Evidence for the long term cost effectiveness of home care reablement programs

Background: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age

Outbursts, State Transitions, and Periodicities Observed with the RXTE All-Sky Monitor

Results from the All-Sky Monitor (ASM) on the Rossi X-ray Timing Explorer are reviewed. A number of recurrent transient sources have been detected, while only a few previously unreported sources have been discovered. The ASM light curves show a wide variety of phenomena in general, and, in particular, those of transient sources show a wide range of properties. Examples are used to illustrate that the distinction between persistent and transient sources may be very unclear. The results of searches for periodicities in the ASM light curves are summarized, and other astrophysical investigations using ASM light curves are suggested. The latter include investigations of the possible causes of long-term quasiperiodic and chaotic variability, and comparative studies on the basis of the observed variability.Comment: 8 pages, 4 figures, in proceedings of the conference "The Active X-ray Sky: Results from BeppoSAX and Rossi-XTE, Rome, Italy, 21-24 October, 1997. Nuclear Physics B Proceedings Supplement

The Reappearance of the Transient Low Mass X-ray Binary X1658-298

In April 1999 the transient low mass X-ray binary X1658-298 resumed its strong and persistent X-ray emission after a 21-year interval of quiescence. We present RXTE data obtained soon after the reappearance, including four eclipses with a mean duration of 901.9 +/- 0.8 sec and ingress/egress times of 6-13 sec. Our updated ephemeris for the source indicates that the 7.1-hr orbital period of the system is decreasing with a timescale of 10^7 yr. Contemporaneous optical observations provide the first-ever lightcurve of V2134 Oph, the optical counterpart of X1658-298. The optical modulation is highly variable from night to night and exhibits a distinct, narrow eclipse feature of about 0.2 mag superposed on a gradual brightness variation with ~0.7-0.8 mag amplitude. Our data indicate that there is no significant offset between the time of mid-eclipse in the X-ray and optical and that the narrow optical eclipse feature is of the same duration as the X-ray eclipse. This implies an accretion disk structure characterized by enhanced optical emission coincident with the central X-ray emitting area.Comment: 13 pages including 4 figures and 3 tables; Accepted for publication in The Astrophysical Journa

A Multicenter Examination and Strategic Revisions of the Yale Global Tic Severity Scale

Objective To examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure. Methods This cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points. Results Children and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference. Conclusions The YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed

Elevated carbon dioxide and ozone alter productivity and ecosystem carbon content in northern temperate forests

Three young northern temperate forest communities in the north‐central United States were exposed to factorial combinations of elevated carbon dioxide ( CO 2 ) and tropospheric ozone (O 3 ) for 11 years. Here, we report results from an extensive sampling of plant biomass and soil conducted at the conclusion of the experiment that enabled us to estimate ecosystem carbon (C) content and cumulative net primary productivity ( NPP ). Elevated CO 2 enhanced ecosystem C content by 11%, whereas elevated O 3 decreased ecosystem C content by 9%. There was little variation in treatment effects on C content across communities and no meaningful interactions between CO 2 and O 3 . Treatment effects on ecosystem C content resulted primarily from changes in the near‐surface mineral soil and tree C, particularly differences in woody tissues. Excluding the mineral soil, cumulative NPP was a strong predictor of ecosystem C content ( r 2  = 0.96). Elevated CO 2 enhanced cumulative NPP by 39%, a consequence of a 28% increase in canopy nitrogen (N) content (g N m −2 ) and a 28% increase in N productivity ( NPP /canopy N). In contrast, elevated O 3 lowered NPP by 10% because of a 21% decrease in canopy N, but did not impact N productivity. Consequently, as the marginal impact of canopy N on NPP (∆ NPP /∆N) decreased through time with further canopy development, the O 3 effect on NPP dissipated. Within the mineral soil, there was less C in the top 0.1 m of soil under elevated O 3 and less soil C from 0.1 to 0.2 m in depth under elevated CO 2 . Overall, these results suggest that elevated CO 2 may create a sustained increase in NPP , whereas the long‐term effect of elevated O 3 on NPP will be smaller than expected. However, changes in soil C are not well‐understood and limit our ability to predict changes in ecosystem C content.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108065/1/gcb12564.pd

Elevated carbon dioxide and ozone alter productivity and ecosystem carbon content in northern temperate forests

