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

A Possible Massive Asteroid Belt Around zeta Lep

We have used the Keck I telescope to image at 11.7 microns and 17.9 microns the dust emission around zeta Lep, a main sequence A-type star at 21.5 pc from the Sun with an infrared excess. The excess is at most marginally resolved at 17.9 microns. The dust distance from the star is probably less than or equal to 6 AU, although some dust may extend to 9 AU. The mass of observed dust is \~10^22 g. Since the lifetime of dust particles is about 10,000 years because of the Poytning-Robertson effect, we robustly estimate at least 4 10^26 g must reside in parent bodies which may be asteroids if the system is in a steady state and has an age of ~300 Myr. This mass is approximately 200 times that contained within the main asteroid belt in our solar system.Comment: 12 pages, 3 figures, ApJL in pres

The Visual Display of Temporal Information

The detection of temporal relationships among time-ordered patient data is an important, but difficult, clinical task. Large volumes of computer-stored clinical data offer the possibility of aiding in the early detection of subtle trends and states, but the presence of irrelevant data can obscure relevant findings and relationships. We present a formal system for representing complex temporal data as events on an abstract entity called a time limit. We define five time line operations, SLICE, FILTER, OVERLAY, NEW, and ADD. For each operation, we precisely define the operator\u27s effect on a time line, including exceptions and boundary conditions. IN addition to our time line, formalism, we describe an interactive environment designed specifically to help humans visualize temporal data. We have developed a database kernel and a graphical user interface that uses our time line formalism and operations to support temporal manipulations. Using our formal system and our visualization environment, we describe two issues in the display and manipulating of temporal data: (1) the temporal granularity problem, and (2) the calendar mapping problem

Do frailty and comorbidity indices improve risk prediction of 28-day ED reattendance? Reanalysis of an ED discharge nomogram for older people

Background: In older people, quantification of risk of reattendance after emergency department (ED) discharge is important to provide adequate post ED discharge care in the community to appropriately targeted patients at risk. Methods: We reanalysed data from a prospective observational study, previously used for derivation of a nomogram for stratifying people aged 65 and older at risk for ED reattendance. We investigated the potential effect of comorbidity load and frailty by adding the Charlson or Elixhauser comorbidity index and a ten-item frailty measure from our data to develop four new nomograms. Model I and model F built on the original nomogram by including the frailty measure with and without the addition of the Charlson comorbidity score; model E adapted for efficiency in the time-constrained environment of ED was without the frailty measure; and model P manually constructed in a purposeful stepwise manner and including only statistically significant variables. Areas under the ROC curve of models were compared. The primary outcome was any ED reattendance within 28 days of discharge. Results: Data from 1357 patients were used. The point estimate of the respective areas under ROC were 0.63 (O), 0.63 (I), 0.68 (E), 0.71 (P) and 0.63 (F). Conclusion: Addition of a comorbidity index to our previous model improves stratifying elderly at risk of ED reattendance. Our frailty measure did not demonstrate any additional predictive benefit

Optical photometry and spectral classification in the field of the open cluster NGC 6996 in the North America Nebula

We present and discuss broad band CCD $UBV(I)_C$ photometry and low resolution spectroscopy for stars in the region of the open cluster NGC 6996, located in the North America Nebula. The new data allow us to tightly constrain the basic properties of this object. We revise the cluster size, which in the past has been significantly underestimated. The width of the Main Sequence is mainly interpreted in terms of differential reddening, and indeed the stars' color excess $E_{B-V}$ ranges from 0.43 to 0.65, implying the presence of a significant and evenly distributed dust component. We cross-correlate our optical photometry with near infrared from 2MASS, and by means of spectral classification we are able to build up extinction curves for an handful of bright members. We find that the reddening slope and the total to selective absorption ratio $R_V$ toward NGC 6996 are anomalous. Moreover the reddening corrected colors and magnitudes allow us to derive estimates for the cluster distance and age, which turn out to be $760 \pm 70 pc$ ($V_{0}-M_{V} = 9.4 \pm 0.2$) and $\sim 350$ Myr, respectively. Basing on our results, we suggest that NGC 6996 is located in front of the North America Nebula, and does not seem to have any apparent relationship with it.Comment: 19 pages, 12 eps figures, in press in A&

The Distance of the Gamma-ray Binary 1FGL J1018.6-5856

The recently discovered gamma-ray binary 1FGL J1018.6-5856 has a proposed optical/near-infrared (OIR) counterpart 2MASS 10185560-5856459. We present Stromgren photometry of this star to investigate its photometric variability and measure the reddening and distance to the system. We find that the gamma-ray binary has E(B-V) = 1.34 +/- 0.04 and d = 5.4^+4.6_-2.1 kpc. While E(B-V) is consistent with X-ray observations of the neutral hydrogen column density, the distance is somewhat closer than some previous authors have suggested.Comment: Accepted to PAS

