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BackgroundAssistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. ObjectiveThis study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. MethodsThe ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days. ResultsData from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. ConclusionsFor participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.

Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches. Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis. Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship. Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements. [ABSTRACT FROM AUTHOR]

It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy. [ABSTRACT FROM AUTHOR]

"Completion" has become the rallying cry at community colleges. As the 21st century unfolds, the earlier emphasis on guaranteeing greater access to a postsecondary education has evolved into a sharp focus on student success. Whether that means earning a workforcerelated certificate or an associate degree transferable to a four-year institution, completion is the goal. How students get to that finish line, however, remains the tricky part of the equation, sparking numerous innovations and reforms on college campuses. Many of them are at the root of the American Association of Community Colleges' (AACC) comprehensive 21st-Century Initiative. Among the proposals: evidence-based academic pathways for students. As defined in "Empowering Community Colleges," "A pathway is a highly structured, coherent educational experience that is built around and through an area of study." The following pathways are presented in this article: (1) Career Pathways, Lane Community College; (2) Math Pathways Programs, Ivy Tech Community College; and (3) ASU Pathways Program, Maricopa Community Colleges.

The skills gap--the disparity between job openings and job seekers in an employment category--is wider in some sectors and parts of the country than others. The disconnect between community colleges and employers perpetuates the skills gap. Despite the current push among educators, politicians, and employers to increase completion rates, that laudable goal is often just the first step in either getting students into the workforce or advancing incumbent workers' careers. There is a growing recognition that workers need continuous education, both in an academic setting and on the job, which will help close the skills gap--and keep it closed. This article discusses how Macomb Community College (MCC) in Warren, Michigan; Florida State College at Jacksonville (FSCJ), Florida; Global Corporate College (GCC) in Solon, Ohio; and Blue Mountain Community College (BMCC) in Pendleton, Oregon, have refocused relationships with employers to discover the dominant needs in local economies, and then customized training programs to help close the skills gap.

When the 10 members of the American Association of Community College's (AACC's) 21st-Century Implementation Team 7 (nine of whom are community college presidents) sat down in 2013 to talk about reforming institutional roles and functions at the nation's two-year career and technical colleges, everyone in the room knew the work before them would be difficult. Handpicked by AACC President and CEO Walter Bumphus, each team member was intimately familiar with the recommendation's set forth in AACC's 2012 report, "Reclaiming the American Dream: Community Colleges and the Nation's Future"--and many had already started making changes at their institutions. AACC has begun an occasional series on the work and contributions of the Implementation Team. In this article, Bob Woods catches up with some of the presidents who participated in the discussions about institutional roles and functions; examines the challenges institutions continued to face en route to change; and sheds light on possible solutions. The subjects discussed include: changes in the student dynamic, an emphasis on academic achievement, and unpredictable funding.

The nation's community colleges have an impressive to-do list: (1) Increase college completion by 50 percent by 2020; (2) Dramatically improve college readiness; (3) Close the American skills gap; (4) Refocus the community college mission; (5) Invest in new support structures; (6) Target public and private investments; and (7) Promote rigor and accountability. On paper, it's hard to argue with any of these seven recommendations outlined by the American Association of Community Colleges (AACC) in its 2012 "Reclaiming the American Dream: Community Colleges and the Nation's Future" report. If community college leaders are going to improve student outcomes and reposition their institutions for future success, reform in these areas is a must. But, as exciting as these goals sound on paper, they can be diffi cult to achieve, especially at the institutional level, where change is never easy. Navigating these reforms takes time, dedication, and creative thinking. To get a clearer sense for how the nation's community college leaders are conducting this tough but necessary work, the editors of Community College Journal reached out to campus leaders responsible for promising reforms in four key areas: institutional culture; instructional programs and workforce partnerships; students services and advising; and professional development and training for future college leaders.

