as time perspective. The present paper reports the findings of two studies examining time perspective in Italian adolescents. The first study surveyed 498 students aged…
Banerjee, S. [Univ. of California, Santa Barbara, CA (United States)
Multifield models for prediction of nuclear reactor thermalhydraulics are reviewed from the viewpoint of their structure and requirements for closure relationships. Their strengths and weaknesses are illustrated with examples, indicating that they are effective in predicting separated and distributed flow regimes, but have problems for flows with large oscillations. Needs for multifield models are also discussed in the context of reactor operations and accident simulations. The highest priorities for future developments appear to relate to closure relationships for three-dimensional multifield models with emphasis on those needed for calculations of phase separation and entrainment/de-entrainment in complex geometries.
Multifield models for prediction of nuclear reactor thermalhydraulics are reviewed from the viewpoint of their structure and requirements for closure relationships. Their strengths and weaknesses are illustrated with examples, indicating that they are effective in predicting separated and distributed flow regimes, but have problems for flows with large oscillations. Needs for multifield models are also discussed in the context of reactor operations and accident simulations. The highest priorities for future developments appear to relate to closure relationships for three-dimensional multifield models with emphasis on those needed for calculations of phase separation and entrainment/de-entrainment in complex geometries
Full Text Available There are various theories, strategies and techniques regarding teaching different language skills. At the same time, as practice shows listening remains the most challenging skill for the educators to teach effectively and for the learners to master. Moreover, both the learners and their teachers have their own, not infrequently rather disparate, subjective theories, as well as learning and teaching preferences. Older adult learners are a peculiar case as they are a very diverse group, aware of their needs and cognitive abilities. At the same time, their teachers are unfortunately often unaware of these needs and do not adapt the materials to suit their students. The aim of this paper is, thus, to present the opinions of the teachers of older adult students and to provide basis for future research.
Leutwyler, Heather; Hubbard, Erin M; Jeste, Dilip V; Vinogradov, Sophia
Targeted physical activity interventions to improve the poor physical function of older adults with schizophrenia are necessary but currently not available. Given disordered thought processes and institutionalization, it is likely that older adults with schizophrenia have unique barriers and facilitators to physical activity. It is necessary to consider the perspective of the mental health staff about barriers and facilitators to physical activity to design a feasible intervention. To describe the perceptions of mental health staff about barriers and facilitators to engage in physical activities that promote physical function among older adults with schizophrenia. We conducted qualitative interviews with 23 mental health staff that care for older adults with schizophrenia. The data were collected and analyzed with grounded theory methodology. The participants were interested in promoting physical activity with older adults with schizophrenia. Facilitators and barriers to physical activity identified were mental health, role models and rewards, institutional factors, and safety. In order to design successful physical activity interventions for this population, the intervention may need to be a routine part of the mental health treatment program and patients may need incentives to participate. Staff should be educated that physical activity may provide the dual benefit of physical and mental health treatment.
Walsh, Bronagh; Lattimer, Valerie; Wintrup, Julie; Brailsford, Sally
There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions. To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions. A qualitative framework analysis of interview data from a System dynamics (SD) modelling study. Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis. Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign. Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system. Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs. © 2014 John Wiley & Sons Ltd.
Bindels, Jill; Cox, Karen; Widdershoven, Guy; van Schayck, Onno C P; Abma, Tineke A
To evaluate care programmes for community-dwelling frail older people from a practice nurse perspective and gain a deeper understanding of their role within the programmes. In response to the increasing frail population, three regions in the Netherlands implemented care programmes, in which a proactive approach is used to identify frail older people in the community and provide them with the appropriate care and support. A constructivist grounded theory approach. A formative process evaluation was performed, in which study participants were practice nurses (n = 23) focusing on the identification of and care for frail older people in primary care settings. Based on the principles of grounded theory, data were collected via semi-structured interviews and focus groups and analysed. The practice nurses explain that 'building a trusting relationship' with the older person and 'making connections' between older people, family and other professionals are key elements of good care in the programmes. 'Targeting the wrong audience' and 'providing good care' reflect the doubts and feelings of insecurity the practice nurses have about the screening and selection procedures and their own role and expertise in the programme. According to the experiences of practice nurses, a trusting relationship with the older people is necessary to provide good care. Practice nurses feel they should receive more support and education to conquer issues concerning social problems in frail older people. Moreover, practice nurses considered the screening and selection procedures to be unsuccessful in identifying frail older people who do need care. A trusting relationship should be given high priority in the care for community-dwelling frail older people. To improve the care programmes, screening and selection procedures need adjustments. Practice nurses should receive more support in dealing with older people with psychosocial problems. © 2013 John Wiley & Sons Ltd.
The Models and Modeling Perspectives (MMP) has evolved out of research that began 26 years ago. MMP researchers use Model Eliciting Activities (MEAs) to elicit students' mental models. In this study MMP was used as the conceptual framework to investigate the nature of students' models of curve fitting in a problem-solving environment consisting of…
Full Text Available Sherrilene Classen1,2, Ellen DS Lopez3, Sandra Winter2, Kezia D Awadzi4, Nita Ferree5, Cynthia W Garvan61Department of Occupational Therapy, College of Public Health and Health Professions (CPHHP, University of Florida (UF, Gainesville, FL, USA; 2PhD Program in Rehabilitation Science, CPHHP, UF Gainesville, FL, USA; 3Department of Behavioral Science and Community Health, CPHHP, UF, Gainesville, FL, USA; 4Department of Health Services Research, Management, and Policy, CPHHP, UF, Gainesville, FL, USA; 5Health Science Center Libraries, UF, Gainesville, FL, USA; 6Division of Biostatistics, College of Medicine, UF, Gainesville, FL, USAAbstract: The topic of motor vehicle crashes among the elderly is dynamic and multi-faceted requiring a comprehensive and synergistic approach to intervention planning. This approach must be based on the values of a given population as well as health statistics and asserted through community, organizational and policy strategies. An integrated summary of the predictors (quantitative research, and views (qualitative research of the older drivers and their stakeholders, does not currently exist. This study provided an explicit socio-ecological view explaining the interrelation of possible causative factors, an integrated summary of these causative factors, and empirical guidelines for developing public health interventions to promote older driver safety. Using a mixed methods approach, we were able to compare and integrate main findings from a national crash dataset with perspectives of stakeholders. We identified: 11 multi-causal factors for safe elderly driving; the importance of the environmental factors - previously underrated in the literature- interacting with behavioral and health factors; and the interrelatedness among many socio-ecological factors. For the first time, to our knowledge, we conceptualized the fundamental elements of a multi-causal health promotion plan, with measurable intermediate and long
Charlton, Kimberly; Murray, Carolyn M; Kumar, Saravana
Older people living in the community need to plan for getting help quickly if they have a fall. In this paper planning for falls is referred to as contingency planning and is not a falls prevention strategy but rather a falls management strategy. This research explored the perspectives of older people and community workers (CWs) about contingency planning for a fall. Using a qualitative descriptive approach, participants were recruited through a community agency that supports older people. In-depth interviews were conducted with seven older people (67-89 years of age) and a focus group was held with seven workers of mixed disciplines from the same agency. Older people who hadn't fallen were included but were assumed to be at risk of falls because they were in receipt of services. Thematic analysis and concept mapping combined the data from the two participant groups. Four themes including preconceptions about planning ahead for falling, a fall changes perception, giving, and receiving advice about contingency plans and what to do about falling. Both CWs and older people agree contingency planning requires understanding of individual identity and circumstances. CWs have limited knowledge about contingency planning and may be directive, informative, or conservative. Implications for Rehabilitation Falls can result in serious consequences for older people. There is an evidence-practice gap as availability of and access to contingency planning does not necessarily mean older people will use it in a falls emergency. Older people prefer community workers to be directive or informative about contingency planning options but they do want choice and control. Increased community workers knowledge of, and collaborative decision-making about, contingency planning may promote patient-centered services and assist in closing the evidence-practice gap.
Kim, Jong In; Kim, Gukbin
Population is aging rapidly in Europe. Older age life expectancy (OLE) can be influenced by country-level depth of credit information (DCI) as an indicator of financial crisis, gross national income (GNI) per capita, and gender inequality index (GII). These factors are key indicators of socio-ecological inequality. They can be used to develop strategies to reduce country-level health disparity. The objective of this study was to confirm the relationship between socio-ecological factors and OLE in Europe. Data were obtained from World Bank, WHO, and UN database for 34 Europe countries. Associations between socio-ecological factors and OLE were assessed with Pearson correlation coefficients and three regression models. These models assumed that appropriate changes in country-level strategies of healthy aging would produce changes in GNI per capital as personal perspective, GII in social environment perspective, and DCI in public policy perspective to implement socio-ecological changes. Hierarchal linear regression was used for final analysis. Although OLE (women and men) had significant negative correlation with GII (gender inequality index, r = - 0.798, p = 0.001), it had positive correlations with GNI (gross national income per capita, r = 0.834, p = 0.001) and DCI (depth of credit information index, r = 0.704, p = 0.001) levels caused by financial crisis. Higher levels GNI and DCI but lower GII were found to be predictors of OLE (women and men) (R 2 = 0.804, p < 0.001). Factors affecting older age life expectancy in Europe were identified from socio-ecological perspective. Socio-ecological indicators (GII, GNI, and DCI) in Europe appear to have a latent effect on OLE levels. Thus, country-level strategies of successful aging in Europe should target socio-ecological factors such as GII, GNI, and DCI value.
Full Text Available Sushmita Karki,1 Dharma Nand Bhatta,1,2 Umesh Raj Aryal3 1Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal; 2Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand; 3Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal Background: Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people's perspectives on an "elderly-friendly" hospital. Methods: Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. Results: Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people's health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. Conclusion: Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that
Ahluwalia, Sangeeta C.; Gill, Thomas M.; Baker, Dorothy I.; Fried, Terri R.
Background Bathing is an important and potentially challenging self-care activity, and disability in bathing is associated with several adverse consequences. Little is known about older persons’ experiences with and perspectives on bathing. Objectives To understand the bathing experiences, attitudes, and preferences of older persons in order to inform the development of effective patient-centered interventions. Design Qualitative Study using the Grounded Theory framework. Participants Twenty-three community-living persons, age ≥ 78 years, identified from the Precipitating Events Project (PEP). Approach In-depth, semi-structured interviews were conducted in the participant’s home. Results Three themes emerged: 1) the importance and personal significance of bathing to older persons, 2) variability in attitudes, preferences, and sources of bathing assistance, and 3) older persons’ anticipation of and responses to bathing disability. Discussion The bathing experiences described by study participants underscore the personal significance of bathing and the need to account for attitudes and preferences when designing bathing interventions. Quantitative disability assessments may not capture the bathing modifications made by older persons in anticipation of disability and may result in missed opportunities for early intervention. Findings from this study can be used to inform the development of targeted, patient-centered interventions that can subsequently be tested in clinical trials. PMID:20158554
Kropf, Nancy P.; And Others
The University of Georgia model curriculum to prepare students to work with mentally retarded older adults has six units: population overview, physiological issues, mental health issues, social support systems, service delivery networks, and legal/ethical issues. (SK)
Pouyan eGhaffari Nouran
Full Text Available Tumor cells alter their metabolism to maintain unregulated cellular proliferation and survival, but this transformation leaves them reliant on constant supply of nutrients and energy. In addition to the widely studied dysregulated glucose metabolism to fuel tumor cell growth, accumulating evidences suggest that utilization of amino acids and lipids contributes significantly to cancer cell metabolism. Also recent progresses in our understanding of carcinogenesis have revealed that cancer is a complex disease and cannot be understood through simple investigation of genetic mutations of cancerous cells. Cancer cells present in complex tumor tissues communicate with the surrounding microenvironment and develop traits which promote their growth, survival and metastasis. Decoding the full scope and targeting dysregulated metabolic pathways that support neoplastic transformations and their preservation requires both the advancement of experimental technologies for more comprehensive measurement of omics as well as the advancement of robust computational methods for accurate analysis of the generated data. Here, we review cancer-associated reprogramming of metabolism and highlight the capability of genome-scale metabolic modeling approaches in perceiving a system-level perspective of cancer metabolism and in detecting novel selective drug targets
Salem, Benissa E; Ma-Pham, Jennifer
Middle-aged and older homeless women have unique health and social service delivery needs; yet, limited research has been conducted in this area. The purpose of this study was to assess perspectives among prefrail and frail, middle-aged and older homeless women. Focus group methodology was conducted to assess perspectives among these homeless women (N=20) aged 43 to 62. Sociodemographic and frailty characteristics were assessed by structured instruments, along with mobility, assistive device use and falls. The average age was 53.4; the majority of the sample was African-American (70%). In total, 60% reported living in a shelter for the last 30 days, while 20% were unsheltered. The majority of the sample reported walking independently (80%) and not using an assistive device (65%). Over one third (35%) fell in the last 30 days and 70% fell in the last year. Content analysis revealed several themes that included (1) health care needs and challenges experienced; (2) perspectives on sexual decision making; (3) employment difficulties; (4) existing support systems; and (5) development of future program planning. Future research development and implications are discussed. © 2015 Wiley Periodicals, Inc.
Eloranta, Sini; Arve, Seija; Routasalo, Pirkko
Home care can be decisive in supporting older people in the home environment. However, one professional in home care cannot take the whole responsibility for promotion alone; on the contrary multiprofessional collaboration is needed. The aim of the study is to describe the experiences of multiprofessional collaboration in promoting personal resources among older home care clients (75+ years) in Finland. The data were collected by unstructured interviews with 21 older home care clients. Their mean age was 83.5 years, ranging from 75 to 91, with 17 female and four male participants. Inductive content analysis was used to analyze the data. The interviewees described the work of professionals from four perspectives: expertise, communication, decision-making and responsibility. Multiprofessional collaboration promoted the personal resources of interviewees with physical, psychological and social support. This study showed that the professionals worked as being expert-oriented: in the multiprofessional collaboration, each expert took care of his/her own part of the client's situation. This included the risk,, that the client's overall situations remained uncharted. However, the client's overall situation is a very important aspect when professionals suppport older people living in their own homes as long as possible. This study revealed the need for developing collaboration skills between social and health care professionals so that the staffs serve the needs of aged clients better together. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.
Strough, JoNell; Schlosnagle, Leo; DiDonato, Lisa
Prior research indicates that older adults (60+ years) are less subject to the sunk-cost fallacy compared with younger adult college students. The objective of this research was to determine if age-related differences in decisions about sunk costs reflected differences in what was salient to individuals about the situation when they described their decision-making goals. Using hypothetical decision-making scenarios, we examined older (N = 21) and younger (N = 20) adults' decisions about sunk costs. Participants responded to open-ended interview questions about their decision-making goals. A coding scheme was developed using qualitative methods and was used to reliably categorize the issues and concerns people expressed when describing their decision-making goals. Compared with younger adults, older adults were less likely to commit the sunk-cost fallacy and were more likely to make normatively correct decisions. When describing their goals, older adults were less likely to focus on the presence or absence of the prior investment (the sunk cost). The salience of investment-related information to individuals when describing their goals mediated age-related differences in the sunk-cost fallacy and normatively correct decisions. The results illustrate how consideration of people's own perspectives of decision-making situations may inform understanding of age-related differences in decision-making fallacies.
Ko, Eunjeong; Nelson-Becker, Holly
This qualitative pilot study explored perspectives, needs, and concerns relating to advance care planning among older homeless adults. Twenty-one older adults residing at a transitional housing facility in an urban area of the West coast were interviewed in person. Key emergent themes included discomfort with the topic, trust in God's decisions, physicians preferred as decision makers, and planning is important but not an immediate concern. Further, people who are homeless want to be approached with sensitivity. Instead of simply eliciting life-sustaining treatment preferences of homeless people, health care professionals should assess their unique concerns and needs regarding death and dying, prepare them to consider their possible end-of-life situation, and assist them to plan in accordance with their needs.
Roberto, Karen A; McCann, Brandy Renee
Intimate partner violence in later life includes physical, psychological, sexual, and financial abuse. Although some researchers have investigated how women in long-term violent partnerships cope with abuse, little is known about the history, experiences, and needs of older women who leave abusive relationships. From a feminist, life course perspective, we interviewed 10 women who had left their abusive partners later in life. We used qualitative methods to analyze the data and found four major themes: (a) the women used the past to account for abuse in their relationships later in life, (b) recognizing abuse signaled to the women to fight back and exit the relationship, (c) financial abuse and exploitation affected women's mental and physical health, and (d) rebuilding was especially challenging as the women faced their future alone with financial, physical, or mental health problems. We conclude that abuse presents lasting and unique challenges for older women.
Butler, Jeffrey I; Fox, Mary T
Older people present with complex health issues on admission to hospital and are at high risk for functional decline and related complications. Thus, they require the services of diverse health-care professionals working in concert to support their functioning. Despite nurses' central role in caring for this patient population, and evidence indicating that interprofessional communication is a persistent challenge for nurses in acute-care settings, little is known about nurses' views on interprofessional communication in care preserving functioning in acutely admitted older people. To fill this knowledge gap, we gathered acute-care staff nurses' perspectives on interprofessional communication in a function-focused, interprofessional approach to hospital care for older adults. Thirteen focus groups were conducted with a purposeful, criterion-based sample of 57 nurses working in acute-care hospitals. Thematic analysis revealed two overarching themes capturing nurses' perspectives on key factors shaping interprofessional communication in a function-focused interprofessional approach to care (1) context of direct communication and (2) context of indirect communication. The first theme demonstrates that nurses preferred synchronous modes of communication, but some ascribed greater importance to unstructured forms of direct information-sharing, while others stressed structured direct communication, particularly interprofessional rounds. The second theme also documents divergence in nurses' views on asynchronous communication, with some emphasizing information technology and others analog tools. Perceptions of some modes of interprofessional communication were found to vary by practice setting. Theoretical and pragmatic conclusions are drawn that can be used to optimize interprofessional communication processes supporting hospitalized older people's functioning.
Wrosch, Carsten; Jobin, Joelle; Scheier, Michael F
This study examined whether the emotional benefits of dispositional optimism for managing stressful encounters decrease across older adulthood. Such an effect might emerge because age-related declines in opportunities for overcoming stressors could reduce the effectiveness of optimism. This hypothesis was tested in a 6-year longitudinal study of 171 community-dwelling older adults (age range = 64-90 years). Hierarchical linear models showed that dispositional optimism protected relatively young participants from exhibiting elevations in depressive symptoms over time, but that these benefits became increasingly reduced among their older counterparts. Moreover, the findings showed that an age-related association between optimism and depressive symptoms was observed particularly during periods of enhanced, as compared to reduced, stress. These results suggest that dispositional optimism protects emotional well-being during the early phases of older adulthood, but that its effects are reduced in advanced old age. © 2016 Wiley Periodicals, Inc.
Maher, Ann Butler
The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):\\r\
Feder, Shelli L; Schulman-Green, Dena; Dodson, John A; Geda, Mary; Williams, Kathleen; Nanna, Michael G; Allore, Heather G; Murphy, Terrence E; Tinetti, Mary E; Gill, Thomas M; Chaudhry, Sarwat I
Risk stratification models support clinical decision making in acute myocardial infarction (AMI) care. Existing models were developed using data from younger populations, potentially limiting accuracy and relevance in older adults. We describe physician-perceived risk factors, views of existing models, and preferences for future model development in older adults. Qualitative study using semi-structured telephone interviews and the constant comparative method. Twenty-two physicians from 14 institutions completed the interviews. Median age was 37, and median years of clinical experience was 11.5. Perceived predictors included cardiovascular, comorbid, functional, and social risk factors. Physicians viewed models as easy to use, yet neither inclusive of risk factors nor predictive of non-mortality outcomes germane to clinical decision making in older adults. Ideal models included multidimensional risk domains and operational requirements. Physicians reported limitations of available risk models when applied to older adults with AMI. New models are needed to guide AMI treatment in this population. © The Author(s) 2015.
Background Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults. Methods 2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality. Results The PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01). Conclusions Social vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A
Mahieu, Lieslot; Gastmans, Chris
emotional discomfort brought on by witnessing this behavior. Relatively little work has been published on older residents' perspectives regarding aged sexuality in institutionalized elderly care. If, however, we wish to devote ourselves to individualized or person-centered nursing care, we will have to gain more insight into the patient's perspective and take notice of the needs, expectations, attitudes, experiences and behaviors of residents with regard to (aged) sexuality. Hence more research is needed that depicts the issue of aged sexuality in institutionalized elderly care from a patient's and thus resident oriented perspective. Copyright © 2015 Elsevier Ltd. All rights reserved.
Relations between minors under the age of consent and older persons are legally prohibited in many countries. However, the nature of these relationships, their impact on the lives of minors involved, and how they should be dealt by law enforcement and welfare systems are highly controversial. The differences between the way these relations are perceived by the minors involved and the public are also unclear. This literature review examines them as perceived by youths or young adults who had experienced sexual relations with a person at least 2 years older during their adolescence as well as by students and other adult members of the public. A systematic search of 977 studies initially identified as relevant yielded 16 studies that fit the inclusion criteria. Most (13) research samples were located in the United States, and the remainder were in the United Kingdom (2) and Australia (1). All were published in English. Four main themes emerged from the analysis of these studies: adolescent motives for sexual relations with older persons (two studies); characteristics of sexual relations between adolescents and older persons (6); contextual factors affecting the way such relations are perceived, including the partners' ages and genders (11); and perspectives on the legal framing of such relations (6). The studies' findings are discussed and implications for future research, policy, and practice are suggested, highlighting the complexity and ambiguity of the phenomenon and calling on intervention programs to focus on strengthening the family unit and social network of these youth and for policies to address teen sexuality as defined both normatively and legally.
Jarling, Aleksandra; Rydström, Ingela; Ernsth-Bravell, Marie; Nyström, Maria; Dalheim-Englund, Ann-Charlotte
To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity. In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay-in-place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace. This study uses a qualitative design with a lifeworld approach. The study having been conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data were analysed using qualitative content analysis. The findings illustrate four sub-themes: adapting to a caring culture, feeling exposed, unable to influence care and forced relations. The overall theme reveals that older people experience a life-changing situation when receiving home care and they become a guest in their own home. Becoming older with increased needs means to disrupt one's life when one's private home becomes a public arena. The gap between an older person's rights by law and the older person's experiences of receiving home care needs to be highlighted to meet the oncoming challenges in providing a home care that includes participation of the older themselves. Only then can care be offered that enables older people to have a sense of control and experience their home as their own. The findings emphasise the need to view older people as being self-determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers. © 2018 John Wiley & Sons Ltd.
Knudstrup, Mary-Ann; Møller, Kurt
of housing on the well-being of older people is a multidimensional phenomenon, however. A large number of different factors influence well-being, and these different factors interact and are often interdependent. The aim of this project is to develop a model for a multidisciplinary approach to investigating......The relationship between housing and the well-being of older people is a topic of growing interest. The focus is often on a specific aspect of housing, for example accessibility, location or interior design, and the perspective taken is typically that of a specific discipline. The influence...... the relationship between housing and the well-being of dependent elderly. This conceptual framework should encompass the many different factors that influence well-being as well as the interactions between these factors, and at the same time recognise the diversity of dependent elderly. The project is part...
Lin, Xiaoping; Bryant, Christina; Boldero, Jennifer; Dow, Briony
Older Chinese immigrants are one of the largest and fastest growing groups in Western societies. This article used the solidarity-conflict model to synthesize current research examining parent-child relationships in this group. A comprehensive literature search was conducted in the CINAHL, Medline, and PubMed databases to identify relevant articles. A narrative approach was used to review the literature. Thirty-six articles were identified. Compared with Caucasians, older Chinese immigrants are more likely to live with children and have higher filial expectations. However, considerable numbers live independently. Of these, most live in public housing and rely on the community rather than their children for instrumental help. Many older Chinese immigrants have adjusted their filial expectations and valued being independent. They also provide extensive household help to their children. There are indications of intergenerational conflict, probably due to generational differences in attitudes toward life and limited intergenerational contact. This review suggests that although filial piety continues to influence older parent-child relationship in Chinese immigrant families, many changes have occurred. These findings have important implications for service planning and delivery for this cultural group. This review also provides evidence for the utility of the solidarity-conflict model. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Solimeo, Samantha L.; Weber, Thomas J.; Gold, Deborah T.
Purpose: To explore the nature of men's experiences of osteoporosis by developing an understanding of men's explanatory models. Design and Methods: This descriptive study invited community-residing male osteoporosis patients aged 50+ to participate in interviews about osteoporosis. Participants were recruited from a hospital-affiliated bone…
Overgaard, Jesper; Rosbjerg, Dan; Butts, M.B.
The purpose of this paper is to provide a review of the different types of energy-based land-surface models (LSMs) and discuss some of the new possibilities that will arise when energy-based LSMs are combined with distributed hydrological modelling. We choose to focus on energy-based approaches......, and the difficulties inherent in various evaluation procedures are presented. Finally, the dynamic coupling of hydrological and atmospheric models is explored, and the perspectives of such efforts are discussed....
Chen, Shueh-Fen; Huang, Su-Fei; Lu, Li-Ting; Wang, Mei-Chuen; Liao, Jung-Yu; Guo, Jong-Long
Falling has high incidence and reoccurrence rates and is an essential factor contributing to accidental injury or death for older adults. Enhancing the participation of community-dwelling older adults in fall-prevention programs is crucial. Understanding fall-prevention beliefs will be beneficial for developing a community-based fall-prevention program. The aim of the present study was to identify the distinct types of subjective views on the fall-prevention beliefs of community-dwelling older adults aged 80 years and older by applying the Q method. The Q method was adopted to investigate the pattern of perception on fall-prevention beliefs. Forty-two older adults aged 80 - 92 years from a community care center in Northern Taiwan were recruited and requested to complete a Q-sorting. A series of Q-sorts was performed by the participants to rank 30 statements into a normal distribution Q-sort grid. The Q-sorts were subjected to principal component analysis by using PQMethod software Version 2.35. Four statistically independent perspectives were derived from the analysis and reflected distinct viewpoints on beliefs related to fall prevention. Participants in the Considerate perspective believed that health problems caused by falling were serious and fall prevention could decrease the burden they place on their family. Participants in the Promising perspective believed that existing health problems could cause a fall and that fall prevention contributed to their well-being. Participants in the Adaptable perspective perceived low barriers to execute fall prevention and displayed self-confidence and independence in preventing falls. Participants in the Ignorance perspective believed that they could not prevent falls and perceived barriers to fall prevention. By combining theoretical constructs and the Q methodology approach, this study identified four distinct perspectives on fall prevention among community-dwelling older adults. Critical reflection on older adult
Pisu, Maria; Martin, Michelle Y; Shewchuk, Richard; Meneses, Karen
Financial burden among cancer survivors is often overlooked in survivorship care planning. Cancer survivors with limited incomes may be particularly affected. Yet, little data are available to address financial issues among them. Eliciting the survivors' perspectives on how to deal with this financial burden is a first crucial step to identifying the means to provide this supportive care. In this pilot study, three nominal group technique (NGT) sessions were conducted with a convenience sample of 23 older breast cancer survivors (age 52 to 83) recruited from a county safety net hospital and a Comprehensive Cancer Center. One single NGT question was posed in these sessions, namely "What could help women deal with the financial burden that cancer brings to them and their families?" Survivors responded in an iterative fashion and then ranked the most relevant responses. The most relevant responses addressed the (1) need for affordable insurance; (2) need to have prompt information on treatment costs patients will face, insurance coverage, and agencies or programs that provide needed products and services; and (3) need to access social workers, navigators, support groups, or others knowledgeable about available resources. Survivors also suggested that physicians become aware of cancer costs and financial issues faced by patients and consider costs in their treatment plans. Older survivors face financial challenges for which there are few available resources. They suggested several avenues to address cancer-related financial issues that may be considered in developing supportive interventions.
Nathália Brandolim Becker
Full Text Available The present review aims to determine the main findings concerning positive psychology in older adults. We used the electronic databases Web of Science and EBSCO, which were efficient tools to find the necessary heterogeneity for the selection of studies published between 2005 and 2015, through the following keywords: “Positive Psychology” and “Older”. After selecting 12 studies, they were assessed regarding the following information: (a source; (b setting; (c number of older adults (participants; (d average age (SD; (e inclusion criteria for each study; (f instruments; and (g the results of our investigative question. The results show that interventions with a positive psychology approach are favorable to the reduction of symptoms (anxiety and depression and the increase of wellbeing; and positive psychology constructs have the same impact on well-being and on reducing symptoms, portraying a promising approach to public health. Our investigation showed the necessity to develop a new perspective on aging. Some of the assessed studies reported that it is possible to achieve this with the inclusion of positive psychology, which can facilitate this development.
Krízová, Eva; Brzyski, Piotr; Strumpel, Charlotte; Billings, Jenny; Lang, Gert
This article describes health promotion for older people in the Czech Republic from the European perspective. It is based on findings from the European project healthPROelderly. Implementation of health promotion in the Czech republic as a new public health concept is outlined from the historical point of view. Structures and processes of health promotion in the Czech Republic are described in the context of social policy, demography and health. The European project healthPROelderly is presented and the outcomes of an international literature search statistically analysed. Participating countries were divided into three macro-regions according to their geographical location and political and historical tradition - Mediterranean, West-European and formerly East-European macro-regions. The outcome of correspondence analysis partially confirms the hypothesis on the cultural background of the health promotion activities and strategies. Concerning themes addressed by health promotion projects most countries belonging to the Mediterranean or "Western European" macro-regions have concentrated on similar themes whereas this is not valid for the countries of the "Former Eastern European" macro-region. The hypothesis on macro-regional similarities in relation to settings of health promotion projects was not confirmed. In the conclusions the location of the Czech Republic in an international perspective is discussed and three Czech selected best practice projects are evaluated in relation to the statistical findings.
West, Robin L; Hastings, Erin C
Memory training has often been supported as a potential means to improve performance for older adults. Less often studied are the characteristics of trainees that benefit most from training. Using a self-regulatory perspective, the current project examined a latent growth curve model to predict training-related gains for middle-aged and older adult trainees from individual differences (e.g., education), information processing skills (strategy use) and self-regulatory factors such as self-efficacy, control, and active engagement in training. For name recall, a model including strategy usage and strategy change as predictors of memory gain, along with self-efficacy and self-efficacy change, showed comparable fit to a more parsimonious model including only self-efficacy variables as predictors. The best fit to the text recall data was a model focusing on self-efficacy change as the main predictor of memory change, and that model showed significantly better fit than a model also including strategy usage variables as predictors. In these models, overall performance was significantly predicted by age and memory self-efficacy, and subsequent training-related gains in performance were best predicted directly by change in self-efficacy (text recall), or indirectly through the impact of active engagement and self-efficacy on gains (name recall). These results underscore the benefits of targeting self-regulatory factors in intervention programs designed to improve memory skills.
Backonja, Uba; Hall, Amanda K; Thielke, Stephen
Technologies have become a major force in people's lives. They change how people interact with the environment, even as the environment changes. We propose that technology use in the setting of changing environments is motivated by essential needs and tensions experienced by the individual. We apply three developmental and behavioral theories (Erikson's stages of psychosocial development, Maslow's hierarchy of needs, and Bronfenbrenner's ecological model) to explain technology-related behaviors among older adults. We consider how technology use has addressed and can address major ecological changes, in three areas: health promotion, natural disasters, and disparities. We propose that considering these theories can help researchers and developers ensure that technologies will help promote a healthier world for older adults. © The Author(s) 2015.
Backonja, Uba; Hall, Amanda K.; Thielke, Stephen
Technologies have become a major force in people’s lives. They change how people interact with the environment, even as the environment changes. We propose that technology use in the setting of changing environments is motivated by essential needs and tensions experienced by the individual. We apply three developmental and behavioral theories (Erikson’s stages of psychosocial development, Maslow’s hierarchy of needs, and Bronfenbrenner’s ecological model) to explain technology-related behaviors among older adults. We consider how technology use has addressed and can address major ecological changes, in three areas: health promotion, natural disasters, and disparities. We propose that considering these theories can help researchers and developers ensure that technologies will help promote a healthier world for older adults. PMID:26215298
Potter, G.L.; Mobely, R.L.; Drach, R.S.; Corsetti, T.G.; Williams, D.N.; Slingo, J.M.
Radiation fields from a perpetual July integration of a T106 version of the ECMWF operational model are used as surrogate observations of the radiation budget at the top of the atmosphere to illustrate various difficulties that modellers might face when trying to reconcile cloud radiation forcings derived from satellite observations with model-generated ones. Differences between the so-called Methods 1 and 2 of Cess and Potter (1987) and a variant Method 3 are addressed. Method 1 is shown to be the least robust of all methods, due to potential uncertainties related to persistent cloudiness, length of the period over which clear-sky conditions are looked for, biases in retrieved clear-sky quantities due to an insufficient sampling of the diurnal cycle. We advocate the use of Method 2 as the only unambiguous one to produce consistent radiative diagnostics for intercomparing model results. Impact of the three methods on the derived sensitivities and cloud feedbacks following an imposed change in sea surface temperature (used as a surrogate climate change) is discussed. 17 refs., 12 figs., 1 tab
Daly, E.; Verma, P.; Loheide, S. P., III
Roots play a key role in the soil water balance. They extract and transport water for transpiration, which usually represents the most important soil water loss in vegetated areas, and can redistribute soil water, thereby increasing transpiration rates and enhancing root nutrient uptake. We present here a two-dimensional model capable of describing two key aspects of root water uptake: root water compensation and hydraulic redistribution. Root water compensation is the ability of root systems to respond to the reduction of water uptake from areas of the soil with low soil water potential by increasing the water uptake from the roots in soil parts with higher water potential. Hydraulic redistribution is a passive transfer of water through the root system from areas of the soil with greater water potential to areas with lower water potential. Both mechanisms are driven by gradients of water potential in the soil and the roots. The inclusion of root water compensation and hydraulic redistribution in models can be achieved by describing root water uptake as a function of the difference in water potential between soil and root xylem. We use a model comprising the Richards equation for the water flow in variably saturated soils and the Darcy's equation for the water flow in the xylem. The two equations are coupled via a sink term, which is assumed to be proportional to the difference between soil and xylem water potentials. The model is applied in two case studies to describe vertical and horizontal hydraulic redistribution and the interaction between vegetation with different root depths. In the case of horizontal redistribution, the model is used to reproduce the fluxes of water across the root system of a tree subjected to uneven irrigation. This example can be extended to situations when only part of the root system has access to water, such as vegetation near creeks, trees at the edge of forests, and street trees in urban areas. The second case is inspired by recent
Lindberg, Elisabeth; Persson, Eva; Hörberg, Ulrica; Ekebergh, Margaretha
Although the importance of patient participation is acknowledged in today's healthcare, many challenges remain before patient participation can become an integral part of care provision. The ward round has traditionally been the forum for crucial decisions about patient care, but often with limited possibilities for patient participation. As part of the process of improving patient participation, the round in the present study has been replaced by a team meeting (TM) to which the patient has been invited. The aim of this study is to highlight nurses' experiences of older patients' participation in TMs. The research process was guided by the principles of phenomenological reflective life world research. Data were collected in a Swedish hospital, in a ward specializing in older patients. Nine nurses, who had invited and planned for a patient to participate in TMs and/or had experienced TMs in which patients participated, were interviewed. The essential meaning of patient participation in the TM, as experienced by the nurses, is that patient participation can be supported by a safe relationship in which the patient can make his or her voice heard. Participation is challenged by the patients' vulnerability and by the subordinated role assigned to the patient. The essential meaning is further described by its constituents: "the need for a guide," "patient participation challenged by structures," and "creating space for the whole human being." In conclusion, the nurse plays a core role in guiding the patient in an unfamiliar situation. The meaning of patient participation in the TM needs to be discussed by professionals so that the patient perspective is present.
Mastel-Smith, Beth; Binder, Brenda; Hersch, Gayle; Davidson, Harriett A; Walsh, Teresa
The purpose of this exploratory, qualitative study was to investigate storytelling by home care clients to their home care workers (HCWs). Specific research questions were: (a) When does storytelling by a care recipient occur during usual care?; (b) How do HCWs engage older clients in storytelling?; (c) How do HCWs respond to the stories told by clients?; and (d) What is the perceived effect of storytelling by older clients on the relationship between the client and the HCW? Two focus groups consisting of 10 HCWs each were conducted. Verbatim transcripts of both focus groups were analyzed using the constant comparative analysis method. Categories and concepts were identified. Characteristics of the HCW and client set the stage for storytelling. The process of storytelling included context, triggers, and temporal aspects. HCWs also shared the content of stories, the impact on their relationship with the client, and the perceived effect on each individual. A visual model depicting the nature of storytelling in association with the care of older clients is presented. Copyright 2011, SLACK Incorporated.
Mathematical modeling is the art and craft of building a system of equations that is both sufficiently complex to do justice to physical reality and sufficiently simple to give real insight into the situation. Mathematical Modeling: A Chemical Engineer's Perspective provides an elementary introduction to the craft by one of the century's most distinguished practitioners.Though the book is written from a chemical engineering viewpoint, the principles and pitfalls are common to all mathematical modeling of physical systems. Seventeen of the author's frequently cited papers are reprinted to illus
McWilliams, A E
This article outlines the basic tenets of attachment theory and its relevance to adult couple psychotherapy. The paper also explores the nihilism around psychic change in older people and people with cancer and explores some possible reasons for this nihilism. A case study of older people, a couple, one of whom has a terminal cancer diagnosis, is presented to demonstrate the usefulness of therapeutic intervention in such cases from an attachment theory perspective. A discussion of the usefulness and difficulties of this approach follows. Other therapeutic models could also be applied usefully to this type of clinical presentation. However, the focus of this paper is the specific elucidation of attachment theory to demonstrate that change can occur regardless of a person's age and physical circumstances. The particular therapeutic approach presented here also represents the specialist interest and training of the writer in regard to couple work.
The aim of this study was to estimate the overall success of services at Gangnam Senior Plaza (GSP), determine the effect of GSP on users, and ascertain local demand for services. A 4-week survey including 1188 participants aged over 50 years old was conducted. Participants included 498 GSP members and 690 older non-members (Gangnam residents). Six GSP members were interviewed to substantiate the survey findings. Survey findings indicated high level of user satisfaction in terms of accessibility to services and facilities, availability of community services and educational programs, staff friendliness and facility cleanliness. GSP service delivery can be further improved by involving highly educated and experienced older people. Health promotion, education and recreation activities inspiring a vibrant lifestyle have been recognised as the success factors for GSP service delivery. Thus, GSP can be considered a model for other welfare services in South Korea. © 2013 ACOTA.
Vijande, J.; Valcarce, A.; Caramés, T.F.; Garcilazo, H.
We present recent results of hadron spectroscopy and hadron–hadron interaction from the perspective of constituent quark models. We pay special attention to the role played by higher order Fock space components in the hadron spectra and the connection of this extension with the hadron–hadron interaction. The main goal of our description is to obtain a coherent understanding of the low-energy hadron phenomenology without enforcing any particular model, to constrain its characteristics and learn about low-energy realization of the theory
Burbank, Patricia M; Reibe, Deborah; Padula, Cynthia A; Nigg, Claudio
The loss of muscle strength, decreased flexibility and range of motion, and decreased sense of balance that frequently accompany aging contribute to falls and functional decline. Even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types. This article outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior. Research studies are documented that support the effectiveness of the TTM in changing behavior. Application of the model is described with specific examples illustrated in two case studies.
Jiang, Quanbao; Li, Xiaomin; Feldman, Marcus W
China, a society long characterized by traditional Confucianism and the practice of filial piety, is undergoing dramatic socioeconomic development and erosion of traditions. In this rapidly changing context, the motives behind rural parental bequests have not been well studied. This paper draws on a survey conducted in rural Anhui province of China and uses hierarchical linear models (HLM) to examine whether three kinds of support from children are associated with older parents' bequest motives. We find that while instrumental support accords with an exchange model of motivation, financial transfer is consistent with an altruistic motivation for parental bequest plans. Offspring gender is strongly associated with parental planning of bequests, when only sons are considered; family division is a strong correlate of parents' bequest plan and reflects exchange motivation. These findings have important implications for research on traditional culture and an evolving social security system.
Full Text Available Autonomous robot world modelling is a “chicken-and-egg” problem: position estimation needs a model of the world, whereas world modelling needs the robot position. Most of the works dealing with this issue propose holistic solutions under an algorithmic perspective by neglecting software architecture issues. This results in huge and monolithic pieces of software where implementation details reify strategic decisions. An architectural approach founded on separation of concerns may help to break the loop. Localisation and modelling, acting on different time scales, are mostly independent of each other. Sometimes synchronisation is required. Whenever needed, an external strategy tunes the relative rates of the two activities. The paper introduces rationale, design, and implementation of such a system which relies on Real-Time Performers, a software architecture providing suitable architectural abstractions to observe and control the system's temporal behaviour.
Domenico G. Sorrenti
Full Text Available Autonomous robot world modelling is a "chicken-and-egg" problem: position estimation needs a model of the world, whereas world modelling needs the robot position. Most of the works dealing with this issue propose holistic solutions under an algorithmic perspective by neglecting software architecture issues. This results in huge and monolithic pieces of software where implementation details reify strategic decisions. An architectural approach founded on separation of concerns may help to break the loop. Localisation and modelling, acting on different time scales, are mostly independent of each other. Sometimes synchronisation is required. Whenever needed, an external strategy tunes the relative rates of the two activities. The paper introduces rationale, design, and implementation of such a system which relies on Real-Time Performers, a software architecture providing suitable architectural abstractions to observe and control the system's temporal behaviour.
GholamHosseini, Hamid; Baig, Mirza Mansoor; Connolly, Martin J; Lindén, Maria
Ageing population worldwide has grown fast with more cases of chronic illnesses and co-morbidity, involving higher healthcare costs. Falls are one of the leading causes of unintentional injury-related deaths in older adults. The aim of this study was to develop a robust multifactorial model toward the falls risk prediction. The proposed model employs real-time vital signs, motion data, falls history and muscle strength. Moreover, it identifies high-risk individuals for the development falls in their activity of daily living (ADL). The falls risk prediction model has been tested at a controlled-environment in hospital with 30 patients and compared with the results from the Morse fall scale. The simulated results show the proposed algorithm achieved an accuracy of 98%, sensitivity of 96% and specificity of 100% among a total of 80 intentional falls and 40 ADLs. The ultimate aim of this study is to extend the application to elderly home care and monitoring.
Arbaje, Alicia I; Newcomer, Alison R; Maynor, Kenric A; Duhaney, Robert L; Eubank, Kathryn J; Carrese, Joseph A
Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize health care professionals' perspectives on (1) successful transitional care of older adults (age 65 years and older), (2) suggestions for improvement, and (3) P4P strategies related to transitional care. In a qualitative study, one-hour semistructured in-depth interviews were conducted in an acute care hospital, a skilled nursing facility, two community-based primary care practices, and one home health care agency with 20 health care professionals (18 physicians and 2 home health care administrators) with direct experience in care transitions of older adults and who were likely to be affected by P4P strategies. Findings were organized into three thematic domains: (1) components and markers of effective transitional care, (2) difficulties in design and implementation of P4P strategies, and (3) health care professionals' concerns and unmet needs related to delivering optimal care during transitions. A conceptual framework was developed on the basis of the findings to guide design and implementation of P4P strategies for improving transitional care. In characterizing health care professionals' perspectives, specific care processes to target, challenges to address in the design of P4P strategies, and unmet needs to consider regarding education and feedback for health care professionals were described. Future investigations could evaluate whether performance targets, educational interventions, and implementation strategies based on this conceptual framework improve quality of transitional care.
Gärtner, Laura U A; Hertel, Guido
Working in teams is quite popular across different industries and cultures. While some of these teams exist for longer time periods, other teams collaborate only for short periods and members switch into new teams after goals are accomplished. However, workers' preferences for joining a new team might vary in different ways. Based on Carstensen's socioemotional selectivity theory, we predict that emotionally meaningful teams are prioritized when occupational future time perspective (OFTP) is perceived as limited. Building and expanding on studies outside of the work context, we expected that older as compared to younger workers prefer more familiar teams, and that this effect is mediated by workers' OFTP. Moreover, we assumed that experimentally manipulated OFTP can change such team preferences. The hypotheses were tested in an online scenario study using three experimental conditions (within-person design). Four hundred and fifty-four workers (57% female, age M = 45.98, SD = 11.46) were asked to choose between a familiar and a new team in three consecutive trials: under an unspecified OFTP (baseline), under an expanded OFTP (amendment of retirement age), and under a restricted OFTP (insolvency of the current company). Whereas the baseline condition was always first, the order of the second and third conditions was randomized among participants. In the baseline condition, results showed the expected mediation effect of workers' OFTP on the relation between workers' age and preference for a familiar over a new team. Higher age was associated with more limited OFTP, which in turn was associated with higher preference for a familiar over a new team. Moreover, experimentally restricting OFTP increased preference for a familiar team over a new team regardless of workers' age, providing further evidence for the assumed causal processes and showing interesting avenues for practical interventions in occupational teams.
Laura U. A. Gärtner
Full Text Available Working in teams is quite popular across different industries and cultures. While some of these teams exist for longer time periods, other teams collaborate only for short periods and members switch into new teams after goals are accomplished. However, workers’ preferences for joining a new team might vary in different ways. Based on Carstensen’s socioemotional selectivity theory, we predict that emotionally meaningful teams are prioritized when occupational future time perspective (OFTP is perceived as limited. Building and expanding on studies outside of the work context, we expected that older as compared to younger workers prefer more familiar teams, and that this effect is mediated by workers’ OFTP. Moreover, we assumed that experimentally manipulated OFTP can change such team preferences. The hypotheses were tested in an online scenario study using three experimental conditions (within-person design. Four hundred and fifty-four workers (57% female, age M = 45.98, SD = 11.46 were asked to choose between a familiar and a new team in three consecutive trials: under an unspecified OFTP (baseline, under an expanded OFTP (amendment of retirement age, and under a restricted OFTP (insolvency of the current company. Whereas the baseline condition was always first, the order of the second and third conditions was randomized among participants. In the baseline condition, results showed the expected mediation effect of workers’ OFTP on the relation between workers’ age and preference for a familiar over a new team. Higher age was associated with more limited OFTP, which in turn was associated with higher preference for a familiar over a new team. Moreover, experimentally restricting OFTP increased preference for a familiar team over a new team regardless of workers’ age, providing further evidence for the assumed causal processes and showing interesting avenues for practical interventions in occupational teams.
