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Chemometric analysis of ethoxylated polymer products using extracted MALDI-TOF-MS peak distribution features
MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) of ethoxylate products produces spectra with distributions of regularly spaced peaks resulting from the addition of monomer units of ethylene oxide to the oligomer. We show that overlapping peak distributions from the different ethoxylated constituents of natural raw materials can be resolved, so that features of the individual distributions ( m/z at distribution maximum, intensity at the distribution maximum, width of the distribution at half height, and ratio of the distribution to the major peak distribution) can be extracted and used with statistical pattern recognition techniques to study ethoxylated products. Crucially, we weight the extracted features, so that features from a distribution with a high ratio to the main distribution are given more importance (‘ratio-scaled’). We exemplify the method by characterizing the structural variation between types of compositionally diverse Polysorbate 80, PEG castor oil and Oleth-20, and compare the chemometric analysis using our extracted features with analysis of the full spectra. We demonstrate that using ratio-scaled extracted features gives superior results to the full spectrum, both in terms of identifying subtle compositional differences that would otherwise be missed, and in interpretability. Importantly, the integrated auto-assignment of peak distributions to possible compounds allows the results to be reported in terms of the most abundant oligomers of the raw material constituents. This simplification facilitates interpretation of the results and allows the comparison of closely related products.
Journal Article
The WTO and environment-related international trade disputes : biosecurity and ecosystem services risks
\"We live in a world that is increasingly dependent on international trade in a context of substantial regional/national political tensions. Adding to this is an emerging understanding and concern about the social impact of biosecurity and ecosystem services risks associated with such trade. As the key international trade 'arbiter', the World Trade Organisation (WTO) has never before faced such complexity within its decision-making remit. With increasing numbers of bilateral and regional agreements, as well as new developments emerging such as the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) initiated by multi-national corporations in 2018, the WTO needs to implement ways of reinforcing its legitimacy and enhancing its relevance. This book provides an original analysis of these linked developments and delivers a timely contribution to resolving environment-related international trade disputes. It provides a clear roadmap for improving WTO trade dispute resolution procedures so both biosecurity and ecosystem services risks are considered in evaluating the social, economic and environmental impacts of international trade proposals. In so doing, the WTO should deliver enhanced multilateral social welfare.\"--Back cover.
Book
Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial
Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.
A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions).
Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes.
FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.
Australian New Zealand Clinical Trial Registry ACTRN12612001164886.
Journal Article
Perceptions of Care Quality during an Acute Hospital Stay for Persons with Dementia and Family/Carers
Objectives: to report on acute hospital care experiences for persons with dementia and family/carers in a pilot study (PiP) of person-centred care compared with usual care. Methods: participants were recruited from one acute aged care ward and one mixed medical/surgical ward. One-on-one interviews occurred soon after discharge using a semi-structured interview guide framed by person-centred principles whereby the person is: V—valued; I—treated as an individual; P—perceived as having a unique identity; and S—supported socially and psychologically. Data were analysed deductively with reference to these a priori principles. Results: 11 consented persons with dementia and 36 family/carers participated. A total of eight core VIPS concepts were derived from the data. While many occasions of person-centred care occurred, there was variability in staff expertise, interest and aptitude for dementia care work. Neglect of person-centred principles more frequently occurred for the usual care group, where staff failed to place the person and their family/carer at the centre of service. Conclusions: person-centred services for persons with dementia requires that hospital executive equip staff with the relevant knowledge, skills and support to adhere to person-centred care guidelines. Hospitals must address workplace cultures and procedures that favour organisational systems over person-centred services.
Journal Article
Critical Contextual Elements in Facilitating and Achieving Success with a Person-Centred Care Intervention to Support Antipsychotic Deprescribing for Older People in Long-Term Care
Antipsychotic and other tranquilising medicines are prescribed to help care staff manages behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study was undertaken to address this issue with 139 people 60 years and over with behaviours of concern for staff living in 24 care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, dementia management education for visiting general practitioners (GP) and pharmacists, use of an individualised deprescribing protocol for residents, and awareness-raising for the resident’s family. The HALT champions completed open-ended questionnaires and semistructured interviews to identify the contextual elements they considered most critical to facilitating, educating care staff, and achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in the absence of antipsychotic medicines; the champions considered that this required strong managerial support, champion empowerment to lead change, reeducation of care staff, and the cooperation of families and GPs.
Journal Article
PerCEN trial participant perspectives on the implementation and outcomes of person-centered dementia care and environments
ABSTRACTBackgroundWell-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting. Data obtained during the Person-Centered Dementia Care and Environment (PerCEN) randomized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants. MethodsData were obtained from PerCEN participants: individual semi-structured interviews with care managers (29), nurses and care staff (70); telephone surveys with family members (73); staff reports of care approaches; and 131 field note entries recorded by the person-centered care and environment facilitators. Data were interpreted inductively using content analysis, code building, theme development, and synthesis of findings. ResultsAll data sources confirmed that, when adopted, the person-centered model increased the number and variety of opportunities for resident interaction, improved flexibility in care regimens, enhanced staff's attention to resident needs, reduced resident agitation, and improved their well-being. Barriers and enablers for the person-centered model related to leadership, manager, staff and family appreciation of the model, staff's capacity, effective communication and team work among direct care staff, care service flexibility, and staff education on how to focus care on the person's well-being. ConclusionsSuccessful knowledge translation of the person-centered model starts with managerial leadership and support; it is sustained when staff are educated and assisted to apply the model, and, along with families, come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being. The Australian New Zealand Clinical Trials Registry number is ACTRN 12608000095369.
Journal Article
A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study
ABSTRACTBackgroundPalliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. MethodSemi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. ResultsInterviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. ConclusionThe facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
Journal Article
Chemometric analysis of ethoxylated polymer products using extracted MALDI-TOF-MS peak distribution features
MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) of ethoxylate products produces spectra with distributions of regularly spaced peaks resulting from the addition of monomer units of ethylene oxide to the oligomer. We show that overlapping peak distributions from the different ethoxylated constituents of natural raw materials can be resolved, so that features of the individual distributions (m/z at distribution maximum, intensity at the distribution maximum, width of the distribution at half height, and ratio of the distribution to the major peak distribution) can be extracted and used with statistical pattern recognition techniques to study ethoxylated products. Crucially, we weight the extracted features, so that features from a distribution with a high ratio to the main distribution are given more importance ('ratio-scaled'). We exemplify the method by characterizing the structural variation between types of compositionally diverse Polysorbate 80, PEG castor oil and Oleth-20, and compare the chemometric analysis using our extracted features with analysis of the full spectra. We demonstrate that using ratio-scaled extracted features gives superior results to the full spectrum, both in terms of identifying subtle compositional differences that would otherwise be missed, and in interpretability. Importantly, the integrated auto-assignment of peak distributions to possible compounds allows the results to be reported in terms of the most abundant oligomers of the raw material constituents. This simplification facilitates interpretation of the results and allows the comparison of closely related products.
Journal Article
Virtual K-12 Learning: New Learning Frontiers for State Education Agencies
This article explores the role of state education agencies in three states that have embarked on ambitious kindergarten through Grade 12 (K-12) virtual learning initiatives: Alabama, Florida, and Idaho. Subject to a rapidly changing environment influenced by factors beyond the jurisdiction of many state departments of education, the world of virtual K-12 education is relatively unregulated and fluid. Case studies describing the virtual learning initiatives of several states suggest that few, if any, state education agencies are currently equipped to regulate the rapidly growing number of independent for-profit and nonprofit organizations delivering online learning options.
Journal Article