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E-bibliotherapy for improving the psychological well-being of informal caregivers of people with dementia: a randomized controlled trial protocol
No full textBackground: Providing informal care for individuals with dementia is frequently a challenging and demanding experience that can have detrimental effects on the psychological well-being of caregivers. Regrettably, community-based caregiver services often prove inadequate, highlighting the necessity for innovative approaches to support caregivers. Aim: To test the efficacy of e-bibliotherapy in improving the psychological well-being of informal caregivers of people with dementia. Method: The study is divided into two phases. In phase 1, the research team will co-design the e-bibliotherapy app with caregivers. In phase 2, a randomized controlled trial will be conducted among 192 informal caregivers of people with dementia in Hong Kong. Caregivers will be randomly assigned to either the e-bibliotherapy group or the control group using simple randomization. Outcome measures will encompass caregivers’ psychological well-being, caregiving appraisal, mental health, saliva cortisol levels as an indicator of stress, and health-related quality of life for caregivers. Data will be collected at baseline, immediately post intervention, and 3 months and 6 months post intervention. General linear mixed model will be employed to analyze intervention effects. Qualitative interviews will be undertaken to explore caregiver experiences within this study and evaluate intervention acceptability using conventional content analysis methods. Discussion: This study represents a pioneering effort in utilizing e-bibliotherapy to enhance the psychological well-being of informal caregivers of individuals with dementia, addressing the existing gap in caregiver services and facilitating knowledge dissemination within the community. Trial registration: The trial has been registered on ClinicalTrial.gov (Ref: NCT05927805)
Synthesis of millimeter-scale ZIF-8 single crystals and their reversible crystal structure changes
No full textAmong various metal-organic frameworks (MOFs), the zeolitic imidazole framework (ZIF), constructed by the regular arrangement of 2-methylimidazole and metal ions, has garnered significant attention due to its distinctive crystals and pore structures. Variations in the sizes and shapes of ZIF crystals have been reported by changing the synthesis parameters, such as the molar ratios of organic ligands to metal ions, choice of solvents, and temperatures. Nonetheless, the giant ZIF-8 single crystals beyond the typical range have rarely been reported. Herein, we present the synthesis of millimeter-scale single crystal ZIF-8 using the solvothermal method in N,N-diethylformamide. The resulting 1-mm single crystal is carefully characterized through N2 adsorption-desorption isotherms, scanning electron microscopy, and other analytical techniques. Additionally, single-crystal X-ray diffraction is employed to comprehensively investigate the framework’s mobility at various temperatures
GrassGro<sup>TM</sup> simulation of pasture, animal performance and greenhouse emissions on low and high sheep productivity grazing systems: 1-year validation and 25-year analysis
No full textGlobally, there is a focus on reducing the absolute methane (CH4) and nitrous oxide emissions, and the emissions intensity (EI, kg CO2e/kg animal product) of livestock production. Increasing the productivity of mixed pasture systems has the potential to increase food (e.g., lamb) and textile fibre (e.g., wool) production while reducing the EI of those products from grazing livestock. The objective of this study was to quantify the differences in greenhouse gas (GHG) emissions and EI between sheep on Low (i.e., low sustainable stocking rate) and High (i.e., high sustainable stocking rate) productivity grazing systems (PGSs). Therefore, a replicated breeding-ewe trial on 18 paddocks was established across 2 - years. Three flocks on Low (3 × 16 ewes/flock) and High PGSs (3 × 32 ewes/flock) rotated across three land-classes and three paddocks per PGS. In year 1, the observed on-farm pasture quantity, quality, and botanical composition, together with lamb BW (kg), and daily CH4 production (DMP, g CH4/head per day) using Open Path Fourier Transformed Infrared (OP-FTIR) spectrometers data were measured. Subsequently, two simulations using GrassGroTM were conducted: (1) a 1-year GrassGroTM simulation that used the observed on-farm data to adjust parameters: date of mating, paddock fertility, and weight of mature ewes to validate GrassGroTM predictions to achieve accuracy and precision targets; and (2) a 25-year (1986–2011) simulation to analyse the effects of Low and High