Boggs, Jennifer M; Dickman Portz, Jennifer; King, Diane K; Wright, Leslie A; Helander, Kenneth; Retrum, Jessica H; Gozansky, Wendolyn S
This qualitative study conducted by a community-research partnership used multiple types of data collection to examine variables relevant for LGBTQ older adults who wished to age in place in their urban Denver neighborhood. Focus groups, interviews, and a town hall meeting were used to identify barriers and supports to aging in place. Participants (N = 73) identified primarily as lesbian or gay, aged 50-69, and lived with a partner. Ageism, heterosexism, and cisgenderism emerged as cross-cutting themes that negatively impact access to health care, housing, social support, home assistance, and legal services. Resilience from weathering a lifetime of discrimination was identified as a strength to handle aging challenges. Recommendations for establishing an aging in place model included establishing welcoming communities and resource centers and increasing cultural competence of service providers. This study provides a unique contribution to understanding the psychosocial, medical, and legal barriers for successfully aging in place.
To test any hypothesis about any dynamic system, it is necessary to build a model that places that hypothesis into the context of everything else that we know about the system: initial and boundary conditions and interactions between various governing processes (Hempel and Oppenheim, 1948, Cartwright, 1983). No hypothesis can be tested in isolation, and no hypothesis can be tested without a model (for a geoscience-related discussion see Clark et al., 2011). Science is (currently) fundamentally reductionist in the sense that we seek some small set of governing principles that can explain all phenomena in the universe, and such laws are ontological in the sense that they describe the object under investigation (Davies, 1990 gives several competing perspectives on this claim). However, since we cannot build perfect models of complex systems, any model that does not also contain an epistemological component (i.e., a statement, like a probability distribution, that refers directly to the quality of of the information from the model) is falsified immediately (in the sense of Popper, 2002) given only a small number of observations. Models necessarily contain both ontological and epistemological components, and what this means is that the purpose of any robust scientific method is to measure the amount and quality of information provided by models. I believe that any viable philosophy of science must be reducible to this statement. The first step toward a unified theory of scientific models (and therefore a complete philosophy of science) is a quantitative language that applies to both ontological and epistemological questions. Information theory is one such language: Cox' (1946) theorem (see Van Horn, 2003) tells us that probability theory is the (only) calculus that is consistent with Classical Logic (Jaynes, 2003; chapter 1), and information theory is simply the integration of convex transforms of probability ratios (integration reduces density functions to scalar
Ayers, Catherine R; Bratiotis, Christiana; Saxena, Sanjaya; Wetherell, Julie Loebach
Utilizing a qualitative approach, the current study explored therapist and patient perspectives on a specialized cognitive-behavioral therapy (CBT) protocol for clinically significant hoarding in older adult patients. Data were derived from the following sources: (1) therapist observation; (2) CBT consultant observation; (3) clinical treatment notes; (4) participant feedback, including a focus group; and (5) participant in-session notes and completed homework assignments. Our findings showed that the value of homework, treatment session compliance, and deficits in executive functioning (prospective memory, planning, problem solving, and cognitive flexibility) were common themes among participants as viewed by the therapist. Patients reported that exposure exercises and the therapeutic relationship were the most helpful aspects of their treatment, while cognitive strategies had limited success. Our results suggest that treatment for hoarding in older adults may be improved by focusing on exposure therapy elements, remediating executive function deficits, providing simplified homework assignments, and decreasing the emphasis or modifying cognitive restructuring techniques.
Stephan, Yannick; Boiche, Julie; Le Scanff, Christine
Drawing upon Self-Determination Theory, the purpose of our study was to examine the motivational determinants of older women's dropout and participation in physical activity (PA). Older women who dropped out (n = 242) or remained (n = 332) in an organized PA program completed the Sport Motivation Scale as well as health and PA measures. We found…
Wright, Tim; Hyner, Gerald C.
Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…
Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas
Surgical workflow management is expected to enable situation-aware adaptation and intelligent systems behavior in an integrated operating room (OR). The overall aim is to unburden the surgeon and OR staff from both manual maintenance and information seeking tasks. A major step toward intelligent systems behavior is a stable classification of the surgical situation from multiple perspectives based on performed low-level tasks. The present work proposes a method for the classification of surgical situations based on multi-perspective workflow modeling. A model network that interconnects different types of surgical process models is described. Various aspects of a surgical situation description were considered: low-level tasks, high-level tasks, patient status, and the use of medical devices. A study with sixty neurosurgical interventions was conducted to evaluate the performance of our approach and its robustness against incomplete workflow recognition input. A correct classification rate of over 90% was measured for high-level tasks and patient status. The device usage models for navigation and neurophysiology classified over 95% of the situations correctly, whereas the ultrasound usage was more difficult to predict. Overall, the classification rate decreased with an increasing level of input distortion. Autonomous adaptation of medical devices and intelligent systems behavior do not currently depend solely on low-level tasks. Instead, they require a more general type of understanding of the surgical condition. The integration of various surgical process models in a network provided a comprehensive representation of the interventions and allowed for the generation of extensive situation descriptions. Multi-perspective surgical workflow modeling and online situation models will be a significant pre-requisite for reliable and intelligent systems behavior. Hence, they will contribute to a cooperative OR environment. Copyright © 2015 Elsevier Inc. All rights reserved.
Knudstrup, Mary-Ann; Møller, Kurt
The relationship between housing and the well-being of older people is a topic of growing interest. The focus is often on a specific aspect of housing, for example accessibility, location or interior design, and the perspective taken is typically that of a specific discipline. The influence...
Møller, Kurt; Knudstrup, M.A.
The relationship between housing and the well-being of older people is a topic of growing interest. The focus is often on a specific aspect of housing, for example accessibility, location or interior design, and the perspective taken is typically that of a specific discipline. The influence...
Courtney, Karen L; Demiris, George; Rantz, Marilyn; Skubic, Marjorie
At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs), which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies. This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology. Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities). This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3). The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns. Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.
A great deal of attention is given to the importance of communication in environmental remediation and radioactive waste management. However, very little attention is given to eliciting multiple perspectives so as to formulate high quality decisions. Plans that are based on a limited number of perspectives tend to be narrowly focused whereas those that are based on a wide variety of perspectives tend to be comprehensive, higher quality, and more apt to be put into application. In addition, existing methods of dialogue have built-in limitations in that they typically draw from the predominant thinking patterns which focus in some areas but ignore others. This can result in clarity but a lack of comprehensiveness. This paper presents a Perspective Awareness Model which helps groups such as partnering teams, interagency teams, steering committees, and working groups elicit a wide net of perspectives and viewpoints. The paper begins by describing five factors that makes cooperation among such groups challenging. Next, a Perspective Awareness Model that makes it possible to manage these five factors is presented. The two primary components of this model --- the eight 'Thinking Directions' and the 'Shared Documentation' --- are described in detail. Several examples are given to illustrate how the Perspective Awareness Model can be used to elicit multiple perspectives to formulate high quality decisions in the area of environmental remediation and radioactive waste management. (authors)
Bal, P.M.; Jansen, P.G.W.; van der Velde, M.E.G.; de Lange, A.H.; Rousseau, D.M.
Using a sample of post-retirement workers (N = 176), this study investigated the role of future time perspective (FTP) in psychological contracts. The study aimed to test: (i) whether future time perspective is related to employer psychological contract fulfillment and (ii) whether it moderates
Steyn, D.; Builtjes, P.; Schaap, M.; Yarwood, G.
An overview of regional-scale quality modeling practices and perspectives in North America and Europe, highlighting the differences and commonalities in how regional-scale air quality modeling systems are being used and evaluated across both continents
Grant, Theresa L; Edwards, Nancy; Sveistrup, Heidi; Andrew, Caroline; Egan, Mary
This qualitative study examined older people's walking experiences in 4 Ottawa neighborhoods. Seventy-five adults age 65 years and older who had lived in their neighborhoods for at least 2 yr participated in focus groups and individual interviews. Four themes were identified through data analysis: multidimensional personal meanings, navigating hostile walking environments, experiencing ambiguity, and getting around. Neighborhood walking was experienced within the continuum of personal and environmental change. Findings indicated that the concept of pedestrian connectivity must incorporate aspects of both intersection regulation and design to ensure relevance for an aging population. Participants called for more clarity about policies that affect pedestrian safety for older people. The overarching theme of getting around indicated that walkability assessments must consider how walking fits within an integrated transportation system and how accessible this system is for older people.
Skingley, Ann; Martin, Anne; Clift, Stephen
Current evidence suggests that participatory arts activities, and particularly group singing, may contribute to the well-being of older people. However, there is currently a paucity of prospective research from the participant perspective. This qualitative study nested within a randomized controlled trial aimed to assess participants' perspectives of the acceptability and effect on health and well-being of a community singing program for older people. Volunteers recruited to the intervention arm (n = 131) were invited to write comments on their experiences over three data collection points of a 14-week singing program. A subsample (n = 19) participated in a retrospective semi-structured interview. Data were subjected to content and thematic analysis. Comments and interviews from 128 individuals suggested that the singing groups led to specific, incremental benefits to physical, psychological, social, and community well-being. Benefits tended to tail off after the program ended. Suggestions were made for the future running of such groups. © The Author(s) 2015.
Kötteritzsch, Anna; Gerling, Kathrin
Growing numbers of older adults requiring aphasia therapy create challenges for the health care system. Information and communication technology (ICT) has the potential to provide computer-mediated, self-administered aphasia therapy that complements conventional therapy. We explore overlaps in ICT for older adults and aphasia therapy applications with the goal of integrating innovative ICT in aphasia therapy. Based on a case study, we explain how results of different disciplines developing IC...
Mortenson, W. Ben; Sixsmith, Andrew; Woolrych, Ryan
There is a long history of surveillance of older adults in institutional settings and it is becoming an increasingly common feature of modern society. New surveillance technologies that include activity monitoring, and ubiquitous computing, which are described as ambient assisted living (AAL) are being developed to provide unobtrusive monitoring and support of activities of daily living and to extend the quality and length of time older people can live in their homes. However, concerns have b...
Nathália Brandolim Becker; Karine Alexandra Del Rio João; Saul Neves de Jesus; João Bonança; Rute Martins
The present review aims to determine the main findings concerning positive psychology in older adults. We used the electronic databases Web of Science and EBSCO, which were efficient tools to find the necessary heterogeneity for the selection of studies published between 2005 and 2015, through the following keywords: “Positive Psychology” and “Older”. After selecting 12 studies, they were assessed regarding the following information: (a) source; (b) setting; (c) number of older adults (partic...
Miron, Anca M; McFadden, Susan H; Hermus, Nathan J; Buelow, Jennifer; Nazario, Amanda S; Seelman, Katarena
No empirical work has systematically explored perceptions of humanness of people with dementia and of older adults and the variables that could improve these perceptions. We thus investigated the role of contact and perspective taking in improving perceptions of humanness of these social groups. To do so, we developed a new concept, humanness standards, defined as the amount of evidence of ability impairment needed to conclude that elderly people and those with dementia have lost personhood. We used a cross-sectional survey design (n = 619) to assess participants' humanness standards and perceptions of uniquely human characteristics and human nature characteristics of two social groups (people with dementia and older adults). Half the participants (n = 311) completed a survey about people with dementia and half (n = 308) assessed older adults. People with dementia were perceived as possessing humanness characteristics to a lesser extent than were older adults. For both groups, contact predicted enhanced perceptions of humanness characteristics. Participants' degree of contact with individuals with dementia also predicted humanness standards, but only under low perspective-taking conditions. As predicted, for older adults, participants set the highest humanness impairment thresholds in the high contact/high perspective-taking condition. We conclude that while social programs that bring persons with dementia and other individuals in contact could change humanness standards and perceptions of humanness characteristics of people with dementia, in the case of elderly adults, the contact must be supplemented by variables that facilitate taking the perspective of the person.
Melo, Denise da Silva; Martins, René Duarte; de Jesus, Renata Patrícia Freitas Soares; Samico, Isabella Chagas; Santo, Antônio Carlos Gomes do Espírito
ABSTRACT OBJECTIVE To assess the quality of health care of older adults using as a parameter the assessment of the responsiveness of the service. METHODS This is a descriptive cross-sectional study conducted in a reference unit of the Brazilian Unified Health System at the outpatient level. The sample was probabilistic and had 385 older adults; data collection occurred in 2014. The domains assessed were: choice, autonomy, confidentiality, dignity, communication, physical facilities, and fast service. To this end, we used Pearson correlation test and Fisher’s exact test. RESULTS The domains of dignity, confidentiality, and communication reached the highest level of adequate responsiveness. On the other hand, freedom of choice and fast service received the worst assessments. Participation in decision-making regarding treatment was significantly lower among the older adults who had no education. In addition, the older adults that self-reported as black receive a lower quality of care regarding clear explanation and respected privacy in the appointment, when compared to users of any other race. CONCLUSIONS Although most domains studied have receive a positive assessment, we have found a need for an equal care by the health professionals, regardless of race, education level, or any other adjective characteristic of older adults, users of public health services. PMID:28678911
Belza, Basia; Walwick, Julie; Shiu-Thornton, Sharyne; Schwartz, Sheryl; Taylor, Mary; LoGerfo, James
Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.
Older patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events and hospitalisations. However, little has been done to identify why PIP occurs. The objectives of this study were; (1) to identify hospital doctors\\' perceptions as to why PIP occurs, (2) to identify the barriers to addressing the issues identified, and (3) to determine which intervention types would be best suited to improving prescribing.
Ho, Andy Hau Yan; Chan, Cecilia Lai Wan; Leung, Pamela Pui Yu; Chochinov, Harvey Max; Neimeyer, Robert A; Pang, Samantha Mei Che; Tse, Doris Man Wah
the empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life. to examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong. using qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed. the three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity. these findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.
Conclusions Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.
Weir, Kristie; Nickel, Brooke; Naganathan, Vasi; Bonner, Carissa; McCaffery, Kirsten; Carter, Stacy M; McLachlan, Andrew; Jansen, Jesse
Polypharmacy in the older population is increasing-and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor is required. This study explores decision-making about polypharmacy with older adults and their companions. Semi-structured interviews were conducted with 30 older people (aged 75+ years, taking multiple medicines) and 15 companions. Framework analysis was used to identify qualitative themes. Participants varied considerably in attitudes towards medicines, preferences for involvement in decision-making, and openness to deprescribing. Three types were identified. Type 1 held positive attitudes towards medicines, and preferred to leave decisions to their doctor. Type 2 voiced ambivalent attitudes towards medicines, preferred a proactive role, and were open to deprescribing. Type 3 were frail, perceived they lacked knowledge about medicines, and deferred most decisions to their doctor or companion. This study provides a novel typology to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing. To enable shared decision-making, prescribers need to adapt their communication about polypharmacy based on their patients' attitudes to medicines and preferences for involvement in decisions. © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Kohn, Marlana; Belza, Basia; Petrescu-Prahova, Miruna; Miyawaki, Christina E.
This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and…
Johanna C. Badcock
Full Text Available KEY POINTS➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement, highlighting the need for accurate assessment and tailored interventions.Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the
Badcock, Johanna C.; Dehon, Hedwige; Larøi, Frank
KEY POINTS ➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions. Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of
Boggs, Jennifer; Portz, Jennifer Dickman; Wright, Leslie; King, Diane; Grimm, Cathy; Retrum, Jessica; Gozansky, Wendolyn
Background/Aims Successful aging in place models promote independence, include older adults in decision-making, create an environment of personal and physical safety, facilitate social support, and provide services to enhance the health and quality of life of older adults within the communities in which they live. The applicability of aging in place models for disenfranchised groups is an important consideration. The current study, undertaken as part of a larger community-research partnership, examined the adequacy of this approach with older LGBT adults in a metropolitan neighborhood. Methods This qualitative study used focus groups (n = 14), interviews (n = 29), and a town hall (n = 30) to assess barriers and supports for LGBT persons to age in place. Results Most of the 73 participants identified as lesbian or gay, were aged 50–69, and lived with a partner. Discrimination and dual stigmatization (ageism plus heterosexism) emerged as cross-cutting themes that negatively impacted the aging in place categories of healthcare, housing, social support, home assistance and legal services. Establishing welcoming social spaces, disseminating knowledge resources, and promoting self-advocacy were suggested solutions. Conclusions This study provides a unique contribution to knowledge about the needs of LGBT older adults pertaining to aging in place. While resilience and coping skills developed at younger ages during the “coming out” process can continue to be leveraged in later years, LGBT seniors who are less “out” are likely particularly vulnerable to the challenges presented by the intersection of ageism and heterosexism. This research offers recommendations for tailoring current aging in place models to better suit the needs of LGBT older adults.
Sandlund, Marlene; Skelton, Dawn A; Pohl, Petra; Ahlgren, Christina; Melander-Wikman, Anita; Lundin-Olsson, Lillemor
To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women
Larsen, Stina Meyer; Mortensen, Rikke Falgreen; Kristensen, Hanne Kaae; Hounsgaard, Lise
To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT). A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13 th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation. Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E. The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older
Maier, Anja; Wynn, David C.; Howard, Thomas J.
The creation and use of models is central to engineering design, to the extent that designing might be perceived as a propagation from model to model and modelling may be described as the language of the designer (the terms product model and artefact model are used synonymously throughout...... out to add value for a given purpose and context. Implications of a cybernetic perspective that could guide effective modelling in design are discussed....
Putnam, Michelle; Pickard, Joseph G.; Rodriguez, Carroll; Shear, Erin
Persons with dementia are often excluded from consumer-directed home- and community-based service programs because they cannot direct their own care. Surrogates are permitted in some states, thereby allowing program participation. This study explored family caregiver perspectives on policies that support family needs related to providing care to…
Spinney, Jamie E L; Millward, Hugh
This research uses four nationally representative samples of time diary data, spanning almost 30 yr, that are fused with energy expenditure information to enumerate the median daily duration of moderate or vigorous effort activity, quantify the prevalence of Canadians age 65 yr and older who are meeting recommended daily levels of physical activity, and explore the factors affecting rates of active living. Results indicate that 41.1% of older Canadians met recommended levels of physical activity in 1992, 40.6% in 1998, 43.5% in 2005, and 39.6% in 2010. Both rates of active living and daily duration of aerobic activity exhibit significant differences among sociodemographic groups, with age, sex, activity limitation, urban-rural, and season exhibiting the most significant influences. This study illustrates the potential for time diary data to provide detailed surveillance of physical activity patterns, active aging research, and program development, as well.
Munjal, Kevin G; Shastry, Siri; Loo, George T; Reid, Daniel; Grudzen, Corita; Shah, Manish N; Chapin, Hugh H; First, Brandon; Sirirungruang, Sasilada; Alpert, Erin; Chason, Kevin; Richardson, Lynne D
Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement. We conducted a cross-sectional study on a convenience sample of patients and caregivers presenting to an urban academic ED between July 2012 and May 2013. Respondents were surveyed on levels of agreement with 13 statements corresponding to various aspects of a proposed patient-centered emergency response system including increased EMS access to healthcare records, shared decision making with the patient and/or primary care physician, transport to alternative destinations, and relative importance of EMS assessment versus transportation. Information on demographic and socioeconomic factors, level of acuity, and EMS utilization history were also determined via survey and chart review. Responses were analyzed descriptively and compared across patient characteristics using chi-square and regression analyses. A total of 621 patients were enrolled. The percentage of patients who agreed or strongly agreed with each of the 13 statements ranged from 48.2 to 93.8%. About 86% agreed with increased EMS access to healthcare records; approximately 72% agreed with coordinating disposition decisions with a primary physician; and about 58% supported transport to alternative destinations for low acuity conditions. No association was found between levels of agreement and the patient's level of acuity or EMS utilization history. Only Black or Hispanic race showed isolated associations with lower rates of agreement with some aspects of an innovative
VanDyke, Melanie M; Steffen, Ann M
This study developed and explored the preliminary reliability and validity of a 6-item Medication Saving Behaviors (MSB) scale when completed by family care partners of older adults. Women (N = 119) helping an aging relative with healthcare appointments and medication management completed an online survey including items related to generalized hoarding and medication saving behaviors. The MSB was psychometrically sound and correlated significantly with hoarding scales and reported number of expired and leftover medications. Compared with those reporting low levels of general hoarding concerns, group means on the MSB were higher for caregivers reporting clinically significant levels of hoarding by their elderly family member. The MSB was unrelated to total prescription or over-the-counter medications for the older adult, lending support for the discriminant validity of the scale. This study provides initial support for the convergent and discriminant validity of the MSB when administered to intergenerational care partners of older adults. The MSB may function to identify higher risk patients via their family members and target families for interventions.
Residential homes encourage new residents to bring belongings with them, so that they can personalise their room and 'feel at home'. Existing literature on material culture in residential homes views objects as symbols and repositories of home and identity, which can facilitate a sense of belonging in residents through their display in residents' rooms. I suggest that this both misunderstands the processual and fluid nature of home and identity, and conceptualises objects as essentially passive. This article uses ethnographic data and theories of practice and relationality to argue that rather than the meaning of home being inherent in objects, or felt subjectively by residents, meaning is generated through ongoing, everyday interactions between the two. I show that residents became at home by acquiring new things -as well as displaying existing possessions - and also through interacting with mundane objects in everyday social and relational practices such as cleaning and hosting. I conclude that being at home in older people's residential homes need not be so different from being at home at other stages of the life course and in other settings. This challenges conceptualisations of older people's homes - and older age itself - as somehow unknowable and unfamiliar. © 2018 Foundation for the Sociology of Health & Illness.
Wong, Rebeca; Espinoza, Mónica; Palloni, Alberto
Describe the Estudio Nacional de Salud y Envejecimiento en México (ENASEM), also known by its name in English as the Mexican Health and Aging Study (MHAS). This article summarizes the study design, its fieldwork protocol, survey contents, scope and analytical potential. It also presents descriptive results on selected topics. This is a prospective panel study on persons aged 50 or older in the year 2000. In the baseline survey, completed in 2001 with a national and urban-rural representation, about 15 200 interviews were completed. In the follow-up survey of the same persons in 2003, 90% of the attempted contacts resulted in successful interviews, and 546 interviews were completed about individuals who had died between the 2001 and 2003 visits. Descriptive results are presented on demographic characteristics, health, life style, institutional support, pensions, employment, family help, and two-year changes in health. There is evidence of large heterogeneity among older adults in Mexico, which is illustrated in a brief and precise way in the results presented. This study and its data bases have great analytical potential for exploring multiple dimensions in the health of older adults.
Northridge, Mary E; Schenkel, Andrew B; Birenz, Shirley; Estrada, Ivette; Metcalf, Sara S; Wolff, Mark S
To help eliminate reported racial/ethnic and socioeconomic inequities in oral health care, listening to the perspectives of racial/ethnic minority older adults on their experiences with dental school clinics is needed. The aim of this study was to examine the experiences of African American, Puerto Rican, and Dominican older adults who attend senior centers in upper Manhattan, New York City, regarding the care received at dental school clinics. Focus groups were conducted from 2013 to 2015 with 194 racial/ethnic minority men and women aged 50 years and older living in upper Manhattan. All of the 24 focus group sessions were digitally audiorecorded and transcribed for analysis. Groups conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Seven subthemes were manifest in the data related to these adults' positive experiences with dental school clinics: excellent outcomes and dentists, painless and safe treatment, affordable care, honest and reputable, benefits of student training, accepting and helpful, and recommended by family and friends. Negative experiences centered around four subthemes: multiple visits required for treatment, loss of interpersonal communication due to use of technology, inconvenient location, and perceived stigma with Medicaid. This study provided novel evidence of the largely positive experiences with dental schools of racial/ethnic minority senior center attendees. Interventions targeted at the organization and provider level, including organizational motivation, resources, staff attributes, climate, and teamwork plus payment programs and services, insurance and affordability, and provider- and system-level supports, may improve health care processes and patient experiences of care.
Page, Sharon; Coupe, Alastair; Barrett, Andrew
An increasing elderly population is leading to a change in the global demographics. This presents a new challenge to society and the pharmaceutical industry. This demographic shift is providing an opportunity for the pharmaceutical industry to meet the specific needs of the changing patient population. One issue that has been identified is defining what is meant by "an older patient", since this definition cannot be simply limited to chronological age. The fundamental purpose of the design and development process is to create a product that can be used by the patient group in a safe and efficacious manner. In the pharmaceutical industry ICH Q8 is used to guide the design and development of medicines. The process leads to the definition of the Quality Target Product Profile (QTPP) for a specific drug product and patient population. One can imagine a product with various presentations described in the QTPP which suit paediatrics, adults and older patients. It is recognised that designing medicines for smaller population groups will result in multiple presentations that could lead to smaller manufacturing batch sizes. In the short to medium term; dose flexibility, easy-to-swallow formulations, and easier access packaging are all factors under consideration. Dose flexibility could be achieved with various dosage forms such as oral liquids, mini-tablets, or multi-particulates. Whilst patient dosage preferences are beginning to be understood, further investigation is needed to balance the needs of the patient, care giver, prescriber, and payer. There also remain a number of challenges with the engineering solutions and delivery device for mini-tablets and multi-particulates (aside from filled capsules) to accurately and robustly deliver the dose, and issues with handling the device and the packaging for an older patient. It is also recognised that there are numerous challenges, not least of which is the definition of the older patient and a generic QTPP for an older
Zhang, Qiuyi; Northridge, Mary E; Jin, Zhu; Metcalf, Sara S
Increased lifespans and population growth have resulted in an older U.S. society that must reckon with the complex oral health needs that arise as adults age. Understanding accessibility to screening and treatment facilities for older adults is necessary in order to provide them with preventive and restorative services. This study uses an agent-based model to examine the accessibility of screening and treatment facilities via transportation networks for older adults living in the neighborhoods of northern Manhattan, New York City. Older adults are simulated as socioeconomically distinct agents who move along a GIS-based transportation network using transportation modes that mediate their access to screening and treatment facilities. This simulation model includes four types of mobile agents as a simplifying assumption: walk, by car, by bus, or by van (i.e., a form of transportation assistance for older adults). These mobile agents follow particular routes: older adults who travel by car, bus, and van follow street roads, whereas pedestrians follow walkways. The model enables the user to focus on one neighborhood at a time for analysis. The spatial dimension of an older adult's accessibility to screening and treatment facilities is simulated through the travel costs (indicated by travel time or distance) incurred in the GIS-based model environment, where lower travel costs to screening and treatment facilities imply better access. This model provides a framework for representing health-seeking behavior that is contextualized by a transportation network in a GIS environment.
Ehlman, Katie; Ligon, Mary
Generativity is a concept first introduced by Erik Erikson as a part of his psychosocial theory which outlines eight stages of development in the human life. Generativity versus stagnation is the main developmental concern of middle adulthood; however, generativity is also recognized as an important theme in the lives of older adults. Building on…
Kaplan, Daniel B; Andersen, Troy Christian; Lehning, Amanda J; Perry, Tam E
Some older adults are more vulnerable to housing concerns due to physical and cognitive challenges, including those with a neurocognitive disorder who need extensive support. Environmental gerontology frameworks, including Wiseman's 1980 Behavioral Model of Elderly Migration, have informed scholarship on aging in place and relocation. Understanding Wiseman's model, including considerations for working with families confronting a neurocognitive disorder, can help practitioners ensure that older clients live in settings that best meet their wants and needs.
Wang, Rosalie H; Korotchenko, Alexandra; Hurd Clarke, Laura; Mortenson, W Ben; Mihailidis, Alex
Collision avoidance technology has the capacity to facilitate safer mobility among older power mobility users with physical, sensory, and cognitive impairments, thus enabling independence for more users. Little is known about consumers' perceptions of collision avoidance. This article draws on interviews (29 users, 5 caregivers, and 10 prescribers) to examine views on design and utilization of this technology. Data analysis identified three themes: "useful situations or contexts," "technology design issues and real-life application," and "appropriateness of collision avoidance technology for a variety of users." Findings support ongoing development of collision avoidance for older adult users. The majority of participants supported the technology and felt that it might benefit current users and users with visual impairments, but might be unsuitable for people with significant cognitive impairments. Some participants voiced concerns regarding the risk for injury with power mobility use and some identified situations where collision avoidance might be beneficial (driving backward, avoiding dynamic obstacles, negotiating outdoor barriers, and learning power mobility use). Design issues include the need for context awareness, reliability, and user interface specifications. User desire to maintain driving autonomy supports development of collaboratively controlled systems. This research lays the groundwork for future development by illustrating consumer requirements for this technology.
Mortenson, W Ben; Sixsmith, Andrew; Woolrych, Ryan
There is a long history of surveillance of older adults in institutional settings and it is becoming an increasingly common feature of modern society. New surveillance technologies that include activity monitoring, and ubiquitous computing, which are described as ambient assisted living (AAL) are being developed to provide unobtrusive monitoring and support of activities of daily living and to extend the quality and length of time older people can live in their homes. However, concerns have been raised with how these kinds of technologies may affect user's privacy and autonomy. The objectives of this paper are 1) to describe the development of home-based surveillance technologies; 2) to examine how surveillance is being restructured with the use of this technology; and 3) to explore the potential outcomes associated with the adoption of AAL as a means of surveillance by drawing upon the theoretical work of Foucault and Goffman. The discussion suggests that future research needs to consider two key areas beyond the current discourse on technology and ageing, specifically: 1) how the new technology will encroach upon the private lived space of the individual, and 2) how it will affect formal and informal caring relationships. This is critical to ensure that the introduction of AAL does not contribute to the disempowerment of residents who receive this technology.
Melo, Denise da Silva; Martins, René Duarte; Jesus, Renata Patrícia Freitas Soares de; Samico, Isabella Chagas; Santo, Antônio Carlos Gomes do Espírito
To assess the quality of health care of older adults using as a parameter the assessment of the responsiveness of the service. This is a descriptive cross-sectional study conducted in a reference unit of the Brazilian Unified Health System at the outpatient level. The sample was probabilistic and had 385 older adults; data collection occurred in 2014. The domains assessed were: choice, autonomy, confidentiality, dignity, communication, physical facilities, and fast service. To this end, we used Pearson correlation test and Fisher's exact test. The domains of dignity, confidentiality, and communication reached the highest level of adequate responsiveness. On the other hand, freedom of choice and fast service received the worst assessments. Participation in decision-making regarding treatment was significantly lower among the older adults who had no education. In addition, the older adults that self-reported as black receive a lower quality of care regarding clear explanation and respected privacy in the appointment, when compared to users of any other race. Although most domains studied have receive a positive assessment, we have found a need for an equal care by the health professionals, regardless of race, education level, or any other adjective characteristic of older adults, users of public health services. Avaliar a qualidade da atenção à saúde da população idosa usando como parâmetro a avaliação da responsividade do serviço. Trata-se de um estudo descritivo, de corte transversal, realizado em uma unidade de referência do Sistema Único de Saúde em nível ambulatorial. A amostra foi probabilística composta por 385 idosos e a coleta de dados ocorreu em 2014. Foram avaliados os domínios: escolha, autonomia, confidencialidade, dignidade, comunicação, instalações físicas e atendimento rápido. Para tanto, foram utilizados o teste de correlação de Pearson e o teste de Fisher. Os domínios dignidade, confidencialidade e comunicação atingiram o
Evans, Bronwynne C; Crogan, Neva; Belyea, Michael; Coon, David
Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.
Nikolai, Tomas; Stepankova, Hana; Kopecek, Miloslav; Sulc, Zdenek; Vyhnalek, Martin; Bezdicek, Ondrej
Outside of the United States, international perspectives on normative data for neuropsychological test performance, within diverse populations, have been scarce. The neuropsychological test battery from the Uniform Data Set (UDS) of the Alzheimer's Disease Centers (ADC) program of the United States National Institute on Aging (NIA) is one of the most sensitive batteries for the evaluation of both normal cognitive aging and pathological cognitive decline. This study aimed to determine the feasibility of the Czech Neuropsychological Test Battery from the Uniform Data Set (UDS-Cz 2.0), while also evaluating the results obtained from an international perspective. This paper describes data from 520 cognitively normal participants. Regression analyses were used to describe the influence of demographic variables on UDS-Cz test performance. Cognitive performance on all measures declined with age, with patient education level serving as a protective factor. Therefore, the present study provides normative data for the UDS-Cz, adjusted for the demographic variables of age and education. The present study determines the psychometric properties of the UDS-Cz and establishes normative values in the aging Czech population, which can be used in clinical settings.
Raffard, Stéphane; Bortolon, Catherine; Burca, Marianna; Gely-Nargeot, Marie-Christine; Capdevielle, Delphine
Apathy defined as a mental state characterized by a lack of goal-directed behavior is prevalent and associated with poor functioning in older adults. The main objective of this study was to identify factors contributing to the distinct dimensions of apathy (cognitive, emotional, and behavioral) in older adults without dementia. One hundred and fifty participants (mean age, 80.42) completed self-rated questionnaires assessing apathy, emotional distress, anticipatory pleasure, motivational systems, physical functioning, quality of life, and cognitive functioning. Data were analyzed using partial least squares variance-based structural equation modeling in order to examine factors contributing to the three different dimensions of apathy in our sample. Overall, the different facets of apathy were associated with cognitive functioning, anticipatory pleasure, sensitivity to reward, and physical functioning, but the contribution of these different factors to the three dimensions of apathy differed significantly. More specifically, the impact of anticipatory pleasure and physical functioning was stronger for the cognitive than for emotional apathy. Conversely, the impact of sensibility to reward, although small, was slightly stronger on emotional apathy. Regarding behavioral apathy, again we found similar latent variables except for the cognitive functioning whose impact was not statistically significant. Our results highlight the need to take into account various mechanisms involved in the different facets of apathy in older adults without dementia, including not only cognitive factors but also motivational variables and aspects related to physical disability. Clinical implications are discussed.
Despite comprehensive school reform (CSR) model developers' best intentions to make school stakeholders adhere strictly to the implementation of model components, school stakeholders implementing CSR models inevitably make adaptations to the CSR model. Adaptations are made to CSR models because school stakeholders internalize CSR model practices…
This paper explores the foundation of the financial accounting model. We examine the properties of the accounting equation as the principal algorithm for the design and the development of a System Dynamics model. Key to the perspective is the foundational requirement that resolves the temporal
Ambalavanan, Namasivayam; Morty, Rory E
There have been many efforts to develop good animal models of bronchopulmonary dysplasia (BPD) to better understand the pathophysiology and mechanisms underlying development of BPD as well as to test potential strategies for its prevention and treatment. This Perspectives summarizes the features of common animal models of BPD and the strengths and limitations of such models. Potential optimal approaches to development of animal models are indicated, with the underlying concepts that require emphasis. Copyright © 2016 the American Physiological Society.
Jung, Dukyoo; Kang, Younhee; Kim, Mi Young; Ma, Rye-Won; Bhandari, Pratibha
The aim of this study was to identify risk factors for falls among community-dwelling older adults. The study used a cross-sectional descriptive design. Self-report questionnaires were used to collect data from 658 community-dwelling older adults and were analyzed using logistic and zero-inflated Poisson (ZIP) regression. Perceived health status was a significant factor in the count model, and fall efficacy emerged as a significant predictor in the logistic models. The findings suggest that fall efficacy is important for predicting not only faller and nonfaller status but also fall counts in older adults who may or may not have experienced a previous fall. The fall predictors identified in this study--perceived health status and fall efficacy--indicate the need for fall-prevention programs tailored to address both the physical and psychological issues unique to older adults. © The Author(s) 2014.
Grossmann, Mathis; Matsumoto, Alvin M
Middle-aged and older men (≥50 years), especially those who are obese and suffer from comorbidities, not uncommonly present with clinical features consistent with androgen deficiency and modestly reduced testosterone levels. Commonly, such men do not demonstrate anatomical hypothalamic-pituitary-testicular axis pathology but have functional hypogonadism that is potentially reversible. Literature review from 1970 to October 2016. Although definitive randomized controlled trials are lacking, evidence suggests that in such men, lifestyle measures to achieve weight loss and optimization of comorbidities, including discontinuation of offending medications, lead to clinical improvement and a modest increase in testosterone. Also, androgen deficiency-like symptoms and end-organ deficits respond to targeted treatments (such as phosphodiesterase-5 inhibitors for erectile dysfunction) without evidence that hypogonadal men are refractory. Unfortunately, lifestyle interventions remain difficult and may be insufficient even if successful. Testosterone therapy should be considered primarily for men who have significant clinical features of androgen deficiency and unequivocally low testosterone levels. Testosterone should be initiated either concomitantly with a trial of lifestyle measures, or after such a trial fails, after a tailored diagnostic work-up, exclusion of contraindications, and appropriate counseling. There is modest evidence that functional hypogonadism responds to lifestyle measures and optimization of comorbidities. If achievable, these interventions may have demonstrable health benefits beyond the potential for increasing testosterone levels. Therefore, treatment of underlying causes of functional hypogonadism and of symptoms should be used either as an initial or adjunctive approach to testosterone therapy.
Slovak, Karen; Pope, Natalie D; Brewer, Thomas W
It has been suggested that clinical screening for suicide, along with firearm assessment and safety counseling, are important in service provision to older adults. It is unclear, however, how geriatric case managers respond to these issues. This study surveyed geriatric case managers (n=161) from Area Agencies on Aging in Ohio on their knowledge, attitudes, and behaviors related to suicide, firearm assessment, and safety counseling. Results indicated that the majority of respondents (70%) agree their clients are at risk for suicide. However, few (30%) in this study reported that they assess for firearms and less than half (48%) discuss firearms with their clients/family members when specifically assessing for suicide. Analyses identified barriers that contribute to the decreased likelihood that routine firearm assessment and safety counseling would occur, such as lack of training and time. Implications include the need for training with geriatric case managers that addresses barriers to suicide, firearm assessment and safety counseling as a means to decrease these population risks.
Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as "almost theirs." The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection.
Norberg, Ragnar; Planchet, Frédéric
Focussing on life insurance and pensions, this book addresses various aspects of modelling in modern insurance: insurance liabilities; asset-liability management; securitization, hedging, and investment strategies. With contributions from internationally renowned academics in actuarial science, finance, and management science and key people in major life insurance and reinsurance companies, there is expert coverage of a wide range of topics, for example: models in life insurance and their roles in decision making; an account of the contemporary history of insurance and life insurance mathematics; choice, calibration, and evaluation of models; documentation and quality checks of data; new insurance regulations and accounting rules; cash flow projection models; economic scenario generators; model uncertainty and model risk; model-based decision-making at line management level; models and behaviour of stakeholders. With author profiles ranging from highly specialized model builders to decision makers at chief ex...
Matsumoto, Alvin M.
Abstract Context: Middle-aged and older men (≥50 years), especially those who are obese and suffer from comorbidities, not uncommonly present with clinical features consistent with androgen deficiency and modestly reduced testosterone levels. Commonly, such men do not demonstrate anatomical hypothalamic–pituitary–testicular axis pathology but have functional hypogonadism that is potentially reversible. Evidence Acquisition: Literature review from 1970 to October 2016. Evidence Synthesis: Although definitive randomized controlled trials are lacking, evidence suggests that in such men, lifestyle measures to achieve weight loss and optimization of comorbidities, including discontinuation of offending medications, lead to clinical improvement and a modest increase in testosterone. Also, androgen deficiency–like symptoms and end-organ deficits respond to targeted treatments (such as phosphodiesterase-5 inhibitors for erectile dysfunction) without evidence that hypogonadal men are refractory. Unfortunately, lifestyle interventions remain difficult and may be insufficient even if successful. Testosterone therapy should be considered primarily for men who have significant clinical features of androgen deficiency and unequivocally low testosterone levels. Testosterone should be initiated either concomitantly with a trial of lifestyle measures, or after such a trial fails, after a tailored diagnostic work-up, exclusion of contraindications, and appropriate counseling. Conclusions: There is modest evidence that functional hypogonadism responds to lifestyle measures and optimization of comorbidities. If achievable, these interventions may have demonstrable health benefits beyond the potential for increasing testosterone levels. Therefore, treatment of underlying causes of functional hypogonadism and of symptoms should be used either as an initial or adjunctive approach to testosterone therapy. PMID:28359097
Allen, Jacqueline; Hutchinson, Alison M; Brown, Rhonda; Livingston, Patricia M
Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow-up care and self-management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care. This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers. The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi-structured interviews about their experience of transition from hospital to home in an urban Australian health-care setting. Interview data were analysed using thematic analysis. All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health-care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self-care. Findings contribute to our understanding that quality transitional care should focus on patients' need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives. Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
Full Text Available Modelling of stable water isotopes H2 18O and HDO within various parts of the Earth’s hydrological cycle has clearly improved our understanding of the interplay between climatic variations and related isotope fractionation processes. In this article key principles and major research results of stable water isotope modelling studies are described. Emphasis is put on research work using explicit isotope diagnostics within general circulation models as this highly complex model setup bears many resemblances with studies using simpler isotope modelling approaches.
Full Text Available Differences in inhibitory ability between older (64-79 years, N=24 and younger adults (18-26 years, N =24 were investigated using a diffusion model analysis. Participants performed a task-switching paradigm that allows assessing n-2 task repetition costs, reflecting inhibitory control on the level of tasks, as well as n-1 response-repetition costs, reflecting inhibitory control on the level of responses. N-2 task repetition costs were of similar size in both age groups. Diffusion model analysis revealed that for both younger and older adults, drift rate parameters were smaller in the inhibition condition relative to the control condition, consistent with the idea that persisting task inhibition slows down response selection. Moreover, there was preliminary evidence for task inhibition effects in threshold separation and non-decision time in the older, but not the younger adults, suggesting that older adults might apply different strategies when dealing with persisting task inhibition. N-1 response-repetition costs in mean RT tended to be larger in older than younger adults, but in mean error rates were larger in younger than older adults. Diffusion-model analysis revealed longer non-decision times in response repetitions than response switches in both age groups, consistent with the idea that motor processes take longer in response repetitions than response switches due to persisting response inhibition of a previously executed response. The data also revealed age-related differences in overall performance: Older adults responded more slowly and more accurately than young adults, which was reflected by a higher threshold separation parameter in diffusion model analysis. Moreover, older adults showed larger non-decision times and higher variability in non-decision time than young adults, possibly reflecting slower and more variable motor processes. In contrast, overall drift rate did not differ between older and younger adults. Taken together
van Hoof, J; Kort, H S M; Rutten, P G S; Duijnstee, M S H
Ambient intelligence technologies are a means to support ageing-in-place by monitoring clients in the home. In this study, monitoring is applied for the purpose of raising an alarm in an emergency situation, and thereby, providing an increased sense of safety and security. Apart from these technological solutions, there are numerous environmental interventions in the home environment that can support people to age-in-place. The aim of this study was to investigate the needs and motives, related to ageing-in-place, of the respondents receiving ambient intelligence technologies, and to investigate whether, and how, these technologies contributed to aspects of ageing-in-place. This paper presents the results of a qualitative study comprised of interviews and observations of technology and environmental interventions in the home environment among 18 community-dwelling older adults with a complex demand for care. These respondents had a prototype of the Unattended Autonomous Surveillance system, an example of ambient intelligence technology, installed in their homes as a means to age-in-place. The UAS-system offers a large range of functionalities, including mobility monitoring, voice response, fire detection, as well as wandering detection and prevention, which can be installed in different configurations. The respondents had various motives to use ambient intelligence technologies to support ageing-in-place. The most prominent reason was to improve the sense of safety and security, in particular, in case of fall incidents, when people were afraid not to be able to use their existing emergency response systems. The ambient intelligence technologies were initially seen as a welcome addition to strategies already adopted by the respondents, including a variety of home modifications and assistive devices. The systems tested increased the sense of safety and security and helped to postpone institutionalisation. Respondents came up with a set of specifications in terms of
... tensor are taken into consideration, whereas the shear stresses are intentionally dropped with the purpose of providing a useful perspective, with which Winkler's model and its associated coefficient of subgrade reaction can be viewed. The formulation takes into account the variation of the elasticity modulus with depth.
Piboon, Kanchana; Subgranon, Rarcharneeporn; Hengudomsub, Pornpat; Wongnam, Pairatana; Louise Callen, Bonnie
The purposes of this study are to develop and empirically test a theoretical model that examines the relationships between a set of predictors and depression among older adults. A biopsychosocial model was tested with 317 community dwelling older adults residing in Chon Buri Province, Thailand. A face-to-face interview was used in a cross-sectional community-based survey. A hypothesized model of depression was tested by using path analysis. It was found that the modified model fitted the data and the predictors accounted for 60% of the variance in depression. Female gender, activities of daily living, loneliness, stressful life events, and emotional-focused coping had a positive direct effect on depression. Social support and problem-focused coping had a negative direct effect on depression. Additionally, perceived stress, stressful life events, loneliness, and income had a negative indirect effect on depression through social support. Female gender, activities of daily living, and perceived stress also had a positive indirect effect on depression through emotional-focused coping. Stressful life events, perceived stress, and income had a negative indirect effect on depression through problem-focused coping. These findings contribute to a better understanding of the variables that predict depression in older adults. Thus, health care providers should consider the effects of these contributing factors on depression in the older adult person and can devise a program to prevent and promote health in older adults alleviating depression.
Mahboobin, Arash; Loughlin, Patrick J; Redfern, Mark S
We conducted a dual-task experiment that involved information processing (IP) tasks concurrent with postural perturbations to explore the interaction between attention and sensory integration in postural control in young and older adults. A postural control model incorporating sensory integration and the influence of attention was fit to the data, from which parameters were then obtained to quantify the interference of attention on postural control. The model hypothesizes that the cognitive processing and integration of sensory inputs for balance requires time, and that attention influences this processing time, as well as sensory selection by facilitating specific sensory channels. Performing a concurrent IP task had an overall effect on the time delay. Differences in the time delay of the postural control model were found for the older adults. The results suggest enhanced vulnerability of balance processes in older adults to interference from concurrent cognitive IP tasks.
Felicia Cornelia MACARIE; Octavian MOLDOVAN
The present paper explores the degree in which universities could/should serve as role models for communities from the perspective of gender integration. Although the theoretical/ moral answer would be affirmative (universities should be in such a position that would allow local communities to regard them as role models of gender integration), the primary empirical analysis leads to another conclusion. A brief theoretical review (that connects gender discrimination, sustainable development, u...
