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Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.
We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.
Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.
Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
Background: Lactate, a by-product of glycolysis, has been well established as a marker of poor tissue perfusion. Elevated lactate production is observed in tumor glycolysis known as the Warburg effect. We have previously shown that serum lactate correlated with brain tumor grade. In this prospective study we aimed to determine if the preoperative serum lactate correlated with preoperative MR spectroscopy and in lactate levels in the fresh frozen tissue samples. Methods: Twenty-one glioma patients (13 male, 8 female) ages 34 – 86 underwent craniotomy at a single institution by lead author. Tumor pathology revealed a Glioblastoma (n=16), grade II (oligodendroglioma n=1) and Grade III Glioma (anaplastic astrocytoma n=4). Preoperative spectroscopy was performed on 18 patients. A fellowship trained neuro-radiologist (JPC) was blinded to the serum and tissue lactate levels and graded the spectroscopy lactate levels as low or elevated. Results: There was direct correlation of spectroscopy tissue lactate levels with serum lactate levels. Pre-operative serum lactate (range 6.6- 29.9 mg/dl) was directly correlated with the fresh frozen tissue lactate levels (range 0.1 – 0.39 ug/mg; Pearson r=0.6 p = 0.0021). Conclusions: This study supports that serum lactate correlates with spectroscopy and tissue lactate levels.
The suppression of interferences from atomic and molecular isobars is a key requirement for the extension of accelerator mass spectrometry (AMS) to the analysis of new cosmogenic isotopes and for increasing the range of applications for small AMS systems. In earlier work, it was shown that unwanted isobars can be eliminated by anion-gas reactions (Litherland et al. 2007). Recently, a prototype system in which such reactions could be applied to ions from an AMS ion source, the Isobar Separator for Anions (ISA), was described (Eliades et al. 2009). This system decelerates the beam of rare anions from keV to eV energies, guides them through a single radiofrequency quadrupole (RFQ) gas cell, and re-accelerates them for further analysis in a 2.5MV AMS system. Tests of this system with Cl and S anions and NO2 gas showed a suppression of S with respect to Cl of over 6 orders of magnitude, with a transmission of ∼30% for the Cl beam. In this work, results of the analysis of a range of standard reference materials are reported; these show the linearity of the system for measuring the 36Cl/35Cl ratio over a span of 2 orders of magnitude. Further tests, using the AMS system as a diagnostic tool, have provided clues about the loss of Cl at higher cell pressure and the nature of the residual low level of S transmission. These lead to the assessment of various gases for cooling the Cl– beam. Suppression measurements for 41K in the analysis of 41Ca, using NO2 as a reaction gas, are also discussed. These preliminary measurements have provided data for the development of a more advanced system with separate cooling and reaction cells.
The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
The mean air temperature of the Icelandic interior is below 10 °C. However, we have previously observed 16S rDNA sequences associated with thermophilic lineages in Icelandic basalts. Measurements of the temperatures of igneous rocks in Iceland showed that solar insolation of these low albedo substrates achieved a peak surface temperature of 44.5 °C. We isolated seven thermophilic Geobacillus species from basalt with optimal growth temperatures of ~65 °C. The minimum growth temperature of these organisms was ~36 °C, suggesting that they could be active in the rock environment. Basalt dissolution rates at 40 °C were increased in the presence of one of the isolates compared to abiotic controls, showing its potential to be involved in active biogeochemistry at environmental temperatures. These data raise the possibility of transient active thermophilic growth in macroclimatically cold rocky environments, implying that the biogeographical distribution of active thermophiles might be greater than previously understood. These data show that temperatures measured or predicted over large scales on a planet are not in themselves adequate to assess niches available to extremophiles at micron scales.
In implementing a hospital mandatory influenza vaccination policy, we developed an automated, real-time tracking and reminder system. Of 6,957 policy-covered individuals automatically identified, automated reminders left only 5 requiring counseling. This decreased Occupational Health workload in contacting noncompliant individuals and hosting vaccination events while simultaneously facilitating a 96% vaccination rate.
Infect Control Hosp Epidemiol 2014;35(11):1421–1424
The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms.
Materials and methods:
A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms.
The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency.
Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.
Monte Carlo simulations of capacitors with polycrystalline (Bax, Sr1−x)TiO3 (BST) dielectrics were performed. The variation in capacitors due to the polycrystalline microstructure of the dielectric was investigated, as well as the effects of varying the distribution of crystal sizes. When a lognormal probability density function (pdf) was used to approximate the crystal area pdf and the average number of crystals per capacitor was near 100, it was found that the minimum capacitance value was nearly independent of the standard deviation of crystal area distribution. Both the mean and maximum capacitance values were found to increase as the width of the standard deviation increased.
