The cost of care homes for people with dementia in England:a modelling approach

Objectives To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development. Methods Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. We estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted. Results Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = −0.002; p = 0.818). Conclusion The absence of an association between cost and needs emphasizes the importance of a more needs-based costing system which could result in clinical and economic advantages

Cataclysmic Variables from The Sloan Digital Sky Survey. I. The First Results

The commissioning year of the Sloan Digital Sky Survey (SDSS) has demonstrated that many cataclysmic variables (CVs) have been missed in previous surveys with brighter limits. We report the identification of 22 CVs, of which 19 are new discoveries and three are known systems (SW UMa, BH Lyn, and OU Vir). A compendium of positions, colors, and characteristics of these systems obtained from the SDSS photometry and spectroscopy is presented, along with data obtained during follow-up studies with the Apache Point Observatory and Manastash Ridge Observatory telescopes. We have determined orbital periods for three of the new systems, two show dwarf nova outbursts, and the third is a likely magnetic system with eclipses of its region of line emission. Based on these results, we expect the completed survey to locate at least 400 new CVs. Most of these will be faint systems with low accretion rates that will provide new constraints on binary evolution models

Discovery of An Unusually Blue L Dwarf Within 10 pc of the Sun

We report the discovery of an unusually blue L5 dwarf within 10 pc of the Sun from a search of Sloan Digital Sky Survey (SDSS) spectra. A spectrophotometric distance estimate of 8.0+/-1.6 pc places SDSS J141624.08+134826.7 among the six closest known L dwarfs. SDSS 1416+13 was overlooked in infrared color-based searches because of its unusually blue J-K_S color, which also identifies it as the nearest member of the blue L dwarf subclass. We present additional infrared and optical spectroscopy from the IRTF/SpeX and Magellan/MagE spectrographs and determine UVW motions that indicate thin disk kinematics. The inclusion of SDSS 1416+13 in the 20 pc sample of L dwarfs increases the number of L5 dwarfs by 20% suggesting that the L dwarf luminosity function may be far from complete.Comment: 15 pages, 3 figures, accepted for publication in AJ; updated version includes corrected radial velocit

Cataclysmic Variables from SDSS II. The Second Year

The first full year of operation following the commissioning year of the Sloan Digital Sky Survey has revealed a wide variety of newly discovered cataclysmic variables. We show the SDSS spectra of forty-two cataclysmic variables observed in 2002, of which thirty-five are new classifications, four are known dwarf novae (CT Hya, RZ Leo, T Leo and BZ UMa), one is a known CV identified from a previous quasar survey (Aqr1) and two are known ROSAT or FIRST discovered CVs (RX J09445+0357, FIRST J102347.6+003841). The SDSS positions, colors and spectra of all forty-two systems are presented. In addition, the results of follow-up studies of several of these objects identify the orbital periods, velocity curves and polarization that provide the system geometry and accretion properties. While most of the SDSS discovered systems are faint (>18th mag) with low accretion rates (as implied from their spectral characteristics), there are also a few bright objects which may have escaped previous surveys due to changes in the mass transfer rate.Comment: Accepted for publication in The Astronomical Journal, Vol. 126, Sep. 2003, 44 pages, 25 figures (now with adjacent captions), AASTeX v5.

Colors and Kinematics of L Dwarfs From the Sloan Digital Sky Survey

We present a sample of 484 L dwarfs, 210 of which are newly discovered from the Sloan Digital Sky Survey (SDSS) Data Release 7 spectroscopic database. We combine this sample with known L dwarfs to investigate their $izJHK_S$ colors. Our spectroscopically selected sample has $\sim$0.1 magnitude bluer median $J-K_S$ colors at a given spectral type (for L0 to L4) than previously known L dwarfs, which reflects a bias towards redder L dwarfs in past selection criteria. We present photometric distance relations based on $i-z$ and $i-J$ colors and derive distances to our L dwarf sample. We combine the distances with SDSS/2MASS proper motions in order to examine the tangential velocities. For the majority of our spectroscopic sample, we measured radial velocities and present three dimensional kinematics. We also provide H$\alpha$ detections for the fraction of our sample with sufficient quality spectra. Comparison of the velocities of our L dwarf sample to a kinematic model shows evidence for both cold and hot dynamical populations, consistent with young and old disk components. The dispersions of these components are similar to those found for M dwarfs. We also show that $J-K_S$ color is correlated with velocity dispersion, confirming a relationship between $J-K_S$ color and age.Comment: 58 pages, 11 figures, 8 tables, accepted for publication in the Astronomical Journa

