Comparing proxy rated quality of life of people living with dementia in care homes

Background: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently

Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study

BACKGROUND: Agitation is reportedly the most common neuropsychiatric symptom in care home residents with dementia. AIMS: To report, in a large care home survey, prevalence and determinants of agitation in residents with dementia. METHOD: We interviewed staff from 86 care homes between 13 January 2014 and 12 November 2015 about residents with dementia with respect to agitation (Cohen-Mansfield Agitation Inventory (CMAI)), quality of life (DEMQOL-proxy) and dementia severity (Clinical Dementia Rating). We also interviewed residents and their relatives. We used random effects models adjusted for resident age, gender, dementia severity and care home type with CMAI as a continuous score. RESULTS: Out of 3053 (86.2%) residents who had dementia, 1489 (52.7%) eligible residents participated. Fifteen per cent of residents with very mild dementia had clinically significant agitation compared with 33% with mild (odds ratios (ORs)=4.49 95% confidence interval (CI)=2.30) and 45% with moderate or severe dementia (OR=6.95 95% CI=3.63, 13.31 and OR=6.23 95% CI=3.25, 11.94, respectively). More agitation was associated with lower quality of life (regression coefficient (rc)=-0.53; 95% CI=-0.61, -0.46) but not with staffing or resident ratio (rc=0.03; 95% CI=-0.04, 0.11), level of residents' engagement in home activities (rc=3.21; 95% CI=-0.82, 7.21) or family visit numbers (rc=-0.03; 95% CI=-0.15, 0.08). It was correlated with antipsychotic use (rc=6.45; 95% CI=3.98, 8.91). CONCLUSIONS: Care home residents with dementia and agitation have lower quality of life. More staffing time and activities as currently provided are not associated with lower agitation levels. New approaches to develop staff skills in understanding and responding to the underlying reasons for individual resident's agitation require development and testing. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license

Search for muonic decays of the antiproton at the Fermilab Antiproton Accumulator

A search for antiproton decay has been made at the Fermilab Antiproton Accumulator. Limits are placed on six antiproton decay modes which contain a final-state muon. At the 90% C.L. we find that tau/B(mu gamma) > 5.0 x 10^4 yr, tau/B(mu pi0) > 4.8 x 10^4 yr, tau/B(mu eta) > 7.9 x 10^3 yr, tau/B(mu gamma gamma) > 2.3 x 10^4 yr, tau/B(mu K0S > 4.3 x 10^3 yr, and tau/B(mu K0L) > 6.5 x 10^3 yr.Comment: 8 pages + 3 Postscript figure

HST Observations of Chromospheres in Metal Deficient Field Giants

HST high resolution spectra of metal-deficient field giants more than double the stars in previous studies, span about 3 magnitudes on the red giant branch, and sample an abundance range [Fe/H]= -1 to -3. These stars, in spite of their age and low metallicity, possess chromospheric fluxes of Mg II (2800 Angstrom) that are within a factor of 4 of Population I stars, and give signs of a dependence on the metal abundance at the lowest metallicities. The Mg II k-line widths depend on luminosity and correlate with metallicity. Line profile asymmetries reveal outflows that occur at lower luminosities (M_V = -0.8) than detected in Ca K and H-alpha lines in metal-poor giants, suggesting mass outflow occurs over a larger span of the red giant branch than previously thought, and confirming that the Mg II lines are good wind diagnostics. These results do not support a magnetically dominated chromosphere, but appear more consistent with some sort of hydrodynamic, or acoustic heating of the outer atmospheres.Comment: 36 pages, 12 figures, 7 tables, and accepted for publication in The Astronomical Journa

Inference for bounded parameters

The estimation of signal frequency count in the presence of background noise has had much discussion in the recent physics literature, and Mandelkern [1] brings the central issues to the statistical community, leading in turn to extensive discussion by statisticians. The primary focus however in [1] and the accompanying discussion is on the construction of a confidence interval. We argue that the likelihood function and $p$-value function provide a comprehensive presentation of the information available from the model and the data. This is illustrated for Gaussian and Poisson models with lower bounds for the mean parameter

Is mindfulness Buddhist? (and why it matters).

