Perceptions on use of home telemonitoring in patients with long term conditions - concordance with the Health Information Technology Acceptance Model: a qualitative collective case study

BACKGROUND: Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). METHODS: An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. RESULTS: Participants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. CONCLUSIONS: HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered

Comments on ``The first detections of the Extragalactic Background Light at 3000, 5500, and 8000 A'' by Bernstein, Freedman and Madore

A critical discussion is presented of the data analysis applied by Bernstein, Freedman and Madore (2002 ApJ, 571, 56; and ApJ 571, 85) in their measurement of the Extragalactic Background Light. There are questionable assumptions in the analysis of the ground-based observations of the Zodiacal Light. The modeling of the Diffuse Galactic Light is based on an underestimated value of the dust column density along the line of sight. Comparison with the previously presented results from the same observations reveals a puzzling situation: in spite of a large difference in the atmospheric scattered light corrections the derived Extragalactic Background Light values are exactly the same. The claim of the paper of a ``detection of the Extragalactic Background Light'' appears premature.Comment: 6 pages, accepted for Ap

Introducing genetic testing for cardiovascular disease in primary care: a qualitative study

Background: While primary care systematically offers conventional cardiovascular risk assessment, genetic tests for coronary heart disease (CHD) are increasingly commercially available to patients. It is unclear how individuals may respond to these new sources of risk information. Aim: To explore how patients who have had a recent conventional cardiovascular risk assessment, perceive additional information from genetic testing for CHD. Design and setting: Qualitative interview study in 12 practices in Nottinghamshire from both urban and rural settings. Method: Interviews were conducted with 29 adults, who consented to genetic testing after having had a conventional cardiovascular risk assessment. Results: Individuals’ principal motivation for genetic testing was their family history of CHD and a desire to convey the results to their children. After testing, however, there was limited recall of genetic test results and scepticism about the value of informing their children. Participants dealt with conflicting findings from the genetic test, family history, and conventional assessment by either focusing on genetic risk or environmental lifestyle factors. In some participants, genetic test results appeared to reinforce healthy behaviour but others were falsely reassured, despite having an ‘above-average’ conventional cardiovascular risk score. Conclusion: Although genetic testing was acceptable, participants were unclear how to interpret genetic risk results. To facilitate healthy behaviour, health professionals should explore patients’ understanding of genetic test results in light of their family history and conventional risk assessment

The Evolution of NGC 7027 at Radio Frequencies: A New Determination of the Distance and Core Mass

We present the results of a 25-year program to monitor the radio flux evolution of the planetary nebula NGC7027. We find significant evolution of the spectral flux densities. The flux density at 1465 MHz, where the nebula is optically thick, is increasing at a rate of 0.251+-0.015 % per year, caused by the expansion of the ionized nebula. At frequencies where the emission is optically thin, the spectral flux density is changing at a rate of -0.145+-0.005 % per year, caused by a decrease in the number of ionizing photons coming from the central star. A distance of 980+-100 pc is derived. By fitting interpolated models of post-AGB evolution to the observed changes, we find that over the 25-yr monitoring period, the stellar temperature has increased by 3900+-900 K and the stellar bolometric luminosity has decreased by 1.75+-0.38 %. We derive a distance-independent stellar mass of 0.655+-0.01 solar masses adopting the Bloecker stellar evolution models, or about 0.04 solar masses higher when using models of Vassiliadis & Wood which may provide a better fit. A Cloudy photoionization model is used to fit all epochs at all frequencies simultaneously. The differences between the radio flux density predictions and the observed values show some time-independent residuals of typically 1 %. A possible explanation is inaccuracies in the radio flux scale of Baars et al. We propose an adjustment to the flux density scale of the primary radio flux calibrator 3C286, based on the Cloudy model of NGC7027. We also calculate precise flux densities for NGC7027 for all standard continuum bands used at the VLA, as well as for some new 30GHz experiments.Comment: submitted to the Astrophysical Journa

Caregivers’ interactions with health care services: mediator of stress or added strain? Experiences and perceptions of informal caregivers of people with dementia: a qualitative study