Rehabilitation strategies following oesophagogastric and Hepatopancreaticobiliary cancer (ReStOre II) : a protocol for a randomized controlled trial

BACKGROUND: Curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers, involves complex surgical resection often in combination with neoadjuvant/adjuvant chemo/chemoradiotherapy. With advancing survival rates, there is an emergent cohort of UGI and HPB cancer survivors with physical and nutritional deficits, resultant from both the cancer and its treatments. Therefore, rehabilitation to counteract these impairments is required to maximise health related quality of life (HRQOL) in survivorship. The initial feasibility of a multidisciplinary rehabilitation programme for UGI survivors was established in the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) feasibility study and pilot randomised controlled trial (RCT). ReStOre II will now further investigate the efficacy of that programme as it applies to a wider cohort of UGI and HPB cancer survivors, namely survivors of cancer of the oesophagus, stomach, pancreas, and liver. METHODS: The ReStOre II RCT will compare a 12-week multidisciplinary rehabilitation programme of supervised and self-managed exercise, dietary counselling, and education to standard survivorship care in a cohort of UGI and HPB cancer survivors who are > 3-months post-oesophagectomy/ gastrectomy/ pancreaticoduodenectomy, or major liver resection. One hundred twenty participants (60 per study arm) will be recruited to establish a mean increase in the primary outcome (cardiorespiratory fitness) of 3.5 ml/min/kg with 90% power, 5% significance allowing for 20% drop out. Study outcomes of physical function, body composition, nutritional status, HRQOL, and fatigue will be measured at baseline (T0), post-intervention (T1), and 3-months follow-up (T2). At 1-year follow-up (T3), HRQOL alone will be measured. The impact of ReStOre II on well-being will be examined qualitatively with focus groups/interviews (T1, T2). Bio-samples will be collected from T0-T2 to establish a national UGI and HPB cancer survivorship biobank. The cost effectiveness of ReStOre II will also be analysed. DISCUSSION: This RCT will investigate the efficacy of a 12-week multidisciplinary rehabilitation programme for survivors of UGI and HPB cancer compared to standard survivorship care. If effective, ReStOre II will provide an exemplar model of rehabilitation for UGI and HPB cancer survivors. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov, registration number: NCT03958019, date registered: 21/05/2019

Executive functions and borderline personality features in adolescents with major depressive disorder

BackgroundExecutive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF).MethodsWe examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child’s EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity.ResultsOver the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T &gt; 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries.ConclusionOn average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF.Clinical trial registrationwww.ClinicalTrials.gov, identifier NCT03167307

Evaluating specialist autism teams' provision of care and support for autistic adults without learning disabilities: the SHAPE mixed-methods study