Modern exponents of mindfulness meditation promote the therapeutic effects of "bare attention"--a sort of non-judgmental, non-discursive attending to the moment-to-moment flow of consciousness. This approach to Buddhist meditation can be traced to Burmese Buddhist reform movements of the first half of the 20th century, and is arguably at odds with more traditional Theravāda Buddhist doctrine and meditative practices. But the cultivation of present-centered awareness is not without precedent in Buddhist history; similar innovations arose in medieval Chinese Zen (Chan) and Tibetan Dzogchen. These movements have several things in common. In each case the reforms were, in part, attempts to render Buddhist practice and insight accessible to laypersons unfamiliar with Buddhist philosophy and/or unwilling to adopt a renunciatory lifestyle. In addition, these movements all promised astonishingly quick results. And finally, the innovations in practice were met with suspicion and criticism from traditional Buddhist quarters. Those interested in the therapeutic effects of mindfulness and bare attention are often not aware of the existence, much less the content, of the controversies surrounding these practices in Asian Buddhist history

The Palomar Testbed Interferometer Calibrator Catalog

The Palomar Testbed Interferometer (PTI) archive of observations between 1998 and 2005 is examined for objects appropriate for calibration of optical long-baseline interferometer observations - stars that are predictably point-like and single. Approximately 1,400 nights of data on 1,800 objects were examined for this investigation. We compare those observations to an intensively studied object that is a suitable calibrator, HD217014, and statistically compare each candidate calibrator to that object by computing both a Mahalanobis distance and a Principal Component Analysis. Our hypothesis is that the frequency distribution of visibility data associated with calibrator stars differs from non-calibrator stars such as binary stars. Spectroscopic binaries resolved by PTI, objects known to be unsuitable for calibrator use, are similarly tested to establish detection limits of this approach. From this investigation, we find more than 350 observed stars suitable for use as calibrators (with an additional $\approx 140$ being rejected), corresponding to $\gtrsim 95$ sky coverage for PTI. This approach is noteworthy in that it rigorously establishes calibration sources through a traceable, empirical methodology, leveraging the predictions of spectral energy distribution modeling but also verifying it with the rich body of PTI's on-sky observations.Comment: 100 pages, 7 figures, 7 tables; to appear in the May 2008ApJS, v176n

FUSE Measurements of Far Ultraviolet Extinction. I. Galactic Sight Lines

We present extinction curves that include data down to far ultraviolet wavelengths (FUV; 1050 - 1200 A) for nine Galactic sight lines. The FUV extinction was measured using data from the Far Ultraviolet Spectroscopic Explorer. The sight lines were chosen for their unusual extinction properties in the infrared through the ultraviolet; that they probe a wide range of dust environments is evidenced by the large spread in their measured ratios of total-to-selective extinction, R_V = 2.43 - 3.81. We find that extrapolation of the Fitzpatrick & Massa relationship from the ultraviolet appears to be a good predictor of the FUV extinction behavior. We find that predictions of the FUV extinction based upon the Cardelli, Clayton & Mathis (CCM) dependence on R_V give mixed results. For the seven extinction curves well represented by CCM in the infrared through ultraviolet, the FUV extinction is well predicted in three sight lines, over-predicted in two sight lines, and under-predicted in 2 sight lines. A Maximum Entropy Method analysis using a simple three component grain model shows that seven of the nine sight lines in the study require a larger fraction of grain materials to be in dust when FUV extinction is included in the models. Most of the added grain material is in the form of small (radii < 200 A) grains.Comment: Accepted for publication in the Astrophysical Journal. 31 pages with 7 figure

The N Enrichment and Supernova Ejection of the Runaway Microquasar LS 5039

We present an investigation of new optical and ultraviolet spectra of the mass donor star in the massive X-ray binary LS 5039. The optical band spectral line strengths indicate that the atmosphere is N-rich and C-poor, and we classify the stellar spectrum as type ON6.5 V((f)). The N-strong and C-weak pattern is also found in the stellar wind P Cygni lines of N V 1240 and C IV 1550. We suggest that the N-enrichment may result from internal mixing if the O-star was born as a rapid rotator, or the O-star may have accreted N-rich gas prior to a common-envelope interaction with the progenitor of the supernova. We re-evaluated the orbital elements to find an orbital period of P=4.4267 +/- 0.0010 d. We compared the spectral line profiles with new non-LTE, line-blanketed model spectra, from which we derive an effective temperature T_eff = 37.5 +/- 1.7 kK, gravity log g = 4.0 +/- 0.1, and projected rotational velocity V sin i = 140 +/- 8 km/s. We fit the UV, optical, and IR flux distribution using a model spectrum and extinction law with parameters E(B-V)= 1.28 +/- 0.02 and R= 3.18 +/- 0.07. We confirm the co-variability of the observed X-ray flux and stellar wind mass loss rate derived from the H-alpha profile, which supports the wind accretion scenario for the X-ray production in LS 5039. Wind accretion models indicate that the compact companion has a mass M_X/M_sun = 1.4 +/- 0.4, consistent with its identification as a neutron star. The observed eccentricity and runaway velocity of the binary can only be reconciled if the neutron star received a modest kick velocity due to a slight asymmetry in the supernova explosion (during which >5 solar masses was ejected).Comment: 38 pages, 9 figures; 2004, ApJ, 600, Jan. 10 issue, in press Discussion revised thanks to comments from P. Podsiadlowsk