REMCARE : pragmatic multi-centre randomised trial of reminiscence groups for people with dementia and their family carers : effectiveness and economic analysis

Background Joint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care. Methods This multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person's home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5) were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both. Results The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions—only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group. Conclusions This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions

Snowmass 2021 Underground Facilities & Infrastructure Frontier Report

The decade since Snowmass 2013 has seen extraordinary progress of high energy physics research performed--or planned for--at underground facilities. Drs. T. Kajita and A.B. McDonald were awarded the 2015 Nobel Prize in Physics for the discovery of neutrino oscillation, which show that neutrinos have mass. The U.S. has embarked on the development of the world-class LBNF/DUNE science program to investigate neutrino properties. The Generation 2 dark matter program is advancing to full data collection in the coming 5 years, a Dark Matter New Initiatives program has begun, and the U.S. dark matter community is looking toward a Generation 3 program of large-scale dark matter direct detection searches. The Sanford Underground Research Facility has become a focal point for U.S. underground facilities and infrastructure investment. The status since the 2013 Snowmass process as well as the outcome from the 2014 P5 program of recommendations is reviewed. These are then evaluated based on the activities and discussions of the Snowmass 2021 process resulting in conclusions looking forward to the coming decade of high energy physics research performed in underground facilities.Comment: Snowmass 2021 Underground Facilities & Infrastructure Frontier Repor

Estimation of Equivalent Sea Level Cosmic Ray Exposure for Low Background Experiment

While scientists at CERN and other particle accelerators around the world explore the boundaries of high energy physics, the Majorana project investigates the other end of the spectrum with its extremely sensitive, low background, low energy detector. The MAJORANA DEMONSTRATOR aims to detect neutrinoless double beta decay (0νββ), a rare theoretical process in which two neutrons decay into two protons and two electrons, without the emission of the two antineutrinos that are a product of a normal double beta decay. This process is only possible if – and therefore a detection would prove — the neutrino is a Majorana particle, meaning that it is its own antiparticle [Aaselth et al. 2004] . The existence of such a decay would also disprove lepton conservation and give information about the neutrino's mass

Reducing 68Ge Background in Dark Matter Experiments

Experimental searches for dark matter include experiments with sub-0.5 keV-energy threshold high purity germanium detectors. Experimental efforts, in partnership with the CoGeNT Collaboration operating at the Soudan Underground Laboratory, are focusing on energy threshold reduction via noise abatement, reduction of backgrounds from cosmic ray generated isotopes, and ubiquitous environmental radioactive sources. The most significant cosmic ray produced radionuclide is 68Ge. This paper evaluates reducing this background by freshly mining and processing germanium ore. The most probable outcome is a reduction of the background by a factor of two, and at most a factor of four. A very cost effective alternative is to obtain processed Ge as soon as possible and store it underground for 18 months

Community occupational therapy for people with dementia and their family carers: A national survey of United Kingdom occupational therapy practice

Introduction: A national survey was conducted with United Kingdom (UK) occupational therapists to scope occupational therapy service provision for people with dementia and their family carers in the community. / Method: This was an online questionnaire with topics on occupational therapists’ roles, service provision, referral, assistive technology and assessment tools. Recruitment was through direct invitation, and promotion via occupational therapy networks, websites and newsletters. / Results: A total of 197 responded. Occupational therapy referrals most commonly came from the multidisciplinary team. Over half primarily undertook profession-specific work, with occupational therapy assessments the most common profession-specific task. Two-thirds of referrals for initial assessments were for people with mild-to-moderate dementia. A median of 2.5 hours for assessment/intervention was spent for each person with dementia. Almost two-thirds used the Model of Human Occupation Screening Tool. Most could prescribe personal activities of daily living equipment and Telecare, with few able to prescribe equipment for reminiscence or leisure. / Conclusion: This national survey increases knowledge of UK community occupational therapy practice and service provision for people with dementia and their family carers. It informs occupational therapists about national trends within this practice area, and development of the community occupational therapy intervention (COTiD-UK) as part of the Valuing Active Life in Dementia research programme

Individual cognitive stimulation therapy for dementia : a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Background Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU). Design A multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point). Setting Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. Participants A total of 356 caregiving dyads were recruited and 273 completed the trial. Intervention iCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. Main outcome measures Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. Results There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference –0.55, 95% confidence interval (CI) –2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference –0.02, 95% CI –1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better relationship quality with their carer, but there was no evidence that iCST improved their activities of daily living, depression or behavioural and psychological symptoms. iCST seemed to improve health-related quality of life for carers but did not benefit carers’ resilience or their relationship quality with their relative. Carers conducting more sessions had fewer depressive symptoms. Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST. Adjusted mean costs were not significantly different between the groups. From the societal perspective, both health gains and cost savings were observed. Conclusions iCST did not improve cognition or quality of life for people with dementia, or carers’ physical and mental health. Costs of the intervention were offset by some reductions in social care and other services. Although there was some evidence of improvement in terms of the caregiving relationship and carers’ health-related quality of life, iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia. Most people received fewer than the recommended number of iCST sessions. Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia