Prediction accuracies of cheese-making traits using Fourier-transform infrared spectra in goat milk.

The objectives of this study were to explore the use of Fourier-transform infrared (FITR) spectroscopy on 458 goat milk samples for predicting cheese-making traits, and to test the effect of the farm variability on their prediction accuracy. Calibration equations were developed using a Bayesian approach with three different scenarios: i) a random cross-validation (CV) [80% calibration (CAL); 20% validation (VAL) set], ii) a stratified CV [(SCV), 13 farms used as CAL, and the remaining one as VAL set], and iii) a SCV where 20% of the goats randomly selected from the VAL farm were included in the CAL set (SCV80). The best prediction performance was obtained for cheese yield solids, justifying for its practical application at population level. Overall results were similar to or outperformed those reported for bovine milk. Our results suggest considering specific procedures for calibration development to propose reliable tools applicable along the dairy goat chain.

Prediction of fresh and ripened cheese yield using detailed milk composition and udder health indicators from individual Brown Swiss cows.

The composition of raw milk is of major importance for dairy products, especially fat, protein, and casein (CN) contents, which are used worldwide in breeding programs for dairy species because of their role in human nutrition and in determining cheese yield (%CY). The aim of the study was to develop formulas based on detailed milk composition to disentangle the role of each milk component on %CY traits. To this end, 1,271 individual milk samples (1.5 L/cow) from Brown Swiss cows were processed according to a laboratory model cheese-making procedure. Fresh %CY (%CYCURD), total solids and water retained in the fresh cheese (%CYSOLIDS and %CYWATER), and 60-days ripened cheese (%CYRIPENED) were the reference traits and were used as response variables. Training-testing linear regression modeling was performed: 80% of observations were randomly assigned to the training set, 20% to the validation set, and the procedure was repeated 10 times. Four groups of predictive equations were identified, in which different combinations of predictors were tested separately to predict %CY traits: (i) basic composition, i.e., fat, protein, and CN, tested individually and in combination; (ii) udder health indicators (UHI), i.e., fat + protein or CN + lactose and/or somatic cell score (SCS); (iii) detailed protein profile, i.e., fat + protein fractions [CN fractions, whey proteins, and nonprotein nitrogen (NPN) compounds]; (iv) detailed protein profile + UHI, i.e., fat + protein fractions + NPN compounds and/or UHI. Aside from the positive effect of fat, protein, and total casein on %CY, our results allowed us to disentangle the role of each casein fraction and whey protein, confirming the central role of ß-CN and κ-CN, but also showing α-lactalbumin (α-LA) to have a favorable effect, and ß-lactoglobulin (ß-LG) a negative effect. Replacing protein or casein with individual milk protein and NPN fractions in the statistical models appreciably increased the validation accuracy of the equations. The cheese industry would benefit from an improvement, through genetic selection, of traits related to cheese yield and this study offers new insights into the quantification of the influence of milk components in composite selection indices with the aim of directly enhancing cheese production.

A systematic study of pulse and pulse reverse plating on acid copper bath for decorative and functional applications.

Today industrial electroplating is mainly carried out using direct current even if the use of modulated currents could offer greats opportunities. Adjusting the amplitude and length of the current's pulses it is possible to control grain size, porosity and homogeneity of the deposits; the use of modulated currents could also decrease the environmental impact of deposition processes as they require a much lower percentage of organic additives. The aim of this work is to assess, through both theoretical and experimental investigation, how the deposition parameters affect the various characteristics of the deposit. We used a commercial acid copper bath for the depositions performing both pulse and reverse pulse sequences. The coatings have been characterised by estimating the deposition yield, homogeneity, hardness and reflectivity. Using pulsed currents, we obtained shinier and brighter films respect to those produced with stationary currents; the deposition efficiency was also improved. Bipolar currents, on the other hand, favour more homogeneous deposits over the entire deposition area, and are less affected by the edge effect.

Dietary Mannan Oligosaccharides Modulate Gut Inflammatory Response and Improve Duodenal Villi Height in Post-Weaning Piglets Improving Feed Efficiency.