Disclosure of information on strategies, business models, critical success factors, risk factors and value drivers in general has gained importance in recent years. Both policy makers and academics have argued that the demand for external communication of new types of value drivers is rising...... as companies increasingly base their competitive strengths and thus the value of the company on know-how, patents, skilled employees and other intangibles. In parallel with the focus on disclosure of value drivers, the concept of business models has gained popularity. However, business models in terms of “ways...... of doing business” have always existed. The business model reflects the way of competing of the specific company, whether it concerns being unique or being the most cost-efficient company in the industry....
Kosteli, Maria-Christina; Cumming, Jennifer; Williams, Sarah E
Limited research has investigated exercise imagery use in middle-aged and older adults and its relationship with affective and behavioral correlates. The study examined the association between self-regulatory imagery and physical activity (PA) through key social cognitive variables. Middle-aged and older adults (N = 299; M age = 59.73 years, SD = 7.73, range = 50 to 80) completed self-report measures assessing self-regulatory imagery use, self-efficacy, outcome expectations, perceived barriers, self-regulatory behavior, enjoyment, and PA levels. Path analysis supported a model (χ²  = 21.76, p = .08, CFI = .99, TLI = .97, SRMR = .03, RMSEA = .04) whereby self-regulatory imagery positively predicted self-efficacy, outcome expectations, and self-regulatory behaviors. Furthermore, self-regulatory imagery indirectly predicted barriers, outcome expectations, self-regulation, enjoyment, and PA. This research highlights self-regulatory imagery as an effective strategy in modifying exercise-related cognitions and behaviors. Incorporating social cognitive constructs into the design of imagery interventions may increase PA engagement.
Wong, Anna; Chau, Anson K C; Fang, Yang; Woo, Jean
Loneliness is a common experience among older people that is associated with health risks and negative well-being. As a psychological phenomenon, it has typically been defined in Western research literature as the discrepancy between desired and actual interpersonal relations. In our qualitative study in Hong Kong, we offer insight into ageing and loneliness in an urban environment of the non-Western world and propose to reconceptualise loneliness by exploring older people's experience of alienation at the societal level as an important but often neglected dimension of their loneliness. Thirty-seven community-dwelling, Chinese adults aged 65 and above were interviewed in focus groups and their accounts analysed and interpreted using a phenomenological approach. Findings revealed that focus group participants perceived insufficient care for older people, a growing distance between themselves and society, and their disintegrating identity in society to be primary sources of societal alienation. In response, older people adopted a more passive lifestyle, attributed marginalisation and inequality to old age, and developed negative feelings including unease towards ageing, vulnerability and helplessness, and anger. The emergence of these key components and underlying themes of societal alienation illuminated neglected facets of the psychological phenomenon of loneliness and highlighted new implications for policy, practice, and research from a societal perspective to address older people's loneliness in urban settings.
Full Text Available Organizations inform stakeholders about their current and future activities, processes, created value, strategic intentions, and other information that may influence the established relationships. Organizations choose to communicate with stakeholders by different means and in varied ways. The annual report represents a way of communicating between companies and their stakeholders, and it is offering comprehensive information about how companies operates and creates value. The business model is an emerging concept in management literature and practice. The concept describes the logic by which a organization creates, maintains and delivers value for its stakeholders. Through annual reports organisations can communicate to stakeholders information about their business models.We investigated how information about business models is explicitly communicated through annual reports, and how this information is reffering to stakeholders. Our paper aims to reveal which stakeholders are more often mentioned when organizations are communicating about business models through annual reports. This approach shows the attention degree given by organizations to stakeholders. We perceived this from a strategic point of view, as a strategic signal. Thus, we considered if the stakeholder is mentioned more frequent in the communicated message it has a greater role in communication strategy about business model. We conducted an exploratory research and have realized a content analysis.The analysed data consist in over a thousand annual reports from 96 organizations. We analysed the informations transmitted by organizations through annual reports. The annual reports were for a time period of 12 years. Most of the selected companies are multi-business, and are operating in different industries. The results show the stakeholder’s hierarchy based on how often they were mentioned in the communicated messages about business models through annual reports. Based on our
Rizzolo, Flavio; Velegrakis, Yannis; Mylopoulos, John; Bykau, Siarhei
The world is changing, and so must the data that describes its history. Not surprisingly, considerable research effort has been spent in Databases along this direction, covering topics such as temporal models and schema evolution. A topic that has not received much attention, however, is that of concept evolution. For example, Germany (instance-level concept) has evolved several times in the last century as it went through different governance structures, then split into two national entities that eventually joined again. Likewise, a caterpillar is transformed into a butterfly, while a mother becomes two (maternally-related) entities. As well, the concept of Whale (a class-level concept) changed over the past two centuries thanks to scientific discoveries that led to a better understanding of what the concept entails. In this work, we present a formal framework for modeling, querying and managing such evolution. In particular, we describe how to model the evolution of a concept, and how this modeling can be used to answer historical queries of the form "How has concept X evolved over period Y". Our proposal extends an RDF-like model with temporal features and evolution operators. Then we provide a query language that exploits these extensions and supports historical queries.
Oliver, T. Emerson; Anzalone, Evan; Park, Thomas; Geohagan, Kevin
The SLS Program has implemented a Model-based Design (MBD) and Model-based Requirements approach for managing component design information and system requirements. This approach differs from previous large-scale design efforts at Marshall Space Flight Center where design documentation alone conveyed information required for vehicle design and analysis and where extensive requirements sets were used to scope and constrain the design. The SLS Navigation Team is responsible for the Program-controlled Design Math Models (DMMs) which describe and represent the performance of the Inertial Navigation System (INS) and the Rate Gyro Assemblies (RGAs) used by Guidance, Navigation, and Controls (GN&C). The SLS Navigation Team is also responsible for navigation algorithms. The navigation algorithms are delivered for implementation on the flight hardware as a DMM. For the SLS Block 1B design, the additional GPS Receiver hardware model is managed as a DMM at the vehicle design level. This paper describes the models, and discusses the processes and methods used to engineer, design, and coordinate engineering trades and performance assessments using SLS practices as applied to the GN&C system, with a particular focus on the navigation components.
Potter, G.L.; Corsetti, L.; Slingo, J.M.
Radiation fields from a perpetual July integration of a T106 version of the ECM-WF operational model are used to identify the most appropriate way to diagnose cloud radiative forcing in a general circulation model, for the purposes of intercomparison between models. Differences between the Methods I and II of Cess and Potter (1987) and a variant method are addressed. Method I is shown to be the least robust of all methods, due to the potential uncertainties related to persistent cloudiness, length of the sampling period and biases in retrieved clear-sky quantities due to insufficient sampling of the diurnal cycle. Method II is proposed as an unambiguous way to produce consistent radiative diagnostics for intercomparing model results. The impact of the three methods on the derived sensitivities and cloud feedbacks following an imposed change in sea surface temperature is discussed. The sensitivity of the results to horizontal resolution is considered by using the diagnostics from parallel integrations with T21 version of the model
Full Text Available This paper proposes a model of country brand equity that incorporates the issue of sustainability in determining destination brand equity. In particular, the model includes elements of sustainability as its core dimensions and promotes the concept of the country sustainability promise that transforms destination resources into the positive perception and experience. The theoretical model is empirically tested using global secondary data confirming that country image is the most important element followed by sustainability and loyalty. Also, the analysis suggests the existence of the higher order construct confirming the country brand equity concept. Based on the research findings, the article offers some implications to the destination managers by suggesting the direction for further development and strategy implementation.
Gibson, Donald E.; Barron, Lisa A.
A sample of 182 engineering managers over age 40 were able to identify multiple role models in their organization. The degree to which they perceived having access to role models and sharing similar attitudes, values, and goals with them was associated with organizational commitment and job satisfaction. (Contains 62 references.) (SK)
Göknil, Arda; Topaloglu, N.Y.
Model Driven Engineering (MDE) aims to facilitate building larger and more complex, reliable software systems by introducing a higher abstraction level than the code level. The technical space concept discusses how the basic MDE principles may be mapped onto modern platform support and several
Macucci, M.; Lannaccone, G.; Greer, J.
During the meetings of the theory and modelling working group, within the MEL-ARI (Microelectronics Advanced Research Initiative) and NID-FET (Nanotechnology information Devices-Future and Emerging Technologies) initiatives of the European Commission, we have been discussing the current status...
Jones, Gareth R; Stathokostas, Liza; Young, Bradley W; Wister, Andrew V; Chau, Shirley; Clark, Patricia; Duggan, Mary; Mitchell, Drew; Nordland, Peter
Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines. An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older. A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults. Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.
Blaszczyk, Michael I.
We consider the compactification of heterotic string theory on toroidal orbifolds and their resolutions. In the framework of gauged linear sigma models we develop realizations of such spaces, allowing to continously vary the moduli and thus smoothly interpolate between different corners of the theory. This way all factorizable orbifold resolutions as well as some non-factorizable ones can be obtained. We find that for a given geometry there are many model which realize it as a target space, differing in their complexity. We explore regions of moduli space which otherwise would not be accessible. In particular we are interested in the orbifold regime, where exact string calculations are possible, and the large volume regime, where techniques of supergravity compactification can be applied. By comparing these two theories and matching the spectra we find evidence for non-perturbative effects which interpolate between these regimes.
Shin, So Young
To evolve a management plan for rheumatoid arthritis, it is necessary to understand the patient's symptom experience and disablement process. This paper aims to introduce and critique two models as a conceptual foundation from which to construct a new model for arthritis care. A Disability Intervention Model for Older Adults with Arthritis includes three interrelated concepts of symptom experience, symptom management strategies, and symptom outcomes that correspond to the Theory of Symptom Management. These main concepts influence or are influenced by contextual factors that are situated within the domains of person, environment, and health/illness. It accepts the bidirectional, complex, dynamic interactions among all components within the model representing the comprehensive aspects of the disablement process and its interventions in older adults with rheumatoid arthritis. In spite of some limitations such as confusion or complexity within the model, the Disability Intervention Model for Older Adults with Arthritis has strengths in that it encompasses the majority of the concepts of the two models, attempts to compensate for the limitations of the two models, and aims to understand the impact of rheumatoid arthritis on a patient's physical, cognitive, and emotional health status, socioeconomic status, and well-being. Therefore, it can be utilized as a guiding theoretical framework for arthritis care and research to improve the functional status of older adults with rheumatoid arthritis. Copyright © 2014. Published by Elsevier B.V.
In most areas of the world the record of historical seismicity is too short or uncertain to accurately characterize the future distribution of earthquakes of different sizes in time and space. Most faults have not ruptured once, let alone repeatedly. Ultimately, the ability to correctly forecast the magnitude, location, and probability of future earthquakes depends on how well one can quantify the past behavior of earthquake sources. Paleoseismological trenching of active faults, historical surface ruptures, liquefaction features, and shaking-induced ground deformation structures provides fundamental information on the past behavior of earthquake sources. These studies quantify (a) the timing of individual past earthquakes and fault slip rates, which lead to estimates of recurrence intervals and the development of recurrence models and (b) the amount of displacement during individual events, which allows estimates of the sizes of past earthquakes on a fault. When timing and slip per event are combined with information on fault zone geometry and structure, models that define individual rupture segments can be developed. Paleoseismicity data, in the form of timing and size of past events, provide a window into the driving mechanism of the earthquake engine--the cycle of stress build-up and release
Gobbens, R.J.J.; Krans, A.; van Assen, M.A.L.M.
Objective The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods Between June 2013 and May 2014
Gobbens, Robbert J J; Krans, Anita; van Assen, Marcel A L M
Objective: The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods: Between June 2013 and May 2014
Stiggelbout, M.; Hopman-Rock, M.; Crone, M.; Lechner, L.; Mechelen, W. van
Little is known about the predictors of maintenance in organized exercise programmes. The aim of this study was to investigate the behavioral predictors of maintenance of exercise participation in older adults, using an integrated social psychological model. To this end, we carried out a prospective
Pham, Tam N; Carrougher, Gretchen J; Martinez, Erin; Lezotte, Dennis; Rietschel, Carly; Holavanahalli, Radha; Kowalske, Karen; Esselman, Peter C
Older patients with burn injury have a greater likelihood for discharge to nursing facilities. Recent research indicates that older patients discharged to nursing facilities are two to three times as likely to die within a 3-year period relative to those discharged to home. In light of these poor long-term outcomes, we conducted this study to identify predictors for discharge to independent vs nonindependent living status in older patients hospitalized for burns. We retrospectively reviewed all older adults (age ≥ 55 years) who were prospectively enrolled in a longitudinal multicenter study of outcomes from 1993 to 2011. Patient, injury, and treatment outcomes data were analyzed. Recognizing that transfer to inpatient rehabilitation may have impacted final hospital discharge disposition: we assessed the likelihood of inpatient rehabilitation stay, based on identified predictors of inpatient rehabilitation. We subsequently performed a logistic regression analysis on the clustered, propensity-matched cohort to assess associations of burn and injury characteristics on the primary outcome of final discharge status. A total of 591 patients aged ≥55 years were treated and discharged alive from three participating U.S. burn centers during the study period. Mean burn size was 14.8% (SD 11.2%) and mean age was 66.7 years (SD 9.3 years). Ninety-three patients had an inpatient rehabilitation stay before discharge (15.7%). Significant factors predictive of inpatient rehabilitation included a burn >20% TBSA, mechanical ventilation, older age, range of motion deficits at acute care discharge, and study site. These factors were included in the propensity model. Four hundred seventy-one patients (80%) were discharged to independent living status. By matched propensity analysis, older age was significantly associated with a higher likelihood of discharge to nonindependent living (P burn centers need to be elucidated to better understand discharge disposition status in older
Mahlman, Jerry D.
Recognition that earth's climate and biogeophysical conditions are likely changing due to human activities has led to a heightened awareness of the need for improved long-term global monitoring. The present long-term measurement efforts tend to be spotty in space, inadequately calibrated in time, and internally inconsistent with respect to other instruments and measured quantities. In some cases, such as most of the biosphere, most chemicals, and much of the ocean, even a minimal monitoring program is not available. Recently, it has become painfully evident that emerging global change issues demand information and insights that the present global monitoring system simply cannot supply. This is because a monitoring system must provide much more than a statement of change at a given level of statistical confidence. It must describe changes in diverse parts of the entire earth system on regional to global scales. It must be able to provide enough input to allow an integrated physical characterization of the changes that have occurred. Finally, it must allow a separation of the observed changes into their natural and anthropogenic parts. The enormous policy significance of global change virtually guarantees an unprecedented level of scrutiny of the changes in the earth system and why they are happening. These pressures create a number of emerging challenges and opportunities. For example, they will require a growing partnership between the observational programs and the theory/modeling community. Without this partnership, the scientific community will likely fall short in the monitoring effort. The monitoring challenge before us is not to solve the problem now, but rather to set appropriate actions in motion so as to create the required framework for solution. Each individual piece needs to establish its role in the large problem and how the required interactions are to take place. Below, we emphasize some of the needs and opportunities that could and should be
Stakeholder literature has acknowledged the need to complement the extant theory on stakeholder management by more dynamic perspectives. This article makes use of the recent terminology of stakewatcher and stakeseeker to illustrate the dynamic aspect of stakeholder theory transposed in the graphical representation of Freeman’s stakeholder model. Presenting a few selected case studies, it applies the scheme on the concept of value responsibility chain; it exemplifies the role of stakeseekers i...
The Shuttle Radar Topography Mission (SRTM) has produced the first high-resolution, near-global elevation dataset of Earth. In recognition of this achievement, and as an illustration of the data, the United States Library of Congress now displays a 'solid terrain model' of Los Angeles and adjacent mountainous terrain. The model was created by carving a high-density foam block using computer-guided drills that referenced the SRTM dataset. The block was then covered with a Landsat satellite image using computer-guided paint guns that referenced both the Landsat image and the SRTM dataset. The view shown here mimics the actual model on display at the Library of Congress and was generated from the same satellite image and elevation data sets. The model shows the Pacific Ocean and Santa Monica Mountains along the Malibu Coast (lower left), San Fernando Valley (left center), downtown Los Angeles (bottom center), San Gabriel and Pomona Valleys (lower right), San Gabriel Mountains (right center to far right), and part of the Mojave Desert (upper right). Colors are enhanced true color with added topographic shading, and elevation differences are exaggerated 1.5 times. The view is toward the north-northwest. The Los Angeles region was chosen for the Library of Congress model because it illustrates so many ways that topography affects the daily lives of people. The region consists of a coastal plain, inland valleys, mountains up to 3068 meters (10,064 feet), and a desert interior. Topography blocks the landward influence of marine airmasses here such that summer temperatures often differ by 40 degrees Fahrenheit (22 C) across this region at a given moment even at similar elevations. Temperatures also typically cool with rising elevation, and winter storms drop most of their moisture in the mountains, leaving little rainfall for areas further inland, thus creating the deserts. Topography also controls the land use pattern. The mountains are mostly very rugged, which greatly
Kaskie, Brian P; Leung, Carol; Kaplan, Mark S
A central objective of the Surgeon General's National Strategy for Suicide Prevention is to focus on older adults. We review individual risk-factors for suicide in late life and then introduce an ecological model to expand conceptualization of elder suicide. We first look at the role of firearms, providing evidence that firearm availability increases the means of elder suicide and gun access policies can contribute to reducing risk. Next, we focus on primary care providers, documenting how older adults often come into contact with these professionals before ending their lives and how these providers could take a more active role in mediating individual-level risk factors. We then turn our attention to the intersection between gun access and primary care and consider how advancing standards of care concerning gun access and suicide risk might be an effective policy alternative for blocking the pathway to suicide among older adults.
Howard, Elizabeth P; Schreiber, Robert; Morris, John N; Russotto, Aline; Flashner-Fineman, Susan
Health care leaders and providers have introduced the assumption the typical elder, even in the presence of complex, chronic disease and prevailing illness, is capable of assuming greater personal responsibility for their health care, with a shift from provider-centered to a person-centered model of care. For older adults who often and repeatedly face challenges managing and maintaining their health status, guidance and support is needed. In this study, COLLAGE 360 , a comprehensive assessment system and wellness coaching program that focuses on prevention and wellness, care coordination and self-management of health care was implemented in one continuing care retirement community. Following completion of two assessment tools via directed conversation with a wellness coach, older adults developed an individualized vitality plan that outlined life goals, supporting goals and action plans for goal achievement. Results from this program suggest engagement in the assessment and wellness coaching process via the COLLAGE 360 program translated into sample older adults sensing that they live in a more supportive environment when compared with elders not receiving any wellness coaching. In addition, the older adults had positive effects in the areas of mood, loneliness, social interaction, health status, and life satisfaction. Strategies to improve health and well being need an extended focus beyond the older adult's medical conditions and consider psychological, spiritual and social needs with personal preferences being paramount. These issues are foundational to a person-centered, health promotion approach needed among this population.
Holliday, Heather V; Jenstad, Lorienne M; Grosjean, Garnet; Purves, Barbara
The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.
van Marion, Denise M S; Domanska, Urszula M; Timmer-Bosscha, Hetty; Walenkamp, Annemiek M E
Cancer metastasis causes most cancer-related deaths. Several model systems to study the complex and multi step process of metastasis exist, including in vitro systems, ex-vivo organ slices, Drosophila Melanogaster and zebrafish models and the use of the chorio allantoic membrane (CAM) of fertilized chicken eggs. These models are relatively easy and cheap but often lack the opportunity to study the complete metastasis cascade. More complex but also more expensive is the use of animal models including the more recently developed patient derived tumor xenografts (PDTX). In this review, we give an overview of the existing metastatic models, discuss the challenges of improving current models to enhance translation from the preclinical to the clinical setting and consider future perspectives. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Mahboobin, Arash; Loughlin, Patrick J.; Redfern, Mark S.
We conducted a dual-task experiment that involved information processing (IP) tasks concurrent with postural perturbations to explore the interaction between attention and sensory integration in postural control in young and older adults. A postural control model incorporating sensory integration and the influence of attention was fit to the data, from which parameters were then obtained to quantify the interference of attention on postural control. The model hypothesizes that the cognitive p...
Gubernskaya, Zoya; Tang, Zequn
Older immigrants are more likely to share residence with their adult children and other family members than are U.S.-born older adults. Because socioeconomic factors only partially explain these differences and direct measures of cultural preferences are seldom available, the persistently high rates of intergenerational coresidence among the older foreign-born are often interpreted as driven by cultural preferences and/or a lack of assimilation. To challenge this interpretation, this study investigates the extent to which older immigrants' living arrangements deviate from those of older adults in their home countries. The analysis combines data on immigrants from the 2008-2012 American Community Survey (ACS) with census data from three major immigrant-sending countries: Mexico, the Dominican Republic, and Vietnam. Despite persistent differences from U.S.-born whites, coresidence in later life is significantly less common than in the sending countries among the older foreign-born who migrated as young adults, and especially among those who migrated as children. The older foreign-born who migrated after age 50, however, are more likely to coreside and less likely to live independently than the older adults in their home countries. The similarity of these patterns across the three immigrant subgroups suggests that the unusually high coresidence among late-life immigrants is driven by U.S. family reunification policy and not simply by cultural influences.
Objective To explore what might encourage older people to exercise at home after falls rehabilitation. Design: Qualitative research methods were used based on a grounded theory approach, to provide insights into older adults' experiences following a fall, of both rehabilitation and home exercise. Setting: Community dwellings. Method: Nine…
Regterschot, G. Ruben H.; Morat, Tobias; Folkersma, Marjanne; Zijlstra, Wiebren
Leg muscle strength (LMS) and leg muscle power (LMP) are determinants of aspects of functional status and important parameters for measuring intervention effects in older adults. Field tests are often used for the evaluation of LMS and LMP in older persons. However, criteria important for the
Ali, Saad; Manocha, Dinesh; Shah, Mubarak
Over the last several years there has been a growing interest in developing computational methodologies for modeling and analyzing movements and behaviors of 'crowds' of people. This interest spans several scientific areas that includes Computer Vision, Computer Graphics, and Pedestrian Evacuation Dynamics. Despite the fact that these different scientific fields are trying to model the same physical entity (i.e. a crowd of people), research ideas have evolved independently. As a result each discipline has developed techniques and perspectives that are characteristically their own.
Lyons, K. J.; Salsbury, S. A.; Hondras, M. A.
implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis. Results: Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model...
Howcroft, Jennifer; Lemaire, Edward D; Kofman, Jonathan
Wearable sensors have potential for quantitative, gait-based, point-of-care fall risk assessment that can be easily and quickly implemented in clinical-care and older-adult living environments. This investigation generated models for wearable-sensor based fall-risk classification in older adults and identified the optimal sensor type, location, combination, and modelling method; for walking with and without a cognitive load task. A convenience sample of 100 older individuals (75.5 ± 6.7 years; 76 non-fallers, 24 fallers based on 6 month retrospective fall occurrence) walked 7.62 m under single-task and dual-task conditions while wearing pressure-sensing insoles and tri-axial accelerometers at the head, pelvis, and left and right shanks. Participants also completed the Activities-specific Balance Confidence scale, Community Health Activities Model Program for Seniors questionnaire, six minute walk test, and ranked their fear of falling. Fall risk classification models were assessed for all sensor combinations and three model types: multi-layer perceptron neural network, naïve Bayesian, and support vector machine. The best performing model was a multi-layer perceptron neural network with input parameters from pressure-sensing insoles and head, pelvis, and left shank accelerometers (accuracy = 84%, F1 score = 0.600, MCC score = 0.521). Head sensor-based models had the best performance of the single-sensor models for single-task gait assessment. Single-task gait assessment models outperformed models based on dual-task walking or clinical assessment data. Support vector machines and neural networks were the best modelling technique for fall risk classification. Fall risk classification models developed for point-of-care environments should be developed using support vector machines and neural networks, with a multi-sensor single-task gait assessment.
Full Text Available Wearable sensors have potential for quantitative, gait-based, point-of-care fall risk assessment that can be easily and quickly implemented in clinical-care and older-adult living environments. This investigation generated models for wearable-sensor based fall-risk classification in older adults and identified the optimal sensor type, location, combination, and modelling method; for walking with and without a cognitive load task. A convenience sample of 100 older individuals (75.5 ± 6.7 years; 76 non-fallers, 24 fallers based on 6 month retrospective fall occurrence walked 7.62 m under single-task and dual-task conditions while wearing pressure-sensing insoles and tri-axial accelerometers at the head, pelvis, and left and right shanks. Participants also completed the Activities-specific Balance Confidence scale, Community Health Activities Model Program for Seniors questionnaire, six minute walk test, and ranked their fear of falling. Fall risk classification models were assessed for all sensor combinations and three model types: multi-layer perceptron neural network, naïve Bayesian, and support vector machine. The best performing model was a multi-layer perceptron neural network with input parameters from pressure-sensing insoles and head, pelvis, and left shank accelerometers (accuracy = 84%, F1 score = 0.600, MCC score = 0.521. Head sensor-based models had the best performance of the single-sensor models for single-task gait assessment. Single-task gait assessment models outperformed models based on dual-task walking or clinical assessment data. Support vector machines and neural networks were the best modelling technique for fall risk classification. Fall risk classification models developed for point-of-care environments should be developed using support vector machines and neural networks, with a multi-sensor single-task gait assessment.
Jastrzembski, Tiffany S.; Charness, Neil
The authors estimate weighted mean values for nine information processing parameters for older adults using the Card, Moran, and Newell (1983) Model Human Processor model. The authors validate a subset of these parameters by modeling two mobile phone tasks using two different phones and comparing model predictions to a sample of younger (N = 20; Mage = 20) and older (N = 20; Mage = 69) adults. Older adult models fit keystroke-level performance at the aggregate grain of analysis extremely well (R = 0.99) and produced equivalent fits to previously validated younger adult models. Critical path analyses highlighted points of poor design as a function of cognitive workload, hardware/software design, and user characteristics. The findings demonstrate that estimated older adult information processing parameters are valid for modeling purposes, can help designers understand age-related performance using existing interfaces, and may support the development of age-sensitive technologies. PMID:18194048
Ip, Edward H; Zhang, Qiang; Rejeski, W Jack; Harris, Tamara B; Kritchevsky, Stephen
At both the individual and societal levels, the health and economic burden of disability in older adults is enormous in developed countries, including the U.S. Recent studies have revealed that the disablement process in older adults often comprises episodic periods of impaired functioning and periods that are relatively free of disability, amid a secular and natural trend of decline in functioning. Rather than an irreversible, progressive event that is analogous to a chronic disease, disability is better conceptualized and mathematically modeled as states that do not necessarily follow a strict linear order of good-to-bad. Statistical tools, including Markov models, which allow bidirectional transition between states, and random effects models, which allow individual-specific rate of secular decline, are pertinent. In this paper, we propose a mixed effects, multivariate, hidden Markov model to handle partially ordered disability states. The model generalizes the continuation ratio model for ordinal data in the generalized linear model literature and provides a formal framework for testing the effects of risk factors and/or an intervention on the transitions between different disability states. Under a generalization of the proportional odds ratio assumption, the proposed model circumvents the problem of a potentially large number of parameters when the number of states and the number of covariates are substantial. We describe a maximum likelihood method for estimating the partially ordered, mixed effects model and show how the model can be applied to a longitudinal data set that consists of N = 2,903 older adults followed for 10 years in the Health Aging and Body Composition Study. We further statistically test the effects of various risk factors upon the probabilities of transition into various severe disability states. The result can be used to inform geriatric and public health science researchers who study the disablement process.
Gibson, Stephen J
This year represents the international year against pain in older persons and it is opportune, therefore, to reflect upon the current status and possible future directions in pain-management practice for this large and growing segment of the population. Epidemiologic studies show a very high prevalence of persistent pain, often exceeding 50% of community-dwelling older persons and up to 80% of nursing home residents. Recently, there has been a major push to develop age-appropriate pain assessment tools, including several observer-rated scales of behavioral pain indicators for use in those with dementia. There has also been the release of several comprehensive guidelines for the assessment and management of pain in older persons, although the current evidence-base used to guide clinical practice is extremely limited. Unfortunately, despite these advances, pain remains grossly under treated in older persons, regardless of the healthcare setting. With the demographic imperative of a rapidly aging society, much greater attention is now being devoted to the problem of geriatric pain, with new initiatives in healthcare planning, calls for better professional education in geriatrics and pain management as well as new directions and funding resources for research into this important problem. Of course, this increased awareness must still be translated into action, not just because better pain relief for older adults is an ethically desirable outcome, but out of the sheer necessity of dealing with the millions of older persons who will suffer from persistent and bothersome pain in the years to come.
Hammar, Lena Marmstål; Holmström, Inger K; Skoglund, Karin; Meranius, Martina Summer; Sundler, Annelie J
Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. The aim of this study was to investigate student nurses' views on the care of and communication with older people. A descriptive study with a mixed-method approach was conducted. Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.
Matusiak Bożena Ewa
Full Text Available The paper presents an overall view of the business model (BM for the e-balance system for: balancing energy production and consumption in energy efficient, smart neighbourhoods (the e-balance project, FP7-SMARTCITIES-2013 along with its functionalities, based upon the Osterwalder’s canvas methodology. Additionally, this is the second, after two years of work, more incisive evaluation of the BM from the user’s and demo site’s perspective (Bronsbergen, the Netherlands. The aim of this paper is to present results and assess the above mentioned BM in the face its commercialisation and applicability to Europe.
The paper considers electronic governmental activities from a business perspective, resulting in a so-called governmental value chain model. This model aims to support practitioners for better understanding and realisation of joint organisational and information system innovations in the public
Lyons, Kevin J; Salsbury, Stacie A; Hondras, Maria A; Jones, Mark E; Andresen, Andrew A; Goertz, Christine M
While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model. We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants' care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis. Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model. Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record
Zhao, Xufeng; Al-Khalifa, Khalifa N.; Magid Hamouda, Abdel; Nakagawa, Toshio
Age replacement models are fundamental to maintenance theory. This paper summarizes our new perspectives and hods in age replacement models: First, we optimize the expected cost rate for a required availability level and vice versa. Second, an asymptotic model with simple calculation is proposed by using the cumulative hazard function skillfully. Third, we challenge the established theory such that preventive replacement should be non-random and only corrective replacement should be made for the unit with exponential failure. Fourth, three replacement policies with random working cycles are discussed, which are called overtime replacement, replacement first, and replacement last, respectively. Fifth, the policies of replacement first and last are formulated with general models. Sixth, age replacement is modified for the situation when the economical life cycle of the unit is a random variable with probability distribution. Finally, models of a parallel system with constant and random number of units are taken into considerations. The models of expected cost rates are obtained and optimal replacement times to minimize them are discussed analytically and computed numerically. Further studies and potential applications are also indicated at the end of discussions of the above models. - Highlights: • Optimization of cost rate for availability level is discussed and vice versa. • Asymptotic and random replacement models are discussed. • Overtime replacement, replacement first and replacement last are surveyed. • Replacement policy with random life cycle is given. • A parallel system with random number of units is modeled.
Shao, Jung-Hua; Chuang, Yeu-Hui; Chen, Su-Hui
To revise items in the Cardiac Diet Self-Efficacy Scale, Chinese version (CDSE-C) using focus groups. There is limited literature on using focus groups with older adults as well as nursing and nutrition professionals to revise a questionnaire. A qualitative research with multi-perspective focus-group approach was used from February through June 2009. Four serial focus groups were conducted including two focus groups of older adults from Taipei County (n = 6) and Yilan County (n = 6), one group of 5 nursing professionals, and one group of 4 nutritionists. Serial focus group discussions added one category to the CDSE-C (reducing salt) and 3 items, resulting in an 18-item scale with six categories: healthy eating behaviors, reducing fat and cholesterol, resisting relapse, increasing fiber and vegetable, reducing sugar, and reducing salt. This revised measure can serve as a reliable tool for assessing older Chinese adults' healthy eating self-efficacy to evaluate and improve nutritional status in this population.
Schwantes, C. R.; McGibbon, R. T.; Pande, V. S.
Molecular dynamics simulations have the potential to provide atomic-level detail and insight to important questions in chemical physics that cannot be observed in typical experiments. However, simply generating a long trajectory is insufficient, as researchers must be able to transform the data in a simulation trajectory into specific scientific insights. Although this analysis step has often been taken for granted, it deserves further attention as large-scale simulations become increasingly routine. In this perspective, we discuss the application of Markov models to the analysis of large-scale biomolecular simulations. We draw attention to recent improvements in the construction of these models as well as several important open issues. In addition, we highlight recent theoretical advances that pave the way for a new generation of models of molecular kinetics
Bergsteiner, Harald; Avery, Gayle C.; Neumann, Ruth
Kolb's experiential learning theory has been widely influential in adult learning. The theory and associated instruments continue to be criticized, but rarely is the graphical model itself examined. This is significant because models can aid scientific understanding and progress, as well as theory development and research. Applying accepted…
Lyudmila A. Mikhailova
Full Text Available Purpose: the main goal of the article is to define the development perspectives of the new franchising models in Russia (specifically quasifranchising, freedom franchising and branchising. To achieve this the following tusks should be completed: to define the specific characteristics of the following models as well as the factors which influenced their occurrence; to question Russian franchisors in order to understand their desire to develop their business under the new franchising models; to identify the key development possibilities of the new franchising models in Russia based on the gathered data. Methods: the article was prepared with the help of theoretical as well as economic analysis. Moreover, the series of the formalized telephone interviews with the Russian businessmen were conducted by the author. Based on the results gathered the conclusions on the development perspectives of the new franchising models in Russia were drawn. Results: currently new franchising models are conquering the Russian market. In comparison to the classical franchising model new franchising models are riskier for the franchisor due to the certain freedom available to franchisees. Quasifranchising, which is based on the business model transfer without the brand transfer, is suitable for the young concepts and for the franchisors seeking for the increasing number of franchisees. Freedom franchising enabling assortment and outlook variety of the point of contact is a good alternative for the franchisees who struggle for individuality even in the boundaries of the franchise as well as for the franchisors looking for the franchisees of that kind. Finally, branchising, which means franchisor’s and franchisee’s co-investment, is applicable for the franchises with high level of investments needed. Conclusions and Relevance: the materials of the article show the certain place of the new franchising models on the Russian market. They make it possible to adjust the
Full Text Available Introduction. The benefits of physical activity (PA have been so well documented that there is no doubt about the significance of PA for personal and social health. Several theoretical models have been proposed with a view to understanding the phenomenon of PA and other health behaviours. The purpose of this study was to evaluate if and how the variables suggested in the Health Belief Model (HBM determine physical activity stages of change in older adults. Material and methods. A total of 172 students of Universities of the Third Age aged 54 to 75 (mean = 62.89 ± 4.83 years agreed to participate in the study, filling out an anonymous survey measuring their stage of exercise change and determinants of health behaviours proposed by the HBM, including: perceived benefits of physical activity, perceived barriers to physical activity, perceived severity of diseases associated with sedentary lifestyle, perceived susceptibility to these diseases, and self-efficacy. Results. The results only partially support the hypothesis that the HBM predicts intentions and behaviours related to the physical activity of older adults. Only two variables were moderately-to-strongly related to stages of exercise change, namely perceived barriers and self-efficacy. Conclusion. Interventions aimed at informing older adults about the benefits of physical activity and the threats associated with sedentary lifestyle can be expected to have rather a weak influence on their readiness for physical activity.
Full Text Available Purpose: PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations. Description: The mechanisms and tools developed and implemented by PRISMA include: (1 co-ordination between decision-makers and managers, (2 a single entry point, (3 a case management process, (4 individualised service plans, (5 a single assessment instrument based on the clients' functional autonomy, and (6 a computerised clinical chart for communicating between institutions for client monitoring purposes. Preliminary results: The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised. Conclusion: The on-going implementation and effectiveness study will show evidence of its real value and its impact on clienteles and cost.
Wann, Daniel L; Rogers, Kelly; Dooley, Keith; Foley, Mary
According to the Team Identification-Social Psychological Health Model (Wann, 2006b), team identification and social psychological health should be positively correlated because identification leads to important social connections which, in turn, facilitate well-being. Although past research substantiates the hypothesized positive relationship between team identification and well-being, earlier studies focused solely on college student populations. The current study extended past work in this area by investigating the team identification/well-being relationship among older sport fans. A sample of older adults (N = 96; M age = 70.82) completed scales assessing demographics, identification with a local college basketball team, and measures of social psychological well-being. As hypothesized, team identification accounted for a significant proportion of unique variance in two measures of social psychological health (collective self-esteem and loneliness).
Aimone, James B.; Weick, Jason P.
Mathematical modeling of anatomically-constrained neural networks has provided significant insights regarding the response of networks to neurological disorders or injury. A logical extension of these models is to incorporate treatment regimens to investigate network responses to intervention. The addition of nascent neurons from stem cell precursors into damaged or diseased tissue has been used as a successful therapeutic tool in recent decades. Interestingly, models have been developed to examine the incorporation of new neurons into intact adult structures, particularly the dentate granule neurons of the hippocampus. These studies suggest that the unique properties of maturing neurons, can impact circuit behavior in unanticipated ways. In this perspective, we review the current status of models used to examine damaged CNS structures with particular focus on cortical damage due to stroke. Secondly, we suggest that computational modeling of cell replacement therapies can be made feasible by implementing approaches taken by current models of adult neurogenesis. The development of these models is critical for generating hypotheses regarding transplant therapies and improving outcomes by tailoring transplants to desired effects.
Aimone, James B.; Weick, Jason P.
In mathematical modeling of anatomically-constrained neural networks we provide significant insights regarding the response of networks to neurological disorders or injury. Furthermore, a logical extension of these models is to incorporate treatment regimens to investigate network responses to intervention. The addition of nascent neurons from stem cell precursors into damaged or diseased tissue has been used as a successful therapeutic tool in recent decades. Interestingly, models have been developed to examine the incorporation of new neurons into intact adult structures, particularly the dentate granule neurons of the hippocampus. These studies suggest that the unique properties of maturing neurons, can impact circuit behavior in unanticipated ways. In this perspective, we review the current status of models used to examine damaged CNS structures with particular focus on cortical damage due to stroke. Secondly, we suggest that computational modeling of cell replacement therapies can be made feasible by implementing approaches taken by current models of adult neurogenesis. The development of these models is critical for generating hypotheses regarding transplant therapies and improving outcomes by tailoring transplants to desired effects.
James B Aimone
Full Text Available Mathematical modeling of anatomically-constrained neural networks has provided significant insights regarding the response of networks to neurological disorders or injury. A logical extension of these models is to incorporate treatment regimens to investigate network responses to intervention. The addition of nascent neurons from stem cell precursors into damaged or diseased tissue has been used as a successful therapeutic tool in recent decades. Interestingly, models have been developed to examine the incorporation of new neurons into intact adult structures, particularly the dentate granule neurons of the hippocampus. These studies suggest that the unique properties of maturing neurons can impact circuit behavior in unanticipated ways. In this perspective, we review the current status of models used to examine damaged CNS structures with particular focus on cortical damage due to stroke. Secondly, we suggest that computational modeling of cell replacement therapies can be made feasible by implementing approaches taken by current models of adult neurogenesis. The development of these models is critical for generating hypotheses regarding transplant therapies and improving outcomes by tailoring transplants to desired effects.
Full Text Available Integrated within neural circuits, astrocytes have recently been shown to modulate brain rhythms thought to mediate sleep function. Experimental evidence suggests that local impact of astrocytes on single synapses translates into global modulation of neuronal networks and behavior. We discuss these findings in the context of current conceptual models of sleep generation and function, each of which have historically focused on neural mechanisms. We highlight the implications and the challenges introduced by these results from a conceptual and computational perspective. We further provide modeling directions on how these data might extend our knowledge of astrocytic properties and sleep function. Given our evolving understanding of how local cellular activities during sleep lead to functional outcomes for the brain, further mechanistic and theoretical understanding of astrocytic contribution to these dynamics will undoubtedly be of great basic and translational benefit.
Shiyanbola, Olayinka O; Mott, David A; Croes, Kenneth D
To describe older adults' perceptions of evaluating and comparing pharmacies based on the Consumer Experience with Pharmacy Services Survey (CEPSS), describe older adults' perceived importance of the CEPSS and its specific domains, and explore older adults' perceptions of the influence of specific CEPSS domains in choosing/switching pharmacies. Focus group methodology was combined with the administration of a questionnaire. The focus groups explored participants' perceived importance of the CEPSS and their perception of using the CEPSS to choose and/or switch pharmacies. Then, using the questionnaire, participants rated their perceived importance of each CEPSS domain in evaluating a pharmacy, and the likelihood of using CEPSS to switch pharmacies if their current pharmacy had low ratings. Descriptive and thematic analyses were done. 6 semistructured focus groups were conducted in a private meeting room in a Mid-Western state in the USA. 60 English-speaking adults who were at least 65 years, and had filled a prescription at a retail pharmacy within 90 days. During the focus groups, the older adults perceived the CEPSS to have advantages and disadvantages in evaluating and comparing pharmacies. Older adults thought the CEPSS was important in choosing the best pharmacies and avoiding the worst pharmacies. The perceived influence of the CEPSS in switching pharmacies varied depending on the older adult's personal experience or trust of other consumers' experience. Questionnaire results showed that participants perceived health/medication-focused communication as very important or extremely important (n=47, 82.5%) in evaluating pharmacies and would be extremely likely (n=21, 36.8%) to switch pharmacies if their pharmacy had low ratings in this domain. The older adults in this study are interested in using patient experiences as a quality metric for avoiding the worst pharmacies. Pharmacists' communication about health and medicines is perceived important and likely
Full Text Available A variety of animal models have been suggested as models of pulmonary emphysema; these are critically discussed in the present article from a stereologist's perspective. In addition, a stereological design for the quantification of experimentally induced emphysema is proposed. On the basis of the widely accepted definition of pulmonary emphysema being an "abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls," quantitative morphology is the only method with which to reliably assess the presence of emphysema. Recognising this, careful inspection of animal models that are based on instillation of elastase, genetic alterations, inhalation of cigarette smoke or induction of apoptosis, reveals that both criteria of emphysema definition were demonstrated in surprisingly few of them. Several aspects are suggested to be critical for the understanding of animal models of human emphysema. For example, genetic models that rely on the inhibition of the formation of alveoli during post-natal alveolarisation should clearly be distinguished from models that rely on the loss of mature alveoli after alveolarisation is complete. Furthermore, inhalation models that are characterised by exposed animals exhibiting a severe loss of body weight should carefully examine the relative contribution of intervention and weight loss, respectively. Models that rely on the exposure of juvenile animals for several weeks or even months should take into account the effects of normal lung growth and ageing. Stereology offers appropriate tools with which to quantify the parameters relevant to assess development and the regeneration of emphysema. Stereologists continue to develop tools that will help ascertain the reliability of established and new models. If inappropriate parameters continue to be used for the evaluation of animal models of emphysema, thinking and resources are likely to be misdirected and the
Evans, Jenna M; Baker, G Ross
Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.
Full Text Available Introduction: There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare.Methods: The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations.Results and conclusions: The results point to the importance of paying regard to the different cultures of the organisations when implementing a new model. The role of upper management emerged as very important. Furthermore, to be accepted, the model has to be experienced as effectively dealing with real problems in the everyday practice of the actors in the organisations, from the bottom to the top.
Eck, D. van; Pijpers, R.A.H.
The phenomenological tradition within human geography continues to inspire research on everyday city life. This paper draws on David Seamon's notion of place ballet to understand the meaning of encounters between older people visiting an urban park in the city of Eindhoven, the Netherlands. The
Long-term unemployment of older people can have severe consequences for individuals, communities and ultimately economies, and is therefore a serious concern in countries with an ageing population. However, the interplay of chronological age and other individual difference characteristics in
Vijay K Bhatia
Full Text Available Genre analysis can be viewed from two different perspectives: it may be seen as a reflection of the complex realities of the world of institutionalised communication, or it may be seen as a pedagogically effective and convenient tool for the design of language teaching programmes, often situated within simulated contexts of classroom activities. This paper makes an attempt to understand and resolve the tension between these two seemingly contentious perspectives to answer the question: "Is generic description a reflection of reality, or a convenient fiction invented by applied linguists?". The paper also discusses issues related to the nature and use of linguistic description in a genre-based educational enterprise, claiming that instead of using generic descriptions as models for linguistic reproduction of conventional forms to respond to recurring social contexts, as is often the case in many communication based curriculum contexts, they can be used as analytical resource to understand and manipulate complex inter-generic and multicultural realisations of professional discourse, which will enable learners to use generic knowledge to respond to novel social contexts and also to create new forms of discourse to achieve pragmatic success as well as other powerful human agendas.
Broome, Kieran; McKenna, Kryss; Fleming, Jennifer; Worrall, Linda
The same reasons that prompt older people to give up driving can also result in difficulties with accessing public transport. Difficulties using public transport can limit older people's participation in society, thereby impacting negatively on their health. Focusing on public buses, this review explicates the link between bus usability and the health of older people and frames existing evidence on bus usability issues. The Person-Environment-Occupation (PEO) model offers a framework by which bus usability can be assessed. A combination of person-centred, environmental, and occupation-related factors, including bus design, service provision and performance, information, and the attitudes of staff and the community, impact on older people's ability to catch buses. More systematic research needs to take place in order to develop a comprehensive understanding of bus usability. Occupational therapy has a key role to play in conceptualizing, implementing, and evaluating improvements in bus usability for older people.
A growing body of work suggests that co- or peer-research may contribute to understanding the complex health and social problems experienced in later life. Yet, only a limited number of studies have involved older persons as partners in the research process. Moreover, in conflict with the philosophy of participatory research, the views of those acting as coresearchers tend to be ignored. This paper gives an "insider" account of the process of coresearch, drawing upon the experiences of older people trained to undertake a community-based research project. Eighteen older adults were recruited and trained as coresearchers to take a leading role in a study aimed at developing "age-friendly" communities in Manchester, UK. The coresearchers completed 68 interviews with residents aged 60 years and over who were experiencing isolation within their neighborhood. The findings are based upon four reflection meetings held with the coresearchers, all of which were transcribed with thematic analysis conducted using Atlas.ti. Coresearchers identified a range of advantages associated with the coresearch approach, these linked to the recruitment of participants, quality of data, potential for social change as well as personal benefits. They also identified ethical, methodological, and practical issues encountered during the research. The study demonstrates the contribution of coresearch for expanding methodological diversity, accessing seldom heard populations, and utilizing the skills and resources of older people. The research also highlights the opportunities for partnerships between older people and local stakeholders to facilitate community change and social action. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Ndoda, Gladys Ruvimbo; Sikwila, Mike Nyamazana
The authors design the innovation and learning perspective of the Balanced Scorecard (BSC) of "Ubuntu and client service charter nexus." This article borrows and advances the research carried out by Khomba, Vermaak and Gouws (2011). The point of departure is on praxis of ubuntu/unhu as a holistic approach in the re-modelling of the BSC…
Hirsch, Christian R., Ed.; McDuffie, Amy Roth, Ed.
Mathematical modeling plays an increasingly important role both in real-life applications--in engineering, business, the social sciences, climate study, advanced design, and more--and within mathematics education itself. This 2016 volume of "Annual Perspectives in Mathematics Education" ("APME") focuses on this key topic from a…
Full Text Available In recent years, GIS systems have evolved because of technological advancements that make possible the simultaneous management of multiple amount of information.Interesting aspects in their application concern the site documentation at the territorial scale taking advantage of CAD/BIM systems, usually working at the building scale instead.In this sense, the survey using sophisticated equipment such as laser scanners or UAV drones quickly captures data that can be enjoyed across even through new “mobile” technologies, operating in the web-based information systems context. This paper aims to investigate use and perspectives pertaining to geographic information technologies, analysis and design tools meant for modeling at different scales, referring to results of research experiences conducted at the University of Bologna.
Visser, Mark; Gesthuizen, M.J.W.; Kraaykamp, G.L.M.; Wolbers, M.H.J.
This study integrates a life course and social stratification perspective to examine early retirement in the Netherlands. Event history analysis of retrospective life course data from four rounds of the Family Survey Dutch Population reveals that employment career characteristics are strongly
Developmental mechanisms: putting genes in their place. STUART A NEWMAN. Department of Cell Biology ... effects, multifactoriality and func- tional redundancy of gene action in the determination of. Perspectives .... The vertebrate seg- mental plate becomes sequentially partitioned into paired somites by a process that ...
Ferrand, Claude; Nasarre, Sandra; Hautier, Christophe; Bonnefoy, Marc
The purpose of this study was to identify the motivational profiles of physically active older adults and to achieve a better understanding of their perceived motives to explain their regular physical activity behavior in relation to self-determination theory (SDT). To address these aims, this study used quantitative and qualitative approaches. Older adults (n = 92; M = 74.95, SD = 4.6) completed the French version of the Sport Motivational Scale. A cluster analysis showed two motivational profiles with differential motivational patterns. The first was named the high combined profile, with high scores on intrinsic motivation and introjected regulation and low levels of external regulation. The second profile was the low to moderate motivational profile, with low scores on intrinsic motivation and moderate scores on introjected regulation. The qualitative study's results demonstrate the usefulness of SDT in explaining the relationship between these motivational profiles and the intertwining of the three basic psychological needs.
Turner Barbara J
Full Text Available Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96% employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods
Spitz, Aerin; Moore, Alison A; Papaleontiou, Maria; Granieri, Evelyn; Turner, Barbara J; Reid, M Carrington
The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions
Emile, Mélanie; Chalabaev, Aina; Colson, Serge S; Vaulerin, Jerome; Falzon, Charlene; D'Arripe-Longueville, Fabienne
This study examined whether stereotype-inconsistent information interacts with implicit theories of ability to affect handgrip strength in older adults. Eighty-two retired older adults (13 men and 69 women) from 61 to 89 years old (M age = 75.8 years; SD = 6.9) performed maximum voluntary contractions (MVC) during a handgrip task in a design manipulating implicit theories of ability and stereotype-inconsistent information related to physical decline with aging. Participants were randomly assigned to one of three groups: incremental condition, entity condition, or control group. The results showed that in the incremental condition the stereotype-inconsistent information improved the peak MVC, the average MVC, the peak rate of force development (RFD), and RFD in the initial 50 ms of the MVC. This study therefore demonstrated that individuals with an incremental mindset who are exposed to stereotype-inconsistent information can boost their physical performance. These findings are discussed from the perspective of regulatory fit (i.e., when task framing is congruent with the individual's goal). © 2016 The Authors. Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.
Bruun, Inge H; Maribo, Thomas; Nørgaard, Birgitte; Schiøttz-Christensen, Berit; Mogensen, Christian B
Identifying older adults with reduced physical performance at the time of hospital admission can significantly affect patient management and trajectory. For example, such patients could receive targeted hospital interventions such as routine mobilisation. Furthermore, at the time of discharge, health systems could offer these patients additional therapy to maintain or improve health and prevent institutionalisation or readmission. The principle aim of this study was to identify predictors for persisting, reduced physical performance in older adults following acute hospitalisation. This was a prospective cohort study that enrolled 117 medical patients, ages 65 or older, who were admitted to a short-stay unit in a Danish emergency department. Patients were included in the study if at the time of admission they performed ≤8 repetitions in the 30-s Chair-Stand Test (30s-CST). The primary outcome measure was the number of 30s-CST repetitions (≤ 8 or >8) performed at the time of follow-up, 34 days after admission. Potential predictors within the first 48 h of admission included: age, gender, ability to climb stairs and walk 400 m, difficulties with activities of daily living before admission, falls, physical activity level, self-rated health, use of a walking aid before admission, number of prescribed medications, 30s-CST, and the De Morton Mobility Index. A total of 78 (67%) patients improved in physical performance in the interval between admission and follow-up assessment, but 76 patients (65%) had persistent reduced physical performance when compared to their baseline (30s-CST ≤ 8). The number of potential predictors was reduced in order to create a simplified prediction model based on 4 variables, namely the use of a walking aid before hospitalisation (score = 1.5), a 30s-CST ≤ 5 (1.8), age > 85 (0.1), and female gender (0.6). A score > 1.8 identified 78% of the older adults who continued to have reduced physical performance following
Szebehely, Marta; Trydegård, Gun-Britt
One aspect of universalism in Swedish eldercare services is that publicly financed and publicly provided services have been both affordable for the poor and attractive enough to be preferred by the middle class. This article identifies two trends in home care for older people in Sweden: a decline in the coverage of publicly funded services and their increasing marketisation. We explore the mechanisms behind these trends by reviewing policy documents and official reports, and discuss the distributional consequences of the changes by analysing two data sets from Statistics Sweden: the Swedish Level of Living surveys from 1988/1989 and 2004/2005 and a database on all users of tax deductions on household and care services in 2009. The analysis shows that the decline of tax-funded home care is not the result of changing eldercare legislation and was not intended by national policy-makers. Rather the decline was caused by a complex interplay of decision-making at central and local levels, resulting in stricter municipal targeting. The trend towards marketisation has been more clearly intended by national policy-makers. Legislative changes have opened up tax-funded services to private provision, and a customer-choice (voucher) model and a tax deduction for household- and care services have been introduced. As a result of declining tax-funded home-care services, older persons with lower education increasingly receive family care, while those with higher education are more likely to buy private services. The combination of income-related user fees, customer-choice models and the tax deduction has created an incentive for high-income older persons to turn to the market instead of using public home-care services. Thus, Swedish home care, as a universal welfare service, is now under threat and may become increasingly dominated by groups with less education and lower income which, in turn, could jeopardise the quality of care. © 2011 Blackwell Publishing Ltd.
Muntinga Maaike E
Full Text Available Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling frail older adults. Methods/design In a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. Participants: 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. Intervention: Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. Evaluation: We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the “intention-to-treat” principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional
Li, Hong; Kyrouac, Gregory A; McManus, Dennis Q; Cranston, Robert E; Hughes, Susan
This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.
Felicia Cornelia MACARIE
Full Text Available The present paper explores the degree in which universities could/should serve as role models for communities from the perspective of gender integration. Although the theoretical/ moral answer would be affirmative (universities should be in such a position that would allow local communities to regard them as role models of gender integration, the primary empirical analysis leads to another conclusion. A brief theoretical review (that connects gender discrimination, sustainable development, universities and local communities is followed by an empirical analysis that compares the management structures of 12 Romanian Universities of Advanced Research and Education (the best Romanian universities according to a national ranking with those of four local communities where they are located (as geographic proximity would lead to a better diffusion of best practices. Contrary to initial expectations, even in higher education institutions, women are underrepresented both in executive and legislative positions. Since universities are subject to the same major patterns of gender discrimination (such as role theory, glass ceiling and glass elevator as private and public organizations, they lose the moral high ground that theory would suggest. However, medicine and pharmacy universities that can be connected with the traditional roles attributed to women provide better gender integration, but glass escalator phenomena remain present even in these limited fields.
Full Text Available This article builds on a paper by Stein and Heikkinen (2009, and suggestsways to expand and improve our measurement of the quality of the developmentalmodels, metrics and instruments and the results we get in collaborating with clients. Wesuggest that this dialogue needs to be about more than stage development measured by(even calibrated stage development-focused, linguistic-based, developmental psychologymetrics that produce lead indicators and are shown to be reliable and valid bypsychometric qualities alone. The article first provides a brief overview of ourbackground and biases, and an applied version of Ken Wilber’s Integral OperatingSystem that has provided increased development, client satisfaction, and contribution toour communities measured by verifiable, tangible results (as well as intangible resultssuch as increased ability to cope with complex surroundings, reduced stress and growthin developmental stages to better fit to the environment in which our clients wereengaged at that time. It then addresses four key points raised by Stein and Heikkinen(need for quality control, defining and deciding on appropriate metrics, building a systemto evaluate models and metrics, and clarifying and increasing the reliability and validityof the models and metrics we use by providing initial concrete steps to:• Adopt a systemic value-chain approach• Measure results in addition to language• Build on the evaluation system for instruments, models and metrics suggested byStein & Heikkinen• Clarify and improve the reliability and validity of the instruments, models andmetrics we useWe complete the article with an echoing call for the community of AppliedDevelopmental Theory suggested by Ross (2008 and Stein and Heikkinen, a briefdescription of that community (from our perspective, and a table that builds on Table 2proposed by Stein and Heikkinen.
Gobbens, Robbert J J; Krans, Anita; van Assen, Marcel A L M
The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses. The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors. The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities. The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities. Copyright © 2015. Published by Elsevier Ireland Ltd.
Metcalf, Sara S; Northridge, Mary E; Widener, Michael J; Chakraborty, Bibhas; Marshall, Stephen E; Lamster, Ira B
In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by older adults in urban environments, this article presents a portfolio of systems science models that have been developed on the basis of observations from the ElderSmile preventive screening program operated in northern Manhattan, New York City, by the Columbia University College of Dental Medicine. Using the methodology of system dynamics, models are developed to explore how interpersonal relationships influence older adults' participation in oral health promotion. Feedback mechanisms involving word of mouth about preventive screening opportunities are represented in relation to stocks that change continuously via flows, as well as agents whose states of health care utilization change discretely using stochastic transitions. Agent-based implementations illustrate how social networks and geographic information systems are integrated into dynamic models to reflect heterogeneous and proximity-based patterns of communication and participation in the ElderSmile program. The systems science approach builds shared knowledge among an interdisciplinary research team about the dynamics of access to opportunities for oral health promotion. Using "what if" scenarios to model the effects of program enhancements and policy changes, resources may be effectively leveraged to improve access to preventive and treatment services. Furthermore, since oral health and general health are inextricably linked, the integration of services may improve outcomes and lower costs.
Johnson, Sophia L; Palta, Mari; Bartels, Christie M; Thorpe, Carolyn T; Weiss, Jennifer M; Smith, Maureen A
Interpreting clinical guideline adherence and the appropriateness of medication regimens requires consideration of individual patient and caregiver factors. Factors leading to initiation of a medication may differ from those determining continued use. We believe this is the case for systemic steroid therapy in inflammatory bowel disease (IBD), resulting in a need to apply methods that separately consider factors associated with initiation and duration of therapy. To evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use we apply a 2-part hurdle model to Medicare data. We do so in older patients with tumor necrosis factor antagonist (anti-TNFs) contraindications, as they are of special interest for compliance with Medicare-adopted, quality metrics calling for anti-TNFs and nonbiologic immune therapies to reduce steroid utilization. Many older patients have contraindications to anti-TNFs. However, nonbiologics cause adverse events that are concerning in older adults, limiting their use in this population and increasing reliance on systemic steroids. We used a national Medicare sample for 2006-2009 including patients with 12 months or greater of Parts A and B and 6 months or greater of Part D coverage, IBD confirmed with at least 2 claims for ICD-9CM 555.xx or 556.xx, anti-TNF contraindications and without contraindications to nonbiologic agents. We applied a negative binomial-logit hurdle model to examine patient characteristics associated with systemic steroid utilization. Among the 1,216 IBD patients without baseline steroid use, 21% used systemic steroids. Odds of receiving systemic steroids were greater in those younger, rural, and those receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration. Our study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization
Bunn, Frances; Goodman, Claire; Manthorpe, Jill; Durand, Marie-Anne; Hodkinson, Isabel; Rait, Greta; Millac, Paul; Davies, Sue L; Russell, Bridget; Wilson, Patricia
Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models. The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction. Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Anderson, Elizabeth Susan; Pollard, Lorraine; Conroy, Simon; Clague-Baker, Nicola
Integrated services which utilise the expertise of team members along care pathways are evolving. Changes in service structure and subsequent team working arrangements can be a challenge for practitioners expected to redefine how they work with one another. These services are particularly important for the care of frail older people. This exploratory study of one newly forming team presents the views of staff involved in establishing an interprofessional healthcare advisory team for older people within an acute hospital admissions unit. Staff experiences of forming a new service are aligned to a model of team development. The findings are presented as themes relating to the stages of team development and identify the challenges of setting up an integrated service alongside existing services. In particular, team process issues relating to the clarity of goals, role clarification, leadership, team culture and identity. Managers must allow time to ensure new services evolve before setting up evaluation studies for efficiency and effectiveness which might prove against the potential for interprofessional teamworking.
Hernández, Carola Hernández; Ravn, Ole; Valero, Paola
of learning. One of the theoretical frameworks underpinning the understanding of learning is the socio-cultural perspective. This paper aims at exploring and analyzing the PO-PBL model from this theoretical perspective. In addition, this reading may also open a new viewpoint in science teaching for other...
Full Text Available Currently, the intensity of enterprise competition has increased as a result of a greater diversity of customer needs as well as the persistence of a long-term recession. The results of competition are becoming severe enough to determine the survival of company. To survive global competition, each firm must focus on achieving innovation excellence and operational excellence as core competency for sustainable competitive advantage. Supply chain management is now regarded as one of the most effective innovation initiatives to achieve operational excellence, and its importance has become ever more apparent. However, few companies effectively manage their supply chains, and the greatest difficulty is in achieving supply chain visibility. Many companies still suffer from a lack of visibility, and in spite of extensive research and the availability of modern technologies, the concepts and quantification methods to increase supply chain visibility are still ambiguous. Based on the extant researches in supply chain visibility, this study proposes an extended visibility concept focusing on a process capability perspective and suggests a more quantitative model using Z score in Six Sigma methodology to evaluate and improve the level of supply chain visibility.
van Eechoud, Ineke J; Piers, Ruth D; Van Camp, Sigrid; Grypdonck, Mieke; Van Den Noortgate, Nele J; Deveugele, Myriam; Verbeke, Natacha C; Verhaeghe, Sofie
Advance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process. To gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process. This was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory. Family members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns. This study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Erlingsson, Christen L
Doing violence and evil always indirectly or directly leads to making someone else suffer. Such is the dialogical structure of evil and it seems to be the dialogical structure of elder abuse as well. There is a perturbing sameness between definitions of evil and definitions of elder abuse. It is hard at times to see how or if there is any line of demarcation between the subjects. Two modern-day philosophers, Paul Ricoeur and Simone Weil have delved particularly into the concept of evil. The symbolism Ricoeur analyses in depth is that of defilement, sin, and guilt and the concept of the servile will. Integral in Weil's description of evil are the concepts of suffering and the special situation of extreme suffering, termed affliction. Grounded in the writings of Ricoeur and Weil, this paper is a series of reflections on the intersection of evil and elder abuse as exemplified in the narrative of an abused older woman. This woman provided around the clock care at home for her husband who had vascular dementia. She was also abused by her husband. This was witnessed by both family and others but no one intervened. In her narrative there were indications of defilement, sin, guilt, and true affliction as a servile will. This paper illuminates the evil of elder abuse that is harm and suffering, and the challenge of untangling issues of blame, free will, responsibility, and self-determinism. When engaging with abused, older persons it can be worthwhile for nurses to enter the encounter with non-judgemental compassion founded on the human to human connection and recognition of our mutual fallibility and potential for evil that is part of our human fragility. © 2011 Blackwell Publishing Ltd.
Jorge Gracia Ibáñez
Full Text Available Gender-based violence affects all kinds of women, including the older. In these cases two determining characteristics intersect: gender and age, which usually means greater vulnerability for the victims. In this paper both the benefits of a look at the issue from the paradigm of intersectionality and the need of an autonomous theoretical construction of the issue are discussed. The issue of gender violence against older women has characteristics of its own even it´s still connected to forms of violence like gender violence, as a broad category, or family elder abuse. Some public policies from the perspective of intersectionality are also analyzed. La violencia de género afecta a todo tipo de mujeres, incluidas las mujeres de edad avanzada. En esos casos interseccionan dos características determinantes: el género y la edad, lo que implica generalmente una mayor vulnerabilidad de las víctimas. Se analizan en este texto tanto los beneficios de una mirada al problema desde el paradigma de la interseccionalidad como la necesidad de una construcción teórica autónoma de este fenómeno con dinámicas y características propias aunque conectado con formas de violencia como la violencia de género, como categoría más amplia, o la violencia familiar contra las personas mayores. Son también abordadas en este texto algunas iniciativas desde la perspectiva de la interseccionalidad entendida en su dimensión de inspiradora de políticas y actuaciones públicas. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2550210
Kussmann, Martin; Morine, Melissa J; Hager, Jörg
We review here the status of human type 2 diabetes studies from a genetic, epidemiological, and clinical (intervention) perspective. Most studies limit analyses to one or a few omic technologies providing data of components of physiological processes. Since all chronic diseases are multifactorial...... and arise from complex interactions between genetic makeup and environment, type 2 diabetes mellitus (T2DM) is a collection of sub-phenotypes resulting in high fasting glucose. The underlying gene-environment interactions that produce these classes of T2DM are imperfectly characterized. Based on assessments...... of the complexity of T2DM, we propose a systems biology approach to advance the understanding of origin, onset, development, prevention, and treatment of this complex disease. This systems-based strategy is based on new study design principles and the integrated application of omics technologies: we pursue...
complex teaching methodology requires in-depth thinking about the role of the teacher, the role of the learner, the nature of the classroom culture, the nature of the negotiation of meaning between the teacher and individuals or groups, the nature of selected problems and material, as well as the kind of integrative assessment used in the mathematics classroom. Modelling is closely related to the problem-centred teaching approach, but it also smoothly relates to bigger and longer mathematical tasks. This article gives a theoretical exposition of the scope and depth of mathematical modelling. It is possible to introduce modelling at every school phase in our educational sytem. Modelling in school mathematics seems to make the learning of mathematics more effective. The mastering of problem solving and modelling strategies has deﬁnitely changed the orientation, the competencies and performances of learners at each school level. It would appear from research that learners like the application side of mathematics and that they want to see it in action. Genuine real life problems should be selected, which is why a modelling perspective is so important for the teaching and mastering of mathematics. Modelling should be integrated into the present curriculum because learners will then get full access to involvement in the classroom, to mathematisation, to doing problems, to criticising arguments, to ﬁnding proofs, to recognising concepts and to obtaining the ability to abstract these from the realistic situation. Modelling should be given a full opportunity in mathematics teacher education so that our learners can get the full beneﬁt of it. This will put the mathematical performances of learners in our country on a more solid base, which will make our learners more competitive at all levels in the future.
Bekisheva, Tatiana Gennadievna; Kovalenko, Natalya Aleksandrovna; Gasparyan, Gayane Aramaisovna
The article deals with the specific information about main resources of E-learning education for older adults. Programs and policies that encourage lifelong educational resources and practices by older persons are needed. These included education level; self-study in the form of reading manuals, reference books and journals; computer/Internet use, use of the library; leisure reading of books; reading letters, notes and e-mails. Ways of application of Information Technology in older adults tea...
Full Text Available Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient’s perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning.
Claire J Foldi
Full Text Available Offspring of older fathers have an increased risk of various adverse health outcomes, including autism and schizophrenia. With respect to biological mechanisms for this association, there are many more germline cell divisions in the life history of a sperm relative to that of an oocyte. This leads to more opportunities for copy error mutations in germ cells from older fathers. Evidence also suggests that epigenetic patterning in the sperm from older men is altered. Rodent models provide an experimental platform to examine the association between paternal age and brain development. Several rodent models of advanced paternal age (APA have been published with relevance to intermediate phenotypes related to autism. All four published APA models vary in key features creating a lack of consistency with respect to behavioural phenotypes. A consideration of common phenotypes that emerge from these APA-related mouse models may be informative in the exploration of the molecular and neurobiological correlates of APA.
Setti, Ilaria; Dordoni, Paola; Piccoli, Beatrice; Bellotto, Massimo; Argentero, Piergiorgio
Purpose: This paper aims at examining the relationship between proactive personality and training motivation among older workers (aged over 55 years) in a context characterized by the growing ageing of the global population. First, the authors hypothesized that proactive personality predicts the motivation to learn among older workers and that…
Puglisi, J. Thomas; Allegretti, Christine L.
Although numerous studies have indicated that older persons process visual information more slowly than younger persons, the precise nature of age-associated changes in the processing of visually presented information remains unclear. Older adults (N=18) and college students (N=18) performed a visual search task in which lists of words and…
Víctor T. Pérez Martínez
Full Text Available Las personas no pueden ser fragmentadas en determinados períodos de existencia, nacen y llegan al final de sus vidas como seres sexuales. La sexualidad humana es un fenómeno sociocultural que está influido por la calidad de las relaciones interpersonales, el contexto en que nos desenvolvemos y por la integración que hemos hecho de las experiencias vividas. La identidad, el deseo y comportamiento sexuales son componentes esenciales de nuestra sexualidad. El disfrute de una relación amorosa no cambia por el paso de los años. El placer sexual es una experiencia deseable y válida para los adultos mayores porque genera gran bienestar. Una menor cantidad de contactos sexuales, los mismos deseos y una mayor calidad en la relación de pareja, conforman las características más notables de la sexualidad en la edad geriátrica. La información sobre los temas sexuales en la senectud es aún insuficiente. Solo una educación sexual desde la temprana infancia permitirá que las futuras generaciones de ancianos accedan a una realidad sexual más justa, en un ambiente carente de prejuicios.Persons cannot be fragmented in certain periods of existence; they are born and reach the end of their lives as sexual beings. Human sexuality is a sociocultural phenomenon that is influenced by the quality of the interpersonal relations, by the context in which we develop, and by the integration of the lived experiences. The sexual identity, the desire and the behavior are essential components of our sexuality. The enjoyment of a love relationship does not change as times goes by. Sexual pleasure is a desirable and valid experience for older adults, since it generates a great wellbeing. Less sexual contacts, the same desires and a higher quality in the couple's relation are the most significant characteristics of sexuality at geriatric age. The information on sexual topics in senescence is still insufficient. Only a sexual education received in early childhood will
Chiao, Chia-Yi; Schepp, Karen G
This article is a report of a study of predicting the factors that influence depression in the older people in Taiwan. Background. In 1991, Taiwan opened the labour market to foreign caregivers for the older people who needed long-term care. With the differences in language, culture and lifestyle between foreign caregivers and older people in Taiwan, it was hypothesized that the older people would not be able to relate to them, and therefore become depressed. The data were collected from 116 Taiwanese older people from July to September, 2005. Path analysis using multiple regression analyses was conducted to estimate the direct and indirect effects of caregiving communication, activities of daily living, income and social support on depression among older people in Taiwan. To evaluate the hypotheses for this research, bi-variate linear regression and multiple regression analyses were used. The results indicated that the level of activities of daily living (β = -0·201, P = 0·010), care-giving communication (β = -0·272, P = 0·002) income (β = -0·305, P = 0·000) and social support (β = -0·276, P = 0·002) were the predictors of depression in older people in Taiwan. Social support was a mediating factor for caregiving communication and depression. Furthermore, foreign caregiver care was not correlated with depression among older people in Taiwan. The findings influence the public awareness of depression in older people, and provide the foundational information to influence the policy makers of Taiwan to evaluate the foreign caregiver policy. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.
Full Text Available AHP and the Kano model are such prevalent TQM tools that it may be surprising that a true hybrid decision-making model has so far eluded researchers. The quest for a hybrid approach is complicated by the differing output perspective of each model, namely discrete ranking (AHP versus a multi-dimensional picture (Kano. This paper presents a hybrid model of AHP and Kano model, so called two-dimension AHP (2D-AHP.
Quinn, Kelly; Smith-Ray, Renae; Boulter, Kristin
Social connection and social support are strong predictors of wellbeing, but maintaining social relations often becomes more difficult at older ages. Because social media enhance feelings of connectedness and reduce feelings of loneliness, they may present accessible and relatively low cost mechanisms to enhance life quality at older ages. Using data gathered from two focus groups of potential older adult social media learners, we explored the physical and cognitive challenges to social media use, perceptions of social media benefits, and conceptual barriers to use. Findings support earlier studies that identify perceived benefit as important to social media adoption at older ages, and extend these by identifying that a lack in conceptual knowledge of these technologies is an additional barrier to use. We then discuss the cognitive implications of gaining this knowledge.
Full Text Available The perspective on integration of two mathematical formalisms, i.e., Colored Petri Nets (CPNs and Topological Functioning Model (TFM, is discussed in the paper. The roots of CPNs are in modeling system functionality. The TFM joins principles of system theory and algebraic topology, and formally bridges the solution domain with the problem domain. It is a base for further automated construction of software design models. The paper discusses a perspective on check of control and data flows in the TFM by CPNs formalism. The research result is definition of mappings from TFMs to CPNs.
Soriano, Christian Albert F; Sarmiento, Winona D; Songco, Francis Justin G; Macindo, John Rey B; Conde, Alita R
The increasing life expectancy of the population prompts an array of health conditions that impair an older adults' quality of life (QoL). Although demographics and spirituality have been associated with QoL, limited literature elucidated the exact mechanisms of their interactions, especially in a culturally-diverse country like Philippines. Hence, this study determined the relationship among socio-demographics, spirituality, and QoL of Filipino older adults in a community and institutional setting. A predictive-correlational study among 200 randomly-selected community-dwelling and institutionalized older adults was conducted, with a 99% power and a medium effect size. Data were collected using a three-part questionnaire from September to November 2015. The questionnaire was composed of the robotfoto, Spirituality Assessment Scale, and modified Older People's Quality of Life which assessed socio-demographics, spirituality, and QoL. Analysis showed that institutionalization in a nursing home positively and negatively affected spirituality and QoL, generating an acceptable model (χ(2)/df=2.12, RMSEA=0.08, and CFI=0.95). The negative direct effect of institutionalization on social relationship, leisure, & social activities QoL (β=-0.42, pspirituality and QoL dimensions. The development of a structural model illustrating the interrelationship of socio-demographics, spirituality, and QoL helps healthcare professionals in predicting facets of spirituality and QoL that can be compromised by living in a nursing home. This understanding provides impetus in evaluating and refining geriatric healthcare programs, policies, and protocols to render individualized, holistic care in a socially-cohesive environment among older adults. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Bu, Huabai; Bu, Shizhen
Gradual integration of synergetic technology, P2P technology and online learning community furnishes a new research field for innovation of teacher training model in a knowledge economy era. This article proposes the innovative model of "whole of three lines" in teacher training in basic education from the perspective of "blended…
Janssen, A.B.G.; Gerla, D.J.
Here, we present a community perspective on how to explore, exploit and evolve the diversity in aquatic ecosystem models. These models play an important role in understanding the functioning of aquatic ecosystems, filling in observation gaps and developing effective strategies for water quality
Bosse, T.; Jonker, C.M.; Treur, J.
This paper explores how the dynamics of complex biological processes can be modelled and simulated as an organisation of multiple agents. This modelling perspective identifies organisational structure occurring in complex decentralised processes and handles complexity of the analysis of the dynamics
Muntinga, M.E.; Hoogendijk, E.O.; van Leeuwen, K.M.; van Hout, H.P.J.; Twisk, J.W.R.; van der Horst, H.E.; Nijpels, G.; Jansen, A.P.D.
Background: Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care
Lauretani, Fulvio; Meschi, Tiziana; Ticinesi, Andrea; Maggio, Marcello
The imperative action of the geriatric medicine is to prevent disability in older persons. Many epidemiological studies have been conducted in the last decades for improving knowledge of the aging process and their interactions with age-related diseases, especially for the identification of the relationship between sarcopenia and loss of mobility. Factors influencing muscle integrity can be classified into six main physiologic subsystems, but the central nervous system certainly plays a crucial role for maintaining muscle integrity in older persons. Recent data show that the reduced muscle strength and not muscle mass could be considered the core of the fragility in predicting changes of gait velocity and mobility and conferring a higher risk of mortality in older persons. Sarcopenia and cognitive decline could, therefore, produce slow gait velocity in older persons, with devastating effect and consequences. Perhaps the most notorious corollary is falling, which is often caused by an underlying gait problem. Injuries caused by accidental falls range from relatively innocent bruises to major fractures or head trauma. Another important consequence is reduced mobility, which leads to loss of independence. This immobility is often compounded by a fear of falling, which further immobilises patients and affects their quality of life and physical performance. When we search the association between brain pathology and muscle function in older persons, we amazingly find that established composite measure of physical frailty is associated with brain pathology. Sarcopenia, which produces muscle dysfunction, slow gait velocity and cognitive decline, could share a strong bidirectional relationship, and this suggests the coexistence of both cognitive and motor dysfunctions in older persons to characterize a new syndrome characterized by slow gait and cognitive complaints, the motoric-cognitive risk syndrome (MRC). In this review, we want to emphasize the relationship between
Full Text Available This article examines political participation among older adults in Österbotten, Finland, and Västerbotten, Sweden. Two specific hypotheses are tested. First, we anticipate that older adults are loyal voters but less avid in engaging in politics between elections. Second, we expect individuallevel resources to explain why older people participate in politics. The article offers two contributions to the literature on political participation of older adults. First, it corroborates earlier findings by showing that older adults indeed have a higher inclination to vote than to engage in political activities between elections, but it also shows that the latter engagement is more diversified than one could expect. Second, although the findings largely support the resource model, they suggest that we need to consider also other factors such as the overall attitude towards older people.
Hughes, Anne K; Rostant, Ola S; Curran, Paul G
Talking about sexual health can be a challenge for some older women. This project was initiated to identify key factors that improve communication between aging women and their primary care providers. A sample of women (aged 60+) completed an online survey regarding their intent to communicate with a provider about sexual health. Using the integrative model of behavioral prediction as a guide, the survey instrument captured data on attitudes, perceived norms, self-efficacy, and intent to communicate with a provider about sexual health. Data were analyzed using structural equation modeling. Self-efficacy and perceived norms were the most important factors predicting intent to communicate for this sample of women. Intent did not vary with race, but mean scores of the predictors of intent varied for African American and White women. Results can guide practice and intervention with ethnically diverse older women who may be struggling to communicate about their sexual health concerns. © The Author(s) 2013.
Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol.
Edwards, Deborah; Carrier, Judith; Hopkinson, Jane
to snacks, and cultural or religious food preferences.In the UK, national reports have shown some older patients with good appetites were not receiving sufficient nourishment because of inadequate feeding assistance. An initial search of literature has found that this problem has also been identified in Australia, New Zealand, Sweden, and the USA.A variety of initiatives have been developed to try to ensure that patients receive mealtime assistance if required, and include, for example:Mealtime assistance has the potential to enhance nutritional intake, clinical outcomes, and patient experience. Four reviews and one scoping review have previously been conducted in this area. All of the reviews included adult patients over 18 years of age. The focus of the systematic review by Green et al. was volunteers providing feeding assistance in any institutional setting; it included a narrative analysis of 10 empirical studies from a limited number of database searches. Weekes et al. conducted a structured literature review focusing on improving nutritional care for patients in any healthcare setting, with specific emphasis on feeding assistance and the dining environment. The review was limited to quantitative study designs (randomized controlled trials, controlled trials and observational studies and audits). A systematic review by Wade et al. investigated nutritional models of care (feeding assistance, protected mealtimes, red tray initiative and communal dining) for hospitalized and rehabilitation inpatients. This review focused on data from trials only and only three databases were searched. A Joanna Briggs Institute (JBI) systematic review has also been published on the topic of mealtime assistance. A comprehensive search strategy was outlined and the review included six randomized controlled trials and quasi experimental designs covering a range of outcomes, but was limited to inpatients in acute care hospitals. The scoping review by Cheung et al. included intervention
Julius Francis Gomes; Sara Moqaddemerad
Purpose: To facilitate futures business research by proposing a novel way to combine business models as a conceptual tool with futures research techniques. Design: A futures perspective is adopted to foresight business models of the Internet of Things (IoT) enabled healthcare sector by using business models as a futures business research tool. In doing so, business models is coupled with one of the most prominent foresight methodologies, Causal Layered Analysis (CLA). Qualitative analysis...
M. Koller (Michael); M.J.G. Leening (Maarten); M. Wolbers (Marcel); E.W. Steyerberg (Ewout); M.G.M. Hunink (Myriam); R. Schoop (Rotraut); A. Hofman (Albert); H.C. Bucher (Heiner); B.M. Psaty (Bruce); D.M. Lloyd-Jones (Donald M.); J.C.M. Witteman (Jacqueline)
textabstractBackground: Risk scores for prediction of coronary heart disease (CHD) in older adults are needed. Objective: To develop a sex-specific CHD risk prediction model for older adults that accounts for competing risks for death. Design: 2 observational cohort studies, using data from 4946
Rosenkoetter, Marlene M; McDonough, JoEllen; McCall, Amber; Smith, Deborah; Looney, Stephen
For the rapidly growing older adult population, disaster consequences are frequently life disruptive and even life threatening. By 2050, it is estimated that the global older adult population will reach 22 percent of the total. With declining health, this population poses a particular risk needing to be addressed in emergency preparedness and disaster recovery. The purpose of this article is to describe a Flex-Model (F-M) for the long-term assessment of older adults following a disaster. An F-M is a series of three-dimensional representations of an archetype with flexible components, both linear and parallel, that can be adapted to situations, time, place, and needs. The model incorporates the Life Patterns Model and provides a template that can be adjusted to meet the needs of a local community, healthcare providers, and emergency management officials, regardless of the country or region, during the months after a disaster. The focus is on changes resulting from the disaster including roles, relationships, support systems, use of time, self-esteem, and life structure. Following a baseline assessment, each of these life patterns is assessed through the model with options for interventions over time. A pilot study was conducted in Georgia to gain information that would be helpful in developing a more specific assessment tool following a severe winter storm. While this is a local study, the findings can nevertheless be used to refine and focus the F-M for future implementation. Results indicated that older adults used high-risk heating and lighting sources and many were totally responsible for their own welfare. Findings have implications for emergency preparedness and long-term recovery.
Chandra Shekhar Bhatnagar
Full Text Available The Sharpe (1964, Lintner (1965 and Black (1972 Capital Asset Pricing Model (CAPM postulates that the equilibrium rates of return on all risky assets are a linear function of their covariance with the market portfolio. Recent work by Fama and French (1996, 2006 introduce a Three Factor Model that questions the “real world application” of the CAPM Theorem and its ability to explain stock returns as well as value premium effects in the United States market. This paper provides an out-of-sample perspective to the work of Fama and French (1996, 2006. Multiple regression is used to compare the performance of the CAPM, a split sample CAPM and the Three Factor Model in explaining observed stock returns and value premium effects in the United Kingdom market. The methodology of Fama and French (2006 was used as the framework for this study. The findings show that the Three Factor Model holds for the United Kingdom Market and is superior to the CAPM and the split sample CAPM in explaining both stock returns and value premium effects. The “real world application” of the CAPM is therefore not supported by the United Kingdom data.
Full Text Available The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients towards their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations, and, consequently, to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council’s (MRC guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program’s feasibility, acceptability and comprehension.The result was a user-endorsed intervention designed to improve older patients’ engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE model. The intervention program, which emerged from this process, consisted of two monthly face-to-face 1-hour sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning. PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it
Göransson, Carina; Wengström, Yvonne; Ziegert, Kristina; Langius-Eklöf, Ann; Eriksson, Irene; Kihlgren, Annica; Blomberg, Karin
To acquire knowledge regarding the contents to be implemented in an interactive information and communication technology-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves. The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals. Descriptive qualitative design. This study was based on three samplings: a scoping review of the literature (n = 20 articles), interviews with healthcare professionals (n = 5) and a secondary analysis of interviews with older persons (n = 8) and nursing assistants (n = 7). The data were analysed using qualitative content analysis. Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons. The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive information and communication technology-platform for use in regular daily care assessments. Descriptions of self-care were limited indicating a possible gap in knowledge that requires further research. Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing. © 2017 John Wiley & Sons Ltd.
Hunka, Agnieszka; Meli, Mattia; Thit, Amalie
The paper closely examines the role of mechanistic effect models (e.g., population models) in the European environmental risk assessment (ERA) of pesticides. We studied perspectives of three stakeholder groups on population modeling in ERA of pesticides. Forty-three in-depth, semi-structured inte......The paper closely examines the role of mechanistic effect models (e.g., population models) in the European environmental risk assessment (ERA) of pesticides. We studied perspectives of three stakeholder groups on population modeling in ERA of pesticides. Forty-three in-depth, semi......-structured interviews were conducted with stakeholders from regulatory authorities, industry and academia all over Europe. The key informant approach was employed in recruiting our participants. They were first identified as key stakeholders in the field and then sampled by means of a purposive sampling, where each...
Ouwehand, Kim; van Gog, Tamara|info:eu-repo/dai/nl/294304975; Paas, Fred
This study investigated whether the positive effects of gestures on learning by decreasing working memory load, found in children and young adults, also apply to older adults, who might especially benefit from gestures given memory deficits associated with aging. Participants learned a
The population of older Americans is increasing due to the aging of the Baby Boomers as well as an increase in the average life span. A number of physiological and biochemical changes occur during aging that could influence the relationship between exposure, dose, and response to...
Melis, R.J.F.; Adang, E.M.M.; Teerenstra, S.; Eijken, M.I.J. van; Wimo, A.; Achterberg, T. van; Lisdonk, E.H. van de; Olde Rikkert, M.G.M.
BACKGROUND: There is growing interest in geriatric care for community-dwelling older people. There are, however, relatively few reports on the economics of this type of care. This article reports about the cost-effectiveness of the Dutch Geriatric Intervention Program (DGIP) compared to usual care
Claassens, L; Widdershoven, G A; Van Rhijn, S C; Van Nes, F; Broese van Groenou, M I; Deeg, D J H; Huisman, M
Frail older adults are increasingly encouraged to be in control of their health care, in Western societies. However, little is known about how they themselves perceive control in health care. Therefore, this study aims to investigate the concept of health care-related perceived control from the
Eveline J.M. Wouters; Sil Aarts; Sebastiaan T. M. Peek
Expectations are high with regards to smart home technology. In particular, smart home technology is expected to support or enable independent living by older adults. This raises the question: can smart home technology contribute to independent living, according to older adults themselves? This
Grabinska, Teresa; Zielinska, Dorota
The authors examine language from the perspective of models of empirical sciences, which discipline studies the relationship between reality, models, and formalisms. Such a perspective allows one to notice that linguistics approached within the classical framework share a number of problems with other experimental sciences studied initially…
Wright, Scott M; Carrese, Joseph A
Role modelling is an effective teaching method in medical education. We sought to better understand role modelling by examining the insights of respected physician role models. We conducted 30-minute in-depth interviews with 29 highly regarded role models at 2 large teaching hospitals. We coded the transcripts independently, and compared our coding for agreement. Content analysis identified several major categories of themes. The informants identified specific characteristics related to role modelling. Subcategories under the domain of personal qualities included interpersonal skills, a positive outlook, a commitment to excellence and growth, integrity and leadership. Under the domain of teaching, the subcategories were establishing rapport with learners, developing specific teaching philosophies and methods, and being committed to the growth of learners. Subjects thought there was some overlap between teaching and role modelling, but felt that the latter was more implicit and more encompassing. Being a strong clinician was regarded as necessary but not sufficient for being an exemplary physician role model. Perceived barriers to effective role modelling included being impatient and overly opinionated, being quiet, being overextended, and having difficulty remembering names and faces. Physician role models described role modeling consciousness, in that they specifically think about being role models when interacting with learners. Subjects believed that medical learners should emulate multiple role models. Highly regarded physician role models possess personal qualities, teaching abilities and exceptional clinical skills that outweigh their own barriers to serving as effective role models. Many of these positive attributes of role models represent behaviours that can be modified or skills that can be acquired.
Liu, Zhicheng; Stasko, John T
Although previous research has suggested that examining the interplay between internal and external representations can benefit our understanding of the role of information visualization (InfoVis) in human cognitive activities, there has been little work detailing the nature of internal representations, the relationship between internal and external representations and how interaction is related to these representations. In this paper, we identify and illustrate a specific kind of internal representation, mental models, and outline the high-level relationships between mental models and external visualizations. We present a top-down perspective of reasoning as model construction and simulation, and discuss the role of visualization in model based reasoning. From this perspective, interaction can be understood as active modeling for three primary purposes: external anchoring, information foraging, and cognitive offloading. Finally we discuss the implications of our approach for design, evaluation and theory development.
The Uddevalla Volvo plant represents a different paradigm for automotive assembly. In parallel-flow work, self-managed work groups assemble entire automobiles with comparable productivity as conventional series-flow assembly lines. From the perspective of the demand-control model, operators at the Uddevalla plant have low physical and timing…
In the interest of developing an adequate and consistent bioethical perspective for reflecting on the ethical issues raised by toxic wastes, this brief paper focuses on the question of whether or not public opposition to past and proposed methods for waste management has been induced as much by technical incompetance as by deficiencies in using risk models for bioethical problem definitions
Sigurdsson, Valdimar; Kahamseh, Saeed; Gunnarsson, Didrik; Larsen, Nils Magne; Foxall, Gordon R.
The behavioral perspective model's (BPM; Foxall, 1990) retailing literature is built on extensive empirical research and techniques that were originally refined in choice experiments in behavioral economics and behavior analysis, and then tested mostly on British consumer panel data. We test the BPM in the context of Norwegian retailing. This…
Hartadiyati, E.; Rizqiyah, K.; Wiyanto; Rusilowati, A.; Prasetia, A. P. B.
In present condition, culture is diminished, the change of social order toward the generation that has no policy and pro-sustainability; As well as the advancement of science and technology are often treated unwisely so as to excite local wisdom. It is therefore necessary to explore intra-curricular local wisdom in schools. This study aims to produce an integration model of sustainability perspectives based on local wisdom on spermatophyta material that is feasible and effective. This research uses define, design and develop stages to an integration model of sustainability perspectives based on local wisdom on spermatophyta material. The resulting product is an integration model of socio-cultural, economic and environmental sustainability perspective and formulated with preventive, preserve and build action on spermatophyta material consisting of identification and classification, metagenesis and the role of spermatophyta for human life. The integration model of sustainability perspective in learning spermatophyta based on local wisdom is considered proven to be effective in raising sustainability’s awareness of high school students.
Mahande, Ridwan Daud; Susanto, Adhi; Surjono, Herman Dwi
This study aimed to describe the dynamics of content aspects, user aspects and social aspects of mobile learning utilization (m-learning) in vocational education from the FRAME Model perspective review. This study was quantitative descriptive research. The population in this study was teachers and students of state vocational school and private…
Full Text Available ABSTRACT The learning model is one of the enabling factors that influence the achievement of students. That students have a good learning outcomes the lecturer must choose appropriate learning models. But in fact not all lecturers choose the most appropriate learning model with the demands of learning outcomes and student characteristics.The study design was descriptive quantitative correlation. Total population of 785 the number of samples are 202 were taken by purposive sampling. Techniques of data collection is done by cross-sectional and then processed through the Spearman test. The results showed no significant relationship between classroom lecture method in the context of blended learning models to study the effectiveness perspective the p value of 0.001. There is a significant relationship between e-learning methods in the context of blended learning models with perspective of activities study of nursing students the p value of 0.028. There is a significant relationship between learning model of blended learning with the perspective of nursing students learning effectiveness p value 0.167. Researchers recommend to future researchers conduct more research on the comparison between the effectiveness of the learning model based on student learning centers with the e-learning models and its impact on student achievement of learning competencies as well as to the implications for other dimensions of learning outcomes and others.
In the public mind, later life is being transformed by the emerging possibility of a flourishing third age with sustained quality of life. We draw trajectories of life quality measured using CASP-19 over eight years. We refine these trajectories by jointly modelling attrition, since older people tend to leave longitudinal studies (attrite) not at random. Growth curve models are applied to the English Longitudinal Study of Ageing waves 1 to 5. Then joint model is estimated where attrition is considered. Extensive predictors are entered including demographic attributes, social and economic status, health conditions, and behaviours. Strong non-linear age trajectory of life quality is revealed by the growth curve models where the peak is achieved in the late 60s. Then the joint model uncovers the peak somewhat later in time, and also reveals secular improvement in life quality experienced by recent cohorts. Sharp estimates for many predictors of higher levels of life quality are also found. For the first time, the trajectories of life quality in the third age are drawn and improvement across cohorts is demonstrated. The contributions are estimated for predictors amenable to intervention such as social capital. This can help in policy discussion on improving the lives of older people in the third age.
Crespo, Luis Guillermo
This paper presents a framework for calibrating computational models using data from sev- eral and possibly dissimilar validation experiments. The offset between model predictions and observations, which might be caused by measurement noise, model-form uncertainty, and numerical error, drives the process by which uncertainty in the models parameters is characterized. The resulting description of uncertainty along with the computational model constitute a predictor model. Two types of predictor models are studied: Interval Predictor Models (IPMs) and Random Predictor Models (RPMs). IPMs use sets to characterize uncer- tainty, whereas RPMs use random vectors. The propagation of a set through a model makes the response an interval valued function of the state, whereas the propagation of a random vector yields a random process. Optimization-based strategies for calculating both types of predictor models are proposed. Whereas the formulations used to calculate IPMs target solutions leading to the interval value function of minimal spread containing all observations, those for RPMs seek to maximize the models' ability to reproduce the distribution of obser- vations. Regarding RPMs, we choose a structure for the random vector (i.e., the assignment of probability to points in the parameter space) solely dependent on the prediction error. As such, the probabilistic description of uncertainty is not a subjective assignment of belief, nor is it expected to asymptotically converge to a fixed value, but instead it is a description of the model's ability to reproduce the experimental data. This framework enables evaluating the spread and distribution of the predicted response of target applications depending on the same parameters beyond the validation domain (i.e., roll-up and extrapolation).