Three young northern temperate forest communities in the north-central United States were exposed to factorial combinations of elevated carbon dioxide (CO2) and tropospheric ozone (O3) for 11 years. Here, we report results from an extensive sampling of plant biomass and soil conducted at the conclusion of the experiment that enabled us to estimate ecosystem carbon (C) content and cumulative net primary productivity (NPP). Elevated CO2 enhanced ecosystem C content by 11%, whereas elevated O3 decreased ecosystem C content by 9%. There was little variation in treatment effects on C content across communities and no meaningful interactions between CO2 and O3. Treatment effects on ecosystem C content resulted primarily from changes in the near-surface mineral soil and tree C, particularly differences in woody tissues. Excluding the mineral soil, cumulative NPP was a strong predictor of ecosystem C content (r2 = 0.96). Elevated CO2 enhanced cumulative NPP by 39%, a consequence of a 28% increase in canopy nitrogen (N) content (g N m−2) and a 28% increase in N productivity (NPP/canopy N). In contrast, elevated O3 lowered NPP by 10% because of a 21% decrease in canopy N, but did not impact N productivity. Consequently, as the marginal impact of canopy N on NPP (ΔNPP/ΔN) decreased through time with further canopy development, the O3 effect on NPP dissipated. Within the mineral soil, there was less C in the top 0.1 m of soil under elevated O3 and less soil C from 0.1 to 0.2 m in depth under elevated CO2. Overall, these results suggest that elevated CO2 may create a sustained increase in NPP, whereas the long-term effect of elevated O3 on NPP will be smaller than expected. However, changes in soil C are not well-understood and limit our ability to predict changes in ecosystem C content

Return to Play practices following hamstring injury: A worldwide survey of 131 premier league football teams

Purpose: Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were 1) to determine if premier-league football teams worldwide follow a RTP continuum, 2) to identify RTP criteria used, and 3) to understand how RTP decision-making occurs in applied practice.Methods: We sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised 4 sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process, and (4) challenges to decision-making.Results: One-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making. Conclusions: General research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key-stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear

Variations of Surveillance Practice for Patients with Bone Sarcoma: A Survey of Australian Sarcoma Clinicians

Introduction. After treatment, bone sarcoma patients carry a high chance of relapse and late effects from multimodal therapy. We hypothesize that significant variation in surveillance practice exists between pediatric medical oncology (PO) and nonpediatric medical oncology (NP) sarcoma disciplines. Methods. Australian sarcoma clinicians were approached to do a web based survey that assessed radiologic surveillance (RS) strategies, late toxicity assessment, and posttreatment psychosocial interventions. Results. In total, 51 clinicians responded. No differences were identified in local disease RS. In metastatic disease response assessment, 100% of POs (23/23) and 93% of NPs (24/26) conducted CT chest. However, this was more likely to occur for NPs in the context of a CT chest/abdomen/pelvis (NP: 10/26; PO: 1/23; p=0.006). POs were more likely to use CXR for RS (p=0.006). POs showed more prescriptive intensity in assessment of heart function (p=0.001), hearing (p<0.001), and fertility (p=0.02). POs were more likely to deliver written information for health maintenance/treatment summary (p=0.04). The majority of respondents described enquiring about psychosocial aspects of health (n=33/37, 89%), but a routine formal psychosocial screen was only used by 23% (n=6/26). Conclusion. There is high variability in bone sarcoma surveillance between PO and NP clinicians. Efforts to harmonize approaches would allow early and late effects recognition/intervention and facilitate improved patient care/transition and research

A Second Intense Burst with Photospheric Radius Expansion from X2127+119 in M15

In 2000 September we observed a bright X-ray burst from X2127+119 with the Rossi X-ray Timing Explorer. This burst has a multi-peaked profile, a peak luminosity of ~6.5x10^{38} erg s^{-1}, a total integrated energy of ~2x10^{40} ergs, and significant photospheric radius expansion to a maximum extent of R=118+-5 km. From the luminosity-temperature relation during the expansion phase we derive estimates for the gravitational redshift at the neutron star surface, the corrected Eddington luminosity, and the neutron star mass. We detect no slow (~30s) radial oscillations or fast (100-1200 Hz) coherent oscillations or QPO during the burst. The 2000 September event is only the second burst ever observed from this globular cluster binary (in M15 = NGC 7078), and it shares many characteristics with the event detected by Ginga in 1988 October (Dotani et al. 1990; van Paradijs et al. 1990), the key difference probably being the total amount of material consumed in the thermonuclear flash.Comment: 8 pages, 5 figures; accepted for publication in Ap