Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes

BACKGROUND: Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. METHODS: We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. RESULTS: Those who received the intervention had lower costs ($22 versus$227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control$64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus$50911 p=0.924), overall ED presentations ($4266 versus$4150, p=0.916), out-patient mental health services ($4494 versus$7717, p=0.282), or opiate pharmacotherapies ($1013 versus$2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008). CONCLUSIONS: An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents

A Global Photometric Analysis of 2MASS Calibration Data

We present results from the application of a global photometric calibration (GPC) procedure to calibration data from the first 2 years of The Two Micron All Sky Survey (2MASS). The GPC algorithm uses photometry of both primary standards and moderately bright `tracer' stars in 35 2MASS calibration fields. During the first two years of the Survey, each standard was observed on approximately 50 nights, with about 900 individual measurements. Based on the photometry of primary standard stars and secondary tracer stars and under the assumption that the nightly zeropoint drift is linear, GPC ties together all calibration fields and all survey nights simultaneously, producing a globally optimized solution. Calibration solutions for the Northern and Southern hemisphere observatories are found separately, and are tested for global consistency based on common fields near the celestial equator. Several results from the GPC are presented, including establishing candidate secondary standards, monitoring of near-infrared atmospheric extinction coefficients, and verification of global validity of the standards. The solution gives long-term averages of the atmospheric extinction coefficients, A_J=0.096, A_H=0.026, A_{K_s}=0.066 (North) and A_J=0.092, A_H=0.031, A_{K_s}=0.065 (South), with formal error of 0.001. The residuals show small seasonal variations, most likely due to changing atmospheric content of water vapor. Extension of the GPC to approximately 100 field stars in each of the 35 calibration fields yields a catalog of more than two thousand photometric standards ranging from 10th to 14th magnitude, with photometry that is globally consistent to $\sim 1$.Comment: 19 pages, 10 figures; Submitted to AJ. The table of secondary standards is available from ftp://nova.astro.umass.edu/pub/nikolaev/ or ftp://anon-ftp.ipac.caltech.edu/pub/2mass/globalcal

Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption

Aims: To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Background: The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design: Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012-June 2013. Findings: Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions: The mainstreaming of telehealth hinges on clinical 'buy-in'. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice

Advances in Marine Ecosystem Dynamics from US GLOBEC: The Horizontal-Advection Bottom-up Forcing Paradigm

A primary focus of the US Global Ocean Ecosystem Dynamics (GLOBEC) program was to identify the mechanisms of ecosystem response to large- scale climate forcing under the assumption that bottom-up forcing controls a large fraction of marine ecosystem variability. At the beginning of GLOBEC, the prevailing bottom-up forcing hypothesis was that climate-induced changes in vertical transport modulated nutrient supply and surface primary productivity, which in turn affected the lower trophic levels (e.g., zooplankton) and higher trophic levels (e.g., fish) through the trophic cascade. Although upwelling dynamics were confirmed to be an important driver of ecosystem variability in GLOBEC studies, the use of eddy- resolving regional-scale ocean circulation models combined with field observations revealed that horizontal advection is an equally important driver of marine ecosystem variability. Trough a synthesis of studies from the four US GLOBEC regions (Gulf of Alaska, Northern California Current, Northwest Atlantic, and Southern Ocean), a new horizontal-advection bottom-up forcing paradigm emerges in which large-scale climate forcing drives regional changes in alongshore and cross-shelf ocean transport that directly impact ecosystem functions (e.g., productivity, species composition, spatial connectivity). Te horizontal advection bottom-up forcing paradigm expands the mechanistic pathways through which climate variability and climate change impact the marine ecosystem. In particular, these results highlight the need for future studies to resolve and understand the role of mesoscale and submesoscale transport processes and their relationship to climate

Advances in Marine Ecosystem Dynamics from US GLOBEC: The Horizontal-Advection Bottom-up Forcing Paradigm