Kim, Hongsoo; Park, Yeon-Hwan; Jung, Young-il; Choi, Hyoungshim; Lee, Seyune; Kim, Gi-Soo; Yang, Dong-wook; Paik, Myunghee Cho; Lee, Tae-Jin
Background Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. Methods/Design SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting...
Bonney, Andrew; Morgan, Simon; Tapley, Amanda; Henderson, Kim; Holliday, Elizabeth; Davey, Andrew; van Driel, Mieke; Spike, Neil; Regan, Cathy; Ball, Jean; Magin, Parker
To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice. Cross-sectional analysis of data from GPR consultations across five regional training providers in Australia. Data were analysed using simple and multiple logistic regression models. Our analysis included details of 118 831 consultations, 20 555 (17.6%, 95% CI 17.4-17.8) with patients aged ≥65 years. Older patient encounters had an increased likelihood of including chronic disease (OR 1.77, 95% CI 1.70, 1.86) and more problems (OR 1.24, 95% CI 1.20, 1.27). However, in-consultation information or advice was less likely to be sought (OR 0.92, 95% CI 0.88, 0.97), and consultations were briefer (OR 0.99, 95% CI 0.99, 1.00). Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and supervision concerns. © 2016 AJA Inc.
Vasca, Francesco; Iannelli, Luigi; Camlibel, M. Kanat; Frasca, Roberto
The switching behavior of power converters with "ideal" electronic devices (EDs) makes it difficult to define a switched model that describes the dynamics of the converter in all possible operating conditions, i.e., a "complete" model. Indeed, simplifying assumptions on the sequences of modes are
Shaw, G.; Schell, W.; Linkov, I.
Ecological modeling is a powerful tool which can be used to synthesize information on the dynamic processes which occur in ecosystems. Models of radionuclide transport in forests were first constructed in the mid-1960's, when the consequences of global fallout from nuclear weapons tests and waste disposal in the environment were of great concern. Such models were developed based on site-specific experimental data and were designed to address local needs. These models had a limited applicability in evaluating distinct ecosystems and deposition scenarios. Given the scarcity of information, the same experimental data sets were often used both for model calibration and validation, an approach which clearly constitutes a methodological error. Even though the carry modeling attempts were far from being faultless, they established a useful conceptual approach in that they tried to capture general processes in ecosystems and thus had a holistic nature. Later, radioecological modeling attempted to reveal ecosystem properties by separating the component parts from the whole system, as an approach to simplification. This method worked well for radionuclide transport in agricultural ecosystems, in which the biogeochemistry of radionuclide cycling is relatively well understood and can be influenced by fertilization. Several models have been successfully developed and applied to human dose evaluation and emergency response to contaminating events in agricultural lands
Verweij, P.J.F.M.; Knapen, M.J.R.; Winter, de W.P.; Wien, J.J.F.; Roller, te J.A.; Sieber, S.; Jansen, J.M.L.
Policy makers have a growing interest in integrated assessments of policies. The Integrated Assessment Modelling (IAM) community is reacting to this interest by extending the application of model development from pure scientific analysis towards application in decision making or policy context by
Morey, Richard D.; Romeijn, Jan-Willem; Rouder, Jeffrey N.
Gelman and Shalizi (2012) criticize what they call the usual story in Bayesian statistics: that the distribution over hypotheses or models is the sole means of statistical inference, thus excluding model checking and revision, and that inference is inductivist rather than deductivist. They present
G.J. Rietveld (Joost)
textabstractThis paper develops a consumer-centric framework for creating value through the freemium business model. Goods that are commercialized through the freemium business model offer basic functionality for free and monetize users for extended use or complementary features. Compared to premium
Wilcox and Shaffer (2005: 135) observe that a model of interpreting demonstrates how interpreters perform their role and guides them towards improving their performance. It is from this point of view that South African court interpreters need to be familiar with different models of interpreting to enable them to understand their ...
van Marion, Denise M. S.; Domanska, Urszula M.; Timmer-Bosscha, Hetty; Walenkamp, Annemiek M. E.
Cancer metastasis causes most cancer-related deaths. Several model systems to study the complex and multi step process of metastasis exist, including in vitro systems, ex-vivo organ slices, Drosophila Melanogaster and zebrafish models and the use of the chorio allantoic membrane (CAM) of fertilized
Mannhardt, Felix; De Leoni, Massimiliano; Reijers, Hajo A.; Van Der Aalst, Wil M P
Process models need to reflect the real behavior of an organization’s processes to be beneficial for several use cases, such as process analysis, process documentation and process improvement. One quality criterion for a process model is that they should precise and not express more behavior than
Clouzot, Ludiwine; Cloutier, Frédéric; Vanrolleghem, Peter A.
Models for predicting the fate of micropollutants (MPs) in wastewater treatment plants (WWTPs) have been developed to provide engineers and decision-makers with tools that they can use to improve their understanding of, and evaluate how to optimize, the removal of MPs and determine their impact o......) addressing advancements in WWTP treatment technologies, (iii) making use of common approaches to data acquisition for model calibration and (iv) integrating ecotoxicological effects of MPs in receiving waters.......Models for predicting the fate of micropollutants (MPs) in wastewater treatment plants (WWTPs) have been developed to provide engineers and decision-makers with tools that they can use to improve their understanding of, and evaluate how to optimize, the removal of MPs and determine their impact...... on the receiving waters. This paper provides an overview of such models, and discusses the impact of regulation, engineering practice and research on model development. A review of the current status of MP models reveals that a single model cannot represent the wide range of MPs that are present in wastewaters...
Skovhus, Torben Lund; Taylor, Christopher; Eckert, Rickard
Microbiologically influenced corrosion (MIC) research in the oil and gas industry has seen a revolution over the past decade with the increased application of molecular microbiological methods (MMM) and new industry standards; however, MIC modelling is an area that has not been fully developed....... Models can provide numerous benefits, e.g., guidance on MIC mitigation selection and prioritization, identification of data gaps, a scientific basis for risk-based inspections, and technical justification for asset design and life-extension. This paper describes trends in MIC modelling; different types...
Devereaux, Thomas Peter
A microscopic understanding of the strongly correlated physics of the cuprates must account for the translational and rotational symmetry breaking that is present across all cuprate families, commonly in the form of stripes. Here we investigate emergence of stripes in the Hubbard model, a minimal model believed to be relevant to the cuprate superconductors, using determinant quantum Monte Carlo (DQMC) simulations at finite temperatures and density matrix renormalization group (DMRG) ground state calculations. By varying temperature, doping, and model parameters, we characterize the extent of stripes throughout the phase diagram of the Hubbard model. Our results show that including the often neglected next-nearest-neighbor hopping leads to the absence of spin incommensurability upon electron-doping and nearly half-filled stripes upon hole-doping. The similarities of these findings to experimental results on both electron and hole-doped cuprate families support a unified description across a large portion of the cuprate phase diagram.
Germain, Ronald N.; Meier-Schellersheim, Martin; Nita-Lazar, Aleksandra; Fraser, Iain D. C.
Systems biology is an emerging discipline that combines high-content, multiplexed measurements with informatic and computational modeling methods to better understand biological function at various scales. Here we present a detailed review of the methods used to create computational models and conduct simulations of immune function, We provide descriptions of the key data gathering techniques employed to generate the quantitative and qualitative data required for such modeling and simulation and summarize the progress to date in applying these tools and techniques to questions of immunological interest, including infectious disease. We include comments on what insights modeling can provide that complement information obtained from the more familiar experimental discovery methods used by most investigators and why quantitative methods are needed to eventually produce a better understanding of immune system operation in health and disease. PMID:21219182
based experiences, especially during compulsory community service, could inform curricula. Objective. To develop a model of community service physiotherapy to guide curriculum reform. Methods. In this appreciative inquiry, trained ...
Skovhus, Torben Lund; Taylor, Christopher; Eckert, Rickard
of corrosion relative to asset integrity, operators commonly use models to support decision-making. The models use qualitative, semi-quantitative or quantitative measures to help predict the rate of degradation caused by MIC and other threats. A new model that links MIC in topsides oil processing systems...... with risk based inspection (RBI) through the application of data obtained by MMMs, and its implementation, are presented and discussed. Integrated computational materials engineering (ICME) is a promising future approach for prediction and management of MIC, using translational research to deliver new......Microbiologically influenced corrosion (MIC) research in the oil and gas industry has seen a revolution over the past decade with the increased application of molecular microbiological methods (MMM) and new industry standards; however, MIC modelling is an area that has not been fully developed...
Van Hoecke, Ann-Sophie
Regular physical activity has been recognized as a major contributor to individuals health and well-being. Moreover, physical activity engagement has been shown to be crucial for healthy ageing and for improving (older) adults ability to perform daily activities. Nevertheless, only half of the Western population attains the recommended physical activity level for health, with decreasing participation rates with advanced age. Considering the continuously growing proportion of older adults as...
N.M. Somaratne; K.R.J. Smettem
A physically based model of soil surface scaling is proposed. The governing equations are formulated on the principle of conservation of mass assuming Darcy's law applies to suspension flowing through the soil surface. The model incorporates the physics of surface sealing by mechanisms that capture suspended particles moving with infiltrating water. As a result of particle retention in the soil system, the intrinsic porosity is reduced and hulk density is increased, resulting in changes to so...
Brinks, Ralph; Hoyer, Annika
The aim of this work is to relate the theory of stochastic processes with the differential equations associated with multistate (compartment) models. We show that the Kolmogorov Forward Differential Equations can be used to derive a relation between the prevalence and the transition rates in the illness-death model. Then, we prove mathematical well-definedness and epidemiological meaningfulness of the prevalence of the disease. As an application, we derive the incidence of diabetes from a series of cross-sections.
Kamino, Luciana H. Y.; Stehmann, João Renato; Amaral, Silvana; De Marco, Paulo; Rangel, Thiago F.; de Siqueira, Marinez F.; De Giovanni, Renato; Hortal, Joaquín
The workshop ‘Species distribution models: applications, challenges and perspectives’ held at Belo Horizonte (Brazil), 29–30 August 2011, aimed to review the state-of-the-art in species distribution modelling (SDM) in the neotropical realm. It brought together researchers in ecology, evolution, biogeography and conservation, with different backgrounds and research interests. The application of SDM in the megadiverse neotropics—where data on species occurrences are scarce—presents several chal...
Wang, Jue; Luo, Sheng
Mixed effects Beta regression models based on Beta distributions have been widely used to analyze longitudinal percentage or proportional data ranging between zero and one. However, Beta distributions are not flexible to extreme outliers or excessive events around tail areas, and they do not account for the presence of the boundary values zeros and ones because these values are not in the support of the Beta distributions. To address these issues, we propose a mixed effects model using Beta rectangular distribution and augment it with the probabilities of zero and one. We conduct extensive simulation studies to assess the performance of mixed effects models based on both the Beta and Beta rectangular distributions under various scenarios. The simulation studies suggest that the regression models based on Beta rectangular distributions improve the accuracy of parameter estimates in the presence of outliers and heavy tails. The proposed models are applied to the motivating Neuroprotection Exploratory Trials in Parkinson's Disease (PD) Long-term Study-1 (LS-1 study, n = 1741), developed by The National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson's Disease (NINDS NET-PD) network. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Succurro, Antonella; Ebenhöh, Oliver
Understanding microbial ecosystems means unlocking the path toward a deeper knowledge of the fundamental mechanisms of life. Engineered microbial communities are also extremely relevant to tackling some of today's grand societal challenges. Advanced meta-omics experimental techniques provide crucial insights into microbial communities, but have been so far mostly used for descriptive, exploratory approaches to answer the initial 'who is there?' An ecosystem is a complex network of dynamic spatio-temporal interactions among organisms as well as between organisms and the environment. Mathematical models with their abstraction capability are essential to capture the underlying phenomena and connect the different scales at which these systems act. Differential equation models and constraint-based stoichiometric models are deterministic approaches that can successfully provide a macroscopic description of the outcome from microscopic behaviors. In this mini-review, we present classical and recent applications of these modeling methods and illustrate the potential of their integration. Indeed, approaches that can capture multiple scales are needed in order to understand emergent patterns in ecosystems and their dynamics regulated by different spatio-temporal phenomena. We finally discuss promising examples of methods proposing the integration of differential equations with constraint-based stoichiometric models and argue that more work is needed in this direction. © 2018 The Author(s).
Full Text Available Today’s supply chains (SCs are more than ever prone to disruptions caused by natural and man-made events with water scarcity identified as one of the highest impact events among these. Leading businesses, understanding that natural resource scarcity (NRS has become a critical supply chain risk factor, extensively incorporate sustainable water management programmes into their corporate social responsibility and environmental management agenda. The question of how industries can efficiently evaluate the progress of these water scarcity mitigation practices, however, remains open. In order to address this question, the present study proposes a conceptual maturity model. The model is rooted in strategies for water scarcity mitigation using a framework developed by Yatskovskaya and Srai and develops an extensive literature review of recent publications on maturity frameworks in the fields of sustainability and operations management. In order to test the proposed proposed, model an exploratory case study with a leading pharmaceutical company was conducted. The proposed maturity model presents an evaluation tool that allows systematic assessment and visualisation of organisational routines and practices relevant to sustainable manufacturing in the context of water scarcity. This model was designed to help illustrate mitigation capabilities evolution over time, where future state desired capabilities were considered through alternative supply network (SN configurations, network structure, process flow, product architecture, and supply partnerships.
Maltsev, Victor A.; Yaniv, Yael; Maltsev, Anna V.; Stern, Michael D.; Lakatta, Edward G.
Cardiac pacemaking is a complex phenomenon that is still not completely understood. Together with experimental studies, numerical modeling has been traditionally used to acquire mechanistic insights in this research area. This review summarizes the present state of numerical modeling of the cardiac pacemaker, including approaches to resolve present paradoxes and controversies. Specifically we discuss the requirement for realistic modeling to consider symmetrical importance of both intracellular and cell membrane processes (within a recent “coupled-clock” theory). Promising future developments of the complex pacemaker system models include the introduction of local calcium control, mitochondria function, and biochemical regulation of protein phosphorylation and cAMP production. Modern numerical and theoretical methods such as multi-parameter sensitivity analyses within extended populations of models and bifurcation analyses are also important for the definition of the most realistic parameters that describe a robust, yet simultaneously flexible operation of the coupled-clock pacemaker cell system. The systems approach to exploring cardiac pacemaker function will guide development of new therapies, such as biological pacemakers for treating insufficient cardiac pacemaker function that becomes especially prevalent with advancing age. PMID:24748434
Momtaz, Yadollah Abolfathi; Hamid, Tengku Aizan; Masud, Jariah; Haron, Sharifah Azizah; Ibrahim, Rahimah
Background There is a growing body of literature indicating that attitudes toward aging significantly affect older adults’ psychological well-being. However, there is a paucity of scientific investigations examining the role of older adults’ attitudes toward aging on their spouses’ psychological well-being. Therefore, the present study aimed to examine the dyadic effects of attitude toward aging on the psychological well-being of older couples. Methods Data for the present study, consisting of 300 couples aged 50 years and older, were drawn from a community-based survey entitled “Poverty among Elderly Women: Case Study of Amanah Ikhtiar” conducted in Peninsular Malaysia. An actor–partner interdependence model using AMOS version 20 (Europress Software, Cheshire, UK) was used to analyze the dyadic data. Results The mean ages of the husbands and wives in this sample were 60.37 years (±6.55) and 56.33 years (±5.32), respectively. Interdependence analyses revealed significant association between older adults’ attitudes toward aging and the attitudes of their spouses (intraclass correlation =0.59; Paging, both among older men (critical ratio =2.92; Paging were significantly correlated with their own and their spouses’ psychological well-being. Conclusion The findings from this study supported the proposed Spousal Attitude–Well-Being Model, where older adults’ attitudes toward aging significantly affected their own and their spouses’ psychological well-being. The theoretical and practical implications of the findings are discussed. PMID:24174873
Momtaz, Yadollah Abolfathi; Hamid, Tengku Aizan; Masud, Jariah; Haron, Sharifah Azizah; Ibrahim, Rahimah
There is a growing body of literature indicating that attitudes toward aging significantly affect older adults' psychological well-being. However, there is a paucity of scientific investigations examining the role of older adults' attitudes toward aging on their spouses' psychological well-being. Therefore, the present study aimed to examine the dyadic effects of attitude toward aging on the psychological well-being of older couples. Data for the present study, consisting of 300 couples aged 50 years and older, were drawn from a community-based survey entitled "Poverty among Elderly Women: Case Study of Amanah Ikhtiar" conducted in Peninsular Malaysia. An actor-partner interdependence model using AMOS version 20 (Europress Software, Cheshire, UK) was used to analyze the dyadic data. The mean ages of the husbands and wives in this sample were 60.37 years (±6.55) and 56.33 years (±5.32), respectively. Interdependence analyses revealed significant association between older adults' attitudes toward aging and the attitudes of their spouses (intraclass correlation =0.59; Paging, both among older men (critical ratio =2.92; Paging were significantly correlated with their own and their spouses' psychological well-being. The findings from this study supported the proposed Spousal Attitude-Well-Being Model, where older adults' attitudes toward aging significantly affected their own and their spouses' psychological well-being. The theoretical and practical implications of the findings are discussed.
Temporal and spatiotemporal data form an inherent fabric of the society as we are faced with streams of data coming from numerous sensors, data feeds, recordings associated with numerous areas of application embracing physical and human-generated phenomena (environmental data, financial markets, Internet activities, etc.). A quest for a thorough analysis, interpretation, modeling and prediction of time series comes with an ongoing challenge for developing models that are both accurate and user-friendly (interpretable). The volume is aimed to exploit the conceptual and algorithmic framework of Computational Intelligence (CI) to form a cohesive and comprehensive environment for building models of time series. The contributions covered in the volume are fully reflective of the wealth of the CI technologies by bringing together ideas, algorithms, and numeric studies, which convincingly demonstrate their relevance, maturity and visible usefulness. It reflects upon the truly remarkable diversity of methodological a...
Turbulent combustion sits at the interface of two important nonlinear, multiscale phenomena: chemistry and turbulence. Its study is extremely timely in view of the need to develop new combustion technologies in order to address challenges associated with climate change, energy source uncertainty, and air pollution. Despite the fact that modeling of turbulent combustion is a subject that has been researched for a number of years, its complexity implies that key issues are still eluding, and a theoretical description that is accurate enough to make turbulent combustion models rigorous and quantitative for industrial use is still lacking. In this book, prominent experts review most of the available approaches in modeling turbulent combustion, with particular focus on the exploding increase in computational resources that has allowed the simulation of increasingly detailed phenomena. The relevant algorithms are presented, the theoretical methods are explained, and various application examples are given. The book ...
Maxwell, Scott E
Through this book's unique model comparison approach, students and researchers are introduced to a set of fundamental principles for analyzing data. After seeing how these principles can be applied in simple designs, students are shown how these same principles also apply in more complicated designs. Drs. Maxwell and Delaney believe that the model comparison approach better prepares students to understand the logic behind a general strategy of data analysis appropriate for various designs; and builds a stronger foundation, which allows for the introduction of more complex topics omitt
The design space of information services evolved from seminal works through a set of prototypical hypermedia systems and matured in open and widely accessible web-based systems. The original concepts of hypermedia systems are now expressed in different forms and shapes. The first works on hypertext invented the term itself, laid out the foundational concept of association or link, and highlighted navigation as the core paradigm for the future information systems. The first engineered systems demonstrated architectural requirements and models and fostered the emergence of the conceptual model r
The ionization of atoms and molecules in strong laser fields is an active field in modern physics and has versatile applications in such as attosecond physics, X-ray generation, inertial confined fusion (ICF), medical science and so on. Classical Trajectory Perspective of Atomic Ionization in Strong Laser Fields covers the basic concepts in this field and discusses many interesting topics using the semiclassical model of classical trajectory ensemble simulation, which is one of the most successful ionization models and has the advantages of a clear picture, feasible computing and accounting for many exquisite experiments quantitatively. The book also presents many applications of the model in such topics as the single ionization, double ionization, neutral atom acceleration and other timely issues in strong field physics, and delivers useful messages to readers with presenting the classical trajectory perspective on the strong field atomic ionization. The book is intended for graduate students and researchers...
... and uses formalisms that force us to recognize that every perceptual decision is context- and task-dependent. Examples of perceptually-signiﬁcant phonetic detail that is neglected by standard models are discussed. Similarities between the theoretical approach recommended and current work on perception–action robots ...
The study follows a qualitative research approach and uses multifaceted theoretical frameworks, namely descriptive translation studies (DTS), cognitive process analysis, and content analysis in collecting and analysing the data. Keywords: court interpreters, cognitive teaching approach, court interpreting models, the role of ...
de Fruyt, F.; Denollet, J.K.L.
This study investigated the position of Type D (high Negative Affectivity and high Social Inhibition) within the Five-Factor Model (FFM) of personality. A sample of 155 healthy subjects were administered the Type D Scale and the NEO-FFI, assessing the FFM traits. Subjects also filled out the General
Daan, S.; Hut, R. A.; Beersma, D.
In the two-process model as developed in the early 1980's sleep is controlled by a process-S, representing the rise and fall of sleep demand resulting from prior sleep-wake history, interacting with a process-C representing circadian variation in sleep propensity. S and C together optimize sleep
de Vries, H.J.M.; Janssen, M.A.; Beusen, A.
Many uncertainties and controversies surround the future of the global energy system. The Targets IMage Energy (TIME) model of which a concise description is given, is used to explore the consequences of divergent assumptions about some uncertain and controversial issues. The IPCC-IS92a Conventional
Antonucci, Sharon M; Alt, Mary
Research regarding semantic knowledge of objects is often conducted independently in children and adults. Review of these bodies of evidence suggests that the two literatures are often complementary. It seems critical to determine what we can learn from a developmental perspective, toward the common goal of understanding semantic organization. Here we focus on the proposal that semantic knowledge about concrete concepts may be built on the foundation of sensory/motor processes. In particular, we focus on a moderate formulation of this viewpoint, the sensory/motor model of semantic representations of objects (e.g., Gainotti 2007; Martin 2007), which has been examined utilizing behavioral, neuroimaging, and neuropsychological evidence. Taken together, behavioral and neuroimaging studies with infants, older children, and adults have suggested that patterns laid down in early childhood remain salient throughout the lifespan and may also predict patterns of deficit that emerge following brain injury.
Roh, Soonhee; Burnette, Catherine E; Lee, Kyoung Hag; Lee, Yeon-Shim; Martin, James I; Lawler, Michael J
American Indian (AI) older adults are vulnerable to mental health disparities, yet very little is known about the factors associated with help-seeking for mental health services among them. The purpose of this study was to investigate the utility of Andersen's Behavioral Model in explaining AI older adults' help-seeking attitudes toward professional mental health services. Hierarchical regression analysis was used to examine predisposing, enabling, and need variables as predictors of help-seeking attitudes toward mental health services in a sample of 233 AI older adults from the Midwest. The model was found to have limited utility in the context of older AI help-seeking attitudes, as the proportion of explained variance was low. Gender, perceived stigma, social support, and physical health were significant predictors, whereas age, perceived mental health, and health insurance were not. © The Author(s) 2014.
Full Text Available A physically based model of soil surface scaling is proposed. The governing equations are formulated on the principle of conservation of mass assuming Darcy's law applies to suspension flowing through the soil surface. The model incorporates the physics of surface sealing by mechanisms that capture suspended particles moving with infiltrating water. As a result of particle retention in the soil system, the intrinsic porosity is reduced and hulk density is increased, resulting in changes to soil hydraulic properties such as moisture retention and hydraulic conductivity. Empirical functions are developed to describe the changes of these properties as the seal develops. With this approach, the seal can be mathematically described by well defined initial and boundary conditions and transient seal properties can be simulated in a physically realistic manner.
Crossa, José; Pérez-Rodríguez, Paulino; Cuevas, Jaime; Montesinos-López, Osval; Jarquín, Diego; de Los Campos, Gustavo; Burgueño, Juan; González-Camacho, Juan M; Pérez-Elizalde, Sergio; Beyene, Yoseph; Dreisigacker, Susanne; Singh, Ravi; Zhang, Xuecai; Gowda, Manje; Roorkiwal, Manish; Rutkoski, Jessica; Varshney, Rajeev K
Genomic selection (GS) facilitates the rapid selection of superior genotypes and accelerates the breeding cycle. In this review, we discuss the history, principles, and basis of GS and genomic-enabled prediction (GP) as well as the genetics and statistical complexities of GP models, including genomic genotype×environment (G×E) interactions. We also examine the accuracy of GP models and methods for two cereal crops and two legume crops based on random cross-validation. GS applied to maize breeding has shown tangible genetic gains. Based on GP results, we speculate how GS in germplasm enhancement (i.e., prebreeding) programs could accelerate the flow of genes from gene bank accessions to elite lines. Recent advances in hyperspectral image technology could be combined with GS and pedigree-assisted breeding. Copyright © 2017 Elsevier Ltd. All rights reserved.
Kamino, Luciana H. Y.; Stehmann, João Renato; Amaral, Silvana; De Marco, Paulo; Rangel, Thiago F.; de Siqueira, Marinez F.; De Giovanni, Renato; Hortal, Joaquín
The workshop ‘Species distribution models: applications, challenges and perspectives’ held at Belo Horizonte (Brazil), 29–30 August 2011, aimed to review the state-of-the-art in species distribution modelling (SDM) in the neotropical realm. It brought together researchers in ecology, evolution, biogeography and conservation, with different backgrounds and research interests. The application of SDM in the megadiverse neotropics—where data on species occurrences are scarce—presents several challenges, involving acknowledging the limitations imposed by data quality, including surveys as an integral part of SDM studies, and designing the analyses in accordance with the question investigated. Specific solutions were discussed, and a code of good practice in SDM studies and related field surveys was drafted. PMID:22031720
This paper describes a method where it is possible to configure and simulate an entire dynamic scenario with several platforms in a network and where electronic warfare (EW) is an integrated part. The method utilizes a multispectral (radio, radar, electro-optics) framework, EWSim (Electronic Warfare Simulation interface model), for distributed EW simulations. In the framework it is possible to design dynamic scenarios which can assess the few-against-few duel, in a single user mode or in an assessment duel where teams can compete against each other. The EWSim method is also compared to simpler methods where events on a timeline is studied to draw conclusions about EW systems in a network and also to more advanced methods where system specific models are used with a high level of fidelity.
Godar, Sean C; Mosher, Laura J; Di Giovanni, Giuseppe; Bortolato, Marco
Tics are repetitive, sudden movements and/or vocalizations, typically enacted as maladaptive responses to intrusive premonitory urges. The most severe tic disorder, Tourette syndrome (TS), is a childhood-onset condition featuring multiple motor and at least one phonic tic for a duration longer than 1 year. The pharmacological treatment of TS is mainly based on antipsychotic agents; while these drugs are often effective in reducing tic severity and frequency, their therapeutic compliance is limited by serious motor and cognitive side effects. The identification of novel therapeutic targets and development of better treatments for tic disorders is conditional on the development of animal models with high translational validity. In addition, these experimental tools can prove extremely useful to test hypotheses on the etiology and neurobiological bases of TS and related conditions. In recent years, the translational value of these animal models has been enhanced, thanks to a significant re-organization of our conceptual framework of neuropsychiatric disorders, with a greater focus on endophenotypes and quantitative indices, rather than qualitative descriptors. Given the complex and multifactorial nature of TS and other tic disorders, the selection of animal models that can appropriately capture specific symptomatic aspects of these conditions can pose significant theoretical and methodological challenges. In this article, we will review the state of the art on the available animal models of tic disorders, based on genetic mutations, environmental interventions as well as pharmacological manipulations. Furthermore, we will outline emerging lines of translational research showing how some of these experimental preparations have led to significant progress in the identification of novel therapeutic targets for tic disorders. Copyright © 2014 Elsevier B.V. All rights reserved.
Teachers' instructional practices are greatly shaped by their own learning experiences as students in K-12 and college classrooms, which for most teachers was traditional, teacher-centered instruction. One of the challenges facing mathematics education reform is that, traditional teaching is in contrast to reform student- centered instruction. If teachers learn from their experiences as mathematics students, mathematics teacher educators are encouraged to model practices they would like teach...
Nozaki, Daijiro; Avdoshenko, Stas M.; Sevinçli, Hâldun; Cuniberti, Gianaurelio
Quantum interference (QI) phenomena between electronic states in molecular circuits offer a new opportunity to design new types of molecular devices such as molecular sensors, interferometers, and thermoelectric devices. Controlling the QI effect is a key challenge for such applications. For the development of single molecular devices employing QI effects, a systematic study of the relationship between electronic structure and the quantum interference is needed. In order to uncover the essential topological requirements for the appearance of QI effects and the relationship between the QI-affected line shape of the transmission spectra and the electronic structures, we consider a homogeneous toy model where all on-site energies are identical and model four types of molecular junctions due to their topological connectivities. We systematically analyze their transmission spectra, density of states, and thermoelectric properties. Even without the degree of freedom for on-site energies an asymmetric Fano peak could be realized in the homogeneous systems with the cyclic configuration. We also calculate the thermoelectric properties of the model systems with and without fluctuation of on-site energies. Even under the fluctuation of the on-site energies, the finite thermoelectrics are preserved for the Fano resonance, thus cyclic configuration is promising for thermoelectric applications. This result also suggests the possibility to detect the cyclic configuration in the homogeneous systems and the presence of the QI features from thermoelectric measurements.
Venables, N C; Hall, J R; Patrick, C J
The triarchic model of psychopathy characterizes the disorder in terms of three distinguishable phenotypic facets: disinhibition, meanness and boldness. The present study sought to (1) inform current debates regarding the role of boldness in the definition of psychopathy and (2) clarify boundaries between psychopathy and antisocial personality disorder (ASPD). This study evaluated the degree to which facets of the triarchic model are represented in the most widely used clinical inventory for psychopathy, the Psychopathy Checklist - Revised (PCL-R), in comparison with ASPD as defined by DSM-IV criteria. Adult male offenders from two distinct correctional settings (n = 157 and 169) were investigated to ensure replicability of findings across samples exhibiting high base rates of psychopathy and antisocial behavior. We found evidence for convergent and discriminant validity of the three triarchic facets in predicting symptomatic components of psychopathy as assessed by the PCL-R. Additionally, and crucially vis-à-vis current debates in the field, we found that boldness contributed incrementally (over and above disinhibition and meanness) to prediction of PCL-R psychopathy, in particular its interpersonal style component, but not ASPD. The three distinct facets of the triarchic model of psychopathy are represented clearly and distinctly in the PCL-R, with boldness through its interpersonal facet, but not in DSM-defined ASPD. Our findings suggest that boldness is central to diagnostic conceptions of psychopathy and distinguishes psychopathy from the more prevalent diagnosis of ASPD.
Li, Linna; Loo, Becky P Y
Revealing the relationship between mobility impairment and life satisfaction can help to propose effective interventions to secure mobility and life satisfaction. However, the relationship remains unclear and lacks quantitative evidence in China. This study therefore assesses the association of mobility impairment, social engagement, and life satisfaction among the older population in China. Based on the sample of China Health and Retirement Longitudinal Survey database in 2013, a structural equation modeling is established. The sample size is 4245 with 55.9% with mobility impairment. The model shows that the length of suffering from disability is significantly related to mobility impairment (β = 0.058, p life satisfaction (β = -0.311, p life satisfaction (β = 0.211, p life satisfaction partly because they usually participate less in social activities. Different strategies are suggested to be adopted to improve the life satisfaction of the older population from the aspects of promoting mobility and social engagement, including improving the design of transport facilitates, providing assistive facilities for the seniors with severe mobility impairment, promoting the accessibility of community leisure and healthcare services, and constructing more community senior activity centers.
Weiner, Neal Jonathan [Univ. of California, Berkeley, CA (United States)
In 1934 Fermi postulated a theory for weak interactions containing a dimensionful coupling with a size of roughly 250 GeV. Only now are we finally exploring this energy regime. What arises is an open question: supersymmetry and large extra dimensions are two possible scenarios. Meanwhile, other experiments will begin providing definitive information into the nature of neutrino masses and CP violation. In this paper, we explore features of possible theoretical scenarios, and study the phenomenological implications of various models addressing the open questions surrounding these issues.
Mishnaevsky, Leon; Zhou, H.W.; Peng, R.D.
Strength and reliability of wind blades produced from polymer composites are the important preconditions for the successful development of wind energy. One of the ways to increase the reliability and lifetime of polymer matrix composites is the nanoengineering of matrix or fiber/matrix interfaces...... in these composites. The potential and results of nanoclay reinforcements for the improvement of the mechanical properties of polymer composites are investigated using continuum mechanics and micromechanics methods and effective phase model. It is demonstrated that nanoreinforcement allows to increase the stiffness...
Ioan Constantin ENACHE
Full Text Available The increase information quantity and availability has generated transformations in customer behaviour, by having almost immediately access to huge amounts of data the customers’ process of buying a product or service is using more information regarding the product characteristics. This situation generates changes on each step of buying process. The customer satisfaction is harder to reach and the sustainable development of a marketing strategy needs to take into consideration more factors. The article aims at providing new information on customer satisfaction and sustainable development by using a marketing models framework.
Weiner, Neal Jonathan
In 1934 Fermi postulated a theory for weak interactions containing a dimensionful coupling with a size of roughly 250 GeV. Only now are we finally exploring this energy regime. What arises is an open question: supersymmetry and large extra dimensions are two possible scenarios. Meanwhile, other experiments will begin providing definitive information into the nature of neutrino masses and CP violation. In this paper, we explore features of possible theoretical scenarios, and study the phenomenological implications of various models addressing the open questions surrounding these issues
Korporaal, Marga; Broese van Groenou, Marjolein I; van Tilburg, Theo G
Older couples are likely to be confronted with health problems of both spouses and these health problems may negatively influence their marital satisfaction. The present study examined these possible negative effects using a dyadic perspective. Data from 78 independently living older couples were analyzed using the Actor-Partner Interdependence Model (APIM). Health problems were modeled as a latent factor of functional disability, the number of chronic diseases, and self-rated health. The couple's health context, that is, similarity or dissimilarity, was examined with an actor-partner interaction variable. For wives, spousal health problems were negatively associated with their marital satisfaction, but only under the condition that their own health was relatively good. For husbands, neither own nor spousal health problems were associated with their marital satisfaction. Future research focusing on older couples needs to consider the couple's health context next to health at the individual level.
Heffernan, John M.; Sirianni, Rachael W.
Following diagnosis of a glioblastoma (GBM) brain tumor, surgical resection, chemotherapy and radiation together yield a median patient survival of only 15 months. Importantly, standard treatments fail to address the dynamic regulation of the brain tumor microenvironment that actively supports tumor progression and treatment resistance. It is becoming increasingly recognized that specialized niches within the tumor microenvironment maintain a population of highly malignant glioblastoma stem-like cells (GSCs). GSCs are resistant to traditional chemotherapy and radiation therapy, suggesting that they may be responsible for the near universal rates of tumor recurrence and associated morbidity in GBM. Thus, disrupting microenvironmental support for GSCs could be critical to developing more effective GBM therapies. Three-dimensional (3D) culture models of the tumor microenvironment are powerful tools for identifying key biochemical and biophysical inputs that impact malignant behaviors. Such systems have been used effectively to identify conditions that regulate GSC proliferation, invasion, stem-specific phenotypes, and treatment resistance. Considering the significant role that GSC microenvironments play in regulating this tumorigenic sub-population, these models may be essential for uncovering mechanisms that limit GSCs malignancy.
Researchers developing mathematical models of the spreading of HIV, the Human Immunodeficiency Virus that causes AIDS, hope to achieve a number of goals. These goals may be classified rather broadly into three categories: understanding, prediction, and control. Understanding which are the key biological and sociological processes spreading this epidemic and leading to the deaths of those infected will allow AIDS researchers to collect better data and to identify ways of slowing the epidemic. Predicting the groups at risk and future numbers of ill people will allow an appropriate allocation of health-care resources. Analysis and comparison of proposed control methods will point out unexpected consequences and allow a better design of these programs. The processes which lead to the spread of HIV are biologically and sociologically complex. Mathematical models allow us to organize our knowledge into a coherent picture and examine the logical consequences, therefore they have the potential to be extremely useful in the search to control this disease. 24 refs., 3 figs.
On 1 April 1991 a new regime for industrial pollution control was introduced in England and Wales: Integrated Pollution Regulation (IPR). For those industrial processes which involve releases of pollutants into the atmosphere, the relevant primary legislation includes: the Environmental Protection Act 1990, which established a system of Integrated Pollution Control for those industries which have the greatest potential to cause pollution, and the Radioactive Substances Act 1960, which is concerned with the regulation of radioactive releases. There is a requirement for the operator of a process to make an application to HMIP for authorization to operate the process and dispose of waste arisings, and an environmental impact assessment must form part of that application. HMIP does not prescribe the type of assessment techniques that the applicant should use. But the Inspectorate will audit the applicant's assessment, and also carry out its own calculations if appropriate. The assessment standards used by HMIP are being published in the form of ''Chief Inspector's Guidance to Inspectors'', which can be referred to by applicants. HMIP makes use of both short-range and longer-range atmospheric dispersion models to fulfill its regulatory duties. Within the former category, the Inspectorate is one of the UK organisations which is sponsoring the development of the UK-ADMS model. (AB)
Pérez-Muñoz, Alfonso; Chacón, Fernando; Martínez Arias, Rosario
Poverty is a social problem, entailing not only an economical perspective but above all a human and social issue. Poverty is promoted, justified and maintained by unique individuals and groups by means of our own attitudes, interests and behavior, as well as with our social structures and social relationships. From this interactive, psychosocial and sociostructural perspective, and also considering poverty as a denial of basic human rights (UNDP, 1998), we carried out a study with the primary objective to design and verify an Explanatory Model of Poverty. This research may helps to increase the validity of diagnostics and the effectiveness of interventions. Most of the hypotheses were accepted during the analysis and verification of the Model (p poverty including its effects, processes and causes; (b) the need for everybody to accept the social responsibility in the prevention and solution to poverty; and (c) the need to conduct longitudinal interventions with scientific methodology and social participation.
Mancho, Ana M.; Hernández-García, Emilio; López, Cristóbal; Turiel, Antonio; Wiggins, Stephen; Pérez-Muñuzuri, Vicente
The third edition of the international workshop Nonlinear Processes in Oceanic and Atmospheric Flows was held at the Institute of Mathematical Sciences (ICMAT) in Madrid from 6 to 8 July 2016. The event gathered oceanographers, atmospheric scientists, physicists, and applied mathematicians sharing a common interest in the nonlinear dynamics of geophysical fluid flows. The philosophy of this meeting was to bring together researchers from a variety of backgrounds into an environment that favoured a vigorous discussion of concepts across different disciplines. The present Special Issue on Current perspectives in modelling, monitoring, and predicting geophysical fluid dynamics contains selected contributions, mainly from attendants of the workshop, providing an updated perspective on modelling aspects of geophysical flows as well as issues on prediction and assimilation of observational data and novel tools for describing transport and mixing processes in these contexts. More details on these aspects are discussed in this preface.
Full Text Available Born also as a reaction, with a pronounced contestatory character and as an alternative to the actual mondialization of the “total capitalism”, the altermondialism has succeeded to impose itself in the last decade as a social movement with transcontinental dimensions and as a theoretical position in full development. By denouncing the essential drawbacks of the international order of finance and commerce – the multiplication of the discrepancies between North and South, the amplification of the inequalities between rich and poor or the emphasis of the ecological insecurity, which demonstrates the incapacity of the occidental economic model in offering a sustainable future for the entire humanity – the altermondialist project proposes a global model of development, multidimensional, in which the factors: economy, society, ecology and culture are combining in a viable way. The neo-liberal dogma of absolute free change and of the pre-eminence of private is replaced with values, such as: solidarity, democracy and social justice. If the diversity of elements and its nature of “movement of movements” prove to be efficient as a front of contesting and denouncing of the existing mondialism, the lack of homogeneity impedes building a clear and coherent strategic program and, consequently, canalizing the efforts of the altermondialist militants towards a unique direction. Nevertheless, a common direction is affirming on general themes, such as: promoting a sustainable development, respecting fundamental rights, protecting the environment, peace and democracy. With an often idealist speech, marching towards a “contestant utopia”, the movement designated as its main ideological adversary, the neo-liberalism and wants to become a “theoretical engine” of social struggle. Until now, the performance of confrontations between the supporters of the two mondialisms – the one still in force and, respectively, the one in project phase, showed
Fate and behavior studies are fundamental to oil spill research and their results are important for operational response. Knowledge of the ultimate fate and behavior of oil should drive countermeasures decisions. Research has been conducted around the world on oil fate and behavior. The effort has not been, in this author's opinion, focussed and long-term as it should have been. Unfortunately, research funding for oil spills is very oscillatory. Fate and behavior studies require a long, concerted effort to yield valuable results. Because of this, fate and behavior studies have suffered much more than others from funding spurts. Little research has been maintained at universities because of the lack of sustained funding. Few other research organizations have facilities, equipment and expertise to carry out fundamental studies. A second difficulty in the field has been the tendency to fund one-year studies. In many cases little can be answered in a year. Specialized apparatus take 6-12 months to build or to acquire. Little time is left to operate these. The learning curve is also a factor. It is generally accepted in a specialized field that it takes a new scientist 6 months to produce any useful work, 2 years to become productive, and 5 years to be fully productive. Hopefully, future efforts will allow for longer-term studies on fate and behavior. The state-of-the-art in the field of fate, behavior, weathering and modelling could be summarized as variable. There are many deficiencies in our knowledge about the fate, weathering and modelling of oil spills. The fate, behavior and transformation of oil is dominated by the reality that oil is a varying mixture of hundreds of compounds
Full Text Available Born also as a reaction, with a pronounced contestatory character and as an alternative to the actual mondialization of the “total capitalism”, the altermondialism has succeeded to impose itself in the last decade as a social movement with transcontinental dimensions and as a theoretical position in full development. By denouncing the essential drawbacks of the international order of finance and commerce – the multiplication of the discrepancies between North and South, the amplification of the inequalities between rich and poor or the emphasis of the ecological insecurity, which demonstrates the incapacity of the occidental economic model in offering a sustainable future for the entire humanity – the altermondialist project proposes a global model of development, multidimensional, in which the factors: economy, society, ecology and culture are combining in a viable way. The neo-liberal dogma of absolute free change and of the pre-eminence of private is replaced with values, such as: solidarity, democracy and social justice. If the diversity of elements and its nature of “movement of movements” prove to be efficient as a front of contesting and denouncing of the existing mondialism, the lack of homogeneity impedes building a clear and coherent strategic program and, consequently, canalizing the efforts of the altermondialist militants towards a unique direction. Nevertheless, a common direction is affirming on general themes, such as: promoting a sustainable development, respecting fundamental rights, protecting the environment, peace and democracy. With an often idealist speech, marching towards a “contestant utopia”, the movement designated as its main ideological adversary, the neo-liberalism and wants to become a “theoretical engine” of social struggle. Until now, the performance of confrontations between the supporters of the two mondialisms – the one still in force and, respectively, the one in project phase, showed
Mediaty,; Said, Darwis; Syahrir,; Indrijawati, Aini
- This research aims to analyze the poverty, education, and health in social security system model based on accounting perspective using empirical study on South Sulawesi Province. Issued Law No. 40 for 2004 regarding National Social Security System is one of attentions from government about social welfare. Accounting as a social science deserves to create social security mechanisms. One of the crucial mechanisms is social security system. This research is a grounded exploratory research w...
Carmelo Manuella, Fabio; Scribano, Vittorio; Carbone, Serafina; Hovland, Martin; Johnsen, Hans-Konrad; Rueslåtten, Håkon
Mediterranean salt giants, occurring both in sub-seafloor and in onshore settings (the "Gessoso Solfifera Group"), are traditionally explained by repeated cycles of desiccation and replenishment of the entire basin. However, such hypotheses are strongly biased by mass balance calculations and geodynamic considerations. In addition, any hypothesis without full desiccation, still based on the evaporite model, should consider that seawater brines start to precipitate halite when 2/3 of the seawater has evaporated, and hence the level of the basin cannot be the same as the adjacent ocean. On the other hand, hydrothermal venting of hot saline brines onto the seafloor can precipitate salt in a deep marine basin if a layer of heavy brine exists along the seafloor. This process, likely related to sub-surface boiling or supercritical out-salting (Hovland et al., 2006), is consistent with geological evidence in the Red Sea "Deeps" (Hovland et al., 2015). Although supercritical out-salting and phase separation can sufficiently explain the formation of several marine salt deposits, even in deep marine settings, the Mediterranean salt giant formations can also be explained by the serpentinization model (Scribano et al., 2016). Serpentinization of abyssal peridotites does not involve seawater salts, and large quantities of saline brines accumulate in pores and fractures of the sub-seafloor serpentinites. If these rocks undergo thermal dehydration, for example, due to igneous intrusions, brines and salt slurries can migrate upwards as hydrothermal plumes, eventually venting at the seafloor, giving rise to giant salt deposits over time. These hydrothermal processes can take place in a temporal sequence, as it occurred in the "Caltanissetta Basin" (Sicily). There, salt accumulation associated with serpentinization started during Triassic times (and even earlier), and venting of heavy brines onto the seafloor eventually occurred in the Messinian via the hydrothermal plume mechanism
Full Text Available Older patients are at an increased risk of developing adverse drug reactions (ADR. Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1 develop and (2 validate an ADR risk prediction model.We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset.Six-hundred-ninety patients (median age 85 years were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively.We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days, some of which have not been previously reported.
