Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia : a mixed-methods study

Background: Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear. Aims: To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay. Design: Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia. Setting: Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit. Participants: Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia. Main outcome measures: Length of stay, quality of assessment and carer-rated experience. Results: People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff. Limitations: The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia. Conclusions: If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised. Future work: Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information

Comment Regarding the Functional Form of the Schmidt Law

Star formation rates on the galactic scale are described phenomenologically by two distinct relationships, as emphasized recently by Elmegreen (2002). The first of these is the Schmidt law, which is a power-law relation between the star formation rate and the column density. The other relationship is that there is a cutoff in the gas density below which star formation shuts off. The purpose of this paper is to argue that 1) these two relationships can be accommodated by a single functional form of the Schmidt law, and 2) this functional form is motivated by the hypothesis that star formation is a critical phenomenon, and that as a corollary, 3) the existence of a sharp cutoff may thus be an emergent property of galaxies, as was argued by Seiden (1983), as opposed to the classical view that this cutoff is due to an instability criterion.Comment: 14 pages, 3 figures, in press, New Astronomy. Figs provided in original (png) format as well as ps format for ps/pdf generatio

Investigating MMM Ponzi scheme on Bitcoin

Cybercriminals exploit cryptocurrencies to carry out illicit activities. In this paper, we focus on Ponzi schemes that operate on Bitcoin and perform an in-depth analysis of MMM, one of the oldest and most popular Ponzi schemes. Based on 423K transactions involving 16K addresses, we show that: (1) Starting Sep 2014, the scheme goes through three phases over three years. At its peak, MMM circulated more than 150M dollars a day, after which it collapsed by the end of Jun 2016. (2) There is a high income inequality between MMM members, with the daily Gini index reaching more than 0.9. The scheme also exhibits a zero-sum investment model, in which one member's loss is another member's gain. The percentage of victims who never made any profit has grown from 0% to 41% in five months, during which the top-earning scammer has made 765K dollars in profit. (3) The scheme has a global reach with 80 different member countries but a highly-asymmetrical flow of money between them. While India and Indonesia have the largest pairwise flow in MMM, members in Indonesia have received 12x more money than they have sent to their counterparts in India

The planar thermal Hall conductivity in the Kitaev magnet {\alpha}-RuCl3

We report detailed measurements of the Onsager-like planar thermal Hall conductivity $\kappa_{xy}$ in $\alpha$-RuCl$_3$, a spin-liquid candidate of topical interest. With the thermal current ${\bf J}_{\rm Q}$ and magnetic field $\bf B\parallel a$ (zigzag axis), the observed $\kappa_{xy}/T$ varies strongly with temperature $T$ (1-10 K). The results are well-described by bosonic edge excitations which evolve to topological magnons at large $B$. Fits to $\kappa_{xy}/T$ yield a Chern number $\sim 1$ and a band energy $\omega_1\sim$1 meV, in agreement with sharp modes seen in electron spin-resonance experiments. The bosonic character is incompatible with half-quantization of $\kappa_{xy}/T$.Comment: 7 pages, 3 figure

Gold nanoparticle-enhanced X-ray microtomography of the rodent reveals region-specific cerebrospinal fluid circulation in the brain

Cerebrospinal fluid (CSF) is essential for the development and function of the central nervous system (CNS). However, the brain and its interstitium have largely been thought of as a single entity through which CSF circulates, and it is not known whether specific cell populations within the CNS preferentially interact with the CSF. Here, we develop a technique for CSF tracking, gold nanoparticle-enhanced X-ray microtomography, to achieve micrometer-scale resolution visualization of CSF circulation patterns during development. Using this method and subsequent histological analysis in rodents, we identify previously uncharacterized CSF pathways from the subarachnoid space (particularly the basal cisterns) that mediate CSF-parenchymal interactions involving 24 functional-anatomic cell groupings in the brain and spinal cord. CSF distribution to these areas is largely restricted to early development and is altered in posthemorrhagic hydrocephalus. Our study also presents particle size-dependent CSF circulation patterns through the CNS including interaction between neurons and small CSF tracers, but not large CSF tracers. These findings have implications for understanding the biological basis of normal brain development and the pathogenesis of a broad range of disease states, including hydrocephalus

