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Depression is common in people with dementia, and negatively affects quality of life.
Aims
This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer's disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives.
Method
A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) (n = 168) or TAU alone (n = 168). Health and social care resource use were collected with the Client Service Receipt Inventory and health-related quality-of-life data with the EQ-5D-5L instrument at baseline and 3-, 6- and 12-month follow-up points. Principal analysis comprised quality-adjusted life-years (QALYs) calculated from the participant responses to the EQ-5D-5L instrument.
Results
The mean cost of the adapted PATH intervention was estimated at £1141 per PATHFINDER participant. From a health and social care perspective, the mean difference in costs between the adapted PATH and control arm at 12 months was −£74 (95% CI −£1942 to £1793), and from the societal perspective was −£671 (95% CI −£9144 to £7801). The mean difference in QALYs was 0.027 (95% CI −0.004 to 0.059). At £20 000 per QALY gained threshold, there were 74 and 68% probabilities of adapted PATH being cost-effective from the health and social care and societal perspective, respectively.
Conclusions
The addition of the adapted PATH intervention to TAU for people with dementia and depression generated cost savings alongside a higher quality of life compared with TAU alone; however, the improvements in costs and QALYs were not statistically significant.
The first part of the chapter provides an overview of assessment as an integral element of undergraduate research’s continued success and sustainability. Building from this introduction, the remainder of the chapter explains the EvaluateUR method, a proven approach to assessing the skills and competencies of undergraduate research students and for improving student learning. The EvaluateUR method documents student growth in academic and workplace-related knowledge and skills and fosters meaningful student–mentor dialog to strengthen students’ awareness of their academic strengths and weaknesses. The chapter includes a summary of the findings from an independent evaluation of the method and concludes with remarks about how the method is being adapted to support the assessment of course-based undergraduate research experiences and students competing in remotely operated underwater vehicle competitions.
This qualitative study aimed to explore young Australians’ perspectives, motivators and current practices in achieving a sustainable and healthy diet.
Design:
Semi-structured online interviews were conducted with young Australians. Interviews were audio-recorded using the online Zoom platform, transcribed and analysed using a deductive analysis method by applying the Theoretical Domains Framework and inductive thematic data analysis.
Setting:
Young Australians recruited via social media platforms, noticeboard announcements and flyers.
Subjects:
Twenty-two Australians aged 18 to 25 years.
Results:
The majority of participants were aware of some aspects of a sustainable and healthy diet and indicated the need to reduce meat intake, increase intake of plant-based foods, reduce food wastage and packaging and reduce food miles. Young adults were motivated to adopt more sustainable dietary practices but reported that individual and environmental factors such as low food literacy, limited food preparation and cooking skills, lack of availability and accessibility of environmentally friendly food options and costs associated with sustainable and healthy diets hindered their ability to do so.
Conclusions:
Given the barriers faced by many of our participants, there is a need for interventions aimed at improving food literacy and food preparation and cooking skills as well as those that create food environments that make it easy to select sustainable and healthy diets. Future research is needed for longitudinal larger scale quantitative studies to confirm our qualitative findings. In addition, the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to
$\sim\!5$
yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of
$\sim\!162$
h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of
$0.24\ \mathrm{mJy\ beam}^{-1}$
and angular resolution of
$12-20$
arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Recent models of psychopathology suggest the presence of a general factor capturing the shared variance among all symptoms along with specific psychopathology factors (e.g., internalizing and externalizing). However, few studies have examined predictors that may serve as transdiagnostic risk factors for general psychopathology from early development. In the current study we examine, for the first time, whether observed and parent-reported infant temperament dimensions prospectively predict general psychopathology as well as specific psychopathology dimensions (e.g., internalizing and externalizing) across childhood. In a longitudinal cohort (N = 291), temperament dimensions were assessed at 4 months of age. Psychopathology symptoms were assessed at 7, 9, and 12 years of age. A bifactor model was used to estimate general, internalizing, and externalizing psychopathology factors. Across behavioral observations and parent-reports, higher motor activity in infancy significantly predicted greater general psychopathology in mid to late childhood. Moreover, low positive affect was predictive of the internalizing-specific factor. Other temperament dimensions were not related with any of the psychopathology factors after accounting for the general psychopathology factor. The results of this study suggest that infant motor activity may act as an early indicator of transdiagnostic risk. Our findings inform the etiology of general psychopathology and have implications for the early identification for children at risk for psychopathology.