Demiralp, Emre; Demiralp, Metin
Recent research suggests that any set of first order linear vector ODEs can be converted to a set of specific vector ODEs adhering to what we have called "Quantum Harmonical Form (QHF)". QHF has been developed using a virtual quantum multi harmonic oscillator system where mass and force constants are considered to be time variant and the Hamiltonian is defined as a conic structure over positions and momenta to conserve the Hermiticity. As described in previous works, the conversion to QHF requires the matrix coefficient of the first set of ODEs to be a normal matrix. In this paper, this limitation is circumvented using a space extension approach expanding the potential applicability of this method. Overall, conversion to QHF allows the investigation of a set of ODEs using mathematical tools available to the investigation of the physical concepts underlying quantum harmonic oscillators. The utility of QHF in the context of dynamical systems and dynamical causal modeling in behavioral and cognitive neuroscience is briefly discussed.
After draining the northern flank of the Alps Mountains in Germany and Austria, the Danube River flows east as it enters this west-looking scene (upper right) and forms the border between Slovakia and Hungary. The river then leaves the border as it enters Hungary and transects the Transdanubian Mountains, which trend southwest to northeast. Upon exiting the mountains, the river turns southward, flowing past Budapest (purplish blue area) and along the western margin of the Great Hungarian Plain.South and west of the Danube, the Transdanubian Mountains have at most only about 400 meters (about 1300 feet) of relief but they exhibit varied landforms, which include volcanic, tectonic, fluvial (river), and eolian (wind) features. A thick deposit of loess (dust deposits likely blown from ancient glacial outwash) covers much of this area, and winds from the northwest, funneled between the Alps and the Carpathian Mountains, are apparently responsible for a radial pattern of erosional streaks across the entire region.This image was generated from a Landsat satellite image draped over an elevation model produced by the Shuttle Radar Topography Mission (SRTM). The view uses a 3-times vertical exaggeration to enhance topographic expression. The false colors of the scene result from displaying Landsat bands 1, 4, and 7 in blue, green, and red, respectively. Band 1 is visible blue light, but bands 4 and 7 are reflected infrared light. This band combination maximizes color contrasts between the major land cover types, namely vegetation (green), bare ground (red), and water (blue). Shading of the elevation model was used to further highlight the topographic features.Elevation data used in this image was acquired by the Shuttle Radar Topography Mission (SRTM) aboard the Space Shuttle Endeavour, launched on February 11, 2000. SRTM used the same radar instrument that comprised the Spaceborne Imaging Radar-C/X-Band Synthetic Aperture Radar (SIR-C/X-SAR) that flew twice on the Space
Mitchell, Elizabeth A; McCance, Tanya
Despite a growing theoretical base to support the development of person-centred practice, the evidence would suggest that this way of working is somewhat elusive in the care of older people. The study aims to explore nurse-older person encounters and relationships within the context of person-centredness. This study involved secondary analysis of interview data originally collected from a commissioned study investigating whole-systems approaches in services for older people. The process of analysis used the Authentic Consciousness Framework. Nurses are often invisible to the patient, unless they are providing care to address a physical need. A sense of rolelessness pervaded the data, when patients were deprived from actively participating in important decisions about their future care. Patients would like nurses to work with them in more transparent ways. Patients are very conscious that nurses are busy and attempt to share the coping with the busy workload by limiting their expectations of the nurse. Person-centred strategies must enhance the capacity of not only older patients and their ability to assert self, but also the capacity of their nurses. Nurses must work to actively recruit the patient in all decision making. © 2010 Blackwell Publishing Ltd.
van Bree, Rob J H; Bolman, Catherine; Mudde, Aart N; van Stralen, Maartje M; Peels, Denise A; de Vries, Hein; Lechner, Lilian
These longitudinal studies in older adults targeted mediated relationships between habit and physical activity (PA). In The Netherlands two independent studies were conducted among 1976 (Study 1: Mage = 63.63, SD = 8.66, 30% functional limitations) and 2140 (Study 2: Mage = 62.75, SD = 8.57, 45% functional limitations) adults aged 50 years or older. Cross-lagged panel designs were applied to examine whether habit mediates the relationship between prior and later PA and whether PA simultaneously mediates the relationship between prior and later habit. Data on habit and PA were collected by means of questionnaires at baseline (t0) and at 6 (t1) and 12 (t2) months after baseline measurement. Results of structural equation modeling analyses were not unambiguous. Indications for the existence of both hypothesized mediation effects were found, but no clear, unequivocal pattern appeared. Somewhat more support was found for the PA-habit-PA path than for the habit-PA-habit path. More research is needed to draw more definitive conclusions.
Full Text Available The performance assessment analysis after the economic crisis by using Balanced Scorecard (BSC method becomes a powerful and effective tool and can provide an integrated view of the performance of an organization. This strategy led to the Indonesian economy being stretched positively after the economic crisis. Taking effective decisions is not spared from combining four BSC perspectives and strategies that focus on a system with different behavior or steps. This paper combines two methods of BSC with structural equation modeling (SEM because they have the same concept, which is a causal relationship, where the research model concept SEM variables use BSC variable. The purpose of this paper is to investigate the influence of variables that synergized between balanced scorecard with SEM as a means of strategic planning in the future. This study used primary data with a large enough sample to meet the maximum likelihood estimation by assessment scale of seven semantic points. This research model is a combination of one and two step models. The next step is to test the measurement model, structural equation modeling, and modification models. The test results indicated that the model has multi colinearities. Therefore, the model is converted into one step model. The test results after being modified into a model of the goodness of fit indices showed a good score. All BSC variables have direct significant influence, including the perspective of strategic goals and sustainable competitive advantage. The implication of the simulation model of goodness of fit-modification results are DF = 227, Chi-square =276.550, P =0.058, CMIN/DF = 1.150, GFI = 0.831, AGFI = 0.791, CFI = 0.972, TLI = 0.965 and RMSEA = 0.039.
Weng, Shuo-Chun; Chen, Yu-Chi; Chen, Ching-Yu; Cheng, Yuan-Yang; Tang, Yih-Jing; Yang, Shu-Hui; Lin, Jwu-Rong
The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P < 0.001 in Poisson regression; coefficient = -0.33, P < 0.001 in order choice profit model; coefficient = -0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652. © 2016 Japan Geriatrics Society.
Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic
Confidence in 3D multi-segment foot models has been limited by a lack of repeatability data, particularly in older populations that may display unique functional foot characteristics. This study aimed to determine the intra and inter-observer repeatability of stance phase kinematic data from a multi-segment foot model described by Leardini et al.  in people aged 50 years or older. Twenty healthy adults participated (mean age 65.4 years SD 8.4). A repeated measures study design was used with data collected from four testing sessions on two days from two observers. Intra (within-day and between-day) and inter-observer coefficient of multiple correlations revealed moderate to excellent similarity of stance phase joint range of motion (0.621-0.975). Relative to the joint range of motion (ROM), mean differences (MD) between sessions were highest for the within-day comparison for all planar ROM at the metatarsus-midfoot articulation (sagittal plane ROM 5.2° vs. 3.9°, MD 3.1°; coronal plane ROM 3.9 vs. 3.1°, MD 2.3°; transverse plane ROM 6.8° vs. 5.16°, MD 3.5°). Consequently, data from the metatarsus-midfoot articulation in the Istituto Ortopedico Rizzoli (IOR) foot model in adults aged over 50 years needs to be considered with respect to the findings of this study. Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.
Julius Francis Gomes
Full Text Available Purpose: To facilitate futures business research by proposing a novel way to combine business models as a conceptual tool with futures research techniques. Design: A futures perspective is adopted to foresight business models of the Internet of Things (IoT enabled healthcare sector by using business models as a futures business research tool. In doing so, business models is coupled with one of the most prominent foresight methodologies, Causal Layered Analysis (CLA. Qualitative analysis provides deeper understanding of the phenomenon through the layers of CLA; litany, social causes, worldview and myth. Findings: It is di cult to predict the far future for a technology oriented sector like healthcare. This paper presents three scenarios for short-, medium- and long-term future. Based on these scenarios we also present a set of business model elements for different future time frames. This paper shows a way to combine business models with CLA, a foresight methodology; in order to apply business models in futures business research. Besides offering early results for futures business research, this study proposes a conceptual space to work with individual business models for managerial stakeholders. Originality / Value: Much research on business models has offered conceptualization of the phenomenon, innovation through business model and transformation of business models. However, existing literature does not o er much on using business model as a futures research tool. Enabled by futures thinking, we collected key business model elements and building blocks for the futures market and ana- lyzed them through the CLA framework.
Mischke, Peggy; Karlsson, Kenneth Bernard
compares 18 energy modelling tools from ten Chinese institutions. These models have been described in English language publications between 2005 and 2013, although not all are published in peer-reviewed journals. When comparing the results for three main energy system indicators across models, this paper...... finds that there are considerable ranges in the reference scenarios: (i) GDP is projected to grow by 630e840% from 2010 to 2050, (ii) energy demand could increase by 200e300% from 2010 to 2050, and (iii) CO2 emissions could rise by 160e250% from 2010 to 2050. Although the access to the modelling tools...... and the underlying data remains challenging, this study concludes that the Chinese perspective, independently from the modelling approach and institution, suggests a rather gradual and long-term transition towards a low carbon economy in China. Few reference scenarios include an emission peak or stabilisation period...
Khosravi, Yahya; Asilian-Mahabadi, Hassan; Hajizadeh, Ebrahim; Hassanzadeh-Rangi, Narmin; Bastani, Hamid; Khavanin, Ali; Mortazavi, Seyed Bagher
There can be little doubt that the construction is the most hazardous industry in the worldwide. This study was designed to modeling the factors affecting unsafe behavior from the perspective of safety supervisors. The qualitative research was conducted to extract a conceptual model. A structural model was then developed based on a questionnaire survey (n=266) by two stage Structural Equation Model (SEM) approach. An excellent confirmed 12-factors structure explained about 62% of variances unsafe behavior in the construction industry. A good fit structural model indicated that safety climate factors were positively correlated with safety individual factors (Pconstruction workers' engagement in safe or unsafe behavior. In order to improve construction safety performance, more focus on the workplace condition is required.
Vafaei, Afshin; Alvarado, Beatriz; Tomás, Concepcion; Muro, Carmen; Martinez, Beatriz; Zunzunegui, Maria Victoria
The Bem Sex Role Inventory (BSRI) is the most commonly used and validated gender role measurement tool across countries and age groups. However, it has been rarely validated in older adults and sporadically used in aging and health studies. Perceived gender role is a crucial part of a person's identity and an established determinant of health. Androgyny model suggests that those with high levels of both masculinity and femininity (androgynous) are more adaptive and hence have better health. Our objectives were to explore the validity of BSRI in an older Spanish population, to compare different standard methods of measuring gender roles, and to examine their impact on health indicators. The BSRI and health indicator questions were completed by 120 community-dwelling adults aged 65+ living in Aragon, Spain. Exploratory factor analysis was performed to examine psychometric properties of the BSRI. Androgyny was measured by three approaches: geometric mean, t-ratio, and traditional four-gender groups classification. Relationships between health indicators and gender roles were explored. Factor analysis resulted in two-factor solution consistent with the original masculine and feminine items with high loadings and good reliability. There were no associations between biological sex and gender roles. Different gender role measurement approaches classified participants differently into gender role groups. Overall, androgyny was associated with better mobility and physical and mental health. The traditional four groups approach showed higher compatibility with the androgyny model and was better able to disentangle the differential impact of gender roles on health. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Taipale, Heidi; Tanskanen, Antti; Koponen, Marjaana; Tolppanen, Anna-Maija; Tiihonen, Jari; Hartikainen, Sirpa
Background PRE2DUP is a modeling method that generates drug use periods (ie, when drug use started and ended) from drug purchases recorded in dispensing-based register data. It is based on the evaluation of personal drug purchasing patterns and considers hospital stays, possible stockpiling of drugs, and package information. Objective The objective of this study was to investigate person-level agreement between self-reported drug use in the interview and drug use modeled from dispensing data with PRE2DUP method for various drug classes used by older persons. Methods Self-reported drug use was assessed from the GeMS Study including a random sample of persons aged ≥75 years from the city of Kuopio, Finland, in 2006. Drug purchases recorded in the Prescription register data of these persons were modeled to determine drug use periods with PRE2DUP modeling method. Agreement between self-reported drug use on the interview date and drug use calculated from register-based data was compared in order to find the frequently used drugs and drug classes, which was evaluated by Cohen’s kappa. Kappa values 0.61–0.80 were considered to represent good and 0.81–1.00 as very good agreement. Results Among 569 participants with mean age of 82 years, the agreement between interview and register data was very good for 75% and very good or good for 93% of the studied drugs or drug classes. Good or very good agreement was observed for drugs that are typically used on regular bases, whereas “as needed” drugs represented poorer results. Conclusion PRE2DUP modeling method validly describes regular drug use among older persons. For most of drug classes investigated, PRE2DUP-modeled register data described drug use as well as interview-based data which are more time-consuming to collect. Further studies should be conducted by comparing it with other methods and in different drug user populations. PMID:27785101
Karnon, Jonathan; Afzali, Hossein Haji Ali; Putro, Gregorius Virgianto Arpuji Anggoro; Thant, Phyu Win; Dompok, Ameline; Cox, Ingrid; Chikhwaza, Owen Henry; Wang, Xian; Mwangangi, Mercy Mukui; Farransahat, Matahari; Cameron, Ian
The clinical importance of frailty is increasing. Existing economic evaluations of interventions to manage frailty have limited time horizons, but even in older populations there may be important longer-term differences in costs and outcomes. This paper reports on the development of a cost-effectiveness model to predict publicly funded health and aged care costs and quality-adjusted life years (QALYs) over the remaining lifetime of frail Australians and a model-based cost-utility analysis of a physiotherapy-based intervention for frail individuals. A cohort-based state transition (Markov) model was developed to predict costs and QALYs over the remaining lifetime of a frail population. Frailty is defined using the phenotypic definition of frailty, and the model comprises health states that describe frailty status, residential status, the experience of bone fractures and depression, and death. Model input parameters were estimated and calibrated using the Dynamic Analyses to Optimise Ageing dataset, supplemented with data from the published literature. The cost-effectiveness model was subject to a range of validation approaches, which did not negate the validity of the model. The evaluated physiotherapy-based frailty intervention has an expected incremental cost per QALY gained of Australian $8129 compared to usual care, but there is a probability of 0.3 that usual care is more effective and less costly than the intervention. Frailty reduces quality of life, is costly to manage and it's prevalence is increasing, but new approaches to managing frailty need to demonstrate value for money. The value of the reported cost-effectiveness model is illustrated through the estimation of all important costs and effects of a physiotherapy-based frailty intervention, which facilitates comparisons with funding decisions for other new technologies in Australia.
Boulton-Lewis, Gillian M.; Buys, Laurie
This paper reports on the findings of qualitative, semistructured interviews conducted with 40 older Australian participants who either did or did not engage in organized learning. Phenomenology was used to guide the interviews and analysis to explore the lived learning experiences and perspectives of these older people. Their experiences of…
Full Text Available Abstract Background Most services provided by health and social care organisations for older people living at home rely on interprofessional working (IPW. Although there is research investigating what supports and inhibits how professionals work together, less is known about how different service models deliver care to older people and how effectiveness is measured. The aim of this study was to describe how IPW for older people living at home is delivered, enacted and evaluated in England. Method An online survey of health and social care managers across England directly involved in providing services to older people, and a review of local strategies for older people services produced by primary care organisations and local government adult services organisations in England. Results The online survey achieved a 31% response rate and search strategies identified 50 local strategies that addressed IPW for older people living at home across health and social care organisations. IPW definitions varied, but there was an internal consistency of language informed by budgeting and organisation specific definitions of IPW. Community Services for Older People, Intermediate Care and Re-enablement (rehabilitation Teams were the services most frequently identified as involving IPW. Other IPW services identified were problem or disease specific and reflected issues highlighted in local strategies. There was limited agreement about what interventions or strategies supported the process of IPW. Older people and their carers were not reported to be involved in the evaluation of the services they received and it was unclear how organisations and managers judged the effectiveness of IPW, particularly for services that had an open-ended commitment to the care of older people. Conclusion Health and social care organisations and their managers recognise the value and importance of IPW. There is a theoretical literature on what supports IPW and what it can achieve
Full Text Available The United Nations Paris agreement of 2015 highlighted the need for urban planning to prevent and contain urban sprawl so as to reduce trip lengths through an efficient distribution of agglomerations and a well-balanced urban pattern distribution, all while considering travel behavior and accessibility to green areas, services, and facilities on different temporal scales. For the Vienna-Bratislava metropolitan region, our integrated modeling approach uses a combination of multifractal spatial modeling along with a space syntax perspective. Multifractal strategies are intrinsically multiscalar and adhere to five planning principles: hierarchical (polycentric urban development to manage urban sprawl; sustainable transit-oriented development; locally well-balanced urban pattern and functions distribution to enhance vital urban systems, local centers, and neighborhoods; penetration of green areas into built-up areas; and the preservation of large interconnected networks of green areas to conserve biodiversity. Adding space syntax modeling to a multifractal strategy integrates how space relates to functional patterns based on centrality, thus applying a socio-spatial perspective. In this paper, we used the following workflow for an integrated modeling approach: (1 Space syntax to identify the urban systems’ hierarchy and so determine a spatial strategy regionally; (2 Fractalopolis to create a multifractal development plan for potential urbanization; and (3 Space syntax to design a strategic urban master plan for locating new housing and facilities vis-à-vis socioeconomic factors.
Rotmans, J.; Van Asselt, M.B.A.; De Bruin, A.J.; Den Elzen, M.G.J.; De greef, J.; Hilderink, H.; Hoekstra, A.Y.; Janssen, M.A.; Koester, H.W.; Martens, W.J.M.; Niessen, L.W.; De Vries, H.J.M.
The main objective of the title program is to develop an integrated modelling framework for analysing global change and sustainable development. The framework to be developed is referred to as TARGETS: Tool to Assess Regional and Global Environmental and health Targets for Sustainability. The research is based on a systems-based, integrated modelling approach and has a multi- and interdisciplinary character. A top-down approach is chosen: analysis starts at the global level and will be disaggregated to the level of major world regions. Alliance has been sought with the IMAGE project team in regard to data collection, regionalization and aggregation levels. The modelling framework is to be used by both researchers and policy analysts. In this report attention is paid to the requirements of an integrated systems approach (a multi-disciplinary systems analysis, quantification of uncertainties, and visualization of various system perspectives); the TARGETS model; the use of sustainability indicators to monitor the pressure on, the status of, and the impact on the global environment, which are linked to TARGETS; the scientific and cultural perspectives from which to describe and evaluate the global change phenomenon; the expected results; and finally the organizational embedment of the title programme. 19 figs., 3 tabs., 200 refs
This paper presents the Model of Strategic e-Learning to explain and evaluate student e-learning from metacognitive perspectives. An in-depth interview, pilot study and main study are employed to construct the model and develop an instrument--the Online Learning Strategies Scale (OLSS). The model framework is constructed and illustrated by four…
Collin F Payne
Full Text Available Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA; by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited.Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%-64% of their remaining 28 y of life (95% CI, 25.7-33.5 with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%-46% of their remaining 25.4 y (95% CI, 23.3-28.8 with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well
Roos, Paulien E.; Dingwell, Jonathan B.
Falls are common in older adults. The most common cause of falls is tripping while walking. Simulation studies demonstrated that older adults may be restricted by lower limb strength and movement speed to regain balance after a trip. This review examines how modeling approaches can be used to determine how different measures predict actual fall risk and what some of the causal mechanisms of fall risk are. Although increased gait variability predicts increased fall risk experimentally, it is not clear which variability measures could best be used, or what magnitude of change corresponded with increased fall risk. With a simulation study we showed that the increase in fall risk with a certain increase in gait variability was greatly influenced by the initial level of variability. Gait variability can therefore not easily be used to predict fall risk. We therefore explored other measures that may be related to fall risk and investigated the relationship between stability measures such as Floquet multipliers and local divergence exponents and actual fall risk in a dynamic walking model. We demonstrated that short-term local divergence exponents were a good early predictor for fall risk. Neuronal noise increases with age. It has however not been fully understood if increased neuronal noise would cause an increased fall risk. With our dynamic walking model we showed that increased neuronal noise caused increased fall risk. Although people who are at increased risk of falling reduce their walking speed it had been questioned whether this slower speed would actually cause a reduced fall risk. With our model we demonstrated that a reduced walking speed caused a reduction in fall risk. This may be due to the decreased kinematic variability as a result of the reduced signal-dependent noise of the smaller muscle forces that are required for slower. These insights may be used in the development of fall prevention programs in order to better identify those at increased risk of
Roos, Paulien E; Dingwell, Jonathan B
Falls are common in older adults. The most common cause of falls is tripping while walking. Simulation studies demonstrated that older adults may be restricted by lower limb strength and movement speed to regain balance after a trip. This review examines how modeling approaches can be used to determine how different measures predict actual fall risk and what some of the causal mechanisms of fall risk are. Although increased gait variability predicts increased fall risk experimentally, it is not clear which variability measures could best be used, or what magnitude of change corresponded with increased fall risk. With a simulation study we showed that the increase in fall risk with a certain increase in gait variability was greatly influenced by the initial level of variability. Gait variability can therefore not easily be used to predict fall risk. We therefore explored other measures that may be related to fall risk and investigated the relationship between stability measures such as Floquet multipliers and local divergence exponents and actual fall risk in a dynamic walking model. We demonstrated that short-term local divergence exponents were a good early predictor for fall risk. Neuronal noise increases with age. It has however not been fully understood if increased neuronal noise would cause an increased fall risk. With our dynamic walking model we showed that increased neuronal noise caused increased fall risk. Although people who are at increased risk of falling reduce their walking speed it had been questioned whether this slower speed would actually cause a reduced fall risk. With our model we demonstrated that a reduced walking speed caused a reduction in fall risk. This may be due to the decreased kinematic variability as a result of the reduced signal-dependent noise of the smaller muscle forces that are required for slower. These insights may be used in the development of fall prevention programs in order to better identify those at increased risk of
Full Text Available Objectives: The aim of the present study is to examine the prediction of the reminiscence functions in older adults on the basis of the five personality factor model. Methods & Materials: 242 elderly adults older than 60 were recruited from retirement clubs of the city of Shiraz via available sampling method. The participants completed the Reminiscence Functions Scale and Goldberg's International Personality Item Pool. Forty participants were deleted from the sample because they did not complete the questionnaires fully. All the participants took part in the study with their conscious consent. To conduct the necessary descriptive and inferential statistical operations, SPSS (Version 16 was used. Mean, standard deviation and Pearson correlation coefficient were utilized to analyze the data in the descriptive statistics section, And in inferential statistics section, simultaneous multiple regression was used to predict reminiscence functions. Results: According to the results of the multiple regression analysis, Neuroticism predicted the reminiscence functions of Bitterness Revival (β=0.28, P≤0.001 and Intimacy Maintenance (β=0.25, P≤0.001 and Extraversion predicted the reminiscence functions of Teach/Inform (β=0.18, P<0.05. Conclusion: The results indicated that people with higher levels of psychological distress tend to rehash and ruminate on bitter memories and hold onto memories of intimate social relations who are no longer part of their lives. Moreover, extravert people tend to share memories to transmit a lesson of life and share personal ideologies and experiences. Clinicians should focus on more adaptive functions of reminiscence (e.g., identity, problem solving and teach/inform and teach such functions.
Howcroft, Jennifer; Kofman, Jonathan; Lemaire, Edward D
Wearable sensors can provide quantitative, gait-based assessments that can translate to point-of-care environments. This investigation generated elderly fall-risk predictive models based on wearable-sensor-derived gait data and prospective fall occurrence, and identified the optimal sensor type, location, and combination for single and dual-task walking. 75 individuals who reported six month prospective fall occurrence (75.2 ± 6.6 years; 47 non-fallers and 28 fallers) walked 7.62 m under single-task and dual-task conditions while wearing pressure-sensinginsoles and tri-axial accelerometers at the head, pelvis, and left and right shanks. Fall-risk classificationmodels were assessed for all sensor combinations and three model types: neural network, naïve Bayesian, and support vector machine. The best performing model used a neural network, dual-task gait data, and input parameters from head, pelvis, and left shank accelerometers (accuracy = 57%, sensitivity = 43%, and specificity = 65%). The best single-sensor model used a neural network, dual-task gait data, and pelvis accelerometer parameters (accuracy = 54%, sensitivity = 35%, and specificity = 67%). Single-task and dual-task gait assessments provided similar fall-risk model performance. Fall-risk predictive models developed for point-of-care environments should use multi-sensor dual-task gait assessment with the pelvis location considered if assessment is limited to a single sensor.
The environmental modeling community has historically been concerned with the proliferation of models and the effort associated with collective model development tasks (e.g., code generation, data provisioning and transformation, etc.). Environmental modeling frameworks (EMFs) have been developed to...
A solution for production scheduling that is lately attracting the interests of the manufacturing industry involves the use of complex mathematical modeling techniques in scheduling software. However this technology is fairly unknown among manufacturing practitioners, as are the social problems...... of its development and use. The aim of this article is to show how an approach based on multiple perspectives can help understand the emergence of complex software and help understand why and how the reasons and motives of the different stakeholders are, at times, incompatible....
Shebley, Mohamad; Sandhu, Punam; Emami Riedmaier, Arian; Jamei, Masoud; Narayanan, Rangaraj; Patel, Aarti; Peters, Sheila Annie; Reddy, Venkatesh Pilla; Zheng, Ming; de Zwart, Loeckie; Beneton, Maud; Bouzom, Francois; Chen, Jun; Chen, Yuan; Cleary, Yumi; Collins, Christiane; Dickinson, Gemma L; Djebli, Nassim; Einolf, Heidi J; Gardner, Iain; Huth, Felix; Kazmi, Faraz; Khalil, Feras; Lin, Jing; Odinecs, Aleksandrs; Patel, Chirag; Rong, Haojing; Schuck, Edgar; Sharma, Pradeep; Wu, Shu-Pei; Xu, Yang; Yamazaki, Shinji; Yoshida, Kenta; Rowland, Malcolm
This work provides a perspective on the qualification and verification of physiologically based pharmacokinetic (PBPK) platforms/models intended for regulatory submission based on the collective experience of the Simcyp Consortium members. Examples of regulatory submission of PBPK analyses across various intended applications are presented and discussed. European Medicines Agency (EMA) and US Food and Drug Administration (FDA) recent draft guidelines regarding PBPK analyses and reporting are encouraging, and to advance the use and acceptability of PBPK analyses, more clarity and flexibility are warranted. © 2018, The Authors Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.
Hydraulic servo system plays a significant role in industries, and usually acts as a core point in control and power transmission. Although linear theory-based control methods have been well established, advanced controller design methods for hydraulic servo system to achieve high performance is still an unending pursuit along with the development of modern industry. Essential nonlinearity is a unique feature and makes model-based nonlinear control more attractive, due to benefit from prior knowledge of the servo valve controlled hydraulic system. In this paper, a discussion for challenges in model-based nonlinear control, latest developments and brief perspectives of hydraulic servo systems are presented: Modelling uncertainty in hydraulic system is a major challenge, which includes parametric uncertainty and time-varying disturbance; some specific requirements also arise ad hoc difficulties such as nonlinear friction during low velocity tracking, severe disturbance, periodic disturbance, etc.; to handle various challenges, nonlinear solutions including parameter adaptation, nonlinear robust control, state and disturbance observation, backstepping design and so on, are proposed and integrated, theoretical analysis and lots of applications reveal their powerful capability to solve pertinent problems; and at the end, some perspectives and associated research topics (measurement noise, constraints, inner valve dynamics, input nonlinearity, etc.) in nonlinear hydraulic servo control are briefly explored and discussed.
Petersen, Juliana J; Paulitsch, Michael A; Mergenthal, Karola; Gensichen, Jochen; Hansen, Heike; Weyerer, Siegfried; Riedel-Heller, Steffi G; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Wiese, Birgitt; van den Bussche, Hendrik; Scherer, Martin; Dahlhaus, Anne
In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the
Kim, Hongsoo; Park, Yeon-Hwan; Jung, Young-Il; Choi, Hyoungshim; Lee, Seyune; Kim, Gi-Soo; Yang, Dong-Wook; Paik, Myunghee Cho; Lee, Tae-Jin
Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted. This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced. ISRCTN11972147.
Lammers, H B
From an Elaboration Likelihood Model perspective, it was hypothesized that postexposure awareness of deceptive packaging claims would have a greater negative effect on scores for purchase intention by consumers lowly involved rather than highly involved with a product (n = 40). Undergraduates who were classified as either highly or lowly (ns = 20 and 20) involved with M&Ms examined either a deceptive or non-deceptive package design for M&Ms candy and were subsequently informed of the deception employed in the packaging before finally rating their intention to purchase. As anticipated, highly deceived subjects who were low in involvement rated intention to purchase lower than their highly involved peers. Overall, the results attest to the robustness of the model and suggest that the model has implications beyond advertising effects and into packaging effects.
Full Text Available Through the use of a historical perspective, the aim of this article is to discuss and clarify the concurrent and conflicting interests and norms that have characterized the establishment and development of important institutions in Norwegian working life. The article concentrates on collective bargaining systems, the arrangements for codetermination, and the working environment regulations in both the public and private sector, which are regarded as the main institutions in the Norwegian and Nordic models of working life relations. The article is structured by an analytical distinction between three different historical periods that have constituted three distinct versions of the Norwegian model. By presenting a historical synthesis of Norwegian experiences, the article is a contribution to the ongoing debate on the varieties in the Nordic model, as to further comparisons and broader transnational studies.
Full Text Available UAV platforms are nowadays a valuable source of data for inspection, surveillance, mapping and 3D modeling issues. New applications in the short- and close-range domain are introduced, being the UAVs a low-cost alternatives to the classical manned aerial photogrammetry. Rotary or fixed wing UAVs, capable of performing the photogrammetric data acquisition with amateur or SLR digital cameras, can fly in manual, semi-automated and autonomous modes. With a typical photogrammetric pipeline, 3D results like DSM/DTM, contour lines, textured 3D models, vector data, etc. can be produced, in a reasonable automated way. The paper reports the latest developments of UAV image processing methods for photogrammetric applications, mapping and 3D modeling issues. Automation is nowadays necessary and feasible at the image orientation, DSM generation and orthophoto production stages, while accurate feature extraction is still an interactive procedure. New perspectives are also addressed.
Hansen Bruun, Inge; Maribo, Thomas; Nørgaard, Birgitte
, but 76 patients (65%) had persistent reduced physical performance when compared to their baseline (30s-CST ≤ 8). The number of potential predictors was reduced in order to create a simplified prediction model based on 4 variables, namely the use of a walking aid before hospitalisation (score = 1.5), a 30...
Wann, Daniel L.; Rogers, Kelly; Dooley, Keith; Foley, Mary
According to the Team Identification-Social Psychological Health Model (Wann, 2006b), team identification and social psychological health should be positively correlated because identification leads to important social connections which, in turn, facilitate well-being. Although past research substantiates the hypothesized positive relationship…
Full Text Available Yadollah Abolfathi Momtaz, Tengku Aizan Hamid, Jariah Masud, Sharifah Azizah Haron, Rahimah IbrahimInstitute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, MalaysiaBackground: There is a growing body of literature indicating that attitudes toward aging significantly affect older adults’ psychological well-being. However, there is a paucity of scientific investigations examining the role of older adults’ attitudes toward aging on their spouses' psychological well-being. Therefore, the present study aimed to examine the dyadic effects of attitude toward aging on the psychological well-being of older couples.Methods: Data for the present study, consisting of 300 couples aged 50 years and older, were drawn from a community-based survey entitled “Poverty among Elderly Women: Case Study of Amanah Ikhtiar” conducted in Peninsular Malaysia. An actor–partner interdependence model using AMOS version 20 (Europress Software, Cheshire, UK was used to analyze the dyadic data.Results: The mean ages of the husbands and wives in this sample were 60.37 years (±6.55 and 56.33 years (±5.32, respectively. Interdependence analyses revealed significant association between older adults’ attitudes toward aging and the attitudes of their spouses (intraclass correlation =0.59; P<0.001, and similar interdependence was found for psychological well-being (intraclass correlation =0.57; P<0.001. The findings from AMOS revealed that the proposed model fits the data (CMIN/degrees of freedom =3.23; goodness-of-fit index =0.90; confirmatory fit index =0.91; root mean square error of approximation =0.08. Results of the actor–partner independence model indicated that older adults’ psychological well-being is significantly predicted by their spouses' attitudes toward aging, both among older men (critical ratio =2.92; P<0.01 and women (critical ratio =2.70; P<0.01. Husbands’ and wives’ own reports of their attitudes toward aging were significantly
van Leeuwen, Esther; Oosterhuis, Misha; Ruyter, Sofie
Student nurses often have a negative attitude towards older patients due to negative stereotypes, which may explain their reluctance to work in geriatric care. The aim of this study was to investigate a dual effect (direct and indirect via anxiety) of patients' age on student nurses' attitudes towards their patients. Quantitative survey study with 2 between-subjects conditions (patient age: young patients vs. older patients; both n's=52). Two schools for higher vocational education in the Netherlands. 104 student nurses between the ages of 16-30 in the third or fourth year of their nursing education (Mage=21.58, SD=2.22; 93 women). Attitudes towards older patients were more negative than those towards young patients. Older patients also elicited less anxiety compared to young patients, and anxiety had a weaker relationship with attitudes towards older patients than attitudes towards younger patients. Attitudes towards younger patients, but not towards older patients, were depressed by anxiety. Older patients generate more negative attitudes among student nurses, but can also improve attitudes indirectly by lowering intergroup anxiety. Older people may be therefore be especially suitable as a patient group to receive care from young nurses in training, who can mature in their profession without being anxious over making a wrong impression. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available With rapid advancement of Cloud computing and networking technologies, a wide spectrum of Cloud services have been developed by various providers and utilized by numerous organizations as indispensable ingredients of their information systems. Cloud service performance has a significant impact on performance of the future information infrastructure. Thorough evaluation on Cloud service performance is crucial and beneficial to both service providers and consumers; thus forming an active research area. Some key technologies for Cloud computing, such as virtualization and the Service-Oriented Architecture (SOA, bring in special challenges to service performance evaluation. A tremendous amount of effort has been put by the research community to address these challenges and exciting progress has been made. Among the work on Cloud performance analysis, evaluation approaches developed with a system modeling perspective play an important role. However, related works have been reported in different sections of the literature; thus lacking a big picture that shows the latest status of this area. The objectives of this article is to present a survey that reflects the state of the art of Cloud service performance evaluation from the system modeling perspective. This articles also examines open issues and challenges to the surveyed evaluation approaches and identifies possible opportunities for future research in this important field.
Maria Gabriella Melchiorre
Full Text Available Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden. We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain and greater social support seemed linked with a decreased probability of being abused.Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male
Payne, S; Doyal, L
Older women make up an increasingly important sector in the labour market. However, we know little about their health-the various influences on their health and the ways in which paid and unpaid work impact on both physical and mental well being. This paper reviews the available literature on older women's health in the workplace, focussing on work-specific and more general risks for older women, including stress, discrimination, physical hazards and the 'double burden' of paid work and caring responsibilities. Databases searched included Web of Science, CAS, CINAHL, Medline and ASSIA, together with UK and European statistical sources. We conclude with a three-point research agenda, calling for more empirical work on the risks faced by older women, studies that take a life-course perspective of women's occupational health and work that explores the interactions between unpaid and paid work in later life.
Mohan Kumar Pasupuleti
Full Text Available Laboratory animal models serve as a facilitator to investigate the etiopathogenesis of periodontal disease, are used to know the efficacy of reconstructive and regenerative procedures, and are also helpful in evaluation of newer therapeutic techniques including laser and implant therapies prior to application in the human beings. The aim of this review is to know the different animal models used in various specialties of dental research and to know the ethical guidelines prior to the usage of experimental models with main emphasis on how to refine, replace, and reduce the number of animal models usage in the laboratory. An online search for experimental animal models used in dental research was performed using MEDLINE/PubMed database. Publications from 2009 to May 2013 in the specialty of periodontics were included in writing this review. A total of 652 references were published in PubMed/MEDLINE databases based on the search terms used. Out of 245 studies, 241 were related to the periodontal research published in English from 2009 to 2013. Relevant papers were chosen according to the inclusion and exclusion criteria. After extensive electronic and hand search on animal models, it has been observed that various animal models were used in dental research. Search on animal models used for dental research purpose revealed that various animals such as rats, mice, guinea pigs, rabbit, beagle dogs, goats, and nonhuman primates were extensively used. However, with the new advancement of ex vivo animal models, it has become easy to investigate disease pathogenesis and to test the efficacy of newer therapeutic modalities with the reduced usage of animal models. This review summarized the large amount of literature on animal models used in periodontal research with main emphasis on ethical guidelines and on reducing the animal model usage in future perspective.
Chan, M L; Gustafsson, L; Liddle, J
With an ageing population, policy makers need to balance active ageing needs with older driver safety. In 2009, a survey of licensing policies for taxi drivers in Singapore, Hong Kong and Australia was undertaken for an evidence-based review of policies. Licensing requirements collected using semi-structured questionnaires were compared descriptively and with evidence from licensing policies on older drivers. All the regions used medical certifications with vision screening. The frequency of medical certification varied according to the renewal cycle and age. Medical guidelines on fitness to drive were available in Australia and Singapore. Legislation for self-reporting of medical conditions by drivers existed in Australia and Hong Kong. Legislation for reporting at-risk drivers by doctors was limited to two Australian states. There were differences in the minimum age and driving experience criteria, the use of practical training, written and English tests, age-based screening, mandatory retirement age, refresher courses, off- and on-road tests. Medical screening for at-risk drivers remains crucial. Age-based mandatory retirement policy at 73 years in Singapore is contrary to evidence-based practice. The lack of legislation for self-reporting of illness by drivers, the high minimum age criteria and therapy driving assessments for healthy taxi drivers are also unique to Singapore. There was stricter age-based relicensing from the age of 65 years in some Australian states and in Singapore. Continuing education for doctors, multi-tier screening for at-risk drivers and licensing policy changes are indicated.
Venkata Mohan, S; Nikhil, G N; Chiranjeevi, P; Nagendranatha Reddy, C; Rohit, M V; Kumar, A Naresh; Sarkar, Omprakash
Increased urbanization worldwide has resulted in a substantial increase in energy and material consumption as well as anthropogenic waste generation. The main source for our current needs is petroleum refinery, which have grave impact over energy-environment nexus. Therefore, production of bioenergy and biomaterials have significant potential to contribute and need to meet the ever increasing demand. In this perspective, a biorefinery concept visualizes negative-valued waste as a potential renewable feedstock. This review illustrates different bioprocess based technological models that will pave sustainable avenues for the development of biobased society. The proposed models hypothesize closed loop approach wherein waste is valorised through a cascade of various biotechnological processes addressing circular economy. Biorefinery offers a sustainable green option to utilize waste and to produce a gamut of marketable bioproducts and bioenergy on par to petro-chemical refinery. Copyright © 2016 Elsevier Ltd. All rights reserved.
Geraldo da Silva e Souza
Full Text Available We describe the relative participation of the Brazilian meat market (beef, pork and chicken in total agribusiness exports and in total country exports. An analysis of the world meat market is carried out from the point of view of the values of consumption, production, exports and imports. A DEA (data envelopment analysis approach is then used to generate classifications of the importance of countries in the meat world market, and the insertion of Brazil into this market is viewed from these perspectives. A partial equilibrium model for the meat market is fitted to Brazilian data by a three-stage least squares procedure. The model is consistent with the data and is used for simulation purposes. In this context, we investigate the joint and separate effects of changes in the corn price and in the exchange rate on the market of endogenous variables, ceteris paribus.
Elbæk, Lars; Friis, Jørgen Jakob
an active lifestyle. Such digitally supported movement promote health and underlines a need for students to understand that movement design incorporates many aspects: technology, gamification, motivation and understanding of health. To support this, a movement innovation program was needed at our sports...... science and health education. We therefore ask: Which learning approach and educational factors does a learning model need to provide, in order to establish the best foundation for learning innovation and the design of game-based movement solutions within sport and health education? This paper suggests...... a model that covers three approaches; design ‘for’, ‘with’ and ‘of’ movement. From an innovation perspective, it is essential to sense needs and identify future opportunities. This includes understanding technologies and the lives of potential users. Being able to transform core knowledge and insights...
Ebrecht, L.; Schmerwitz, S.
Synthetic vision systems (SVS) appear as spreading technology in the avionic domain. Several studies prove enhanced situational awareness when using synthetic vision. Since the introduction of synthetic vision a steady change and evolution started concerning the primary flight display (PFD) and the navigation display (ND). The main improvements of the ND comprise the representation of colored ground proximity warning systems (EGPWS), weather radar, and TCAS information. Synthetic vision seems to offer high potential to further enhance cockpit display systems. Especially, concerning the current trend having a 3D perspective view in a SVS-PFD while leaving the navigational content as well as methods of interaction unchanged the question arouses if and how the gap between both displays might evolve to a serious problem. This issue becomes important in relation to the transition and combination of strategic and tactical flight guidance. Hence, pros and cons of 2D and 3D views generally as well as the gap between the egocentric perspective 3D view of the PFD and the exocentric 2D top and side view of the ND will be discussed. Further a concept for the integration of a 3D perspective view, i.e., bird's eye view, in synthetic vision ND will be presented. The combination of 2D and 3D views in the ND enables a better correlation of the ND and the PFD. Additionally, this supports the building of pilot's mental model. The authors believe it will improve the situational and spatial awareness. It might prove to further raise the safety margin when operating in mountainous areas.
Ozbek, M. M.
Fuzzy rule-based systems provide an efficient environment for the modeling of expert information in the context of risk management for groundwater contamination problems. In general, their use in the form of conditional pieces of knowledge, has been either as a tool for synthesizing control laws from data (i.e., conjunction-based models), or in a knowledge representation and reasoning perspective in Artificial Intelligence (i.e., implication-based models), where only the latter may lead to coherence problems (e.g., input data that leads to logical inconsistency when added to the knowledge base). We implement a two-fold extension to an implication-based groundwater risk model (Ozbek and Pinder, 2002) including: 1) the implementation of sufficient conditions for a coherent knowledge base, and 2) the interpolation of expert statements to supplement gaps in knowledge. The original model assumes statements of public health professionals for the characterization of the exposed individual and the relation of dose and pattern of exposure to its carcinogenic effects. We demonstrate the utility of the extended model in that it: 1)identifies inconsistent statements and establishes coherence in the knowledge base, and 2) minimizes the burden of knowledge elicitation from the experts for utilizing existing knowledge in an optimal fashion.ÿÿ
Pham-The, Hai; Nam, Nguyen-Hai; Nga, Doan-Viet; Hai, Dang Thanh; Dieguez-Santana, Karel; Marrero-Poncee, Yovani; Castillo-Garit, Juan A; Casanola-Martin, Gerardo M; Le-Thi-Thu, Huong
Quantitative Structure - Activity Relationship (QSAR) modeling has been widely used in medicinal chemistry and computational toxicology for many years. Today, as the amount of chemicals is increasing dramatically, QSAR methods have become pivotal for the purpose of handling the data, identifying a decision, and gathering useful information from data processing. The advances in this field have paved a way for numerous alternative approaches that require deep mathematics in order to enhance the learning capability of QSAR models. One of these directions is the use of Multiple Classifier Systems (MCSs) that potentially provide a means to exploit the advantages of manifold learning through decomposition frameworks, while improving generalization and predictive performance. In this paper, we presented MCS as a next generation of QSAR modeling techniques and discuss the chance to mining the vast number of models already published in the literature. We systematically revisited the theoretical frameworks of MCS as well as current advances in MCS application for QSAR practice. Furthermore, we illustrated our idea by describing ensemble approaches on modeling histone deacetylase (HDACs) inhibitors. We expect that our analysis would contribute to a better understanding about MCS application and its future perspectives for improving the decision making of QSAR models. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Full Text Available An increasing trend was observed over the last years in the modelling of soil-plant-management interactions of protected crops, mainly as an adaptation of approaches originally developed for field crops. The variety of modelling approaches used world-wide reflects the difficulty of unifying physiological principles across various crops (plant types. The heterogeneity of software development techniques (typically based on procedural principles has been another obstacle to the progress of research in this field, since it hampered model extension and re-usability. This paper describes and discusses the scientific basis, the design, implementation and perspectives in modelling greenhouse crops. Generic modular architectures developed according to up to date software technologies (.NET, Java were identified and proposed as valuable for the design, implementation, verification and comparison of process-based modelling approaches. On this basis, the authors argue that the combination of good software engineering with sound crop science can enhance the rate of advance in crop modelling for protected crops.
Full Text Available An increasing trend was observed over the last years in the modelling of soil-plant-management interactions of protected crops, mainly as an adaptation of approaches originally developed for field crops. The variety of modelling approaches used world-wide reflects the difficulty of unifying physiological principles across various crops (plant types. The heterogeneity of software development techniques (typically based on procedural principles has been another obstacle to the progress of research in this field, since it hampered model extension and re-usability. This paper describes and discusses the scientific basis, the design, implementation and perspectives in modelling greenhouse crops. Generic modular architectures developed according to up to date software technologies (.NET, Java were identified and proposed as valuable for the design, implementation, verification and comparison of process-based modelling approaches. On this basis, the authors argue that the combination of good software engineering with sound crop science can enhance the rate of advance in crop modelling for protected crops.
Capezuti, Elizabeth A; Bricoli, Barbara; Briccoli, Barbara; Boltz, Marie P
The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Kho, Yan; Kane, Robert T; Priddis, Lynn; Hudson, Josephine
Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief. To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts. Men (N = 21) and women (N = 68) aged 60 years and above who had lost a partner within the last 12 to 72 months were invited to participate. Participants rated their levels of yearning thoughts about the deceased, emotions and non-acceptance on the Texas Revised Inventory of Grief (TRIG-Present), and their type and level of general romantic attachment on the Experiences In Close Relationship questionnaire (ECR). Structural equation modelling (SEM) indicated that individuals who reported higher levels of avoidant attachment reported less emotional responses and less non-acceptance. SEM also showed that individuals who reported higher levels of anxious attachment reported greater emotional responses and greater non-acceptance. SEM further indicated that these relationships were mediated by yearning thoughts. People adopt different grief coping patterns according to their self-reported attachment representations, with the nature of their yearning thoughts influencing the process. Grief therapy may be organized according to individual differences in attachment representations.