This paper reviewed work to date on multicomponent oxides deposited, utilizing openatmosphere Combustion Chemical Vapor Deposition for electronic applications. Epitaxial barium strontium titanate and strontium titanate thin films were deposited on (100) MgO single crystal substrates. They were patterned to form interdigitated structures for electrically tunable devices, namely, coupled microstripline phase shifters (CMPS). The undoped, as-deposited perovskite dielectrics exhibited a figure of merit of 53°/dB at 20 GHz and 23°C, indicating high degree of tunability and fairly low loss. High-permittivity (ε=263), polycrystalline BST and SrTiO3 were studied for dynamic random access memory, and leakage current density of 10−7 A/cm2 was measured. Intended for non-volatile ferroelectric memory, lead zirconium titanate was deposited onto a seed layer of perovskite structure to prevent the growth of the unwanted pyrochlore phase. To function as buffer layers for superconductor applications, epitaxial CeO2, YSZ, SrTiO3, LaAlO3, Y2O3, and Yb2O3 coatings on single crystal and textured nickel substrate were investigated. Electronic analyses and characterization, using SEM, EDS, XRD, and X-ray pole figures, were presented.
Detailed investigations of strain generation and relaxation in Si films grown on thin Si0.78Ge0.22 virtual substrates using Raman spectroscopy are presented. Good virtual substrate relaxation (>90%) is achieved by incorporating C during the initial growth stage. The robustness of the strained layers to relaxation is studied following high temperature rapid thermal annealing typical of CMOS processing (800-1050 °C). The impact of strained layer thickness on thermal stability is also investigated. Strain in layers below the critical thickness did not relax following any thermal treatments. However for layers above the critical thickness the annealing temperature at which the onset of strain relaxation occurred appeared to decrease with increasing layer thickness. Strain in Si layers grown on thin and thick virtual substrates having identical Ge composition and epilayer thickness has been compared. Relaxation through the introduction of defects has been assessed through preferential defect etching in order to verify the trends observed. Raman signals have been analysed by calibrated deconvolution and curve-fitting of the spectra peaks. Raman spectroscopy has also been used to study epitaxial layer thickness and the impact of Ge out-diffusion during processing. Improved device performance and reduced self-heating effects are demonstrated in thin virtual substrate devices when fabricated using strained layers below the critical thickness. The results suggest that thin virtual substrates offer great promise for enhancing the performance of a wide range of strained Si devices.
High quality CdS thin films made with ultrasonic agitation during chemical bath deposition were investigated. The change in band gap and variation of atomic stacking during the film growth was observed as a function of bath pH. The band gap of as-deposited thin films of CdS was found to be between 2.26 eV and 2.50 eV, the highest being observed when the pH was 9.0. The transition from cubic (β-CdS) to hexagonal (a-CdS) was observed with decreasing pH. The lattice parameters of CdCl2 treated CdS were found to be a = 0.414 nm and c = 0.672 nm. Calculations based on the Sherrer formula showed significant grain growth after annealing with CdCl2. No apparent effect of ultrasonication on crystalline structure of CdS was seen in this method, although ultrasonication was noted to produce films with a higher quality optical surface. A maximum bath temperature was fixed at 70°C in order to suppress the rate of homogeneous reaction and minimise the evaporation of ammonia from the chemical bath.
The effects of low levels of nitrogen addition (7·7 and
N ha−1 yr−1) on plant sensitivity to
biotic and abiotic
stress were studied at a lowland heath in the south of England that
has received N treatments since 1989. Larval
growth rates and adult weights of heather beetles were found to be
significantly higher when insects were reared
on plants that had received additional N, with implications for insect
survival and reproductive success.
Electrolyte leakage measurements failed to reveal any significant
impact of N addition on plant sensitivity to frost
episodes in early winter. In April, however, there was some evidence
of slightly decreased frost hardiness in plants
receiving additional N. Accelerated spring bud burst also suggested
earlier physiological activity in N-treated
plots. The rate of water loss from excised shoots of Calluna vulgaris
(L.) Hull was significantly faster in plants
receiving additional N, although no difference in plant water potential
was measured in the field after a prolonged
dry spell. Whilst experimental N addition had only a small effect on
plant sensitivity to abiotic stress, the
relationship between enhanced deposition and increased insect performance
was clear, with the potential for
substantially increased insect damage at deposition rates around the critical
load contributing to the formation of gaps in the Calluna canopy.