A primary focus of the US Global Ocean Ecosystem Dynamics (GLOBEC) program was to identify the mechanisms of ecosystem response to large- scale climate forcing under the assumption that bottom-up forcing controls a large fraction of marine ecosystem variability. At the beginning of GLOBEC, the prevailing bottom-up forcing hypothesis was that climate-induced changes in vertical transport modulated nutrient supply and surface primary productivity, which in turn affected the lower trophic levels (e.g., zooplankton) and higher trophic levels (e.g., fish) through the trophic cascade. Although upwelling dynamics were confirmed to be an important driver of ecosystem variability in GLOBEC studies, the use of eddy- resolving regional-scale ocean circulation models combined with field observations revealed that horizontal advection is an equally important driver of marine ecosystem variability. Trough a synthesis of studies from the four US GLOBEC regions (Gulf of Alaska, Northern California Current, Northwest Atlantic, and Southern Ocean), a new horizontal-advection bottom-up forcing paradigm emerges in which large-scale climate forcing drives regional changes in alongshore and cross-shelf ocean transport that directly impact ecosystem functions (e.g., productivity, species composition, spatial connectivity). Te horizontal advection bottom-up forcing paradigm expands the mechanistic pathways through which climate variability and climate change impact the marine ecosystem. In particular, these results highlight the need for future studies to resolve and understand the role of mesoscale and submesoscale transport processes and their relationship to climate

Feasibility and acceptability evaluation of the Promoting Independence in Dementia (PRIDE) intervention for living well with dementia

OBJECTIVES: Post-diagnostic psychosocial interventions could play an important role in supporting people with mild dementia remain independent. The Promoting Independence in Dementia (PRIDE) intervention was developed to address this. METHOD: The mixed methods non-randomized, pre-post feasibility study occurred across England. Facilitators were recruited from the voluntary sector and memory services. Participants and their supporters took part in the three-session intervention. Outcome measures were collected at baseline and follow-up. To evaluate acceptability, focus groups and interviews were conducted with a subsample of participants and facilitators. RESULTS: Contextual challenges to delivery including national research governance changes, affected recruitment of study sites. Thirty-four dyads consented, with 14 facilitators providing the intervention. Dyads took part in at least two sessions (79%), and 73% in all three. Outcome measures were completed by 79% without difficulty, with minimal missing data. No significant changes were found on pre and post assessments. Post hoc analysis found moderate effect size improvements for self-management (SMAS instrument) in people with dementia (d = 0.41) and quality of life (EQ5D measure) in carers (d = 0.40). Qualitative data indicated that dyads found PRIDE acceptable, as did intervention facilitators. CONCLUSIONS: The three-session intervention was well accepted by participant-dyads and intervention facilitators. A randomized controlled trial of PRIDE would need to carefully consider recruitment potential across geographically varied settings and site stratification according to knowledge of contextual factors, such as the diversity of post-diagnostic services across the country. Letting sites themselves be responsible for identifying suitable intervention facilitators was successful. The self-report measures showed potential to be included in the main trial

What influences uptake of psychosocial interventions by people living with early dementia? A qualitative study

Background \ud Health policy promotes post-diagnostic support for people affected by dementia. Evidence suggests psychosocial interventions can effectively support people living with dementia after diagnosis. Yet, what influences uptake of psychosocial interventions by people with early dementia is poorly understood. This research aimed to identify influences on uptake of psychosocial interventions by people with early dementia. Methods Sixteen face-to-face semi-structured interviews with people with early dementia, either alone or with a family member(s), were completed. Twelve staff participated in semi-structured interviews or a focus group. Thematic analysis and triangulation enabled identification of overall themes across different participant groups and interview types. Main Findings Four overarching themes influencing uptake were identified: (1) adjusting to a diagnosis, (2) appeal of activities and perception of benefit, (3) service and societal context, and (4) relationships and communication. Individual responses to diagnosis, experiences of dementia and dementia services influenced uptake. Group interventions were discussed the most by all participants. Group interventions offering social contact, peer support, information, enjoyable activities and mental stimulation were valued. However, group interventions specifically aimed at people with dementia did not appeal to all. Ability to travel and convenience of locations were important. Continuing with community activities not focused on dementia was valued. Stigma around dementia appeared to discourage uptake. Emotional and practical support from family was key to facilitating uptake as were the relationships between people with dementia and staff. Conclusion A complex interplay of individual, service and societal influences affect uptake of psychosocial interventions by people with early dementia. How interventions and which services can enable people with early dementia remain engaged in their everyday lives needs consideration. Further research examining uptake of specific interventions commonly offered to people living with early dementia is needed. Involving people with early dementia in designing interventions aiming to support them is paramount