The Science of Pronominal Usage: He and It in Co-Reference to Inanimate Objects in Late Middle English Texts on Alchemy

This is the author's accepted manuscript. The published version can be found at http://dx.doi.org/10.1177/0075424210384225This article explores the variation between he and it in coreference to inanimate entities (such as mercury, sulfur, and salt). Using alchemical texts from the fifteenth century as material, the article demonstrates that there was much more variation in pronominal reference in this period than has previously been shown. Of the possible explanations suggested by previous research, the earlier grammatical gender system and transference from Latin do not seem to play a role, while pronoun clustering and pronominal reanalysis appear to influence the quantitative distribution. The scale of individuation used by Siemund and Stenroos to explain similar usage is shown not to be a straightforward predictor. Other factors such as personification and perceived similarities between animate and inanimate entities may affect the degree of perceived individuation. The choice of he over she seems to be influenced by pronominal reanalysis and straightforward personification in some cases. In other instances, it is speculated that the he usage reflects (stereotypical) gender conceptions in the Middle Ages

Simple measures of climate, soil properties and plant traits predict national scale grassland soil carbon stocks

1. Soil carbon (C) storage is a key ecosystem service. Soil C stocks play a vital role in soil fertility and climate regulation, but the factors that control these stocks at regional and national scales are unknown, particularly when their composition and stability are considered. As a result, their mapping relies on either unreliable proxy measures or laborious direct measurements. 2. Using data from an extensive national survey of English grasslands we show that surface soil (0-7cm) C stocks in size fractions of varying stability can be predicted at both regional and national scales from plant traits and simple measures of soil and climatic conditions. 3. Soil C stocks in the largest pool, of intermediate particle size (50-250 µm), were best explained by mean annual temperature (MAT), soil pH and soil moisture content. The second largest C pool, highly stable physically and biochemically protected particles (0.45-50 µm), was explained by soil pH and the community abundance weighted mean (CWM) leaf nitrogen (N) content, with the highest soil C stocks under N rich vegetation. The C stock in the small active fraction (250-4000 µm) was explained by a wide range of variables: MAT, mean annual precipitation, mean growing season length, soil pH and CWM specific leaf area; stocks were higher under vegetation with thick and/or dense leaves. 4. Testing the models describing these fractions against data from an independent English region indicated moderately strong correlation between predicted and actual values and no systematic bias, with the exception of the active fraction, for which predictions were inaccurate. 5. Synthesis and Applications: Validation indicates that readily available climate, soils and plant survey data can be effective in making local- to landscape-scale (1-100,000 km2) soil C stock predictions. Such predictions are a crucial component of effective management strategies to protect C stocks and enhance soil C sequestration

Measurement of proton, deuteron, triton, and α particle emission after nuclear muon capture on Al, Si, and Ti with the AlCap experiment

Heavy charged particles after nuclear muon capture are an important nuclear physics background to the muon-to-electron conversion experiments Mu2e and COMET, which will search for charged lepton flavor violation at an unprecedented level of sensitivity. The AlCap experiment measured the yield and energy spectra of protons, deuterons, tritons, and alpha particles emitted after the nuclear capture of muons stopped in Al, Si, and Ti in the low energy range relevant for the muon-to-electron conversion experiments. Individual charged particle types were identified in layered silicon detector packages and their initial energy distributions were unfolded from the observed energy spectra. Detailed information on yields and energy spectra for all observed nuclei are presented in the paper.Comment: 24 pages, 19 figure

Painting: Process

Catalog for the exhibition Painting: Process held at the Seton Hall University Walsh Gallery, January 14 - February 15, 2008. Curated by Jackie Bekiaris and Maria Silvestri. Includes an essay by Jackie Bekiaris and Maria Silvestri. Includes color illustrations