Full Text Available OBJETIVO: Describir el Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM, conocido también por su nombre en inglés: Mexican Health and Aging Study (MHAS. MATERIAL Y MÉTODOS: Se hace una descripción del diseño del estudio, su trabajo de campo y contenido temático, sus alcances y potencial analítico. Se presentan resultados descriptivos acerca de temas selectos. Este es un estudio prospectivo de panel sobre personas de 50 años de edad o más en 2000. RESULTADOS: En la encuesta inicial, realizada en 2001 con representatividad nacional y en áreas urbanas y rurales, se entrevistó aproximadamente a 15 200 personas. La encuesta de seguimiento realizada en 2003 recontactó exitosamente a más de 90% de los individuos entrevistados en la encuesta inicial y se realizaron 546 entrevistas sobre personas fallecidas entre 2001 y 2003. Se presentan resultados descriptivos de características demográficas, de salud, estilo de vida, apoyo institucional, pensiones, empleo, ayudas familiares y cambios en la salud a dos años. CONCLUSIONES: Los adultos mayores en México presentan gran heterogeneidad, la cual se ilustra en forma concisa y breve en los resultados presentados. El estudio y las bases de datos derivadas tienen un gran potencial analítico para explorar múltiples dimensiones de la salud en adultos mayores.OBJECTIVES: Describe the Estudio Nacional de Salud y Envejecimiento en México (ENASEM, also known by its name in English as the Mexican Health and Aging Study (MHAS. MATERIALS AND METHODS: This article summarizes the study design, its fieldwork protocol, survey contents, scope and analytical potential. It also presents descriptive results on selected topics.This is a prospective panel study on persons aged 50 or older in the year 2000. RESULTS: In the baseline survey, completed in 2001 with a national and urban-rural representation, about 15 200 interviews were completed. In the follow-up survey of the same persons in 2003
This text is a short summary of the work on pedagogical analysis carried out when EML (Educational Modelling Language) was being developed. Because we address pedagogical meta-models the consequence is that I must justify the underlying pedagogical models it describes. I have included a (far from
Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid
Introduction The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. Methods In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. Results There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (−0.88) and responsiveness (−0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. Conclusion There were gaps between the patients’ perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time. PMID:27123218
Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid
The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (-0.88) and responsiveness (-0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. There were gaps between the patients' perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.
Bertsimas, Dimitris; Gupta, Vishal; Paschalidis, Ioannis Ch.
The Black-Litterman (BL) model is a widely used asset allocation model in the financial industry. In this paper, we provide a new perspective. The key insight is to replace the statistical framework in the original approach with ideas from inverse optimization. This insight allows us to significantly expand the scope and applicability of the BL model. We provide a richer formulation that, unlike the original model, is flexible enough to incorporate investor information on volatility and market dynamics. Equally importantly, our approach allows us to move beyond the traditional mean-variance paradigm of the original model and construct “BL”-type estimators for more general notions of risk such as coherent risk measures. Computationally, we introduce and study two new “BL”-type estimators and their corresponding portfolios: a Mean Variance Inverse Optimization (MV-IO) portfolio and a Robust Mean Variance Inverse Optimization (RMV-IO) portfolio. These two approaches are motivated by ideas from arbitrage pricing theory and volatility uncertainty. Using numerical simulation and historical backtesting, we show that both methods often demonstrate a better risk-reward tradeoff than their BL counterparts and are more robust to incorrect investor views. PMID:25382873
Bertsimas, Dimitris; Gupta, Vishal; Paschalidis, Ioannis Ch
The Black-Litterman (BL) model is a widely used asset allocation model in the financial industry. In this paper, we provide a new perspective. The key insight is to replace the statistical framework in the original approach with ideas from inverse optimization. This insight allows us to significantly expand the scope and applicability of the BL model. We provide a richer formulation that, unlike the original model, is flexible enough to incorporate investor information on volatility and market dynamics. Equally importantly, our approach allows us to move beyond the traditional mean-variance paradigm of the original model and construct "BL"-type estimators for more general notions of risk such as coherent risk measures. Computationally, we introduce and study two new "BL"-type estimators and their corresponding portfolios: a Mean Variance Inverse Optimization (MV-IO) portfolio and a Robust Mean Variance Inverse Optimization (RMV-IO) portfolio. These two approaches are motivated by ideas from arbitrage pricing theory and volatility uncertainty. Using numerical simulation and historical backtesting, we show that both methods often demonstrate a better risk-reward tradeoff than their BL counterparts and are more robust to incorrect investor views.
Full Text Available Land use patterns and transport system are considered to be the two basic components of the urban development process, and as such they have been in the core of spatial planning policies for the last 4 decades. Land use transport interaction models are computer tools that could help us understand land use changes and organization of human activities in relation to existing or planned transport infrastructure. In this context this paper examines the perspectives of applying a land use transport interaction model for the city of Thessaloniki. Obtaining, preparing and validating socioeconomic data is a crucial part of the modeling process, therefore an extensive search of the required data was performed. The quest for appropriate and suitable data concluded with a detailed recording of emerged problems. In response to the inability of finding suitable data to perform the first step of the modeling process i.e. calibration, the paper concludes with some thoughts related to data availability, organization and standardization issues. Last but not least, the paper stresses out the significance of data availability for utilization of land use transport models, so as not to remain purely academic products but tools with practical value in planning.
Monier, Erwan; Kicklighter, David W.; Sokolov, Andrei P.; Zhuang, Qianlai; Sokolik, Irina N.; Lawford, Richard; Kappas, Martin; Paltsev, Sergey V.; Groisman, Pavel Ya
Northern Eurasia is made up of a complex and diverse set of physical, ecological, climatic and human systems, which provide important ecosystem services including the storage of substantial stocks of carbon in its terrestrial ecosystems. At the same time, the region has experienced dramatic climate change, natural disturbances and changes in land management practices over the past century. For these reasons, Northern Eurasia is both a critical region to understand and a complex system with substantial challenges for the modeling community. This review is designed to highlight the state of past and ongoing efforts of the research community to understand and model these environmental, socioeconomic, and climatic changes. We further aim to provide perspectives on the future direction of global change modeling to improve our understanding of the role of Northern Eurasia in the coupled human–Earth system. Modeling efforts have shown that environmental and socioeconomic changes in Northern Eurasia can have major impacts on biodiversity, ecosystems services, environmental sustainability, and the carbon cycle of the region, and beyond. These impacts have the potential to feedback onto and alter the global Earth system. We find that past and ongoing studies have largely focused on specific components of Earth system dynamics and have not systematically examined their feedbacks to the global Earth system and to society. We identify the crucial role of Earth system models in advancing our understanding of feedbacks within the region and with the global system. We further argue for the need for integrated assessment models (IAMs), a suite of models that couple human activity models to Earth system models, which are key to address many emerging issues that require a representation of the coupled human–Earth system.
I have attempted to cover some aspects of the rather disjointed interdisciplinary field of family and socialization from a cross-cultural perspective. The coverage has necessarily been incomplete and selective, focusing mainly on intergenerational family interactions along the dependence/independence dimension, working toward a model of family change. I started out with an observation that psychology has not concerned itself much with holistic study of the family or the complex socialization process, especially within a cross-cultural perspective, even though some of the main models of person-environment relations at its disposal are appropriate for such study. With the recently increasing acceptance and use of the ecological and contextual models in coverging interdisciplinary approaches, the time may be ripe for cross-cultural theorizing on the family and socialization. The contextual approach to socially defined meaning is a key in such an endeavor to develop a thorough understanding of family diversity. Such an approach goes beyond simple description of cross-cultural differences and explains what meanings are attributed to events and how similar behaviors may be given different meanings in different contexts or how apparently contrasting behaviors may carry common meanings and lead to common outcomes. Family diversity in parental beliefs and values, parent-child interactions, and social class and family types can be better understood with such a contextual approach, where structural-functional links between underlying causes and behavioral outcomes are sought. Macro-level explanations such as industrialization, economic development models, and political/religious ideologies are often proposed to explain human diversity. What seem to be lacking are psychological models with cross-cultural validity that can tackle both human diversity and commonality. The (inter)dependence/independence dimension of human (family) relations is proposed as a psychological
Cole, Wesley J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Frew, Bethany A. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mai, Trieu T. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Sun, Yinong [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bistline, John [Electric Power Research Inst., Palo Alto, CA (United States); Blanford, Geoffrey [Electric Power Research Inst., Palo Alto, CA (United States); Young, David [Electric Power Research Inst., Palo Alto, CA (United States); Marcy, Cara [Energy Information Administration, Washington, DC (United States); Namovicz, Chris [Energy Information Administration, Washington, DC (United States); Edelman, Risa [Environmental Protection Agency, Washington, DC (United States); Meroney, Bill [Environmental Protection Agency; Sims, Ryan [Environmental Protection Agency; Stenhouse, Jeb [Environmental Protection Agency; Donohoo-Vallett, Paul [U.S. Department of Energy
Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision makers. With the recent surge in variable renewable energy (VRE) generators - primarily wind and solar photovoltaics - the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. To assess current best practices, share methods and data, and identify future research needs for VRE representation in capacity expansion models, four capacity expansion modeling teams from the Electric Power Research Institute, the U.S. Energy Information Administration, the U.S. Environmental Protection Agency, and the National Renewable Energy Laboratory conducted two workshops of VRE modeling for national-scale capacity expansion models. The workshops covered a wide range of VRE topics, including transmission and VRE resource data, VRE capacity value, dispatch and operational modeling, distributed generation, and temporal and spatial resolution. The objectives of the workshops were both to better understand these topics and to improve the representation of VRE across the suite of models. Given these goals, each team incorporated model updates and performed additional analyses between the first and second workshops. This report summarizes the analyses and model 'experiments' that were conducted as part of these workshops as well as the various methods for treating VRE among the four modeling teams. The report also reviews the findings and learnings from the two workshops. We emphasize the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making.
Ybema,J.F.; Giesen, F.
Due to an ageing population and global economic competition, there is a societal need for people to extend their working lives while maintaining high work productivity. This article presents an overview of the labour participation, job performance, and job characteristics of older workers in the
Hansen, Lise Lotte
In Europe, flexicurity is seen as a way to develop labour markets so they will stay or be more competitive and at the same time secure the European welfare tradition. The Danish welfare society builds on a division of work and co-operation between the labour market and the welfare state. This div......In Europe, flexicurity is seen as a way to develop labour markets so they will stay or be more competitive and at the same time secure the European welfare tradition. The Danish welfare society builds on a division of work and co-operation between the labour market and the welfare state....... This division and co-operation also applies to the Danish flexicurity model which this article focuses on from a gender perspective. The analysis presented here relates to the labor market, the welfare state, and the active labor market policy. The article shows that welfare policies on public care...
P Le Roux
Full Text Available Even though econometric models and yield curve analysis are useful in assessing the impact of interest rate changes on the economic structure, their power to predict the magnitude and direction of swings in the business cycle is often restricted to the use of short-term interest rates. From an Austrian school perspective on interest rates, empirical evidence suggests that the profitability of heavy industries further downstream outperforms that of light industries in the initial stages of monetary easing, due to a rising demand for investment goods and a rise in capacity utilisation levels. This paper assesses the impact of interest rates changes on the productive structure of the economy by taking into account the effect thereof on sector earnings and ultimately share prices.
Samson, Sundeep; Reneke, James A.; Wiecek, Margaret M.
The literature in economics, finance, operations research, engineering and in general mathematics is first reviewed on the subject of defining uncertainty and risk. The review goes back to 1901. Different perspectives on uncertainty and risk are examined and a new paradigm to model uncertainty and risk is proposed using relevant ideas from this study. This new paradigm is used to represent, aggregate and propagate uncertainty and interpret the resulting variability in a challenge problem developed by Oberkampf et al. [2004, Challenge problems: uncertainty in system response given uncertain parameters. Reliab Eng Syst Safety 2004; 85(1): 11-9]. The challenge problem is further extended into a decision problem that is treated within a multicriteria decision making framework to illustrate how the new paradigm yields optimal decisions under uncertainty. The accompanying risk is defined as the probability of an unsatisfactory system response quantified by a random function of the uncertainty
Ayhan, Yavuz; McFarland, Ross; Pletnikov, Mikhail V
Schizophrenia has long been considered as a disorder with multifactorial origins. Recent discoveries have advanced our understanding of the genetic architecture of the disease. However, even with the increase of identified risk variants, heritability estimates suggest an important contribution of non-genetic factors. Various environmental risk factors have been proposed to play a role in the etiopathogenesis of schizophrenia. These include season of birth, maternal infections, obstetric complications, adverse events at early childhood, and drug abuse. Despite the progress in identification of genetic and environmental risk factors, we still have a limited understanding of the mechanisms whereby gene-environment interactions (G × E) operate in schizophrenia and psychoses at large. In this review we provide a critical analysis of current animal models of G × E relevant to psychotic disorders and propose that dimensional perspective will advance our understanding of the complex mechanisms of these disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.
to interpret. As there are many similarities between waste management and energy management, experiences from systems analysis of waste management can be used for planning of more sustainable solutions in the energy management. That is why it is interesting to develop the methodology used in ORWARE and adapt it to a partly new area like e.g. energy management. One example of improving the methodology is to extend the number of impact categories. Another example is to put the functions delivered in focus. ORWARE focuses at the waste management system, and thus 'treating waste from a certain area' is one fundamental functional unit. Translated to energy that would mean to build a model of the energy supply system. But to optimise the whole system that delivers a function ought to be a more efficient way to head for sustainability than to study the supply system and the applications separately. That would mean to put the end user functions provided by some kind of energy transformation in focus instead. In systems analysis it is also important to consider the alternatives to different options of technologies or system designs. In order to understand and assess the influence from e.g. waste management and energy on the environment and the socio-technical system called society, a systems perspective is thus very important. The systems perspective should work at all decision levels and with a life cycle perspective on the function.
Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Frew, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Mai, Trieu [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sun, Yinong [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bistline, John [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Blanford, Geoffrey [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Young, David [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Marcy, Cara [U.S. Energy Information Administration, Washington, DC (United States); Namovicz, Chris [U.S. Energy Information Administration, Washington, DC (United States); Edelman, Risa [US Environmental Protection Agency (EPA), Washington, DC (United States); Meroney, Bill [US Environmental Protection Agency (EPA), Washington, DC (United States); Sims, Ryan [US Environmental Protection Agency (EPA), Washington, DC (United States); Stenhouse, Jeb [US Environmental Protection Agency (EPA), Washington, DC (United States); Donohoo-Vallett, Paul [Dept. of Energy (DOE), Washington DC (United States)
Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision-makers. With the recent surge in variable renewable energy (VRE) generators — primarily wind and solar photovoltaics — the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. This report summarizes the analyses and model experiments that were conducted as part of two workshops on modeling VRE for national-scale capacity expansion models. It discusses the various methods for treating VRE among four modeling teams from the Electric Power Research Institute (EPRI), the U.S. Energy Information Administration (EIA), the U.S. Environmental Protection Agency (EPA), and the National Renewable Energy Laboratory (NREL). The report reviews the findings from the two workshops and emphasizes the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making. This research is intended to inform the energy modeling community on the modeling of variable renewable resources, and is not intended to advocate for or against any particular energy technologies, resources, or policies.
Jhaveri, D; Larkins, S; Kelly, J; Sabesan, S
Townsville Cancer Centre (TCC), a tertiary cancer centre in North Queensland, Australia, provides chemotherapy services to surrounding small rural towns using the Queensland Remote Chemotherapy Supervision model (QReCS). Under this model, selected chemotherapy regimens are administered in rural hospitals by rural based generalist doctors and nurses, under the supervision of TCC-based medical oncologists and chemotherapy competent nurses through videoconferencing. We sought to explore the perspectives of health professionals participating in QReCS. This qualitative study used semi-structured interviews with 19 participants, including nine nurses, eight doctors, one rural pharmacist and one administration officer. The interviews were recorded and transcribed. Transcripts were examined using iterative thematic analysis. Four major themes were identified from the data: (1) benefits of the model, (2) enablers of implementation, (3) operational requirements for optimal functioning and (4) disadvantages of the model. The reported benefits of the model were patient convenience, inter-professional communication across health district borders, expanded scope of practice, continuity of care and maintenance of patient safety and compliance with guidelines while delivering chemotherapy. Further improvements in the quality of training for rural nurses, coordination between urban and rural sites and between health professionals and documentation of clinical encounters would optimise the operation of the model. QReCS appears to provide many benefits to patients and health professionals and a framework for safe administration of chemotherapy in rural areas. Coordination of care, the quality of training for rural nurses as well as clinical documentation needs to improve to optimise the operation of the model. © 2015 John Wiley & Sons Ltd.
Ludwig, R.; Escher-Vetter, H.; Hennicker, R.; Mauser, W.; Niemeyer, S.; Reichstein, M.; Tenhunen, J.
Within the GLOWA initiative of the German Ministry for Research and Educa- tion (BMBF), the project GLOWA-Danube is funded to establish a transdisciplinary network-based decision support tool for water related issues in the Upper Danube wa- tershed. It aims to develop and validate integration techniques, integrated models and integrated monitoring procedures and to implement them in the network-based De- cision Support System DANUBIA. An accurate description of processes involved in energy, water and matter fluxes and turnovers requires an intense collaboration and exchange of water related expertise of different scientific disciplines. DANUBIA is conceived as a distributed expert network and is developed on the basis of re-useable, refineable, and documented sub-models. In order to synthesize a common understand- ing between the project partners, a standardized notation of parameters and functions and a platform-independent structure of computational methods and interfaces has been established using the Unified Modeling Language UML. DANUBIA is object- oriented, spatially distributed and raster-based at its core. It applies the concept of "proxels" (Process Pixel) as its basic object, which has different dimensions depend- ing on the viewing scale and connects to its environment through fluxes. The presented study excerpts the hydrological view point of GLOWA-Danube, its approach of model coupling and network based communication (using the Remote Method Invocation RMI), the object-oriented technology to simulate physical processes and interactions at the land surface and the methodology to treat the issue of spatial and temporal scal- ing in large, heterogeneous catchments. The mechanisms applied to communicate data and model parameters across the typical discipline borders will be demonstrated from the perspective of a land-surface object, which comprises the capabilities of interde- pendent expert models for snowmelt, soil water movement, runoff formation, plant
leading to the risk of overfitting. The final aim of the work is to facilitate the use of the model also by scientists that do not necessarily have a solid background on modelling or physics. However, this work should not be considered simply as a collection of best practices, but also as the attempt to foster the communication and interaction among colleagues of a branch of science, limnology, that suffer of significant fragmentation. This is summarized in the future perspectives and challenges concerning potential improvements of the air2water, with a particular emphasis on possible cross-sectoral applications.
Greenly, G.D.; Dickerson, M.H.
Numerical models on several levels of complexity should be available to the emergency response planner. They are a basic tool but must be used in conjunction with both measurements and experience. When these tools are used in a complimentary fashion they greatly enhance the capability of the consequence manager to respond in an emergency situation. Because each accident or incident develops it's own characteristics and requirements the system must be capable of a flexible response. Interaction and feedback between model results from a suite of models and measurements (including airborne measurements) serve the emergency response planner's spectrum of needs, ranging from planning exercises and emergency precalculations to a real-time emergency response
Full Text Available This paper briefly presents two approaches for effective three-dimensional (3D building model reconstruction from terrestrial laser scanning (TLS data and single perspective view imagery and assesses their applicability to the reconstruction of 3D models of landmark or historical buildings. The collected LiDAR point clouds are registered based on conjugate points identified using a seven-parameter transformation system. Three dimensional models are generated using plan and surface fitting algorithms. The proposed single-view reconstruction (SVR method is based on vanishing points and single-view metrology. More detailed models can also be generated according to semantic analysis of the façade images. Experimental results presented in this paper demonstrate that both TLS and SVR approaches can successfully produce accurate and detailed 3D building models from LiDAR point clouds or different types of single-view perspective images.
Full Text Available Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief.To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts.Men (N = 21 and women (N = 68 aged 60 years and above who had lost a partner within the last 12 to 72 months were invited to participate. Participants rated their levels of yearning thoughts about the deceased, emotions and non-acceptance on the Texas Revised Inventory of Grief (TRIG-Present, and their type and level of general romantic attachment on the Experiences In Close Relationship questionnaire (ECR.Structural equation modelling (SEM indicated that individuals who reported higher levels of avoidant attachment reported less emotional responses and less non-acceptance. SEM also showed that individuals who reported higher levels of anxious attachment reported greater emotional responses and greater non-acceptance. SEM further indicated that these relationships were mediated by yearning thoughts.People adopt different grief coping patterns according to their self-reported attachment representations, with the nature of their yearning thoughts influencing the process. Grief therapy may be organized according to individual differences in attachment representations.
Galambos, Colleen; Rantz, Marilyn; Back, Jessie; Jun, Jung Sim; Skubic, Marjorie; Miller, Steven J
Aging in place is a preferred and cost-effective living option for older adults. Research indicates that technology can assist with this goal. Information on consumer preferences will help in technology development to assist older adults to age in place. The study aim was to explore the perceptions and preferences of older adults and their family members about a fall risk assessment system. Using a qualitative approach, this study examined the perceptions, attitudes, and preferences of 13 older adults and five family members about their experience living with the fall risk assessment system during five points in time. Themes emerged in relation to preferences and expectations about the technology and how it fits into daily routines. We were able to capture changes that occurred over time for older adult participants. Results indicated that there was acceptance of the technology as participants adapted to it. Two themes were present across the five points in time-safety and usefulness. Five stages of acceptance emerged from the data from preinstallation to 2 years postinstallation. Identified themes, stages of acceptance, and design and development considerations are discussed.
Van Zomeren, M.; Postmes, T.; Spears, R.
An integrative social identity model of collective action (SIMCA) is developed that incorporates 3 socio-psychological perspectives on collective action. Three meta-analyses synthesized a total of 182 effects of perceived injustice, efficacy, and identity on collective action (corresponding to these
Sabbe, Maarten; Reyniers, Marie-Françoise; Reuter, Karsten
Electronic structure calculations have emerged as a key contributor in modern heterogeneous catalysis research, though their application in chemical reaction engineering remains largely limited to academia. This perspective aims at encouraging the judicious use of first-principles kinetic models in industrial settings based on a critical discussion of present-day best practices, identifying existing gaps, and defining where further progress is needed.
Durbin, J.; Koopman, S.J.M.
The analysis of non-Gaussian time series using state space models is considered from both classical and Bayesian perspectives. The treatment in both cases is based on simulation using importance sampling and antithetic variables; Monte Carlo Markov chain methods are not employed. Non-Gaussian
The first goal of this study is to see if social relationships in the church influence feelings of gratitude toward God. The second goal is to assess the impact of race and ethnicity on this relationship. The data support the following hypotheses: (1) older people who go to church more often tend to receive more spiritual support from fellow church members; (2) older adults who receive more spiritual support at church will derive a deeper understanding of themselves and others; (3) older people who develop greater insight into themselves and others will derive a greater sense of religious meaning in life; and (4) older adults who develop a deeper sense of religious meaning in life will feel more grateful to God. The results also indicate that the study model explains how feelings of gratitude toward God arise among older blacks and whites, but not older Mexican Americans.
The first goal of this study is to see if social relationships in the church influence feelings of gratitude toward God. The second goal is to assess the impact of race and ethnicity on this relationship. The data support the following hypotheses: (1) older people who go to church more often tend to receive more spiritual support from fellow church members; (2) older adults who receive more spiritual support at church will derive a deeper understanding of themselves and others; (3) older people who develop greater insight into themselves and others will derive a greater sense of religious meaning in life; and (4) older adults who develop a deeper sense of religious meaning in life will feel more grateful to God. The results also indicate that the study model explains how feelings of gratitude toward God arise among older blacks and whites, but not older Mexican Americans. PMID:23543840
Babuska, Vaclav; Moztarzadeh, Omid; Kubikova, Tereza; Moztarzadeh, Amin; Hrusak, Daniel; Tonar, Zbynek
The aim of this paper is to review the experimental methods currently being used to evaluate the osseointegration of nanostructured titanium implants using animal models. The material modifications are linked to the biocompatibility of various types of oral implants, such as laser-treated, acid-etched, plasma-coated, and sand-blasted surface modifications. The types of implants are reviewed according to their implantation site (endoosseous, subperiosteal, and transosseous implants). The animal species and target bones used in experimental implantology are carefully compared in terms of the ratio of compact to spongy bone. The surgical technique in animal experiments is briefly described, and all phases of the histological evaluation of osseointegration are described in detail, including harvesting tissue samples, processing undemineralized ground sections, and qualitative and quantitative histological assessment of the bone-implant interface. The results of histological staining methods used in implantology are illustrated and compared. A standardized and reproducible technique for stereological quantification of bone-implant contact is proposed and demonstrated. In conclusion, histological evaluation of the experimental osseointegration of dental implants requires careful selection of the experimental animals, bones, and implantation sites. It is also advisable to use larger animal models and older animals with a slower growth rate rather than small or growing experimental animals. Bones with a similar ratio of compact to spongy bone, such as the human maxilla and mandible, are preferred. A number of practical recommendations for the experimental procedures, harvesting of samples, tissue processing, and quantitative histological evaluations are provided.
Objectives. We evaluated the relationship between financial hardship and self-reported oral health for older men and women. Methods. We focused on adults in the 2008 Health and Retirement Study (n = 1359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health. Results. In the non–gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12% greater prevalence of poor self-reported oral health (95% confidence interval [CI] = 1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24% greater prevalence of poor self-reported oral health than women with zero (95% CI = 1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50% lower prevalence of poor self-reported oral health (95% CI = 0.32, 0.76). Conclusions. Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults’ oral health should account for gender-based heterogeneity in financial hardship experiences. PMID:23327271
Akimov, Alexey V.; Wang, Linjun; Prezhdo, Oleg V.; Trivedi, Dhara
We analyze the applicability of the seminal fewest switches surface hopping (FSSH) method of Tully to modeling quantum transitions between electronic states that are not coupled directly, in the processes such as Auger recombination. We address the known deficiency of the method to describe such transitions by introducing an alternative definition for the surface hopping probabilities, as derived from the Markov state model perspective. We show that the resulting transition probabilities simplify to the quantum state populations derived from the time-dependent Schrödinger equation, reducing to the rapidly switching surface hopping approach of Tully and Preston. The resulting surface hopping scheme is simple and appeals to the fundamentals of quantum mechanics. The computational approach is similar to the FSSH method of Tully, yet it leads to a notably different performance. We demonstrate that the method is particularly accurate when applied to superexchange modeling. We further show improved accuracy of the method, when applied to one of the standard test problems. Finally, we adapt the derived scheme to atomistic simulation, combine it with the time-domain density functional theory, and show that it provides the Auger energy transfer timescales which are in good agreement with experiment, significantly improving upon other considered techniques. (author)
Ana Vazquez Alejos
Full Text Available The frequency-dependent behavior in subsurface and through-the-wall media is analyzed in this paper as well as the formation of the Brillouin precursor waveforms inherently related to this feature. The emergence of these forerunners is presented as a plausible form to explain classical impairments observed in imaging technologies. The evolution of mono- and multicycle rectangular and first derivative Gaussian pulses through two dispersive media—concrete blocks and soil—is analyzed using a frequency-domain technique and the Debye dielectric model to characterize the media, at operating frequencies below 3 GHz. The frequency-domain approach facilitated to check the influence of some parameters considered critical for the precursor emergence—operating frequency, input pulse configuration, and internal structure of the underlying medium—results in a versatile tool suitable for any kind of modulated input signal propagated through any dispersive medium. The internal multireflection model has been considered as the most suitable model to describe the transmission process underlying both subsurface and through-wall imaging technologies. Two different moisture contents have been considered for concrete as a parameter to determine the performance of through-wall imaging radar from the precursor formation perspective. The results reveal that precursor is a phenomenon to take into account for application demanding larger signal-to-noise ratios.
Robinson, Stephen K.
Direct numerical simulations of turbulent boundary layers have been analyzed to develop a unified conceptual model for the kinematics of coherent motions in low Reynolds number canonical turbulent boundary layers. All classes of coherent motions are considered in the model, including low-speed streaks, ejections and sweeps, vortical structures, near-wall and outer-region shear layers, sublayer pockets, and large-scale outer-region eddies. The model reflects the conclusions from the study of the simulated boundary layer that vortical structures are directly associated with the production of turbulent shear stresses, entrainment, dissipation of turbulence kinetic energy, and the fluctuating pressure field. These results, when viewed from the perspective of the large body of published work on the subject of coherent motions, confirm that vortical structures may be considered the central dynamic element in the maintenance of turbulence in the canonical boundary layer. Vortical structures serve as a framework on which to construct a unified picture of boundary layer structure, providing a means to relate the many known structural elements in a consistent way.
Dois, Angelina; Bravo, Paulina; Soto, Gabriela
The Family and Community Health Model is based on three essential principles: user-centered care, comprehensive care and continuity of care. To describe the attributes and characteristics of the guiding principles of the Family and Community Health Model (FHM) from the perspective of primary care experts. This was a qualitative study. An electronic Delphi was conducted with 29 national experts on primary care. The experts agree that user centered care must be based on a psycho-social model integrating the multiple factors that influence health problems. It also must integrate patients' individual features, family and environmental issues. The proposed actions promote shared decision making. To promote integral care, anticipatory guidelines should be expanded and health care of patients with chronic conditions should be improved. Continuity of care should be promoted increasing working hours of medical centers and easing access to integrated electronic medical records, thereby generating efficient links between the different care levels. The results of the study can guide the clinical and administrative management of health teams, allowing the strengthening of primary health care according to the local realities.
Dolfin, M; Leonida, L; Outada, N
We take advantage of the challenging comments to the modeling approach we proposed in  to look ahead at a number of applications of the methods to the alternative questions these comments raise. In turn, our effort results in a number of interesting and valuable research perspectives. The presentation goes along three main lines. In the first line, we summarize briefly the aims and results in . In the second section we give a technical the issues raised and, finally, the focus moves to the above mentioned research perspectives. Copyright © 2017 Elsevier B.V. All rights reserved.
Beglaryan, Mher; Petrosyan, Varduhi; Bunker, Edward
In health care, information technologies (IT) hold a promise to harness an ever-increasing flow of health related information and bring significant benefits including improved quality of care, efficiency, and cost containment. One of the main tools for collecting and utilizing health data is the Electronic Health Record (EHR). EHRs implementation can face numerous barriers to acceptance including attitudes and perceptions of potential users, required effort attributed to their implementation and usage, and resistance to change. Various theories explicate different aspects of technology deployment, implementation, and acceptance. One of the common theories is the Technology Acceptance Model (TAM), which helps to study the implementation of different healthcare IT applications. The objectives of this study are: to understand the barriers of EHR implementation from the perspective of physicians; to identify major determinants of physicians' acceptance of technology; and develop a model that explains better how EHRs (and technologies in general) are accepted by physicians. The proposed model derives from a cross-sectional survey of physicians selected through multi-stage cluster sampling from the hospitals of Yerevan, Armenia. The study team designed the survey instrument based on a literature review on barriers of EHR implementation. The analysis employed exploratory structural equation modeling (ESEM) with a robust weighted least squares (WLSMV) estimator for categorical indicators. The analysis progressed in two steps: appraisal of the measurement model and testing of the structural model. The derived model identifies the following factors as direct determinants of behavioral intention to use a novel technology: projected collective usefulness; personal innovativeness; patient influence; and resistance to change. Other factors (e.g., organizational change, professional relationships, administrative monitoring, organizational support and computer anxiety) exert their
modeling of toxic material 6 transport .,d transformation including synthetic organics ( pesticides , insectLA,.des) and metals. The report concludes with a...wntershcd. Flow rate, sediment load, and nutrient and pesticide concen- trations are predicted. The program takes these results, along with...toxic chemical present and reacting. 134. Photodegradation (photolysis) is the transformation or degradation of a compound that results directly from
Adhikary, B.; Bonasoni, P.; Cristofanelli, P.; Marinoni, A.; Duchi, R.; Calzolari, F.; Landi, T.; Putero, D.; Fuzzi, S.; Decesari, S.; Vuillermoz, E.; Stocchi, P.; Verza, G.; Kulkarni, S.
SHARE (Stations at High Altitude Research on the Environment) project is promoted by Ev-K2-CNR and funded by the Ministry of Education, University and Research (MIUR) through the Italian National Research Council (CNR). Today SHARE monitoring stations span four continents around the globe. This paper will present the results from the SHARE-Nepal Climate Observatory-Pyramid (NCO-P) monitoring station located in the foothills of Mount Everest at an altitude of 5079 m.a.s.l. NCO-P is also one of the Global AtmosphericWatch stations of the World Meteorological Organization (WMO-GAW) and is the only currently operating GAW station in South Asia and the highest station of the UNEP ABC (Atmospheric Brown Clouds) project. Results obtained from the monitoring of aerosols and trace gases for multi years starting from 2006 will be presented. Seasonal distribution, composition, case studies and events related to high aerosol loadings will be discussed. A regional scale meteorological / chemical transport modeling projecthas been initiated to help put the measurements in perspective and provide decision support for policy makers. The paper will also describe themodeling framework,modeled case studiesillustrating sectoral and regional contribution to the aerosol loading over the Himalayan region will be presented.
Pittore, Massimiliano; Haas, Michael; Wieland, Marc
Less than 5% of earth's surface is urbanized, and currently hosts around 7.5 billion people, with these figures constantly changing as increasingly faster urbanization takes place. A significant percentage of this population, often in economically developing countries, is exposed to different natural hazards which contribute to further raise the bar on the expected economic and social consequences. Global initiatives such as GAR 15 advocate for a wide scale, possibly global perspective on the assessment of risk arising from natural hazards, as a way to increase the risk-awareness of decision-makers and stakeholders, and to better harmonize large-scale prevention and mitigation actions. Realizing, and even more importantly maintaining a widely-scalable exposure model suited for the assessment of different natural risks would allow large-scale quantitative risk and loss assessment in a more efficient and reliable way. Considering its complexity and extent, such a task is undoubtedly a challenging one, spanning across multiple disciplines and operational contexts. On the other hand, with a careful design and an efficient and scalable implementation such endeavour would be well within reach and would contribute to significantly improve our understanding of the mechanisms lying behind what we call natural catastrophes. In this contribution we'll review existing relevant applications, will discuss how to tackle the most critical issues and will outline a road map for the implementation of global-scoped exposure models.
Lin, Yuan; Abaid, Nicole
Bats navigating with echolocation - which is a type of active sensing achieved by interpreting echoes resulting from self-generated ultrasonic pulses - exhibit unique behaviors during group flight. While bats may benefit from eavesdropping on their peers׳ echolocation, they also potentially suffer from confusion between their own and peers׳ pulses, caused by an effect called frequency jamming. This hardship of group flight is supported by experimental observations of bats simplifying their sound-scape by shifting their pulse frequencies or suppressing echolocation altogether. Here, we investigate eavesdropping and varying pulse emission rate from a modeling perspective to understand these behaviors׳ potential benefits and detriments. We define an agent-based model of echolocating bats avoiding collisions in a three-dimensional tunnel. Through simulation, we show that bats with reasonably accurate eavesdropping can reduce collisions compared to those neglecting information from peers. In large populations, bats minimize frequency jamming by decreasing pulse emission rate, while collision risk increases; conversely, increasing pulse emission rate minimizes collisions by allowing more sensing information generated per bat. These strategies offer benefits for both biological and engineered systems, since frequency jamming is a concern in systems using active sensing. Copyright © 2015 Elsevier Ltd. All rights reserved.
Tohidi, Hamid; Namdari, Alireza; Keyser, Thomas K.; Drzymalski, Julie
Teamwork contributes to a considerable improvement in quality and quantity of the ultimate outcome. Collaboration and alliance between team members bring a substantial progress for any business. However, it is imperative to acquire an appropriate team since many factors must be considered in this regard. Team size may represent the effectiveness of a team and it is of paramount importance to determine what the ideal team size exactly should be. In addition, information technology increasingly plays a differentiating role in productivity and adopting appropriate information sharing systems may contribute to improvement in efficiency especially in competitive markets when there are numerous producers that compete with each other. The significance of transmitting information to individuals is inevitable to assure an improvement in team performance. In this paper, a model of teamwork and its organizational structure are presented. Furthermore, a mathematical model is proposed in order to characterize a group of sub-teams according to two criteria: team size and information technology. The effect of information technology on performance of team and sub-teams as well as optimum size of those team and sub-teams from a productivity perspective are studied. Moreover, a quantitative sensitivity analysis is presented in order to analyze the interaction between these two factors through a sharing system.
Yuan, Naiming; Fu, Zuntao; Liu, Shida
Long term memory (LTM) in climate variability is studied by means of fractional integral techniques. By using a recently developed model, Fractional Integral Statistical Model (FISM), we in this report proposed a new method, with which one can estimate the long-lasting influences of historical climate states on the present time quantitatively, and further extract the influence as climate memory signals. To show the usability of this method, two examples, the Northern Hemisphere monthly Temperature Anomalies (NHTA) and the Pacific Decadal Oscillation index (PDO), are analyzed in this study. We find the climate memory signals indeed can be extracted and the whole variations can be further decomposed into two parts: the cumulative climate memory (CCM) and the weather-scale excitation (WSE). The stronger LTM is, the larger proportion the climate memory signals will account for in the whole variations. With the climate memory signals extracted, one can at least determine on what basis the considered time series will continue to change. Therefore, this report provides a new perspective on climate prediction. PMID:25300777
Lin, XuXun; Yuan, PengCheng
In this research we consider commuters' dynamic learning effect by modeling the trip mode choice behavior from a new perspective of dynamic evolutionary game theory. We explore the behavior pattern of different types of commuters and study the evolution path and equilibrium properties under different traffic conditions. We further establish a dynamic parking charge optimal control (referred to as DPCOC) model to alter commuters' trip mode choice while minimizing the total social cost. Numerical tests show. (1) Under fixed parking fee policy, the evolutionary results are completely decided by the travel time and the only method for public transit induction is to increase the parking charge price. (2) Compared with fixed parking fee policy, DPCOC policy proposed in this research has several advantages. Firstly, it can effectively turn the evolutionary path and evolutionary stable strategy to a better situation while minimizing the total social cost. Secondly, it can reduce the sensitivity of trip mode choice behavior to traffic congestion and improve the ability to resist interferences and emergencies. Thirdly, it is able to control the private car proportion to a stable state and make the trip behavior more predictable for the transportation management department. The research results can provide theoretical basis and decision-making references for commuters' mode choice prediction, dynamic setting of urban parking charge prices and public transit induction.
Maria Aparecida Salci
Full Text Available ABSTRACT Objective: to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas. Method: qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique. Results: at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice. Conclusion: the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model.
Avner, Philip R
Type 1 diabetes (T1D) is a major disease affecting primarily young children with an incidence in Western societies of around 0.3% by 20 years of age. Although both genetic and environmental factors contribute to the disease aetiology, the precise nature of both the genetic and environmental contribution to human disease onset and progression remains poorly defined. Despite showing some differences from human T1D, rodent models for T1D (Leiter and von Herrath, 2004; von Herrath and Nepom, 2009) and, in particular the nonobese diabetic (NOD) mouse (Atkinson and Leiter, 1999; Kikutani and Makino, 1992), have provided important insights into the disease process, even if they have not yet allowed definitive identification of many of the genetic factors involved in the process. The recent isolation of germline-competent embryonic stem (ES) cells from the NOD mouse strain, and from the rat, will greatly facilitate the functional analysis of T1D in the mouse, and open up the possibility of improved exploitation of rat T1D models. This important technological breakthrough has the potential to remove bottlenecks from the identification of T1D genes, allowing the underlying metabolic pathways to be established and facilitating evaluation of the eventual role of the human homologues in the disease process. The current status and perspectives for an improved mechanistic understanding of the disease process will be addressed.
Piccoli, Beatrice; De Witte, Hans; Reisel, William D
This study examines the relationship between job insecurity and discretionary behaviors, that is, organizational citizenship behaviors (OCB) and counterproductive work behaviors (CWB), with the purpose to extend knowledge on the theoretical explanations for these outcomes. Considering the employment relationship with the organization, two different perspectives are suggested and compared in a multiple mediator model, in order to understand the reasons for discretionary behaviors. We draw upon social exchange theory as the basis of psychological contract perceptions and we rely on the group value model to explain organizational justice evaluations. A total of 570 blue-collar workers in Italy participated in our survey. The results show that job insecurity is indirectly related to OCB and CWB through psychological contract breach and organizational injustice. Both mediational mechanisms have equivalent strength in explaining the relationships, namely, they are complementary processes in accounting for both behaviors. These findings suggest that employees' behaviors in job insecure contexts are driven not only by concerns related to the exchange of resources with the organization, but also by evaluations about their value as important members of the group. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
Full Text Available Finite strain analyses were performed in metavolcanic rocks (agglomerates and pillowed metabasalts from the Orijärvi area, southwestern Finland. In this area, tight folding (F1 of layered metasedimentary rocks and development of a penetrative axial plane schistosity (S1 took place during an early stage in the Svecofennian orogeny. Within the domain, there is no evidence of older deformational structures or of a later deformation phase; except in narrow, late-stage shear zones that bound the Orijärvi triangle. During the orogenic evolution, a pervasive attenuation of the fabric in metavolcanic rocks has taken place. In order to quantify strain intensity and to investigate the relation of strain in metavolcanics and folding in metasediments, strain analyses were performed by the Rf/φ method on (subelliptical markers. Metavolcanic rocks demonstrate relatively homogeneous strain values on the outcrop scale, but strain parameters vary strongly on the scale of the study area. This variation in strain correlates with variation in rock composition; felsic metavolcanics demonstrate consistently lower strain intensities than mafic ones. Finite strain ellipsoids are prolate, indicating that the rocks underwent apparent constriction. X axes of strain are(subparallel to the regional fold axis. Constriction in the Orijärvi triangle is not in conflict with any of the current tectonic models. However, given the local structural setting, the most straightforward interpretation is that of progressive constriction by plutonic diapirism.
Melanie D Logue
Full Text Available Background Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chronically ill older adult has unique circumstances that impact their decision to participate in self-directed care, a theoretical framework to help understand factors that influence the adoption of PHRs is important. Here we describe the results of an exploratory study that provided an initial test of such a framework.Methods The study used a descriptive survey methodology with 38 older adults. The survey questionnaire asked about the personal barriers and facilitators associated with personal health record adoption and included items measuring each of the PHRAM’s four interacting factors (environmental factors, personal factors, technology factors, and self-management, and the resulting behavioural outcome.Results Younger seniors had a more positive attitude toward computers, knew what health resources were available on the internet, agreed that they had the resources in place to use PHRs, and would be more influenced by a family member than a healthcare provider to use them. Conversely, older seniors reported less confidence in their ability to use Internet-based PHRs and did not perceive that they had the resources in place to use them.Conclusions The results of this study indicated that personal, environmental, technology, chronic illness, and behavioral factors operated concurrently as personal barriers and/or facilitators to the adoption of PHRs among the older adult with chronic illness. These factors cannot be isolated because the person commonly
This paper uses the social cognitive theory model to review the literature on older adult gambling, and related personal and environment characteristics. Results show that lottery is the kind of gambling most frequently played by older adults, followed by casino games. Older adults take trips to casinos to socialize, find excitement, and win…
Lipman, Peter W.; Calvert, Andrew T.
Recent ocean-bottom geophysical surveys, dredging, and dives, which complement surface data and scientific drilling at the Island of Hawaii, document that evolutionary stages during volcano growth are more diverse than previously described. Based on combining available composition, isotopic age, and geologically constrained volume data for each of the component volcanoes, this overview provides the first integrated models for overall growth of any Hawaiian island. In contrast to prior morphologic models for volcano evolution (preshield, shield, postshield), growth increasingly can be tracked by age and volume (magma supply), defining waxing alkalic, sustained tholeiitic, and waning alkalic stages. Data and estimates for individual volcanoes are used to model changing magma supply during successive compositional stages, to place limits on volcano life spans, and to interpret composite assembly of the island. Volcano volumes vary by an order of magnitude; peak magma supply also varies sizably among edifices but is challenging to quantify because of uncertainty about volcano life spans. Three alternative models are compared: (1) near-constant volcano propagation, (2) near-equal volcano durations, (3) high peak-tholeiite magma supply. These models define inconsistencies with prior geodynamic models, indicate that composite growth at Hawaii peaked ca. 800–400 ka, and demonstrate a lower current rate. Recent age determinations for Kilauea and Kohala define a volcano propagation rate of 8.6 cm/yr that yields plausible inception ages for other volcanoes of the Kea trend. In contrast, a similar propagation rate for the less-constrained Loa trend would require inception of Loihi Seamount in the future and ages that become implausibly large for the older volcanoes. An alternative rate of 10.6 cm/yr for Loa-trend volcanoes is reasonably consistent with ages and volcano spacing, but younger Loa volcanoes are offset from the Kea trend in age-distance plots. Variable magma flux
Full Text Available Time out-of-home has been linked with numerous health outcomes, including cognitive decline, poor physical ability and low emotional state. Comprehensive characterization of this important health metric would potentially enable objective monitoring of key health outcomes. The objective of this study is to determine the relationship between time out-of-home and cognitive status, physical ability and emotional state.Participants included 85 independent older adults, age 65-96 years (M = 86.36; SD = 6.79 who lived alone, from the Intelligent Systems for Assessing Aging Changes (ISAAC and the ORCATECH Life Laboratory cohorts. Factors hypothesized to affect time out-of-home were assessed on three different temporal levels: yearly (cognitive status, loneliness, clinical walking speed, weekly (pain and mood or daily (time out-of-home, in-home walking speed, weather, and season. Subject characteristics including age, race, and gender were assessed at baseline. Total daily time out-of-home in hours was assessed objectively and unobtrusively for up to one year using an in-home activity sensor platform. A longitudinal tobit mixed effects regression model was used to relate daily time out-of-home to cognitive status, physical ability and emotional state. More hours spend outside the home was associated with better cognitive function as assessed using the Clinical Dementia Rating (CDR Scale, where higher scores indicate lower cognitive function (βCDR = -1.69, p<0.001. More hours outside the home was also associated with superior physical ability (βPain = -0.123, p<0.001 and improved emotional state (βLonely = -0.046, p<0.001; βLow mood = -0.520, p<0.001. Weather, season, and weekday also affected the daily time out-of-home.These results suggest that objective longitudinal monitoring of time out-of-home may enable unobtrusive assessment of cognitive, physical and emotional state. In addition, these results indicate that the factors affecting out
Alyamani, Talal M.