Background The National Institute for Health and Care Excellence recommends that every locality has a ‘Specialist Autism Team’: an specialist autism, community-based, multidisciplinary service that is responsible for developing, co-ordinating and delivering care and support. The National Institute for Health and Care Excellence recommended that this novel delivery model was evaluated. Objectives The objectives were to identify services fulfilling the National Institute for Health and Care Excellence’s description of a Specialist Autism Team; to describe practitioner and user experiences; to investigate outcomes; to identify factors associated with these outcomes; and to estimate costs and investigate cost-effectiveness of these services. Design During stage 1, desk-based research and a survey to identify Specialist Autism Teams were carried out. Stage 2 comprised a mixed-methods observational study of a cohort of Specialist Autism Team users, which was followed for up to 2 years from the assessment appointment. The cohort comprised users of a Specialist Autism Team not previously diagnosed with autism (the ‘Diagnosis and Support’ group) and those already diagnosed (the ‘Support-Only’ group). Stage 2 also involved a nested qualitative study of senior practitioners and an exploratory comparison of the Diagnosis and Support group with a cohort who accessed a service which only provided autism diagnostic assessments (‘Diagnosis-Only’ cohort). Setting The setting in stage 2 was nine Specialist Autism Teams; three also provided a regional diagnostic assessment service (used to recruit the Diagnosis-Only cohort). Participants There were 252 participants in the Specialist Autism Team cohort (Diagnosis and Support, n = 164; Support Only, n = 88) and 56 participants in the Diagnosis-Only cohort. Thirty-eight participants (across both cohorts) were recruited to the qualitative evaluation and 11 practitioners to the nested qualitative study. Main outcome measures The World Health Organization Quality of Life assessment, abbreviated version (psychological domain) and the General Health Questionnaire (12-item version). Data sources Self-reported outcomes, qualitative interviews with users and focus groups with practitioners. Results A total of 18 Specialist Autism Teams were identified, all for autistic adults without learning disabilities. Services varied in their characteristics. The resources available, commissioner specifications and clinical opinion determined service design. Practitioners working in Specialist Autism Teams recruited to stage 2 reported year-on-year increases in referral rates without commensurate increases in funding. They called for an expansion of Specialist Autism Teams’ consultation/supervision function and resources for low-intensity, ongoing support. For the Specialist Autism Team cohort, there was evidence of prevention of deterioration in outcomes and positive benefit for the Diagnosis and Support group at the 1-year follow-up (T3). Users of services with more professions involved were likely to experience better outcomes; however, such services may not be considered cost-effective. Some service characteristics were not associated with outcomes, suggesting that different structural/organisational models are acceptable. Findings suggest that one-to-one work for mental health problems was cost-effective and an episodic approach to delivering care plans was more cost-effective than managed care. Qualitative findings generally align with quantitative findings; however, users consistently connected a managed-care approach to supporting improvement in outcomes. Among the Diagnosis-Only cohort, no changes in mental health outcomes at T3 were observed. Findings from the interviews with individuals in the Diagnosis and Support group and Diagnosis-Only cohort suggest that extended psychoeducation post diagnosis has an impact on immediate and longer-term adjustment. Limitations Sample size prohibited an investigation of the associations between some service characteristics and outcomes. Comparison of the Diagnosis-Only cohort and the Diagnosis and Support group was underpowered. The economic evaluation was limited by incomplete costs data. Conclusions The study provides first evidence on the implementation of Specialist Autism Teams. There is some evidence of benefit for this model of care. Service characteristics that may affect outcomes, costs and cost-effectiveness were identified. Finding suggest that extended psychoeducation post diagnosis is a critical element of Specialist Autism Team provision

Two More Candidate AM Canum Venaticorum (AM CVn) Binaries from the Sloan Digital Sky Survey

AM CVn systems are a select group of ultracompact binaries with the shortest orbital periods of any known binary subclass; mass-transfer is likely from a low-mass (partially-)degenerate secondary onto a white dwarf primary, driven by gravitational radiation. In the past few years, the Sloan Digital Sky Survey (SDSS) has provided five new AM CVns. Here we report on two further candidates selected from more recent SDSS data. SDSS J1208+3550 is similar to the earlier SDSS discoveries, recognized as an AM CVn via its distinctive spectrum which is dominated by helium emission. From the expanded SDSS Data Release 6 (DR6) spectroscopic area, we provide an updated surface density estimate for such AM CVns of order 10^{-3.1} to 10^{-2.5} per deg^2 for 15<g<20.5. In addition, we present another new candidate AM CVn, SDSS J2047+0008, that was discovered in the course of followup of SDSS-II supernova candidates. It shows nova-like outbursts in multi-epoch imaging data; in contrast to the other SDSS AM CVn discoveries, its (outburst) spectrum is dominated by helium absorption lines, reminiscent of KL Dra and 2003aw. The variability selection of SDSS J2047+0008 from the 300 deg^2 of SDSS Stripe 82 presages further AM CVn discoveries in future deep, multicolor, and time-domain surveys such as LSST. The new additions bring the total SDSS yield to seven AM CVns thus far, a substantial contribution to this rare subclass, versus the dozen previously known.Comment: 19 pages, 5 figures, 1 table; submitted to A