"Reclaiming the American Dream" is the cornerstone of American Association of Community Colleges's (AACC) 21st-Century Initiative, launched in 2011 with the goal of outfitting an additional 5 million students with degrees, certificates, or other credentials by 2020. In Phase 1 of the initiative, featured was a nationwide "listening tour" by AACC staff, who gathered input from more than 1,300 students, college faculty and staff, administrators, trustees, state policymakers, and college presidents and chancellors. Phase 2 established the "21st-Century Commission on the Future of Community Colleges," a group of community college leaders charged with safeguarding the fundamental mission of community colleges and imagining a new path forward for their institutions, their students, and, ultimately, the nation. In this article, Bob Woods describes how community colleges around the country are responding to the AACC initiative.

A growing number of community colleges are investing in new facilities and programs to train health care workers in a variety of professions, including nursing, radiology, health information technology, physical therapy, dentistry, and surgical technology. Community colleges have historically offered job training programs in health care, but with the growth of the "medical industrial complex," the ongoing implementation of the Patient Protection and Affordable Care Act (ACA), and the aging baby boomer generation, the need for health care workers is expected to grow exponentially by 2020. The U.S. Bureau of Labor Statistics (BLS) predicts a 26 percent spike in jobs for registered nurses, a 32 percent increase in jobs for pharmacy technicians, a 28 percent increase in jobs for radiologic technologists, and a 33 percent increase in jobs for emergency medical technicians, among other sectors. This article discusses how the following community colleges are investing in their facilities and programs to prepare students and meet the demand for health professionals: (1) Elgin Community College (ECC), in Illinois, added new certificate programs and started offering non-credit continuing education workshops for health care practitioners; (2) A consortium of three Maryland community colleges--Carroll Community College, Frederick Community College, and Howard Community College--implemented an unusual approach to boosting their collective health care education offerings by building a facility that allows the three colleges to share their resources and programs; (3) Largo, Maryland, Prince George's Community College (PGCC) recently marked a significant expansion in its health care curriculum with the opening of its $43 million Center for Health Studies, featuring smart classrooms, a computer lab, simulation labs, and dozens of faculty and administrative offices; and (4) Houston Community College (HCC) Coleman College for Health Sciences offers associate degrees and certificates in twenty health science fields, but plans on branching out even more into the local community. A section titled "Meeting the Demand Online" discusses how the American Association of Community Colleges' Virtual Career Network (VCN) seeks to demystify the health care training and job-hunting process by linking student skills and educational backgrounds to careers in their desired fields.

In this article, Bob Woods reports that "Big data" is all the rage on college campuses, and it makes sense that administrators would use what they know to boost student outcomes. Woods points out that community colleges around the country are using the data: (1) to guide the systematic expansion of its curriculum, providing targeted career and learning opportunities for students and (2) to identify new workforce opportunities for students across the region. Together, colleges and business partners have developed customized job-training programs with a focus on emerging career sectors, such as energy, computer technology, and advanced manufacturing. Big data helps the college tailor their curriculum, so that instead of just having welding, there is a combing of machining and automated manufacturing with technical math and blueprint reading as core skills required for some of today's jobs. Colleges are realizing they must be more proactive to help their students get a job, not just degrees.

Last year, amid the tumult of the Middle East's Arab Spring--a series of uprisings that have toppled governments and tested the United States' foreign policies throughout the region--administrators at Kirkwood Community College (KCC) in Cedar Rapids, Iowa, received an intriguing request. The school was among a group of institutions contacted by the U.S. embassy in Tunisia about establishing components of the community college model in the Middle Eastern nation to help address both its higher education and workforce needs. After a round of discussions, and backed by a $250,000 Economic Support Fund grant from the U.S. embassy, KCC entered into a two-year partnership project with Tunisia's Institut Supérieur des Etudes Technologiques in the city of Sfax (ISET-Sfax), America-Mideast Educational and Training Services Inc. (AMIDEAST), and Iowa State University. "This program is designed to encourage the exchange of knowledge about the important role of community colleges and the ISET system in educating students and finding employment for recent graduates," U.S. embassy officials said of the program.