Background: There are an estimated 46.8 million people worldwide living with dementia in 2015, being cared for usually by family members or friends (informal caregivers). The challenges faced by informal caregivers often lead to increased levels of stress, burden and risk of care-recipient institutionalisation. Aim: The overarching aim of this study was to explore the experiences and perceptions of informal caregivers of people with dementia when interacting with the health care system, and whether the support received acted as a mediator of caregiver stress. The secondary aim was to investigate healthcare professionals’ views and current practice regarding people with dementia and their interactions with informal caregivers. Method: We employed a qualitative research design, using focus groups and one face-to-face interview with a purposive sample of informal caregivers and healthcare professionals (HCPs) in Lincolnshire, UK. Data were collected between March and July 2015. We used the stress-process model of stress in caregivers as a theoretical framework. Results: We interviewed 18 caregivers and 17 HCPs. Five themes, mapped to the stress-process in caregivers’ model, captured the main challenges faced by caregivers and the type of support they wanted from health care services. Primary stressors included the challenge of diagnosing dementia; caregivers’ needs and expectations of an in-depth knowledge and understanding of dementia from HCPs; and need for carer education. Secondary role strain included lack of support and mismatch of communication and expectations. Caregiver involvement in monitoring care and disease was a potential mediator tool. Conclusions: Fragmentation of dementia care services, lack of training for HCPs and the dearth of information for caregivers means health care services are only partially fulfilling a support role. In turn, lack of support may be intensifying caregiver stress leading to worsening in their health and well-being; thus, potentially increasing the risk of institutionalisation of their care-recipient

Gas phase atomic metals in the circumstellar envelope of IRC+10216

We report the results of a search for gas phase atomic metals in the circumstellar envelope of the AGB carbon star IRC+10216. The search was made using high resolution (R=50000) optical absorption spectroscopy of a backgound star that probes the envelope on a line of sight 35" from the center. The metal species that we detect in the envelope include NaI, KI, CaI, CaII, CrI, and FeI, with upper limits for AlI, MnI, TiI, TiII, and SrII. The observations are used to determine the metal abundances in the gas phase and the condensation onto grains. The metal depletions range from a factor of 5 for Na to 300 for Ca, with some similarity to the depletion pattern in interstellar clouds. Our results directly constrain the condensation efficiency of metals in a carbon-rich circumstellar envelope and the mix of solid and gas phase metals returned by the star to the ISM. The abundances of the uncondensed metal atoms that we observe are typically larger than the abundances of the metal-bearing molecules detected in the envelope. The metal atoms are therefore the major metal species in the gas phase and likely play a key role in the metal chemistry.Comment: 11 pages, 8 Figures. Accepted by Astronomy and Astrophysic

Metal-rich absorbers at high redshifts: abundance patterns

(Abbreviated) From six spectra of high-z QSOs, we select eleven metal-rich, Z>=Z_solar, and optically-thin to the ionizing radiation, N(HI)<10^17 cm^-2, absorption systems ranging between z=1.5 and z=2.9 and revealing lines of different ions in subsequent ionization stages. The majority of the systems (10 from 11) show abundance patterns which relate them to outflows from low and intermediate mass stars. All systems have sub-kpc linear sizes along the line-of-sight with many less than 20 pc. In several systems, silicon is deficient, presumably due to the depletion onto dust grains in the envelopes of dust-forming stars and the subsequent gas-dust separation. At any value of [C/H], nitrogen can be either deficient, [N/C]0, which supposes that the nitrogen enrichment occurs irregularly. In some cases, the lines of MgII 2796, 2803 appear to be shifted, probably as a result of an enhanced content of heavy isotopes 25Mg and 26Mg in the absorbing gas relative to the solar isotopic composition. Seven absorbers are characterized by low mean ionization parameter U, log U<-2.3, among them only one system has a redshift z>2 whereas all others are found at z ~= 1.8. Comparing the space number density of metal-rich absorbers with the comoving density of star-forming galaxies at z ~= 2, we estimate that the circumgalactic volume of each galaxy is populated by 10^7 - 10^8 such absorbers with total mass <=1/100th of the stellar galactic mass. Possible effects of high metal content on the peak values of star-forming and AGN activities at z~2 are discussed.Comment: 19 pages, 16 figures, 3 tables. Accepted for publication in A&