Including Systematic Uncertainties in Confidence Interval Construction for Poisson Statistics

One way to incorporate systematic uncertainties into the calculation of confidence intervals is by integrating over probability density functions parametrizing the uncertainties. In this note we present a development of this method which takes into account uncertainties in the prediction of background processes, uncertainties in the signal detection efficiency and background efficiency and allows for a correlation between the signal and background detection efficiencies. We implement this method with the Feldman & Cousins unified approach with and without conditioning. We present studies of coverage for the Feldman & Cousins and Neyman ordering schemes. In particular, we present two different types of coverage tests for the case where systematic uncertainties are included. To illustrate the method we show the relative effect of including systematic uncertainties the case of dark matter search as performed by modern neutrino tel escopes.Comment: 23 pages, 10 figures, replaced to match published versio

New optical and near-infrared Surface Brightness Fluctuations models. A primary distance indicator ranging from Globular Clusters to distant galaxies?

We present new theoretical models for Surface Brightness Fluctuations (SBF) both for optical and near-infrared bands in standard ground-based and Hubble Space Telescope filter systems. Simple Stellar Population simulations are adopted. Models cover the age and metallicity ranges from $t=5$ to $15~Gyr$ and from $Z=0.0001$ to 0.04 respectively. Effects due to the variation of the Initial Mass Function and the stellar color-temperature relations are explored. Particular attention is devoted to very bright stars in the color-magnitude diagram and to investigate the effects of mass loss along the Red Giant Branch (RGB) and the Asymptotic Giant Branch (AGB). It is found that $U$ and $B$ bands SBF amplitudes are powerful diagnostics for the morphology of the Horizontal Branch and the Post-AGB stars population. We point out that a careful treatment of mass loss process along the RGB and AGB is fundamental in determining reliable SBF evaluations. The SBF measurements are used to give robust constraints on the evolution of AGB stars, suggesting that mass loss activity on AGB stars should be twice more efficient than on the RGB stars. Our models are able to reproduce the absolute SBF magnitudes of the Galactic Globular Clusters and of galaxies, and their integrated colors. New calibrations of absolute SBF magnitude in $V$, $R$, $I$, and $K$ photometric filters are provided, which appear reliable enough to directly gauge distances bypassing other distance indicators. The SBF technique is also used as stellar population tracer to derive age and metallicity of a selected sample of galaxies of known distances. Finally, {\it SBF color} versus {\it integrated color} diagrams are proposed as particularly useful in removing the well known {\it age-metallicity degeneracy} affecting our knowledge of remote stellar systems.Comment: AJ accepted, 46 pages, 21 figures, 10 tables, uses aastex.cl

NGC 2401: A template of the Norma-Cygnus Arm's young population in the Third Galactic Quadrant

Based on a deep optical CCD (UBV(RI)_C) photometric survey and on the Two-Micron All-Sky-Survey (2MASS) data we derived the main parameters of the open cluster NGC 2401. We found this cluster is placed at 6.3 $\pm$ 0.5 kpc (V_O - M_V = 14.0 \pm 0.2) from the Sun and is 25 Myr old, what allows us to identify NGC 2401 as a member of the young population belonging to the innermost side of the extension of the Norma-Cygnus spiral--arm in the Third Galactic Quadrant. A spectroscopic study of the emission star LSS 440 that lies in the cluster area revealed it is a B0Ve star; however, we could not confirm it is a cluster member. We also constructed the cluster luminosity function (LF) down to $V \sim 22$ and the cluster initial mass function (IMF) for all stars with masses above M \sim 1-2 M_{\sun}. It was found that the slope of the cluster IMF is $x \approx 1.8 \pm 0.2$. The presence of a probable PMS star population associated to the cluster is weakly revealed.Comment: 10 paginas, 11 eps figures, accepted for publication in MNRA

A Photometric Technique to Search for Be Stars in Open Clusters

We describe a technique to identify Be stars in open clusters using Stromgren b, y, and narrow-band Halpha photometry. We first identify the B-type stars of the cluster using a theoretical isochrone fit to the (b-y, y) color-magnitude diagram. The strongest Be stars are easily identified in a (b-y, y-Halpha) color-color diagram, but those with weaker Halpha emission (classified as possible Be star detections) may be confused with evolved or foreground stars. Here we present such photometry plus Halpha spectroscopy of members of the cluster NGC 3766 to demonstrate the accuracy of our technique. Statistical results on the relative numbers of Be and B-type stars in additional clusters will be presented in a future paper.Comment: 15 pages, 6 figures, 1 table. Accepted by Ap