The economic impact of moderate stage Alzheimer's disease in Italy: Evidence from the UP-TECH randomized trial

Background: There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. Methods: This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. Results: The societal burden of AD, composed of public, patient, and informal care costs, was about �20,000/yr. Out of this, the cost borne by the public sector was �4,534/yr. The main driver of public cost was the national cash-for-care allowance (�2,324/yr), followed by drug prescriptions (�1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at �13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. Conclusion: The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556). Copyright � International Psychogeriatric Association 2015

Effects of human-induced habitat changes on site-use patterns in large Amazonian Forest mammals

The Amazon is one of the most diverse biomes around the globe, currently threatened by economic and industrial development and climate change. Large mammals are keystone species, playing an important role in ecosystem structure and function as ecological engineers, while being highly susceptible to deforestation, habitat degradation, and human exploitation. Using a unifying hierarchical Bayesian spatial approach, we examine the site-use patterns of four large Amazonian Forest mammals and their relationships to anthropogenic factors at a biome-wide scale. Our results showed that species’ patterns of site use are correlated with human induced habitat changes, and that this correlation is species-specific. The white-lipped peccary shows highest site-use estimates within strict protected areas, affected by proximity to urban areas and benefiting from indigenous territories, the tapir responding slightly to proximity to burned forested areas, while the giant armadillo and the jaguar were primarily affected by vegetation cover loss; disturbances related to the colonization of the Amazon. Our findings contribute to the understanding of how human-induced environmental changes influence the site-use patterns of these four large mammals, and inform future conservation and land use planning. Transboundary conservation efforts, empowering and integrating native (indigenous and non-indigenous) communities in land governance schemes, involving the private sector and securing the commitment of developed countries are important paths for the protection and sustainability of the globally-crucial Amazon rainforest

Planck early results XXIII : The first all-sky survey of Galactic cold clumps

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Planck early results. XXII. The submillimetre properties of a sample of Galactic cold clumps

We perform a detailed investigation of sources from the Cold Cores Catalogue of Planck Objects (C3PO). Our goal is to probe the reliability of the detections, validate the separation between warm and cold dust emission components, provide the first glimpse at the nature, internal morphology and physical characterictics of the Planck-detected sources. We focus on a sub-sample of ten sources from the C3PO list, selected to sample different environments, from high latitude cirrus to nearby (150 pc) and remote (2 kpc) molecular complexes. We present Planck surface brightness maps and derive the dust temperature, emissivity spectral index, and column densities of the fields. With the help of higher resolution Herschel and AKARI continuum observations and molecular line data, we investigate the morphology of the sources and the properties of the substructures at scales below the Planck beam size. The cold clumps detected by Planck are found to be located on large-scale filamentary (or cometary) structures that extend up to 20 pc in the remote sources. The thickness of these filaments ranges between 0.3 and 3 pc, for column densities NH2 ∼ 0.1 to 1.6 × 1022 cm−2, and with linear mass density covering a broad range, between 15 and 400 M pc−1. The dust temperatures are low (between 10 and 15K) and the Planck cold clumps correspond to local minima of the line-of-sight averaged dust temperature in these fields. These low temperatures are confirmed when AKARI and Herschel data are added to the spectral energy distributions. Herschel data reveal a wealth of substructure within the Planck cold clumps. In all cases (except two sources harbouring young stellar objects), the substructures are found to be colder, with temperatures as low as 7 K. Molecular line observations provide gas column densities which are consistent with those inferred from the dust. The linewidths are all supra-thermal, providing large virial linear mass densities in the range 10 to 300 M pc−1, comparable within factors of a few, to the gas linear mass densities. The analysis of this small set of cold clumps already probes a broad variety of structures in the C3PO sample, probably associated with different evolutionary stages, from cold and starless clumps, to young protostellar objects still embedded in their cold surrounding cloud. Because of the all-sky coverage and its sensitivity, Planck is able to detect and locate the coldest spots in massive elongated structures that may be the long-searched for progenitors of stellar clusters

Planck early results. IX. XMM-Newton follow-up for validation of Planck cluster candidates

