Proxy and self-report agreement on the Stroke and Aphasia Quality of Life Scale-39

Background and purpose: Health related quality of life outcomes are increasingly used to measure the effectiveness of stroke interventions. People with severe aphasia after stroke may be unable to self-report on such measures, necessitating the use of proxy respondents. We explored the level of agreement between people with aphasia (PWA) and their proxies on the Stroke and Aphasia Quality of Life Scale (SAQOL-39) and whether this agreement is influenced by demographic variables and proxy levels of depression and carer strain. Methods: People with chronic aphasia (≥6 months post stroke) were recruited through the UK national charity for PWA. They were interviewed on the SAQOL-39 and their nominated proxies were interviewed on the SAQOL-39, the General Health Questionnaire and the Caregiver Strain Index. Proxy respondents had to be ≥18 years of age, see the person with aphasia at least twice a week and have no known severe mental health problems or cognitive decline. Results: 50 of 55 eligible pairs (91%) took part in the study. Proxies rated PWA as more severely affected than PWA rated themselves. The SDs of the difference scores were large and the difference was significant for three of the four SAQOL-39 domains and the overall mean (p≤0.01). However, the bias as indicated by effect sizes was small to moderate (0.2–0.5). The strength of the agreement was excellent for the overall SAQOL-39 and the physical domain (intra-class correlation coefficient ICC 0.8), good for the psychosocial and communication domains (0.7) and fair for the energy domain (0.5). Demographic variables and proxy’s mood and carer strain did not affect the level of agreement. Conclusions: For group comparisons, proxy respondents who are in frequent contact with people with chronic aphasia can reliably report on their health related quality of life, using the SAQOL-39. Although there are significant differences between PWA and proxy responses, the magnitude of this difference is small to moderate

Establishing Social Work Practices in England: The Early Evidence

Social Work Practices (SWPs) were established in England in 2009 to deliver social work services to looked after children and care leavers. The introduction of independent social work-led organisations generated controversy focused on issues such as the privatisation of children's services and social workers' conditions of employment. This paper reports early findings from the evaluation of four of these pilots, drawing on interviews with children and young people, staff, and local authority and national stakeholders. The SWPs assumed a variety of organisational forms. The procurement process was demanding, with protracted negotiations over matters such as budgetary control and providing a round-the-clock service. Start-up was facilitated by an established relationship between the SWP provider and the local authority. Once operational, SWPs continued to rely on local authorities for various functions; in most cases, local authorities retained control of placement budgets. Levels of consultation and choice offered to children and young people regarding the move to an SWP varied considerably. Children's understanding about SWPs was generally low except in the pilot where most children retained their original social worker. These early findings show some dilution of the original SWP model, while the pilots' diversity allows the benefits of particular models to emerge

Quantum Systems Equilibrate Rapidly for Most Observables

Considering any Hamiltonian, any initial state, and measurements with a small number of possible outcomes compared to the dimension, we show that most measurements are already equilibrated. To investigate non-trivial equilibration we therefore consider a restricted set of measurements. When the initial state is spread over many energy levels, and we consider the set of observables for which this state is an eigenstate, most observables are initially out of equilibrium yet equilibrate rapidly. Moreover, all two-outcome measurements, where one of the projectors is of low rank, equilibrate rapidly.Comment: Main Text: 5 pages, 1 figure. Appendices: 7 pages, 1 figur

Spontaneous emission of non-dispersive Rydberg wave packets

Non dispersive electronic Rydberg wave packets may be created in atoms illuminated by a microwave field of circular polarization. We discuss the spontaneous emission from such states and show that the elastic incoherent component (occuring at the frequency of the driving field) dominates the spectrum in the semiclassical limit, contrary to earlier predictions. We calculate the frequencies of single photon emissions and the associated rates in the "harmonic approximation", i.e. when the wave packet has approximately a Gaussian shape. The results agree well with exact quantum mechanical calculations, which validates the analytical approach.Comment: 14 pages, 4 figure