The two campuses that make up the West Valley-Mission Community College District (WVMCCD) in northern California's Santa Clara County share a history typical of many community colleges across the country. Its buildings were constructed in the 1960s and '70s, and like many public structures of that vintage, today they bear the ravages of time--in need of routine maintenance and, in many cases, extensive renovations or even complete replacement. Finding money and support for massive public infrastructure upgrades is never easy. It is especially difficult in the shadow of the worst economic crisis since the Great Depression. A lack of funding has forced governments at every level to make tough choices, cutting capital spending for everything from highways to bridges to municipal buildings, and in particular the types of infrastructure upgrades most needed by the nation's community colleges. Community college administrators nationwide are grappling with the dilemma of providing 21st-century education and job training in aging classrooms, laboratories, lecture halls, technical centers, and other facilities, with scant state and local funds to pay for upgrades. As pressure mounts on the nation's two-year career and technical colleges to boost completion rates and resuscitate local economies through improved job training, the situation will likely get worse before it gets better. The American Association of Community Colleges (AACC) estimates that community colleges currently face $100 billion in unmet infrastructure needs. Faced with a daunting $100 billion infrastructure backlog, colleges find creative ways to finance essential infrastructure projects.

As community colleges cement their role as catalysts for the nation's economic recovery, administrators struggle to set the record straight about one long-standing misconception: that a large number of community college students leave without achieving their professional or academic goals. Now, a new policy brief from the American Association of Community Colleges (AACC) stands to put an end to the notion of the community college revolving door. The report, "The Road Ahead: A Look at Trends in the Educational Attainment of Community College Students," indicates that the number of professional credentials awarded to students over the past 20 years, primarily in associate degrees, diplomas, and certificates, has risen at nearly double the rate of enrollment. Though persistently high unemployment remains a problem, there's ample evidence that as the job market rebounds, community colleges will play an integral role in working closely with employers to develop the workforce of the future, especially as a new generation of workers fills the pipeline. (Contains 1 figure.)

Relationship quality (RQ) between a person with dementia and a family carer may influence their health and quality of life. However, evidence regarding its course and influencing factors is limited. We aimed to explore RQ trajectories in dementia, and identify predictors of change. We analysed longitudinal data from a cohort of 350 community-dwelling people with dementia and their informal carers, participating in the Actifcare study in eight European countries. The Positive Affect Index, rated separately by both people with dementia and their carers, assessed RQ. Other measures included the Neuropsychiatric Inventory Questionnaire (regarding persons with dementia), and the Relative Stress Scale, Sense of Coherence Scale and Lubben Social Network Scale (for carers). Trajectories and influencing factors were explored applying a latent growth model (LGM). RQ in the group of carers declined over 1 year, but RQ scores for the persons with dementia did not change. Higher stress in carers negatively influenced their baseline RQ ratings. Carer sense of coherence and being a spouse were associated with more positive baseline RQ carer assessments. Higher levels of neuropsychiatric symptoms were linked to decline in carers' RQ, whereas social support was associated with more positive RQ trajectories. This study provides a valuable insight into the course of RQ. LGM proved useful to explore the factors that influence RQ trajectories and variability within- and between-persons. Our findings emphasise the importance of carer-perceived social support and sense of coherence, and of reducing neuropsychiatric symptoms, in maintaining a good RQ. [ABSTRACT FROM AUTHOR]

Background Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. Methods and findings This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. Conclusions These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. Trial registration ISRCTN Registry ISRCTN62237498, Author(s): Clive Ballard 1,*, Anne Corbett 1, Martin Orrell 2,3, Gareth Williams 4, Esme Moniz-Cook 5, Renee Romeo 6, Bob Woods 7, Lucy Garrod 6, Ingelin Testad 1,8, Barbara Woodward-Carlton [...]