The temporal and spatial evolution of the starburst in ESO 338-IG04 as probed by its star clusters

In this paper we use ultra-violet (UV) and optical HST photometry in five bands, and an extensive set of spectral evolutionary synthesis scenarios to investigate the age and masses of 124 star clusters in the luminous blue compact galaxy ESO338-IG04 (Tololo 1924-416). The very small internal reddening makes ESO 338-IG04 an excellent laboratory for studying the formation of massive star clusters. We have used the star clusters to trace the temporal and spatial evolution of the starburst, and to put constraints on the star formation activity over a cosmological time-scale. The present starburst has been active for about 40 Myr. A standard Salpeter initial mass function (IMF) extending up to 120 solar masses provides the best fit to the data, although a flatter IMF cannot be excluded. The compact star clusters provide 30-40 percent of the UV luminosity and star formation activity. We find no evidence for dust obscuration even among the youngest (< 1 Myr) clusters. The fraction of stellar mass contained in compact star clusters is found to be several percent, which is an unusually high value. The intermediate age clusters show a flattened space distribution which agrees with the isophotal shape of the galaxy, whereas the oldest clusters seem to have a spherical distribution.(abridged)Comment: Accepted for publication in A&

The Fine Structure Lines of Hydrogen in HII Regions

The 2s_{1/2} state of hydrogen is metastable and overpopulated in HII regions. In addition, the 2p states may be pumped by ambient Lyman-alpha radiation. Fine structure transitions between these states may be observable in HII regions at 1.1 GHz (2s_{1/2}-2p_{1/2}) and/or 9.9 GHz (2s_{1/2}-2p_{3/2}), although the details of absorption versus emission are determined by the relative populations of the 2s and 2p states. The n=2 level populations are solved with a parameterization that allows for Lyman-alpha pumping of the 2p states. The density of Lyman-alpha photons is set by their creation rate, easily determined from the recombination rate, and their removal rate. Here we suggest that the dominant removal mechanism of Lyman-alpha radiation in HII regions is absorption by dust. This circumvents the need to solve the Lyman-alpha transfer problem, and provides an upper limit to the rate at which the 2p states are populated by Lyman-alpha photons. In virtually all cases of interest, the 2p states are predominantly populated by recombination, rather than Lyman-alpha pumping. We then solve the radiative transfer problem for the fine structure lines in the presence of free-free radiation. In the likely absence of Lyman-alpha pumping, the 2s_{1/2}-2p_{1/2} lines will appear in stimulated emission and the 2s_{1/2}-2p_{3/2} lines in absorption. Searching for the 9.9 GHz lines in high emission measure HII regions offers the best prospects for detection. The lines are predicted to be weak; in the best cases, line-to-continuum ratios of several tenths of a percent might be expected with line strengths of tens to a hundred mK with the Green Bank Telescope.Comment: 18 pages, 2 figures, accepted by ApJ, references added, typos correcte

The kinematics of the large western knot in the halo of the young planetary nebula NGC 6543

A detailed analysis is presented of the dominant ionised knot in the halo of the planetary nebula NGC 6543. Observations were made at high spectral and spatial resolution of the [OIII] 5007 line using the Manchester echelle spectrometer combined with the 2.1-m San Pedro Martir Telescope. A 20-element multislit was stepped across the field to give almost complete spatial coverage of the knot and surrounding halo. The spectra reveal, for the first time, gas flows around the kinematically inert knot. The gas flows are found to have velocities comparable to the sound speed as gas is photo-evaporated off an ionised surface. No evidence is found of fast wind interaction with the knot and we find it likely that the fast wind is still contained in a pressure-driven bubble in the core of the nebula. This rules out the possibility of the knot having its origin in instabilities at the interface of the fast and AGB winds. We suggest that the knot is embedded in the slowly expanding Red Giant wind and that its surfaces are being continually photoionised by the central star.Comment: 13 pages, 11 figures (all eps format). To be published in MNRAS, accepted on 6/7/0