The health and well-being of older adults with dual sensory impairment (DSI) in four countries

Objectives Dual sensory impairment (DSI) is a combination of vision and hearing impairments that represents a unique disability affecting all aspects of a person’s life. The rates of DSI are expected to increase due to population aging, yet little is known about DSI among older adults (65+). The prevalence of DSI and client characteristics were examined among two groups, namely, older adults receiving home care services or those residing in a long-term care (LTC) facility in four countries (Canada, US, Finland, Belgium). Methods Existing data, using an interRAI assessment, were analyzed to compare older adults with DSI to all others across demographic characteristics, functional and psychosocial outcomes. Results In home care, the prevalence of DSI across the four countries ranged from 13.4% to 24.6%; in LTC facilities, it ranged from 9.7% to 33.9%. Clients with DSI were more likely to be 85+, have moderate/severe cognitive impairment, impairments in activities of daily living, and have communication difficulties. Among residents of LTC facilities, individuals with DSI were more likely to be 85+ and more likely have a diagnosis of Alzheimer’s disease. Having DSI increased the likelihood of depression in both care settings, but after adjusting for other factors, it remained significant only in the home care sample. Conclusions While the prevalence of DSI cross nationally is similar to that of other illnesses such as diabetes, depression, and Alzheimer’s disease, we have a limited understanding of its affects among older adults. Raising awareness of this unique disability is imperative to insure that individuals receive the necessary rehabilitation and supportive services to improve their level of independence and quality of life

Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries

BACKGROUND: Caesarean delivery (CD) rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD) or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS) have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries. METHODS: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy) from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined. RESULTS: Adjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS. CONCLUSION: Risk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD

Prognosis Does not Change the Landscape: Palliative Home Care Clients Experience High Rates of Pain and Nausea, Regardless of Prognosis

Background: Most individuals who typically receive palliative care (PC) tend to have cancer and a relatively short prognosis (\u3c 6 months). People with other life-limiting illnesses can also benefit from a palliative care approach. However, little is known about those who receive palliative home care in Ontario, Canada\u27s largest province. To address this gap, the goal of this project was to understand the needs, symptoms and potential differences between those with a shorter (\u3c 6 months) and longer prognosis (6+ months) for individuals receiving PC in the community. Methods: A cross-sectional analysis was conducted using interRAI Palliative Care (interRAI PC) assessment data collected between 2011 and 2018. Individuals with a shorter prognosis (\u3c 6 months; n = 48,019 or 64.1%) were compared to those with a longer prognosis (6+ months; n = 26,945) across several clinical symptoms. The standardized difference (stdiff), between proportions, was calculated to identify statistically meaningful differences between those with a shorter and longer prognosis. Values of the stdiff of 0.2 or higher (absolute value) indicated a statistically significant difference. Results: Overall, cancer was the most prevalent diagnosis (83.2%). Those with a shorter prognosis were significantly more likely to experience fatigue (75.3% vs. 59.5%; stdiff = 0.34) and shortness of breath at rest (22.1% vs. 13.4%; stdiff = 0.23). However, the two groups were similar in terms of severe pain (73.5% vs. 66.5%; stdiff = - 0.15), depressive symptoms (13.2% vs. 10.7%; stdiff = 0.08) and nausea (35.7% vs. 29.4%; stdiff = 0.13). Conclusions: These results highlight the importance of earlier identification of individuals who could benefit from a palliative approach to their care as individuals with a longer prognosis also experience high rates of symptoms such as pain and nausea. Providing PC earlier in the illness trajectory has the potential to improve an individual\u27s overall quality of life throughout the duration of their illness

The interRAI CHESS Scale is Comparable to the Palliative Performance Scale in Predicting 90-day Mortality in a Palliative Home Care Population

Background: Prognostic accuracy is important throughout all stages of the illness trajectory as it has implications for the timing of important conversations and decisions around care. Physicians often tend to over-estimate prognosis and may under-recognize palliative care (PC) needs. It is therefore essential that all relevant stakeholders have as much information available to them as possible when estimating prognosis. Aims: The current study examined whether the interRAI Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale is a good predictor of mortality in a known PC population and to see how it compares to the Palliative Performance Scale (PPS) in predicting 90-day mortality. Methods: This retrospective cohort study used data from 2011 to 2018 on 80,261 unique individuals receiving palliative home care and assessed with both the interRAI Palliative Care instrument and the PPS. Logistic regression models were used to evaluate the relationship between the main outcome, 90-day mortality and were then replicated for a secondary outcome examining the number of nursing visits. Comparison of survival time was examined using Kaplan-Meier survival curves. Results: The CHESS Scale was an acceptable predictor of 90-day mortality (c-statistic = 0.68; p \u3c 0.0001) and was associated with the number of nursing days (c = 0.61; p \u3c 0.0001) and had comparable performance to the PPS (c = 0.69; p \u3c 0.0001). The CHESS Scale performed slightly better than the PPS in predicting 90-day mortality when combined with other interRAI PC items (c = 0.72; p \u3c 0.0001). Conclusion: The interRAI CHESS Scale is an additional decision-support tool available to clinicians that can be used alongside the PPS when estimating prognosis. This additional information can assist with the development of care plans, discussions, and referrals to specialist PC teams

Potential Quality Indicators for Seriously Ill Home Care Clients: A Cross-Sectional Analysis Using Resident Assessment Instrument for Home Care (RAI-HC) Data for Ontario

Background Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment. Methods Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation. Results Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%). Conclusion Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice

IceCube Science

We discuss the status of the kilometer-scale neutrino detector IceCube and its low energy upgrade Deep Core and review its scientific potential for particle physics. We subsequently appraise IceCube's potential for revealing the enigmatic sources of cosmic rays. After all, this aspiration set the scale of the instrument. While only a smoking gun is missing for the case that the Galactic component of the cosmic ray spectrum originates in supernova remnants, the origin of the extragalactic component remains as inscrutable as ever. We speculate on the role of the nearby active galaxies Centaurus A and M87.Comment: 19 pages, 8 figures; Talk at Discrete 08, Valencia, Spai

Soil Settlement and Uplift Damage to Architectural Heritage Structures in Belgium: Country-Scale Results from an InSAR-Based Analysis

Soil movement may be induced by a wide variety of natural and anthropogenic causes, which are detectable in the local scale, but may influence the movement of the soil over vast geographical expanses. Space borne interferometric synthetic aperture radar (InSAR) measurements of ground movement provide a method for the remote sensing of soil settlement and uplift over wide geographic areas. Based on this settlement and uplift evaluation, the assessment of the potential damage to architectural heritage structures is possible. In this paper an interdisciplinary monitoring and analysis method is presented that processes satellite, cadastral, patrimonial and building geometry data, used for the calculation of settlement and uplift damage to architectural heritage structures in Belgium. It uses processed InSAR data for the determination of the soil movement profile around each case study, of which the typology is determined from patrimonial information databases and the geometry is calculated from digital elevation models. The impact on the historic structures is calculated from the determined soil movement profile based on various soilstructure interaction models for buildings. The resulting damage is presented in terms of a numerical index illustrating its severity according to different criteria. In this way the potential soil movement damage is quantified in a large number of buildings in an easily interpretable and user-friendly fashion. The processing of InSAR data collected over the previous 3 decades allows the determination of the progress of settlement- and uplift-induced damage in this time period. With the integration of newly acquired and more accurate data, the methodology will continue to produce results in the coming years, both for the evaluation of soil settlement and uplift in Belgium as for introducing related damage risk data for existing architectural heritage buildings. Results of the analysis chain are presented in terms of potential current damage for selected areas and buildings