We present the XMM-Newton follow-up for confirmation of Planck cluster candidates. Twenty-five candidates have been observed to date using snapshot (∼10 ks) exposures, ten as part of a pilot programme to sample a low range of signal-to-noise ratios (4 < S/N < 6), and a further 15 in a programme to observe a sample of S/N > 5 candidates. The sensitivity and spatial resolution of XMM-Newton allows unambiguous discrimination between clusters and false candidates. The 4 false candidates have S/N ≤ 4.1. A total of 21 candidates are confirmed as extended X-ray sources. Seventeen are single clusters, the majority of which are found to have highly irregular and disturbed morphologies (about ∼70%). The remaining four sources are multiple systems, including the unexpected discovery of a supercluster at z = 0.45. For 20 sources we are able to derive a redshift estimate from the X-ray Fe K line (albeit of variable quality). The new clusters span the redshift range 0.09 <∼ z <∼ 0.54, with a median redshift of z ∼ 0.37. A first determination is made of their X-ray properties including the characteristic size, which is used to improve the estimate of the SZ Compton parameter, Y500. The follow-up validation programme has helped to optimise the Planck candidate selection process. It has also provided a preview of the X-ray properties of these newly-discovered clusters, allowing comparison with their SZ properties, and to the X-ray and SZ properties of known clusters observed in the Planck survey. Our results suggest that Planck may have started to reveal a non-negligible population of massive dynamically perturbed objects that is under-represented in X-ray surveys. However, despite their particular properties, these new clusters appear to follow the Y500–YX relation established for X-ray selected objects, where YX is the product of the gas mass and temperature

Planck early results. II. The thermal performance of Planck

The performance of the Planck instruments in space is enabled by their low operating temperatures, 20 K for LFI and 0.1 K for HFI, achieved through a combination of passive radiative cooling and three active mechanical coolers. The scientific requirement for very broad frequency coverage led to two detector technologies with widely different temperature and cooling needs. Active coolers could satisfy these needs; a helium cryostat, as used by previous cryogenic space missions (IRAS, COBE, ISO, Spitzer, AKARI), could not. Radiative cooling is provided by three V-groove radiators and a large telescope baffle. The active coolers are a hydrogen sorption cooler (<20 K), a 4He Joule-Thomson cooler (4.7 K), and a 3He-4He dilution cooler (1.4 K and 0.1 K). The flight system was at ambient temperature at launch and cooled in space to operating conditions. The HFI bolometer plate reached 93 mK on 3 July 2009, 50 days after launch. The solar panel always faces the Sun, shadowing the rest of Planck, and operates at a mean temperature of 384 K. At the other end of the spacecraft, the telescope baffle operates at 42.3 K and the telescope primary mirror operates at 35.9 K. The temperatures of key parts of the instruments are stabilized by both active and passive methods. Temperature fluctuations are driven by changes in the distance from the Sun, sorption cooler cycling and fluctuations in gas-liquid flow, and fluctuations in cosmic ray flux on the dilution and bolometer plates. These fluctuations do not compromise the science data

Planck Early Results. VII. The Early Release Compact Source Catalogue

A brief description of the methodology of construction, contents and usage of the Planck Early Release Compact Source Catalogue (ERCSC), including the Early Cold Cores (ECC) and the Early Sunyaev-Zeldovich (ESZ) cluster catalogue is provided. The catalogue is based on data that consist of mapping the entire sky once and 60% of the sky a second time by Planck, thereby comprising the first high sensitivity radio/submillimetre observations of the entire sky. Four source detection algorithms were run as part of the ERCSC pipeline. A Monte-Carlo algorithm based on the injection and extraction of artificial sources into the Planck maps was implemented to select reliable sources among all extracted candidates such that the cumulative reliability of the catalogue is ≥90%. There is no requirement on completeness for the ERCSC. As a result of the Monte-Carlo assessment of reliability of sources from the different techniques, an implementation of the PowellSnakes source extraction technique was used at the five frequencies between 30 and 143 GHz while the SExtractor technique was used between 217 and 857GHz. The 10σ photometric flux density limit of the catalogue at |b| > 30◦ is 0.49, 1.0, 0.67, 0.5, 0.33, 0.28, 0.25, 0.47 and 0.82 Jy at each of the nine frequencies between 30 and 857 GHz. Sources which are up to a factor of ∼2 fainter than this limit, and which are present in “clean” regions of the Galaxy where the sky background due to emission from the interstellar medium is low, are included in the ERCSC if they meet the high reliability criterion. The Planck ERCSC sources have known associations to stars with dust shells, stellar cores, radio galaxies, blazars, infrared luminous galaxies and Galactic interstellar medium features. A significant fraction of unclassified sources are also present in the catalogs. In addition, two early release catalogs that contain 915 cold molecular cloud core candidates and 189 SZ cluster candidates that have been generated using multifrequency algorithms are presented. The entire source list, with more than 15000 unique sources, is ripe for follow-up characterisation with Herschel, ATCA, VLA, SOFIA, ALMA and other ground-based observing facilities

Planck early results XXIV : Dust in the diffuse interstellar medium and the Galactic halo

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