PGSs on sheep production and GHG emissions across a variable climate. The 1-year validation predictions fitted well with the observed on-farm data for: pasture biomass (kg/ha), DM digestibility (%), botanical composition (kg/ha), lamb (kg) product, and DMP (g CH4/head per day). The subsequent predicted results from the 25-year GrassGroTM simulation showed minimal effect of PGS on the mean DM intake (kg DM/day) or DMP for Low and High PGSs, but this was thought to be due to the biomass in both PGSs exceeding 1 500 kg DM/ha. The EI, over the 25-year simulation, on the High PGS was 16.5% lower than the Low PGS. Additional calculations of DMP were conducted using a recent global equation, giving estimates of DMP that closely matched the observed on-farm OP-FTIR DMP measurements, but these were lower than the GrassGroTM predictions and improved the accuracy and precision. It is concluded that in some pasture situations, managing pastures and stock numbers to intensify grazing systems can allow increased livestock production, without increasing daily CH4 emissions/head while substantially decreasing the EI of the animal products generated
Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults
No full textObjective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods: Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results: Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's =.31–.37, p <.001), and ACP engagement (r's = −.41 to −.37, p <.001) indicated convergent validity. Conclusion: A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution: The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners
Patients’ perspectives on quality and patient safety failures: lessons learned from an inquiry into transvaginal mesh in Australia
No full textBackground: Transvaginal mesh (TVM) surgeries emerged as an innovative treatment for stress urine incontinency and/or pelvic organ prolapse in 1996. Years after rapid adoption of these surgeries into practice, they are a key example of worldwide failure of healthcare quality and patient safety. The prevalence of TVM-associated harms eventually prompted action globally, including an Australian Commonwealth Government Senate Inquiry in 2017. Method: We analysed 425 submissions made by women (n = 417) and their advocates (n = 8) to the Australian Senate Inquiry, and documents from 5 public hearings, using deductive and inductive coding, categorisation and thematic analysis informed by three ‘linked dilemmas’ from healthcare quality and safety theory. We focused on women’s accounts of: a) how harms arose from TVM procedures, and b) micro, meso and macro factors that contributed to their experience. Our aim was to explain, from a patient perspective, how these harms persisted in Australian healthcare, and to identify mechanisms at micro, meso and macro levels explaining quality and safety system failure. Results: Our findings suggest three mechanisms explaining quality and safety failure: 1. Individual clinicians could ignore cases of TVM injury or define them as ‘non-preventable’; 2. Women could not go beyond their treating clinicians to participate in defining and governing quality and safety; and. 3. Health services set thresholds for concern based on proportion of cases harmed, not absolute number or severity of harms. Conclusion: We argue that privileging clinical perspectives over patient perspectives in evaluating TVM outcomes allowed micro-level actors to dismiss women’s lived experience, such that women’s accounts of harms had insufficient or no weight at meso and macro levels. Establishing system-wide expectations regarding responsiveness to patients, and communication of patient reported outcomes in evaluation of healthcare delivery, may help prevent similar failures
Cross-cultural adaptation and psychometric validation of point-of-care outcome assessment tools in Chinese palliative care clinical practice
No full textBackground: A standardized national approach to routinely assessing palliative care patients helps improve patient outcomes. However, a quality improvement program-based on person centered outcomes within palliative care is lacking in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality. This study aimed to culturally adapt and validate three measures that form part of the PCOC program for palliative care clinical practice in China: The PCOC Symptom Assessment Scale (PCOC SAS), Palliative Care Problem Severity Scale (PCPSS), Palliative Care Phase. Methods: A study was conducted on cross-cultural adaptation and validation of PCOC SAS, PCPSS and Palliative Care Phase, involving translation methods, cognitive interviewing, and psychometric testing through paired assessments. Results: Cross-cultural adaptation highlighted the need to strengthen the link