Environmental issues and reliance on fossil fuel sources, including coal, oil, and natural gas, are the two most common energy issues that are currently faced by the United States (U.S.). Incorporation of renewable energy sources, a non-economical option in electricity generation compared to conventional sources that burn fossil fuels, single handedly promises a viable solution for both of these issues. Several energy policies have concordantly been suggested to reduce the financial burden of adopting renewable energy technologies and make such technologies competitive with conventional sources throughout the U.S. This study presents a modeling and analysis approach for comprehensive evaluation of renewable energy policies with respect to their benefits to various related stakeholders--customers, utilities, governmental and environmental agencies--where the debilitating impacts, advantages, and disadvantages of such policies can be assessed and quantified at the state level. In this work, a novel simulation framework is presented to help policymakers promptly assess and evaluate policies from different perspectives of its stakeholders. The proposed framework is composed of four modules: 1) a database that collates the economic, operational, and environmental data; 2) elucidation of policy, which devises the policy for the simulation model; 3) a preliminary analysis, which makes predictions for consumption, supply, and prices; and 4) a simulation model. After the validity of the proposed framework is demonstrated, a series of planned Florida and Texas renewable energy policies are implemented into the presented framework as case studies. Two solar and one energy efficiency programs are selected as part of the Florida case study. A utility rebate and federal tax credit programs are selected as part of the Texas case study. The results obtained from the simulation and conclusions drawn on the assessment of current energy policies are presented with respect to the
Markle-Reid, Maureen; Browne, Gina
The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail. Despite the dramatic increase in use of the term 'frailty' over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults. The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research. The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.
Understanding the Attributes of Implementation Frameworks to Guide the Implementation of a Model of Community-based Integrated Health Care for Older Adults with Complex Chronic Conditions: A Metanarrative Review
Full Text Available Introduction: Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best. Methods: We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. Results: Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Five metanarratives emerged 1 theoretical constructs; 2 multiple influencing factors; 3 development of new frameworks; 4 application of existing frameworks; and 5 effectiveness of interventions within frameworks/models. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone. Discussion: The research identified perspectives central to integrated CBPHC that were missing in the literature. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible. Conclusions: All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.
Monguzzi, Angelo; Tubino, Riccardo; Hoseinkhani, Sajjad; Campione, Marcello; Meinardi, Francesco
In the last few years, non-coherent sensitized photon up-conversion (SUC) in multi-component systems has been developed to achieve significantly high quantum yields for various chromophore combinations at low excitation powers, spanning from the ultraviolet (UV) to near infrared (NIR) spectrum. This promising photon energy management technique became indeed suitable for wide applications in lighting technology and especially in photovoltaics, being able to recover the sub-bandgap photons lost by current devices. A full and general description of the SUC photophysics will be presented, with the analysis of the parameter affecting the photon conversion quantum yield and the quantities which define the optimal working range of any SUC system, namely the threshold and saturation excitation intensity. It will be shown how these quantities depend on intrinsic photophysical properties of the moieties involved and on the SUC solid host matrix. The model proposed represents a powerful tool for evaluation of a newly proposed system, and its reliability will be discussed in respect to an optimized system with SUC yield of 0.26 ± 0.02. The results obtained will outline the research guidelines which must be pursued to optimize the SUC efficiency for its perspective technological applications.
Hanlin, Erin R; Delgado-Rendón, Angélica; Lerner, E Brooke; Hargarten, Stephen; Farías, René
The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population. The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project. A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics. We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively). Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.
Wilson, Christine Brown; Clissett, Philip
Aim The purpose of this paper is to identify practical suggestions that could enable other researchers to consider how quality may be evidenced using constructivist principles including the perspectives of older people and their caregivers. Background Constructivism suggests that reality is part of a social construction, which holds different meanings for each person, in which people are active agents, making autonomous decisions. This approach to research has been identified as suitable for health and social care professionals because these underpinning principles reflect the values of these professions, facilitating the involvement of users and carers. The authenticity criteria have been developed to reflect these philosophical principles but have been criticized for their inaccessible language. To incorporate user and carer perspectives, the criteria have been revised into a more accessible model matrix known as the AldreVast Sjuharad criteria. Discussion This paper reports on two constructivist studies that explored relationships between older people, families and staff in different settings – the community and care homes. Examples from both settings demonstrate how the perspectives of users and carers were incorporated throughout the research process. Following the AldreVast Sjuharad model matrix, practical guidance is provided on how the quality of constructivist research may be implemented in nursing research. Conclusions The different settings in this paper influenced how the AldreVast Sjuharad model matrix was applied. Further work is needed in exploring how the perspective of users and carers may be incorporated into the quality process of constructivist research. PMID:21073505
Full Text Available As the world faces great challenges from climate change and environmental pollution, China urgently requires energy saving, emission reduction, and carbon reduction programmes. However, the non-cooperative energy saving model (NCESM, the simple regulation mode that is China’s main model for energy saving, is not beneficial for optimization of energy and resource distribution, and cannot effectively motivate energy saving at the provincial level. Therefore, we propose an interprovincial cooperative energy saving model (CESM from the perspective of electricity utilization, with the object of maximizing the benefits from electricity utilization of the cooperation union based on achieving the energy saving goals of the union as a whole. The CESM consists of two parts: (1 an optimization model that calculates the optimal quantities of electricity consumption for each participating province to meet the joint energy saving goal; and (2 a model that distributes the economic benefits of the cooperation among the provinces in the cooperation based on the Shapley value method. We applied the CESM to the case of an interprovincial union of Shanghai, Sichuan, Shanxi, and Gansu in China. The results, based on the data from 2001–2014, show that cooperation can significantly increase the benefits of electricity utilization for each province in the union. The total benefits of the union from utilization of electricity increased 38.38%, or 353.98 billion CNY, while the benefits to Shanghai, Sichuan, Shanxi, and Gansu were 200.28, 58.37, 57.11, and 38.22 billion CNY respectively greater under the CESM than the NCESM. The implementation of the CESM provides the provincial governments not only a flexible and incentive way to achieve short-term goals, but also a feasible and effective path to realize long-term energy saving strategies. To test the impact of different parameter values on the results of the CESM, a sensitivity analysis was conducted. Some policy
Jacelon, Cynthia S
The purpose of this research was to identify themes in the daily lives of community-dwelling older adults with chronic health problems. Qualitative descriptive methods based on symbolic interaction were used. Data were generated through unstructured interviews, participant diaries, and researcher logs. Participants were interviewed twice and kept diaries in between. Measures to enhance trustworthiness included bracketing, multiple data sources, repeated interviews, prolonged engagement, an audit trail, participant checking, and consultation with an expert qualitative researcher. Ten older adults 75-98 years of age living in their own homes with at least one self-reported chronic health problem participated in the research. Participants' health problems varied, and they developed strategies to maintain balance in activity, attitude, autonomy, health, and relationships. This research provides a new perspective on living with chronic illness, and the model may provide a framework for rehabilitation nurses who work with older adults.
Kim, Hea-Won; Park, Taekyung; Quiring, Stephanie; Barrett, Diana
A coalition model is often used to serve victims of human trafficking but little is known about whether the model is adequately meeting the needs of the victims. The purpose of this study was to examine anti-human trafficking collaboration model in terms of its impact and the collaborative experience, including challenges and lessons learned from the service providers' perspective. Mixed methods study was conducted to evaluate the impact of a citywide anti-trafficking coalition model from the providers' perspectives. Web-based survey was administered with service providers (n = 32) and focus groups were conducted with Core Group members (n = 10). Providers reported the coalition model has made important impacts in the community by increasing coordination among the key agencies, law enforcement, and service providers and improving quality of service provision. Providers identified the improved and expanded partnerships among coalition members as the key contributing factor to the success of the coalition model. Several key strategies were suggested to improve the coalition model: improved referral tracking, key partner and protocol development, and information sharing.
Estai, Mohamed; Bunt, Stuart; Kanagasingam, Yogesan; Tennant, Marc
Objective The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children. Methods A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7million children) aged 5-14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars. Results The total estimated cost of the teledentistry model was $50million. The fixed cost of teledentistry was $1million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49million. The estimated staff salary saved with the teledentistry model was $56million, and the estimated travel allowance and supply expenses avoided were $16million and $14million respectively; an annual reduction of $85million in total. Conclusions The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas. What is known about the topic? Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great
Full Text Available The development of biofuel as an ecofriendly energy alternative has a value chain problem in alignment policies between related parties. Identifiying its alignment, we make a strategic mapping by building integrated base scorecard, so the strategic target in the subsequent perspective layer can be developed more realistically. Structural Equation Modeling (SEM modeling was used to examine horizontal connection validity to show strong relation between objectives strategy, and it will be measured of constructed component on the internal process by Technology Coefficient Contribution indexes.
An, Sok; Jang, Yuri
Building upon the widely known link between physical and mental health, the present study explored the buffering effects of social capital (indicated by social cohesion, social ties, and safety) in the relationship between physical constraint (indicated by chronic conditions and functional disability) and mental distress (indicated by symptoms of depression and anxiety). Using data from 2,264 community-dwelling older adults in the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (M age = 74.51, SD = 6.67), a latent interaction model was tested. The model of mental distress, including both the main effect of physical constraint and social capital and their latent interaction, presented an excellent fit. The latent constructs of physical constraint (β = .54, p social capital (β = -.11, p social capital had a heightened vulnerability to mental distress when faced with physical constraint, whereas the group with a high level of social capital demonstrated resilience. Findings call attention to ways to enhance older individuals' social capital in efforts to promote their health and well-being.
Ekberg, Katie; Grenness, Caitlin; Hickson, Louise
The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment. Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.
Full Text Available A wealth of current research in microengineering aims at fabricating devices of increasing complexity, notably by (self-assembling elementary components into heterogeneous functional systems. At the same time, a large body of robotic research called swarm robotics is concerned with the design and the control of large ensembles of robots of decreasing size and complexity. This paper describes the asymptotic convergence of micro/nano electromechanical systems (M/NEMS on one side, and swarm robotic systems on the other, toward a unifying class of systems, which we denote Smart Minimal Particles (SMPs. We deﬁne SMPs as mobile, purely reactive and physically embodied agents that compensate for their limited on-board capabilities using speciﬁcally engineered reactivity to external physical stimuli, including local energy and information scavenging. In trading off internal resources for simplicity and robustness, SMPs are still able to collectively perform non-trivial, spatio-temporally coordinated and highly scalable operations such as aggregation and self-assembly (SA. We outline the opposite converging tendencies, namely M/NEMS smarting and robotic minimalism, by reviewing each field’s literature with speciﬁc focus on self-assembling systems. Our main claim is that the SMPs can be used to develop a unifying technological and methodological framework that bridges the gap between passive M/NEMS and active, centimeter-sized robots. By proposing this unifying perspective, we hypothesize a continuum in both complexity and length scale between these two extremes. We illustrate the beneﬁts of possible cross-fertilizations among these originally separate domains, with speciﬁc emphasis on the modeling of collective dynamics. Particularly, we argue that while most of the theoretical studies on M/NEMS SA dynamics belong so far to one of only two main frameworks—based on analytical master equations and on numerical agent-based simulations
Smith, Naomi; Barnes, Marian
The Partnerships for Older People Projects programme provided government funding for local and health authorities to pilot prevention and intervention services in partnership with the voluntary sector and older people between 2006 and 2009. This local evaluation of a pilot in southern England undertaken between 2007 and 2009 used a Theory of Change approach to gathering and reflecting on data with different groups involved in the delivery of this whole-system based model of prevention. The model was delivered in the same way in seven social services locality areas within a large county authority. The method of data gathering enabled structured reflection on the implementation, development and projected outcomes of the model and a consideration of the key learning of working in a whole-system way with partners and stakeholders. The whole-system model, although complex and challenging to implement, was considered overall to have been a success and provided significant learning for partners and stakeholders on the challenges and benefits of working across professional and sectoral boundaries. New posts were created as part of the model. Two of these, recruited to and managed by voluntary sector partners, were identified as 'new jobs', but echoed 'old roles' within community and voluntary sector based health and social care. The authors reflect on the parallels of these roles with previously existing roles and ways of working and reflect on how the whole-system approach of this particular pilot enabled these new jobs to develop in particularly appropriate and successful ways. © 2012 Blackwell Publishing Ltd.
Wang, Yan-Yan; Liao, Yu-Lin; Gao, Lang-Li; Hu, Xiu-Ying; Yue, Ji-Rong
Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the "guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010" and the "clinical practice guideline for postoperative delirium in older adults" produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery.
Li, Si; Liao, Shudi
Although a plethora of studies have examined the antecedents of creativity, empirical studies exploring the role of individual behaviors in relation to creativity are relatively scarce. Drawing on the model of perspective taking, this study examines the relationship between help-giving during creative problem solving process and employee creativity. Specifically, we test perspective taking as an explanatory mechanism and propose organization-based self-esteem as the moderator. In a sample collected from a field survey of 247 supervisor-subordinate dyads from 2 large organizations in China at 3 time points, we find that help-giving during creative problem solving process positively related with perspective taking; perspective taking positively related with employees' creativity; employees' organization-based self-esteem strengthened the link between perspective taking and creativity; besides, there existed a moderated mediation effect. We conclude this paper with discussions on the implications for theory, research, and practice.
Full Text Available Although a plethora of studies have examined the antecedents of creativity, empirical studies exploring the role of individual behaviors in relation to creativity are relatively scarce. Drawing on the model of perspective taking, this study examines the relationship between help-giving during creative problem solving process and employee creativity. Specifically, we test perspective taking as an explanatory mechanism and propose organization-based self-esteem as the moderator. In a sample collected from a field survey of 247 supervisor-subordinate dyads from 2 large organizations in China at 3 time points, we find that help-giving during creative problem solving process positively related with perspective taking; perspective taking positively related with employees’ creativity; employees’ organization-based self-esteem strengthened the link between perspective taking and creativity; besides, there existed a moderated mediation effect. We conclude this paper with discussions on the implications for theory, research, and practice.
The hydrological community has recently engaged in a discussion regarding future directions of Hydrology as an Earth Science. In this context, I will comment on the role of "dynamical systems modeling" (and more generally the systems-theoretic perspective) as a vehicle for informing the Discovery and Learning Process. I propose that significant advances can occur through a better understanding of what is meant by "Information", and by focusing on ways to characterize and quantify the nature, quality and quantity of information in models and data, thereby establishing a more robust and insightful (less ad-hoc) basis for learning through the model-data juxtaposition. While the mathematics of Information Theory has much to offer, it will need to be augmented and extended by bringing to bear contextual perspectives from both dynamical systems modeling and the Hydrological Sciences. A natural consequence will be to re-emphasize the a priori role of Process Modeling (particularly specification of System Architecture) over that of the selection of System Parameterizations, thereby shifting the emphasis to the more creative inductive aspects of scientific investigation.
Turusheva, Anna; Frolova, Elena; Bert, Vaes; Hegendoerfer, Eralda; Degryse, Jean-Marie
Prediction models help to make decisions about further management in clinical practice. This study aims to develop a mortality risk score based on previously identified risk predictors and to perform internal and external validations. In a population-based prospective cohort study of 611 community-dwelling individuals aged 65+ in St. Petersburg (Russia), all-cause mortality risks over 2.5 years follow-up were determined based on the results obtained from anthropometry, medical history, physical performance tests, spirometry and laboratory tests. C-statistic, risk reclassification analysis, integrated discrimination improvement analysis, decision curves analysis, internal validation and external validation were performed. Older adults were at higher risk for mortality [HR (95%CI)=4.54 (3.73-5.52)] when two or more of the following components were present: poor physical performance, low muscle mass, poor lung function, and anemia. If anemia was combined with high C-reactive protein (CRP) and high B-type natriuretic peptide (BNP) was added the HR (95%CI) was slightly higher (5.81 (4.73-7.14)) even after adjusting for age, sex and comorbidities. Our models were validated in an external population of adults 80+. The extended model had a better predictive capacity for cardiovascular mortality [HR (95%CI)=5.05 (2.23-11.44)] compared to the baseline model [HR (95%CI)=2.17 (1.18-4.00)] in the external population. We developed and validated a new risk prediction score that may be used to identify older adults at higher risk for mortality in Russia. Additional studies need to determine which targeted interventions improve the outcomes of these at-risk individuals. Copyright © 2017 Elsevier B.V. All rights reserved.
Lightowlers, S V; Boersma, L J; Fourquet, A
Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature...
Borger, M.; van Hoof, A.M.J.; Sanders, J.
This study examines ‘participatory journalism’ from the perspective of participants. Through a series of in-depth interviews with 32 participants from two different participatory journalistic environments set up by professional news organizations, we investigated how participants view and evaluate
Fleer, Marilyn; Li, Liang
In recent times there has been a major international push for giving voice to children in the provision of services for early education and development particularly among researchers and non-government organisations. However, what has been missing from this body of literature and activity is the children's perspective when centres and services are…
Determining the factors that attract FDI, and furthermore identify the main characteristics of the host country’s economy, are essential to understand the reason of FDI inflows to a country or region. In the empirical perspective, various studies give different results. More specifically, this paper has focused on determining the factors for and against FDI in Albania.
Ossenbach, Gabriela; del Pozo, Maria del Mar
In this article we wish to propose a debate on postcolonialism and its role in the history of Latin American education. Our starting point is the acknowledgement of the reality that postcolonial historiographic perspectives have yet to be applied in studies of one of history's great empires, namely, the Spanish Empire. This is surprising for…
Stergiopoulos, Vicky; Zerger, Suzanne; Jeyaratnam, Jeyagobi; Connelly, Jolynn; Kruk, Katherine; O'Campo, Patricia; Hwang, Stephen
Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors…
Mazerolle, Stephanie M; Bowman, Thomas G; Pitney, William A
The decision has been made to move away from the traditional bachelor's degree professional program to a master's degree professional program. Little is known about the perceptions about this transition from those involved with education. To examine multiple stakeholders' perspectives within athletic training education on the effect that a change to graduate-level education could have on the profession and the educational and professional development of the athletic trainer. Qualitative study. Web-based survey. A total of 18 athletic training students (6 men, 12 women; age = 24 ± 5 years), 17 athletic training faculty (6 men, 9 women, 2 unspecified; 7 program directors, 5 faculty members, 3 clinical coordinators, 2 unidentified; age = 45 ± 8 years), and 15 preceptors (7 men, 7 women, 1 unspecified; age = 34 ± 7 years) completed the study. Participants completed a structured Web-based questionnaire. Each cohort responded to questions matching their roles within an athletic training program. Data were analyzed following a general inductive process. Member checks, multiple-analyst triangulation, and peer review established credibility. Thirty-one (62%) participants supported the transition, 14 (28%) were opposed, and 5 (10%) were neutral or undecided. Advantages of and support for transitioning and disadvantages of and against transitioning emerged. The first higher-order theme, advantages, revealed 4 benefits: (1) alignment of athletic training with other health care professions, (2) advanced coursework and curriculum delivery, (3) improved student and professional retention, and (4) student maturity. The second higher-order theme, disadvantages, was defined by 3 factors: (1) limited time for autonomous practice, (2) financial concerns, and (3) lack of evidence for the transition. Athletic training students, faculty, and preceptors demonstrated moderate support for a transition to the graduate-level model. Factors supporting the move were comparable with those
Sady Darcy da Silva Jr
Full Text Available Measuring the organizational performance is a big challenge to companies. Thus, we should highlight the organizational performance measurement model Balanced Scorecard (BSC. However, the Performance Prism (PP model emphasizes the organizational stakeholders and states that BSC treats them in a superficial way, giving more importance to the shareholders and the customers. The objective of this research is to identify the PP contributions to the BSC, from the stakeholders perspective. With this objective, a semi-structured script to the interviews was applied to professionals of the strategic area. In parallel, the structure of the models was compared to enrich the results, as well as to complement the analysis of the perceptions of respondents. The results were very relevant given important contributions of the PP to the BSC, opposing the original criticisms of the PP. These criticisms became questionable through the perception of respondents and the comparison between the models.
Money, Arthur G; Atwal, Anita; Young, Katherine L; Day, Yasmin; Wilson, Lesley; Money, Kevin G
In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult's views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process. Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged. Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were
Lawrence, Vanessa; Murray, Joanna; Banerjee, Sube; Turner, Sara; Sangha, Kuljeet; Byng, Richard; Bhurgra, Dinesh; Huxley, Peter; Tylee, Andre; Macdonald, Alastair
Purpose: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature…
Alrence S Halibas
Full Text Available Aim/Purpose: Countries today strategically pursue regional development and economic diversification to compete in the world market. Higher Education Institutions (HEIs are at the crux of this political strategy. The paper reviews how HEIs can propel regional socio-economic growth and development by way of research innovation and entrepreneurship. Background: Offering an academic perspective about the role of HEIs using the Penta Helix innovation network for business and social innovation, the paper discusses opportunities and challenges in gestating an innovation culture. It likewise seeks, identifies and details strategies and workable programs. Methodology: Best-practice innovation campaigns initiated by Omani HEIs in collaboration with capstone programs organized by the government were parsed from selected local and international literature. The study includes a causal analysis of innovation information contained in 40 out of 44 published OAAA Quality Audit reports about HEIs from 2009 to 2016. The best-practice programs serve as success indicators and will be used as a field metric effect a Penta Helix blueprint for innovation. Contribution: The paper discusses how HEIs can engender, nurture, drive, and sustain innovation and entrepreneurial activity by using an innovation strategic blueprint like the Penta Helix model. It gathers together the recent historical attempts at promoting innovation by HEIs. It likewise suggests the creation of a network channel to allow key players in the innovation network to share innovation information and to collaborate with each other. Furthermore, it contributes to the development of innovation culture in HEIs. Findings: Expectations run high in academia. For one, universities believe that all innovations embryonically begin within their halls. Universities–too–believe it is naturally incumbent on them to stimulate and advance innovation despite that most innovation programs are initiated by the
Shany, Tal; Wang, Kejia; Liu, Ying; Lovell, Nigel H; Redmond, Stephen J
The field of fall risk testing using wearable sensors is bustling with activity. In this Letter, the authors review publications which incorporated features extracted from sensor signals into statistical models intended to estimate fall risk or predict falls in older people. A review of these studies raises concerns that this body of literature is presenting over-optimistic results in light of small sample sizes, questionable modelling decisions and problematic validation methodologies (e.g. inherent problems with the overly-popular cross-validation technique, lack of external validation). There seem to be substantial issues in the feature selection process, whereby researchers select features before modelling begins based on their relation to the target, and either perform no validation or test the models on the same data used for their training. This, together with potential issues related to the large number of features and their correlations, inevitably leads to models with inflated accuracy that are unlikely to maintain their reported performance during everyday use in relevant populations. Indeed, the availability of rich sensor data and many analytical options provides intellectual and creative freedom for researchers, but should be treated with caution, and such pitfalls must be avoided if we desire to create generalisable prognostic tools of any clinical value.
Impact of environmental factors in home rehabilitation--a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers.
Randström, Kerstin Björkman; Asplund, Kenneth; Svedlund, Marianne
The aim of this study was to explore older people's experience of environmental factors that impact on their activity and participation in home rehabilitation. Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.
Nguyen, Hai V; Bose, Saideep; Mital, Shweta; Yii, Anthony Chau Ang; Ang, Shin Yuh; Lam, Sean Shao Wei; Anantham, Devanand; Finkelstein, Eric; Koh, Mariko Siyue
Bronchial thermoplasty (BT) has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe persistent asthma but it is also expensive. Evidence on its cost-effectiveness is limited and inconclusive. In this study, we aim to evaluate the incremental cost-effectiveness of BT combined with optimized asthma therapy (BT-OAT) relative to OAT for difficult-to-treat and severe asthma patients in Singapore, and to provide a general framework for determining BT's cost-effectiveness in other healthcare settings. We developed a Markov model to estimate the costs and quality-adjusted life years (QALYs) gained with BT-OAT versus OAT from the societal and health system perspectives. The model was populated using Singapore-specific costs and transition probabilities and utilities from the literature. Sensitivity analyses were conducted to identify the main factors determining cost-effectiveness of BT-OAT. BT-OAT is not cost-effective relative to OAT over a 5-year time horizon with an incremental cost-effectiveness ratio (ICER) of $US138 889 per QALY from the societal perspective and $US139 041 per QALY from the health system perspective. The cost-effectiveness of BT-OAT largely depends on a combination of the cost of the BT procedure and the cost of asthma-related hospitalizations and emergency department (ED) visits. Based on established thresholds for cost-effectiveness, BT-OAT is not cost-effective compared with OAT in Singapore. Given its current clinical efficacy, BT-OAT is most likely to be cost-effective in a setting where the cost of BT procedure is low and costs of hospitalization and ED visits are high. © 2017 Asian Pacific Society of Respirology.
Mier, Nelda; Ory, Marcia G; Towne, Samuel D; Smith, Matthew Lee
Background : The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods : This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results : Two personal characteristics (number of chronic conditions and educational level) were consistently related ( p environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.
Chin, Hoong Chor; Zhou, Mo
A number of studies on motor vehicle crashes have suggested that older drivers are more likely to be at-fault compared to younger drivers. The objective of this paper is to identify factors that contribute to older drivers (aged 65 and above) being at fault in light vehicle crashes in Singapore. Based on 3 years of crash data, the calibrated binary logit model shows that older drivers are more likely to be at fault during peak periods and festive seasons between November to February, as well as at gore areas of expressways, intersections. Curb lanes of multi-lane roads and single-lane roads are also found to increase the odds of older drivers being at fault. Furthermore, older drivers appear to have more problems on roads with wet surfaces and speed limits of 60 km/h and 70 km/h. In the light of an aging population in Singapore, it is imperative that more targeted countermeasures be taken from multiple perspectives to lower such risks. Copyright © 2018 Elsevier Ltd. All rights reserved.
Joha, A.; Janssen, M.F.W.H.A.
Software as a Service (SaaS) can be viewed as the fourth wave of outsourcing. SaaS is a relatively new type of service delivery model in which a service provider delivers its services over the web to many users on a pay per use or period basis. In the scarce literature available, the SaaS business model is almost always analyzed from the perspective of the service provider perspective, and rarely from the user organization. Using the unified business model conceptual framework, two case studi...
Overgeneral autobiographical memory in healthy young and older adults: Differential age effects on components of the capture and rumination, functional avoidance, and impaired executive control (CaRFAX) model.
Ros, Laura; Latorre, Jose M; Serrano, Juan P; Ricarte, Jorge J
The CaRFAX model (Williams et al., 2007) has been used to explain the causes of overgeneral autobiographical memory (OGM; the difficulty to retrieve specific autobiographical memories), a cognitive phenomenon generally related with different psychopathologies. This model proposes 3 different mechanisms to explain OGM: capture and rumination (CaR), functional avoidance (FA) and impaired executive functions (X). However, the complete CaRFAX model has not been tested in nonclinical populations. This study aims to assess the usefulness of the CaRFAX model to explain OGM in 2 healthy samples: a young sample and an older sample, to test for possible age-related differences in the underlying causes of OGM. A total of 175 young (age range: 19-36 years) and 175 older (age range: 53-88 years) participants completed measures of brooding rumination (CaR), functional avoidance (FA), and executive tasks (X). Using structural equation modeling, we found that memory specificity is mainly associated with lower functional avoidance and higher executive functions in the older group, but only with executive functions in young participants. We discuss the different roles of emotional regulation strategies used by young and older people and their relation to the CaRFAX model to explain OGM in healthy people. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Matthew R Nassar
Full Text Available Fitting models to behavior is commonly used to infer the latent computational factors responsible for generating behavior. However, the complexity of many behaviors can handicap the interpretation of such models. Here we provide perspectives on problems that can arise when interpreting parameter fits from models that provide incomplete descriptions of behavior. We illustrate these problems by fitting commonly used and neurophysiologically motivated reinforcement-learning models to simulated behavioral data sets from learning tasks. These model fits can pass a host of standard goodness-of-fit tests and other model-selection diagnostics even when the models do not provide a complete description of the behavioral data. We show that such incomplete models can be misleading by yielding biased estimates of the parameters explicitly included in the models. This problem is particularly pernicious when the neglected factors are unknown and therefore not easily identified by model comparisons and similar methods. An obvious conclusion is that a parsimonious description of behavioral data does not necessarily imply an accurate description of the underlying computations. Moreover, general goodness-of-fit measures are not a strong basis to support claims that a particular model can provide a generalized understanding of the computations that govern behavior. To help overcome these challenges, we advocate the design of tasks that provide direct reports of the computational variables of interest. Such direct reports complement model-fitting approaches by providing a more complete, albeit possibly more task-specific, representation of the factors that drive behavior. Computational models then provide a means to connect such task-specific results to a more general algorithmic understanding of the brain.
Full Text Available In this paper we present the current version of the Parallelized Large-Eddy Simulation Model (PALM whose core has been developed at the Institute of Meteorology and Climatology at Leibniz Universität Hannover (Germany. PALM is a Fortran 95-based code with some Fortran 2003 extensions and has been applied for the simulation of a variety of atmospheric and oceanic boundary layers for more than 15 years. PALM is optimized for use on massively parallel computer architectures and was recently ported to general-purpose graphics processing units. In the present paper we give a detailed description of the current version of the model and its features, such as an embedded Lagrangian cloud model and the possibility to use Cartesian topography. Moreover, we discuss recent model developments and future perspectives for LES applications.
Maronga, B.; Gryschka, M.; Heinze, R.; Hoffmann, F.; Kanani-Sühring, F.; Keck, M.; Ketelsen, K.; Letzel, M. O.; Sühring, M.; Raasch, S.
In this paper we present the current version of the Parallelized Large-Eddy Simulation Model (PALM) whose core has been developed at the Institute of Meteorology and Climatology at Leibniz Universität Hannover (Germany). PALM is a Fortran 95-based code with some Fortran 2003 extensions and has been applied for the simulation of a variety of atmospheric and oceanic boundary layers for more than 15 years. PALM is optimized for use on massively parallel computer architectures and was recently ported to general-purpose graphics processing units. In the present paper we give a detailed description of the current version of the model and its features, such as an embedded Lagrangian cloud model and the possibility to use Cartesian topography. Moreover, we discuss recent model developments and future perspectives for LES applications.
Full Text Available Motivated by the importance of the clock synchronization in wireless sensor networks (WSNs, this paper proposes a new research approach and model approach, which quantitatively analyzes clock synchronization from the perspective of modern control theory. Two kinds of control strategies are used as examples to analyze the effect of the control strategy on clock synchronization from different perspectives, namely, the single-step optimal control and the LQG global optimal control. The proposed method establishes a state space model for clock relationship, thus making dimension extension and parameter identification easier, and is robust to changes under the condition of node failures and new nodes. And through the design of different control strategies and performance index functions, the method can satisfy various requirements of the synchronization precision, convergence speed, energy consumption and the computational complexity, and so on. Finally, the simulations show that the synchronization accuracy of the proposed method is higher than that of the existing protocol, and the former convergence speed of the synchronization error is faster.
Druce, Maralyn; Howden, Stella
The growth of e-learning in health professional education reflects expansion of personal use of online resources. Understanding the user perspective in a fast-changing digital world is essential to maintain the currency of our approach. Mixed methods were used to investigate a cohort of postgraduate, e-learning healthcare students' perspectives on their use of online resources for personal and/or professional roles, via questionnaire and student-constructed diagrams, capturing use of online resources (underpinned by White's model of "resident" and "visitor" online engagement). Semistructured interviews explored the use and value of resources afforded via the online environment. The 45 study participants described a range of prior experiences with online resources in personal and professional capacities, but overall students tended to use online "tools" ("visitor" mode) rather than highly collaborative networks ("resident" mode). In relation to e-learning, the dominant interview theme was valuing knowledge transfer from the tutor and using "visitor" behaviors to maximize knowledge acquisition. Peer-learning opportunities were less valued and barriers to collaborative "resident" modes were identified. These findings help to inform e-learning course design to promote engagement. The results enable recommendations for use of the "Visitor and Residents" model and for planning activities that learners might utilize effectively.
Jensen, Anna Rose Vagn; Clausen, Christian; Gish, Liv
This paper presents three complementary perspectives on the management of front end innovation: A process model perspective, a knowledge perspective and a translational perspective. While the first two perspectives are well established in literature, we offer the translation perspective...... as a complementary perspective. The paper combines a literature review with an empirical examination of the application of these multiple perspectives across three cases of front end of innovation (FEI) management in mature product developing companies. While the process models represent the dominant, albeit rather...... to represent an emergent approach in managing FEI where process models, knowledge strategies and objects become integrated elements in more advanced navigational strategies for key players....
Provencher, Louis; Frid, Leonardo; Czembor, Christina; Morisette, Jeffrey T.
State-and-Transition Simulation Modeling (STSM) is a quantitative analysis method that can consolidate a wide array of resource management issues under a “what-if” scenario exercise. STSM can be seen as an ensemble of models, such as climate models, ecological models, and economic models that incorporate human dimensions and management options. This chapter presents STSM as a tool to help synthesize information on social–ecological systems and to investigate some of the management issues associated with exotic annual Bromus species, which have been described elsewhere in this book. Definitions, terminology, and perspectives on conceptual and computer-simulated stochastic state-and-transition models are given first, followed by a brief review of past STSM studies relevant to the management of Bromus species. A detailed case study illustrates the usefulness of STSM for land management. As a whole, this chapter is intended to demonstrate how STSM can help both managers and scientists: (a) determine efficient resource allocation for monitoring nonnative grasses; (b) evaluate sources of uncertainty in model simulation results involving expert opinion, and their consequences for management decisions; and (c) provide insight into the consequences of predicted local climate change effects on ecological systems invaded by exotic annual Bromus species.
Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.
Blom, Jeanet; den Elzen, Wendy; van Houwelingen, Anne H; Heijmans, Margot; Stijnen, Theo; Van den Hout, Wilbert; Gussekloo, Jacobijn
older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.
Glynn, Robert J; Colditz, Graham A; Tamimi, Rulla M; Chen, Wendy Y; Hankinson, Susan E; Willett, Walter W; Rosner, Bernard
A breast cancer risk prediction rule previously developed by Rosner and Colditz has reasonable predictive ability. We developed a re-fitted version of this model, based on more than twice as many cases now including women up to age 85, and further extended it to a model that distinguished risk factor prediction of tumors with different estrogen/progesterone receptor status. We compared the calibration and discriminatory ability of the original, the re-fitted, and the type-specific models. Evaluation used data from the Nurses' Health Study during the period 1980-2008, when 4384 incident invasive breast cancers occurred over 1.5 million person-years. Model development used two-thirds of study subjects and validation used one-third. Predicted risks in the validation sample from the original and re-fitted models were highly correlated (ρ = 0.93), but several parameters, notably those related to use of menopausal hormone therapy and age, had different estimates. The re-fitted model was well-calibrated and had an overall C-statistic of 0.65. The extended, type-specific model identified several risk factors with varying associations with occurrence of tumors of different receptor status. However, this extended model relative to the prediction of any breast cancer did not meaningfully reclassify women who developed breast cancer to higher risk categories, nor women remaining cancer free to lower risk categories. The re-fitted Rosner-Colditz model has applicability to risk prediction in women up to age 85, and its discrimination is not improved by consideration of varying associations across tumor subtypes.
Liu, Hui; Waite, Linda; Shen, Shannon; Wang, Donna
Working from a social relationship and life course perspective, we provide generalizable population-based evidence on partnered sexuality linked to cardiovascular risk in later life using national longitudinal data from the NSHAP (N=2204). We consider characteristics of partnered sexuality of older men and women, particularly sexual activity and sexual quality, as they affect cardiovascular risk. Cardiovascular risk is defined as hypertension, rapid heart rate, elevated CRP, and general cardiovascular events. We find that older men are more likely to report being sexually active, report having sex more often and more enjoyably than are older women. Results from cross-lagged models suggest that high frequency of sex is positively related to later risk of cardiovascular events for men but not women, whereas good sexual quality seems to protect women but not men from cardiovascular risk in later life. We find no evidence that poor cardiovascular health interferes with later sexuality for either gender. PMID:27601406
Andrei Jean Vasile
Full Text Available The evolution of the Common Agricultural Policy and the changing of its paradigm was a subject of extensive consideration in the literature, but never the implications of specific cultural aspects on agricultural performance and production structures were ever taken into consideration. The main aim of the paper is the analysis of the some aspects regarding the influences of the cultural models on agricultural production structures in Romania and some EU-28 countries, form a larger perspective, starting with the CAP transformations over the time and the European agricultural model, analysing the role of the multifunctional agriculture in shaping the holding's structure and performances, and in the last it is considered the role of agriculture and rural communities in promoting renewable including bio-fuels.
Kassab, Ghassan S; An, Gary; Sander, Edward A; Miga, Michael I; Guccione, Julius M; Ji, Songbai; Vodovotz, Yoram
In this era of tremendous technological capabilities and increased focus on improving clinical outcomes, decreasing costs, and increasing precision, there is a need for a more quantitative approach to the field of surgery. Multiscale computational modeling has the potential to bridge the gap to the emerging paradigms of Precision Medicine and Translational Systems Biology, in which quantitative metrics and data guide patient care through improved stratification, diagnosis, and therapy. Achievements by multiple groups have demonstrated the potential for (1) multiscale computational modeling, at a biological level, of diseases treated with surgery and the surgical procedure process at the level of the individual and the population; along with (2) patient-specific, computationally-enabled surgical planning, delivery, and guidance and robotically-augmented manipulation. In this perspective article, we discuss these concepts, and cite emerging examples from the fields of trauma, wound healing, and cardiac surgery.
Salci, Maria Aparecida; Meirelles, Betina Hörner Schlindwein; Silva, Denise Maria Guerreiro Vieira da
to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas. qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique. at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice. the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model. evaluar la atención de salud desarrollada por los integrantes de la Atención Primaria de Salud a las personas con diabetes mellitus en la perspectiva del Modelo de Atenção às Condições Crônicas. estudio cualitativo, con referencial teórico del Pensamiento Complejo y del Modelo de Atenção às Condições Crônicas y metodológico de la investigación evaluativa. Para recolectar los datos fueron efectuadas 38 entrevistas con profesionales de salud y gestores; observación de las actividades practicadas por los equipos de salud: y análisis de 25 archivos de personas que recibían esa atención. Los datos fueron analizados con auxilio del software
Costa, André Luis Sales da; Souza, Maximiliano Loiola Ponte de
To analyze the narratives of family members on the suicide of older adults in Manaus, State of Amazonas, Brazil. This is a qualitative study of the narratives of eight older adults, who committed suicide in the period of 2001-2012. In the analytic-interpretative process, we have tried to perform the hermeneutic double exercise: to interpret the interpretation of narrators. We have used as theoretical references authors who have investigated suicide from the perspective of gender and its correlations with the sociofamiliar context and with mental disorders. The family members would conceive the suicide of the older adults as related to losses, which would occur in a strained sociofamiliar scenario, leading to the appearance of psychopathological situations that, if not properly followed, would result in death. There would also be something inexorable in this sequence of events. The older adults, by the very time of their life, would tend to accumulate losses of different aspects in their trajectory. Their rigor and other relational limitations would simultaneously stress family relationships, favoring conflicts, and hinder adherence to treatment. This model of understanding, which has a wide support in the hegemonic medical-psychological discourse, in a sense minimizes possible self- or heteroaccusations directed at family members. Special attention should be given to identify the older adults who present losses, family conflicts, and signs of psychopathology and who do not follow-up psychosocial care services. Strategies to help older adults handle family conflicts and losses, empowering them, should be developed and made available by intersectoral actions. The adequate treatment of psychopathological conditions should be implanted in a context in which active search mechanisms also existed for older adults who abandoned follow-up. The implementation of these actions is a challenge to be faced in Manaus, State of Amazonas, Brazil, where there is a low availability
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Caboral-Stevens, Meriam; Whetsell, Martha V; Evangelista, Lorraine S; Cypress, Brigitte; Nickitas, Donna
The purpose of the current study was to present a framework to determine potential usability of health websites by older adults. Review of the literature showed paucity of nursing theory related to the use of technology and usability, particularly in older adults. The Roy Adaptation Model, a widely used nursing theory, was chosen to provide framework for the new model. Technology constructs from the Technology Acceptance Model and United Theory of Acceptance and Use of Technology and behavioral control construct from the Theory of Planned Behavior were integrated into the construction of the derived model. The Use of Technology for Adaptation by Older Adults and/or Those With Limited Literacy (U.S.A.B.I.L.I.T.Y.) Model was constructed from the integration of diverse theoretical/conceptual perspectives. The four determinants of usability in the conceptual model include (a) efficiency, (b) learnability, (c) perceived user experience, and (d) perceived control. Because of the lack of well-validated survey questionnaires to measure these determinants, a U.S.A.B.I.L.I.T.Y. Survey was developed. A panel of experts evaluated face and content validity of the new instrument. Internal consistency of the new instrument was 0.96. Usability is key to accepting technology. The derived U.S.A.B.I.L.I.T.Y. framework could serve as a guide for nurses in formative evaluation of technology. Copyright 2015, SLACK Incorporated.
Graham, Carrie L.; Scharlach, Andrew E.; Price Wolf, Jennifer
Background: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of…
Ruwanpathirana, Thilanga; Owen, Alice; Renzaho, Andre M N; Zomer, Ella; Gambhir, Manoj; Reid, Christopher M
The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations. © 2015 Wiley Publishing Asia Pty Ltd.
PPARγ-modulators, a class of anti-diabetic drugs as represented by thiazolidinediones (TZD), have been associated with cardiovascular risks in type-2 diabetes in humans but a similar liability has not been demonstrated in preclinical models. This gap between clinical and preclinical observations may reflect the lack of a translational model for cardiac safety assessment because preclinical efficacy for glycemic control for PPARγ-modulators is routinely conducted in animals with diabetic background while drug safety study is performed in young and health animals with little risk of heart failure, in contrast to the complex pathophysiological conditions of patients subjected to the treatment of TZDs. Therefore, some key steps are important to address this translational gap. First, it is essential to use an appropriate translational model that mimics most of human pathophysiology for the assessment of cardiovascular safety for TZDs. Second, it calls for the discovery of a translational biomarker (most likely a collection of biomarkers due to multiple risk factors contributed to the complex disease) to be able to sensitively detect the disease progression and in response to therapy. Specific examples are provided in this review for the use of a rodent model of myocardial infarction-induced heart failure to address the cardiac safety concern in response to chronic treatment of rosiglitazone. Multiple biomarkers, including physiological, biochemical, pharmacogenomic and imaging biomarkers, were applied to assess the cardiovascular risk in this heart failure model. The data and strategic approach are discussed from translational medicine perspectives.
Rohr, Margund K; John, Dennis T; Fung, Helene H; Lang, Frieder R
Although extensive findings underscore the relevance of future time perspective (FTP) in the process of aging, the assumption of FTP as a unifactorial construct has been challenged. The present study explores the factorial structure of the FTP scale (Carstensen & Lang, 1996) as one of the most widely used measures (Ntotal = 2,170). Results support that FTP reflects a higher-order construct that consists of 3 interrelated components-Opportunity, Extension, and Constraint. It is suggested that the flexible usage of the FTP scale as an all compassing 10-item measure or with focus on specific components depends on the concrete research question. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Slack, Tim; Jensen, Leif
The realities of a rapidly aging society make the employment circumstances of older workers an increasingly important social issue. We examine the prevalence and correlates of underemployment among older Americans, with a special focus on residence and gender, to provide an assessment of the labor market challenges facing older workers. We analyzed data from the March Current Population Surveys for the years 2003, 2004, and 2005. We used descriptive statistics to explore the prevalence of underemployment among older workers and developed multivariate models to assess the impact of age, residence, and gender on the likelihood of underemployment, net of other predictors. We found clear disadvantages for older workers relative to their middle-aged counterparts, and particular disadvantages for older rural residents and women. Multivariate models showed that the disadvantages of older age held net of other predictors. The results also indicated that much of the disadvantage faced by older rural workers and women was explained by factors other than age, particularly education. In an aging society, underemployment among older workers comes at an increasing social cost. Policies aimed at supporting older workers and alleviating employment hardship among them are increasingly in the public interest.
Nielsen, Louise Møldrup; Maribo, Thomas; Nielsen, Hanne Grethe
Aim: This study aimed to develop an understanding of how primary and secondary care health professionals perceive current practice and challenges in assessing older patients’ functional abilities. A secondary aim was to gain insight into how these professionals perceive the need for generic tools...... for assessing functional ability among older patients. Method: A qualitative design was used to explore health professionals’ perspectives on the assessment of older patients’ functional ability. Two groups of health professionals participated in focus group interviews, with one group for each of the two...... from the hospital expressed a need for a fast and simple screening tool to identify those in need of further rehabilitation and care after discharge. Participants from the municipality expressed a need for a more detailed assessment tool to capture information about patients’ ability to perform daily...
Giles, H; Coupland, N; Coupland, J; Williams, A; Nussbaum, J
A program of research conducted within an anti-agism paradigm demonstrates that young people process and respond to the speech of older people in stereotypical ways. Such conclusions result from studies using a variety of research methods. Experimental studies demonstrate that older-sounding speech triggers age schematic responses and that young people tend to use agist strategies of information seeking and compliance gaining from older people, while interactive studies explore how stereotypes and age identities are co-produced by young and old people in conversation. We use lifespan and intercultural perspectives to argue that the communicative patterns we observe in our studies are in some senses and contexts counterproductive in both the long and short term, in that they can reproduce negative attitudes toward aging as well as inhibit successful aging.
Despite socio-economic, demographic and epidemiological facts and realities that point to a potential risk for explosion in the prevalence of childhood mental health problems in sub-Saharan Africa, there is still a severe dearth of child and adolescent mental health (CAMH) policy or strategy to respond to the situation in the region. Unfortunately, current attempts at suggesting courses of action in this regard appear to be focused on narrow reactionary approaches. There is a need for theoretical frameworks to capture the full ramification of childhood in sub-Saharan Africa, from which multi-level, context-appropriate and holistic CAMH policy directions can be understood. In this commentary, we propose an amended version of the Bronfenbrenner's ecological model of childhood as such framework that captures proximal, intermediate and distal factors that influence the care environment of children. We then used the insights provided by the model to identify and prioritize intervention points and appropriate intervention strategies in charting a tentative course for CAMH policy development in the region. Though the ecological model provides a distinct perspective to the structure and dynamics of the care environment of children, the proposed framework using the model is still largely theoretical and need to be further integrated into future studies on CAMH policy development in the region. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Full Text Available Current reputation models lack the research on