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

Transient flow-driven distortion of a nematic liquid crystal in channel flow with dissipative weak planar anchoring

Motivated by the one-drop-filling (ODF) method for the industrial manufacturing of liquid crystal displays, we analyze the pressure-driven flow of a nematic in a channel with dissipative weak planar anchoring at the boundaries of the channel. We obtain quasisteady asymptotic solutions for the director angle and the velocity in the limit of small Leslie angle, in which case the key parameters are the Ericksen number and the anchoring strength parameter. In the limit of large Ericksen number, the solution for the director angle has narrow reorientational boundary layers and a narrow reorientational internal layer separated by two outer regions in which the director is aligned at the positive Leslie angle in the lower half of the channel and the negative Leslie angle in the upper half of the channel. On the other hand, in the limit of small Ericksen number, the solution for the director angle is dominated by splay elastic effects with viscous effects appearing at first order. As the Ericksen number varies, there is a continuous transition between these asymptotic behaviors, and in fact the two asymptotic solutions capture the behavior rather well for all values of the Ericksen number. The steady-state value of the director angle at the boundaries and the timescale of the evolution toward this steady-state value in the asymptotic limits of large and small Ericksen number are determined. In particular, using estimated parameter values for the ODF method, it is found that the boundary director rotation timescale is substantially shorter than the timescale of the ODF method, suggesting that there is sufficient time for significant transient flow-driven distortion of the nematic molecules at the substrates from their required orientation to occur

Tsunami vulnerability of buildings and people in South Java ? field observations after the July 2006 Java tsunami

International audienceA team of scientists from New Zealand and Indonesia undertook a reconnaissance mission to the South Java area affected by the tsunami of 17 July 2006. The team used GPS-based surveying equipment to measure ground profiles and inundation depths along 17 transects across affected areas near the port city of Cilacap and the resort town of Pangandaran. The purpose of the work was to acquire data for calibration of models used to estimate tsunami inundations, casualty rates and damage levels. Additional information was gathered from interviews with eyewitnesses. The degree of damage observed was diverse, being primarily dependant on water depth and the building construction type. Water depths were typically 2 to 4 m where housing was seriously damaged. Damage levels ranged from total for older brick houses, to about 50% for newer buildings with rudimentary reinforced-concrete beams and columns, to 5?20% for engineered residential houses and multi-storey hotels with heavier RC columns. "Punchout" of weak brick walls was widespread. Despite various natural warning signs very few people were alerted to the impending tsunami. Hence, the death toll was significant, with average death and injury rates both being about 10% of the people exposed, for water depths of about 3 m

Comparison of the properties of two fossil groups of galaxies with the normal group NGC 6034 based on multiband imaging and optical spectroscopy

We collected multiband imaging and spectroscopy for two fossil groups (RX J1119.7+2126 and 1RXS J235814.4+150524) and one normal group (NGC 6034). We computed photometric redshifts in the central zones of each group, combining previous data with the SDSS five-band data. For each group we investigated the red sequence (RS) of the color-magnitude relation and computed the luminosity functions, stellar population ages and distributions of the group members. Spectroscopy allowed us to investigate the large-scale surroundings of these groups and the substructure levels in 1RXS J235814.4+150524 and NGC 6034. The large-scale environment of 1RXS J235814.4+150524 is poor, though its galaxy density map shows a clear signature of the surrounding cosmic web. RX J1119.7+2126 appears to be very isolated, while the cosmic environment of NGC 6034 is very rich. At the group scale, 1RXS J235814.4+150524 shows no substructure. Galaxies with recent stellar populations seem preferentially located in the group outskirts. A RS is discernable for all three groups in a color-magnitude diagram. The luminosity functions based on photometric redshift selection and on statistical background subtraction have comparable shapes, and agree with the few points obtained from spectroscopic redshifts. These luminosity functions show the expected dip between first and second brightest galaxies for the fossil groups only. Their shape is also regular and relatively flat at faint magnitudes down to the completeness level for RX J1119.7+2126 and NGC 6034, while there is a clear lack of faint galaxies for 1RXS J235814.4+150524. RX J1119.7+2126 is definitely classified as a fossil group; 1RXS J235814.4+150524 also has properties very close to those of a fossil group, while we confirm that NGC 6034 is a normal group.Comment: Accepted in A&A, english-improved, 5 jpeg figures, and shortened abstrac

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

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

Mass Segregation in the Globular Cluster Palomar 5 and its Tidal Tails

We present the stellar main sequence luminosity function (LF) of the disrupted, low-mass, low-concentration globular cluster Palomar 5 and its well-defined tidal tails, which emanate from the cluster as a result of its tidal interaction with the Milky Way. The results of our deep (B ~ 24.5) wide-field photometry unequivocally indicate that preferentially fainter stars were removed from the cluster so that the LF of the cluster's main body exhibits a significant degree of flattening compared to other globular clusters. There is clear evidence of mass segregation, which is reflected in a radial variation of the LFs. The LF of the tidal tails is distinctly enhanced with faint, low-mass stars. Pal 5 exhibits a binary main sequence, and we estimate a photometric binary frequency of roughly 10%. Also the binaries show evidence of mass segregation with more massive binary systems being more strongly concentrated toward the cluster center.Comment: 14 pages, 12 figures, accepted for publication in the Astronomical Journa

Understanding stage of innovation of invasive procedures and devices:Protocol for a systematic review and thematic analysis

INTRODUCTION: Surgical innovation has generally occurred in an unstandardised manner. This has led to unnecessary exposure of patients to harm, research waste and inadequate evidence. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) Collaboration provided a set of recommendations for evaluating surgical innovations based on their stage of innovation. Despite further refinements and guidance, adoption of the IDEAL recommendations has been slow; an important reason may be that determining the stage of innovation is often difficult. To facilitate evaluation of surgical innovations, there is a need for a detailed insight into what stage of innovation means, and how it can be determined. The aim of this study is to understand the concept of stage of innovation as reported in the literature. METHODS AND ANALYSIS: A systematic review is being conducted. Ovid MEDLINE and Embase databases were searched from their inception until July 2021 using an iteratively developed strategy based on the concepts of stage of innovation, invasive procedures or devices and guidance. Articles were included if they described an approach to evaluating surgical innovations in stages, described a method for determining stage of innovation, described indicators of stage of innovation, defined stages or described potential sources of stage-related information. Conference abstracts and non-English language articles were excluded. Other articles were detected from citations within included articles and suggestions from experts in surgical innovation. Data will be extracted regarding approaches to evaluating surgical innovations, methods for determining stage of innovation, indicators of stage of innovation, definitions of stages and potential sources of stage-related information. A thematic analysis will be conducted, and findings summarised in a narrative report. ETHICS AND DISSEMINATION: Ethical approval will not be required. This systematic review will be published in a peer-reviewed journal and presented at appropriate conferences. PROSPERO REGISTRATION NUMBER: CRD42021270812