The ability to understand others’ actions and intentions is at the core of human social competence. Action understanding, what it means and how it develops, has received much attention in developmental research because it is viewed as one of the most fundamental abilities in early social-cognitive development. For example, there is a growing body of evidence linking early action understanding with later theory of mind (Brooks & Meltzoff, 2015; Charman et al., 2000; Wellman, Phillips, Dunphy-Lelii, & LaLonde, 2004), and to the development of communicative skills (e.g., Brooks & Meltzoff, 2008). Increasing evidence suggests that the mirror neuron system (MNS) is a key neural correlate of action understanding. In this chapter, we discuss the role the MNS is thought to play in the development of social cognitive skills in infancy. We also discuss the current challenges of measuring the MNS that are unique to work with infants, what such studies have found in both typical and atypical populations, and how this work can impact our understanding of development.
OBJECTIVES/SPECIFIC AIMS: The development of new anti-cancer agents for children requires an inherently longer timeline than in adults. The 3+3 study design for Phase 1 dose escalation trials is commonly used to estimate the maximum tolerated dose and assess safety. The Rolling 6 study design was developed to shorten the study conduct timeline. METHODS/STUDY POPULATION: This study compares twenty Phase 1 COG Pilot and Phase 1 Consortium trials that employed the Rolling 6 design with hypothetical results under the assumption that a 3+3 design had been executed. The number of evaluable patients required to complete the study, number of DLTs, number of inevaluable patients, overall study duration, time suspended to enrollment (i.e., waiting for DLT evaluation), and DLT risk are compared between study designs using Wilcoxon’s signed rank test. RESULTS/ANTICIPATED RESULTS: The Rolling 6 study design required less time to complete the studies compared with 3+3 design (median 273 vs. 297 days, P = 0.01). In general, the Rolling 6 study design required more patients, had more inevaluable patients, and there were more dose limiting toxicity (DLT) events. However, there was no significant difference in DLT risk (median 0.15 vs. 0.17, P = 0.72). DISCUSSION/SIGNIFICANCE OF IMPACT: The Rolling 6 study design effectively shortens the study conduct timeline compared with the traditional 3+3 design for Phase 1 COG Pilot and Phase 1 Consortium trials without increasing the risk of toxicity.
Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45–75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component.
Aim
To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial.
Method
Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis.
Findings
Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as ‘kick-starting’ regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of ‘top-up’ intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups).
Conclusion
A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.
Understanding the origin of modern communities is a fundamental goal of ecology, but reconstructing communities with durations of 103–106 years requires data from the fossil record. Early Pliocene to latest Pleistocene faunas and sediments in the Meade Basin and modern soils and rodents from the same area are used to examine the role of environmental change in the emergence of the modern community. Paleoenvironmental proxies measured on modern surface soils and paleosols are described, and faunal dynamics of fossil rodents are discussed. Mean annual precipitation (MAP) was estimated from elemental concentrations and magnetic properties, and warm-season temperature and δ18O of soil water was estimated using carbonate isotope paleothermometry on pedogenic nodules. MAP and temperature estimates from paleosols exhibit no short-term variability, no long-term trends, and generally bracket modern values. Estimated soil water δ18O values increased through time, suggesting aridification played a role in the evolution of the regional grassland ecosystem. Carbon isotope analyses of biomarkers are used to examine the abundance of C4 grasses, which suggest more C4 biomass and more variability in C4 biomass than carbonate proxies. Rodent species richness remained constant due to balanced rates of extinction and immigration, both of which show episodic spikes consistent with a balance between forcing mechanisms that result in equilibrium on long time scales. Overall, these results suggest that different mechanisms of faunal change may be acting at different time scales, although the stratigraphic resolution of paleoenvironmental proxies needs to be increased, and body size and dietary distributions of rodents need to be determined before which processes of change are most important can be decided.
Drawing on everyday telephone and video interactions, this book surveys how English speakers use grammar to formulate responses in ordinary conversation. The authors show that speakers build their responses in a variety of ways: the responses can be longer or shorter, repetitive or not, and can be uttered with different intonational 'melodies'. Focusing on four sequence types: responses to questions ('What time are we leaving?' - 'Seven'), responses to informings ('The May Company are sure having a big sale' - 'Are they?'), responses to assessments ('Track walking is so boring. Even with headphones' - 'It is'), and responses to requests ('Please don't tell Adeline' - 'Oh no I won't say anything'), they argue that an interactional approach holds the key to explaining why some types of utterances in English conversation seem to have something 'missing' and others seem overly wordy.