The aim of this study was to evaluate the effects of mannan oligosaccharides (MOS) on gut health and performance in post-weaning piglets. In total, 40 piglets were divided into two experimental groups and fed a basal diet with (TRT) or without (CON) 0.2% mannan oligosaccharides for 35 days. Growth performance was determined weekly and faecal microbial composition on days 0, 14 and 35. On day 36, histometrical evaluations were performed on duodenal, jejunal, ileal, and colon samples. mRNA gene expression of inflammation-related genes was evaluated in samples of ileal Peyer's patches (IPP). MOS administration improved feed efficiency in the last two weeks of the trial (p < 0.05), and a decreased clostridia content was found in faeces at day 14 (p = 0.05). TRT piglets showed increased duodenal villi height (p < 0.05), and reduced mRNA levels of Tumour Necrosis Factor α (p < 0.05) and Toll-Like Receptor 4 (p < 0.01) in IPP. Our results suggest beneficial effects of MOS supplementation on gut morphology and the expression of inflammation-related genes in post-weaning piglets, accompanied by increased feed efficiency.

Genetic Variability and Management in Nero di Parma Swine Breed to Preserve Local Diversity.

Nero di Parma is an endangered swine breed reared in the North of Italy which nowadays counts 1603 alive pigs. The aims of this study were (i) to explore the genetic diversity of the breed at pedigree level to determine the actual genetic structure, (ii) to evaluate the effectiveness of the breeding recovery project and (iii) to potentially propose breeding strategies for the coming generations. The pedigree dataset contained 14,485 animals and was used to estimate demographic and genetic parameters. The mean equivalent complete generations was equal to 6.47 in the whole population, and it reached a mean value of 7.94 in the live animals, highlighting the quality of the available data. Average inbreeding was 0.28 in the total population, whereas it reached 0.31 in the alive animals and it decreased to 0.27 if only breeding animals were considered. The rate of inbreeding based on the individual increase in inbreeding was equal to 7%. This study showed the effectiveness of the recovery project of the breed. Nevertheless, we found that inbreeding and genetic diversity have reached alarming levels, therefore novel breeding strategies must be applied to ensure long-term survival of this breed.

Remote home physical training for seniors: guidelines from the AAL-supported MOTION project.

European population will face an unprecedented aging era in the next years. Albeit aging in itself is a success goal, it may bring with it a general decline and functional limitations. In order to decelerate such decline, one of the most efficient strategies is physical activity. The present paper reports the insight emerging from three focus-group interviews organized at the beginning of the MOTION-Remote Home Physical Training for Seniors project, whose main aim regarded the implementation of an ICT system capable of offering home-based gym sessions to healthy seniors. The sixteen interview participants (11 females and 5 males, averaged age 72.3) provided several indications, which were grouped into the following themes: (1) ICT technical characteristics; (2) Platform accessibility; (3) Physical program features; (4) Psychological factors. At the end of the thematic analysis, results suggest that theoretical frameworks mainly focusing on ICT issues might be insufficient to endorse the successful development and maintenance of ICT systems such as MOTION, which challenges seniors to accept ICT while staying committed to the physical exercise program .

Nursing home staff members' knowledge, experience and attitudes regarding advance care planning: a cross-sectional study involving 12 Italian nursing homes.

BACKGROUND: Advance care planning may be beneficial for nursing home residents, but its implementation is suboptimal in several countries. AIMS: To investigate knowledge of, attitudes towards, and experience with advance care planning of nursing home staff members in Italy. METHODS: Cross-sectional survey involving all healthcare professionals working in 12 Italian nursing homes. Statistical analyses investigated interactions between participants' characteristics, knowledge, attitudes and frequency of advance care planning discussion with residents. RESULTS: Of the 185 participants (80.5% female, mean age 43.6 ± 9.2 years), 29.7% reported that they had heard of advance care planning, but their actual knowledge was suboptimal. Participants had positive attitudes towards advance care planning, and most of them clearly recognized its benefits. Apprehension about upsetting the patient or their family, or that patients were not ready for these conversations were the main concerns. Only 16% of respondents discussed advance care planning at least sometimes, usually upon patient/family input. Greater knowledge was significantly correlated with more positive attitudes towards advance care planning. The issues of healthcare professionals' knowledge and training in advance care planning, and of knowledge and awareness of advance care planning in patients, their families, and the general population were considered either main barriers or facilitators. DISCUSSION: Nursing home staff members' concerns towards advance care planning seemed to be related to a misconception about patient and family willingness to discuss it. CONCLUSIONS: A multifaceted strategy including educational and training programmes and the increase of public awareness is needed to implement advance care planning in Italian nursing homes.

The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care.

BACKGROUND: Shared decision-making (SDM) can be a way for staff to adopt international recommendations advocating the involvement of nursing home residents and their family members in care planning and the development of personalized care plans. OBJECTIVE: The main aim was to analyze the effects of training nursing home staff in the implementation of SDM on agreement of residents' 'life-and-care plans' with the recommendations (primary outcome) and on family caregivers' quality of life and sense of competence, and staff's job satisfaction (secondary outcomes). METHODS: In the intervention condition, staff attended a training program on the use of SDM with residents and family caregivers in the care planning process. In the control condition, care planning as usual took place. For the primary outcome, in-depth qualitative and quantitative analyses of the care plans were performed. Multivariate Permutation Tests were applied to assess the impact on secondary outcomes. RESULTS: Forty-nine residents and family caregivers and 34 professionals were involved. Overall, many of the care plans developed during the intervention showed a high level of agreement with the care planning recommendations. Both Italian and Dutch care plans showed improvement in the number of clear problem statements (p < 0.001). In Italy, significant improvements (p < 0.05) were also found regarding specific care objectives, documentation of objectives met, and of residents and families' involvement. No impact was found on secondary outcomes. CONCLUSION: The involvement of residents and family caregivers in care planning contributed to an improvement of the residents' care plans, but it did not have an effect on family caregivers and staff outcomes.

Discussing advance care planning: insights from older people living in nursing homes and from family members.

ABSTRACTBackground:Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP. METHODS: This was a qualitative study using face-to-face interviews with 30 residents (age range 66-94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis. RESULTS: Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents' concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives. CONCLUSIONS: ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.

Family Trajectories and Well-being of Children Born to Lone Mothers in the UK.

We investigate how lone mothers' heterogeneity in partnership trajectories is associated with children's well-being. We use data from the Millennium Cohort Study, which follows a large sample of children born in the UK in 2000-2002. We divide children who were born to lone mothers into four groups based on their mothers' partnership trajectories between birth and age seven, which cover more than 80% of these children's family experiences. We then analyse how these trajectories are associated with markers of health, cognitive and socio-emotional outcomes measured at around age seven. We find that compared to the children that live continuously with lone mothers, children whose biological father stably joined the household have better cognitive and socio-emotional outcomes. In contrast, children in trajectories characterised by living with a stepfather or who experienced biological father joining in the family followed by biological parents' dissolution had outcomes similar to children living continuously with lone mothers. The results underscore the importance of treating children born to lone mothers as a heterogeneous category.

Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis.

OBJECTIVE: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. METHODS: The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. RESULTS: The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1) plans already made; 2) end-of-life care and decision-making; 3) opinions and attitudes toward ACP; and 4) how, when, about what, and with whom to do ACP. CONCLUSION: Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. PRACTICAL IMPLICATIONS: In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities.

Shared decision-making in dementia care planning: barriers and facilitators in two European countries.

BACKGROUND: Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands. METHODS: Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data. RESULTS: Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents' cognitive status that influenced their degree of involvement. CONCLUSION: Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.

Care Plan Improvement in Nursing Homes: An Integrative Review.

BACKGROUND: Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. OBJECTIVE: The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. METHODS: An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. RESULTS: Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. CONCLUSION: Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

Shared decision-making on a 'life-and-care plan' in long-term care facilities: research protocol.

AIM: To determine whether the number of residents' preferences and needs together with the actions taken to satisfy them recorded into their 'life-and-care plans' will increase and the process of shared decision-making will improve the residents' psychosocial well-being. BACKGROUND: Shared decision-making is defined as a process where healthcare professionals and patients make decisions together, using the best available evidence. The aims of the present study were to assess the feasibility and acceptability of an SDM framework for care planning in long-term care facilities and its potential effectiveness on the proportion of dementia residents whose own preferences and needs and the related actions, are known, satisfied and documented in their 'life-and-care plans'. DESIGN: The current project is a feasibility trial and it was approved in November 2013. METHODS: Research subjects are triads composed of the resident with dementia, a family caregiver and the professional usually taking care for the resident. Professional caregivers of two nursing homes, one located in Italy and one in the Netherlands, will receive a specific training in SDM principles and will guide the SDM interview in the triad. The primary outcome will be the proportion of residents whose preferences and needs, together with the related actions to meet them, are known, documented and satisfied in their 'life-and-care plans'. TRIAL REGISTRATION: NCT02118701.

Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals.

BACKGROUND: People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care. METHODS: Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers. RESULTS: Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn't even reach consensus when considering persons with dementia eligible for palliative care. CONCLUSION: The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.

Improving the organization of palliative care: identification of barriers and facilitators in five European countries.

BACKGROUND: Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care's complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. METHODS: Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. RESULTS: Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. CONCLUSION: This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.

Quality palliative care for cancer and dementia in five European countries: some common challenges.

OBJECTIVES: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. METHOD: One focus group (n=7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. RESULTS: The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. CONCLUSION: These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care.

Modelling the landscape of palliative care for people with dementia: a European mixed methods study.

BACKGROUND: Palliative care for people with dementia is often sub-optimal. This is partly because of the challenging nature of dementia itself, and partly because of system failings that are particularly salient in primary care and community services. There is a need to systematize palliative care for people with dementia, to clarify where changes in practice could be made.To develop a model of palliative care for people with dementia that captures commonalities and differences across Europe, a technology development approach was adopted, using mixed methods including 1) critical synthesis of the research literature and policy documents, 2) interviews with national experts in policy, service organisation, service delivery, patient and carer interests, and research in palliative care, and 3) nominal groups of researchers tasked with synthesising data and modelling palliative care. DISCUSSION: A generic model of palliative care, into which quality indicators can be embedded. The proposed model includes features deemed important for the systematisation of palliative care for people with dementia. These are: the division of labour amongst practitioners of different disciplines; the structure and function of care planning; the management of rising risk and increasing complexity; boundaries between disease-modifying treatment and palliative care and between palliative and end-of-life care; and the process of bereavement. SUMMARY: The co-design approach to developing a generic model of palliative care for people with dementia has placed the person needing palliative care within a landscape of services and professional disciplines. This model will be explored further in the intervention phase of the IMPACT project.

Emotional and psychological distress of persons involved in the care of patients with Alzheimer disease predicts falls and fractures in their care recipients.

BACKGROUND/AIMS: Elderly patients with dementia have a higher risk of falls and fractures as compared to cognitively intact elderly subjects. To investigate whether psychological distress of the caregiver might predispose older persons with Alzheimer disease (AD) to falls and fractures, we performed a prospective cohort study. METHODS: A consecutive series of 110 subjects with dementia underwent baseline and follow-up clinical and functional evaluations. The burden of the caregivers was recorded at baseline. Any intervening fall or fracture was ascertained at the 1-year follow-up. RESULTS: The caregiver burden was significantly higher in persons involved in the care of patients with AD who subsequently fell. In a multivariate regression model, the caregiver burden score predicted falls and fractures. CONCLUSION: Part of the increased risk of falls and fractures in AD might be due to the distress of caregivers, a factor potentially amenable to treatment.

High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects.

A higher daily intake of fruits and vegetables in healthy elderly is associated with an improved antioxidant status in comparison to subjects consuming diets poor in fruits and vegetables, but the impact on cognitive performance is unclear. Healthy community dwellers (45 to 102 years old, n=193) underwent cognitive testing and blood withdrawal for the measurement of antioxidant micronutrients and biomarkers of oxidative stress as well as administration of a food frequency questionnaire to assess the daily intake of fruits and vegetables (high intake HI, low intake LI). Ninety-four subjects of the HI group had significantly higher cognitive test scores, higher levels of carotenoids, alpha- and gamma-tocopherol as well as lower levels of F2 alpha isoprostanes than the 99 subjects of the LI group. Cognitive scores were directly correlated with blood levels of alpha-tocopherol and lycopene and negatively correlated with F2 alpha isoprostanes and protein carbonyls. The results were independent of age, gender, body mass index, education, total cholesterol, LDL- and HDL-cholesterol, triglycerides, and albumin. Healthy subjects of any age with a high daily intake of fruits and vegetables have higher antioxidant levels, lower levels of biomarkers of oxidative stress, and better cognitive performance than healthy subjects of any age consuming low amounts of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables should be encouraged to lower prevalence of cognitive impairment in later life.