between the patient’s care plan and the outcome measures to improve outcomes, and the concept of distress in PCOC SAS. Analysis of 368 paired assessments (n = 135 inpatients, 22 clinicians) demonstrated that the PCOC SAS and PCPSS had good and acceptable coherence (Cronbach’s a = 0.85, 0.75 respectively). Palliative Care Phase detected patients’ urgent needs. PCOC SAS and PCPSS showed fair discriminant and concurrent validity. Inter-rater reliability was fair for Palliative Care Phase (k = 0.31) and PCPSS (k = 0.23–0.30), except for PCPSS-pain, which was moderate (k = 0.53). Conclusions: The Chinese version of PCOC SAS, PCPSS, and Palliative Care Phase can be used to assess outcomes as part of routine clinical practice in Mainland China. Comprehensive clinical education regarding the assessment tools is necessary to help improve the inter-rater reliability
Bisguanidinium-catalyzed remote enantioselective desymmetrization with 1,2-acyl shift
No full textIn this work, we described a remote desymmetrization reaction in which cesium carboxylate, in the presence of bisguanidinium as catalyst, was added to (cis)-α,α′-dibromocyclohexanone to access 6-oxocyclohex-1-enyl ester via a 1,2-acyl shift in a highly enantioselective fashion. In this process, the carboxylate initiated a nucleophilic attack, and then a keto-enol tautomerism led to a 1,2-acyl shift to the neighboring alcohol. Key intermediates were isolated and determined using single-crystal X-ray crystallography. The remote desymmetrization that includes stepwise SN2 and intramolecular acyl transfer was proposed and was further supported using computational studies. Finally, it was successfully applied to a tropinone derivative, realizing carbonyl chain walking efficiently
A versatile semi-active magnetorheological inerter with energy harvesting and active control capabilities
No full textSemi-active devices typically adjust the system’s damping coefficient to control vibration, offering advantages such as excellent performance and low power consumption. However, the output force of the traditional variable damping (VD) device can only be opposite to the relative motion direction of the device’s two terminals, which limits the vibration control performance. This paper introduces a versatile semi-active magnetorheological (MR) inerter with three operating modes, the VD, energy harvesting, and active control modes, to break through the performance bottleneck of traditional semi-active devices. The MR inerter combines two MR dampers and a flywheel, acting as the controllable units and energy sink. The built prototype is tested, and its parameters are identified. When the innovative semi-active inerter works with a corresponding control strategy to regulate the current in two MR dampers, it can achieve vibration energy storage and release. The harvested energy can help to reduce the high dependency of the semi-active output force on external inputs. The proposed semi-active inerter has excellent potential in the future applications
Rumor blocking with pertinence set in large graphs
No full textOnline social networks facilitate the spread of information, while rumors can also propagate widely and fast, which may mislead some users. Therefore, suppressing the spread of rumors has become a daunting task. One of the widely used approaches is to select users in the social network to spread the truth and compete against the rumor, so that users who receive the truth before receiving rumors will not trust or propagate the rumor. However, the existing works only aim to speed up blocking rumors without considering the pertinency of users. For example, consider a social media platform operator aiming to enhance user online safety. Based on the user’s online behavior, the users who are at high risk should be alerted first. Motivated by this, we formally define the rumor blocking with pertinence set (RBP) problem, which aims to find a truth seed set that maximizes the number of nodes affected by truth and ensures that the number of influenced nodes within the pertinence set reaches at least a given threshold. To solve this problem, we design a hybrid greedy framework (HGF) algorithm with local and global phases. We prove that HGF can provide a (1 - 1 / e- ϵ) -approximate solution with high probability while reducing the cost of the sampling process. Extensive experiments on 8 real social networks demonstrate the efficiency and effectiveness of our proposed algorithms
Eurobodalla Shire’s food environment
No full textMapping the food environment helps us understand if everyone can easily get healthy food. The healthiness of the Eurobodalla Shire food environment matters because it directly impacts the dietary choices of local residents and, consequently, their overall health and well-being