EXAMINING QUALITY INDICATOR RATES FOR OLDER HOME CARE CLIENTS WITH DUAL SENSORY IMPAIRMENT (DSI) AND EXPLORING THE HETEROGENEITY WITHIN DSI.

Older adults with impairments in both hearing and vision, called dual sensory impairment (DSI), are at an increased risk of negative health outcomes such as impaired communication and difficulties with mobility. It is unknown whether DSI is associated with potential quality of care issues. This study used a set of home care quality indicators (HCQIs) to examine potential quality issues in older clients (65+) with DSI. Further, it looked to explore how HCQI rates differed based on the geographic region of care and whether the client’s level of hearing and vision impairment was related to certain HCQIs. The HCQIs were generated from data collected using the Resident Assessment Instrument for Home Care and capture undesirable outcomes (e.g., falls, cognitive decline). Higher rates indicate a greater frequency of experiencing the issue. In this sample (n=352,656), the average age was 82.8 years (sd=7.9), the majority were female (63.2%), and 20.5% experienced DSI. Compared to those without DSI, clients with DSI had higher rates across 20 of the 22 HCQIs. The HCQI rates differed by geographic region, with specific regions consistently performing worse than others. Finally, the level of hearing and vision impairment was related to certain HCQIs more than others, for example hearing impairment appeared to be more related to the quality indicator measuring communication difficulty. Overall, the hope is that this information can help to identify some of the potential issues around quality and in turn, assist in continually improving the services being provided to these clients

Preferred Workflows for Syndromic Surveillance Systems

Workflows are a sequence of information processing operations that people carry out to meet certain in-formational goals [1]. Using various user-centered design (UCD) techniques we uncovered the workflows that epidemiologists wished to follow when using syndromic surveillance (SS) systems

Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt

Hedging the Value of Waiting

We analyze the optimal hedging policy of a firm that has flexibility in the timing of investment. Conventional wisdom suggests that hedging adds value by alleviating the underinvestment problem associated with capital market frictions. However, our model shows that hedging also adds value by allowing investment to be delayed in circumstances where the same frictions would cause it to commence prematurely. Thus, hedging can have the paradoxical effect of reducing investment. We also show that greater timing flexibility increases the optimal quantity of hedging, but has a non-monotonic effect on the additional value created by hedging. These results may help explain the empirical findings that investment rates do not differ between hedgers and non-hedgers, and that hedging propensities do not depend on standard measures of growth opportunities

A study of B-type stars

The effect of rotation on quantities used in classifying B -type stars is discussed. The tendency for stars with high rotational velocities to have weaker Balmer lines for the same (U - B)₀ has been investigated using published data. Abt's explanation of the affect in terms of the change in effective surface gravity due to rotation is confirmed. A correction term in Crawford's method of determining ages of clusters and field stars from Balmer line intensities and UBV photometry is derived. It is shown that errors in age determinations due to rotation are much smaller when the wavelength λ₁ of the Balmer discontinuity is used instead of Balmer line intensities. A colour index sensitive to λ₁ is discussed. Methods of determining the inclinations of the axes of rotation are suggested. It is shown that the "cosmic dispersion" in the relation between Balmer line intensities and absolute magnitudes is largely caused , by rotation. A scheme of two -dimensional spectral classification using measurements of the position and size of the Balmer discontinuity on low dispersion objective prism plates is outlined. Rotational velocities for 18 stars have been derived from slit spectrograms; several lines including five Balmer lines were measured for each star

Rotation and chemical composition of early-type stars

Some early-type stars with abnormal line strengths for their intrinsic colours are investigated in order to determine their structure and the chemical composition of their atmospheres. The abnormal line strengths in several B-type stars (αScl, 36 Lyn, 20 Tau and HD 175156) are shown to be probably due to large ranges of surface temperature such as would be observed in rapidly rotating stars of normal chemical composition, if viewed pole-on. These stars differ from the peculiar A stars, which rotate slowly and have abnormal chemical composition. Members of the Mn group of peculiar A stars rotate more slowly than those of the Si-4200 group, although the mean intrinsic colours of the two groups are similar.Previous work on abundance determination in peculiar A stars is reviewed. The chemical composition of the manganese star 53 Tau is studied by a refined differential curve-of-growth method with αLyr as the comparison star. Groups of lines of similar mean excitation and ionisation potentials and wavelengths are used so that the results are independent of the structure of 53 Tau, which is shown to be abnormal. A new double-line peculiar A spectroscopic binary HR 4072 was discovered, and it was found that excesses of Sr and Y are common to both components. Spectral variations in some peculiar A stars are described.Well established abundance abnormalities in peculiar A stars may be explained on a modified form of van den Heuvel's theory that peculiar A stars have been secondaries of binary systems with initial separations in the range 10 a.u. to 100 a.u. approximately. The primaries, initially earlier than spectral type B8, have evolved and exploded as type II supernovae. During the explosions material enriched in heavy elements by interior nuclear reactions was transferred to the surfaces of the secondaries, which are now observed as peculiar A stars and are still on the main sequence. Excesses of Be and Si and deficiencies of 0 are caused by surface nuclear reactions on the secondaries after the explosions of the primaries. Ln stars differ from other peculiar A stars in many respects; the differences may be due to the primaries expanding beyond the Roche limits before they explode. On the oblique rotator theory, spectrum variables result from irregular distributions of surface nuclear reactions and ion migration on the secondaries. Some other theories of peculiar A stars are reviewed and shown to be in conflict with observation

Response to Comment on "Pairing and Phase Separation in a Polarized Fermi Gas"

Zwierlein and Ketterle rely on subjective arguments and fail to recognize important differences in physical parameters between our experiment and theirs. We stand by the conclusions of our original report

Dr. Forbes and Mr. Guthrie.

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