Healthcare decision-making: past present and future, in light of a diagnosis of dementia

End-of-life care policy in the UK states that all people should identify their needs, priorities and preferences for end-of-life care in the form of advance care planning. Advance care planning in dementia is less well developed than in some other disease groups such as cancer and, arguably, may be more complex. A person with dementia may lose the capacity to make decisions associated with advance care planning early in the course of the disease, requiring more involvement of family carers. This study explores the 'lived' context to health care decision-making of dyads (the person with dementia and their carer) in respect of past, present and future healthcare decision-making

Density functionals and half-metalicity in La2/3Sr1/3MnO3

The electronic structure and equilibrium geometry of La2/3Sr1/3MnO3 are studied theoretically by means of density functional calculations. The doping is treated by introducing holes and a compensating jellium background. The results for the local density approximation (LDA) agree with previous LDA calculations, with an equilibrium volume 5.3% too small and with both majority and minority spin states present at the Fermi level for the relaxed system. The generalised gradient approximation (GGA) offers a qualitatively improved description of the system, with a more realistic volume, and a half-metallic behaviour for the relaxed structure, which enables studies needing theoretical relaxation.The ideal MnO2-terminated (001) surface is then described with explicit doping.Comment: 5 pages, 3 Encapsulated Postscript figures. Submitted to the Proceedings of TNT 2005, Oviedo, Spai

Is preparation for end of life associated with pre-death grief in caregivers of people with dementia?

OBJECTIVES: Family caregivers of people with dementia can experience loss and grief before death. We hypothesized that modifiable factors indicating preparation for end of life are associated with lower pre-death grief in caregivers. DESIGN: Cross-sectional. SETTING: Caregivers of people with dementia living at home or in a care home. PARTICIPANTS: In total, 150 caregivers, 77% female, mean age 63.0 (SD = 12.1). Participants cared for people with mild (25%), moderate (43%), or severe dementia (32%). MEASUREMENTS: Primary outcome: Marwit-Meuser Caregiver Grief Inventory Short Form (MMCGI-SF). We included five factors reflecting preparation for end of life: (1) knowledge of dementia, (2) social support, (3) feeling supported by healthcare providers, (4) formalized end of life documents, and (5) end-of-life discussions with the person with dementia. We used multiple regression to assess associations between pre-death grief and preparation for end of life while controlling for confounders. We repeated this analysis with MMCGI-SF subscales ("personal sacrifice burden"; "heartfelt sadness"; "worry and felt isolation"). RESULTS: Only one hypothesized factor (reduced social support) was strongly associated with higher grief intensity along with the confounders of female gender, spouse, or adult child relationship type and reduced relationship closeness. In exploratory analyses of MMCGI-SF subscales, one additional hypothesized factor was statistically significant; higher dementia knowledge was associated with lower "heartfelt sadness." CONCLUSION: We found limited support for our hypothesis. Future research may benefit from exploring strategies for enhancing caregivers' social support and networks as well as the effectiveness of educational interventions about the progression of dementia (ClinicalTrials.gov ID: NCT03332979)

Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study.

BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection

Living with an Older Person Dying from Cancer, Lung Disease or Dementia: Health Outcomes from a General Practice Cohort Study

CONTEXT: Increasing numbers of people will die from chronic disease. Families contribute significantly to end-of-life care but their role may not be recognized. OBJECTIVES: To 1) establish the proportion of older cohabitees identified in primary care as "carers;" 2) describe demographic and lifestyle characteristics of cohabitees of people terminally ill with cancer, dementia, and chronic obstructive pulmonary disease (COPD); 3) describe their health a year before and after bereavement; and 5) compare health outcomes between cohabitees of people dying with cancer, COPD, or dementia. METHODS: Retrospective cohort study using a U.K. primary care database (The Health Improvement Network) of 13,693 bereaved cohabitees (a proxy marker for being a carer), aged 60 years or older of people dying from cancer, COPD, or dementia. Characteristics were described one year before and after bereavement. We compared cancer, COPD, and dementia cohabitee outcomes using incidence rate ratios one year before and after bereavement and calculated mortality risk post-bereavement. RESULTS: A total of 6.9% of cohabitees were recorded as carers. Health outcomes differed little between the three groups of cohabitees in the year prior to or after bereavement. The proportion of cohabitees with six or more consultations increased the year after bereavement (cancer cohabitees 16.0% to 18.8%, COPD cohabitees 17.8% to 20.4% and dementia cohabitees 15.5% to 17.5%). At post-bereavement (follow-up median 3 years, IQR 1.3-5.4), we found no mortality differences between the three groups. CONCLUSION: Recording of carers of terminally ill people was suboptimal. Cause of bereavement produced few differential effects on health outcomes or mortality

Redundant movements in autonomous mobility: experimental and theoretical analysis

&lt;p&gt;Distributed load balancers exhibit thrashing where tasks are repeatedly moved between locations due to incomplete global load information. This paper shows that systems of autonomous mobile programs (AMPs) exhibit the same behaviour, and identifies two types of redundant movement (greedy effect). AMPs are unusual in that, in place of some external load management system, each AMP periodically recalculates network and program parameters and may independently move to a better execution environment. Load management emerges from the behaviour of collections of AMPs.&lt;/p&gt; &lt;p&gt;The paper explores the extent of greedy effects by simulating collections of AMPs and proposes negotiating AMPs (NAMPs) to ameliorate the problem. We present the design of AMPs with a competitive negotiation scheme (cNAMPs), and compare their performance with AMPs by simulation. We establish new properties of balanced networks of AMPs, and use these to provide a theoretical analysis of greedy effects.&lt;/p&gt

Stellar Nucleosynthesis in the Hyades Open Cluster

We report a comprehensive light element (Li, C, N, O, Na, Mg, and Al) abundance analysis of three solar-type main sequence (MS) dwarfs and three red giant branch (RGB) clump stars in the Hyades open cluster using high-resolution and high signal-to-noise spectroscopy. For each group (MS or RGB), the CNO abundances are found to be in excellent star-to-star agreement. Our results confirm that the giants have undergone the first dredge-up and that material processed by the CN cycle has been mixed to the surface layers. The observed abundances are compared to predictions of a standard stellar model based on the Clemson-American University of Beirut (CAUB) stellar evolution code. The model reproduces the observed evolution of the N and O abundances, as well as the previously derived 12C/13C ratio, but it fails to predict by a factor of 1.5 the observed level of 12C depletion. Li abundances are derived to determine if non-canonical extra mixing has occurred in the Hyades giants. The Li abundance of the giant gamma Tau is in good accord with the predicted level of surface Li dilution, but a ~0.35 dex spread in the giant Li abundances is found and cannot be explained by the stellar model. Possible sources of the spread are discussed; however, it is apparent that the differential mechanism responsible for the Li dispersion must be unrelated to the uniformly low 12C abundances of the giants. Na, Mg, and Al abundances are derived as an additional test of our stellar model. All three elements are found to be overabundant by 0.2-0.5 dex in the giants relative to the dwarfs. Such large enhancements of these elements are not predicted by the stellar model, and non-LTE effects significantly larger (and, in some cases, of opposite sign) than those implied by extant literature calculations are the most likely cause.Comment: 40 pages, 6 figures, 6 tables; accepted by Ap