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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.
Methods
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.
Results
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.
Conclusion
Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
As part of further investigations into three linked haemorrhagic fever with renal syndrome (HFRS) cases in Wales and England, 21 rats from a breeding colony in Cherwell, and three rats from a household in Cheltenham were screened for hantavirus. Hantavirus RNA was detected in either the lungs and/or kidney of 17/21 (81%) of the Cherwell rats tested, higher than previously detected by blood testing alone (7/21, 33%), and in the kidneys of all three Cheltenham rats. The partial L gene sequences obtained from 10 of the Cherwell rats and the three Cheltenham rats were identical to each other and the previously reported UK Cherwell strain. Seoul hantavirus (SEOV) RNA was detected in the heart, kidney, lung, salivary gland and spleen (but not in the liver) of an individual rat from the Cherwell colony suspected of being the source of SEOV. Serum from 20/20 of the Cherwell rats and two associated HFRS cases had high levels of SEOV-specific antibodies (by virus neutralisation). The high prevalence of SEOV in both sites and the moderately severe disease in the pet rat owners suggest that SEOV in pet rats poses a greater public health risk than previously considered.
Passive surveillance for lyssaviruses in UK bats has been ongoing since 1987 and has identified 13 cases of EBLV-2 from a single species; Myotis daubentonii. No other lyssavirus species has been detected. Between 2005 and 2015, 10 656 bats were submitted, representing 18 species, creating a spatially and temporally uneven sample of British bat fauna. Uniquely, three UK cases originate from a roost at Stokesay Castle in Shropshire, England, where daily checks for grounded and dead bats are undertaken and bat carcasses have been submitted for testing since 2007. Twenty per cent of Daubenton's bats submitted from Stokesay Castle since surveillance began, have tested positive for EBLV-2. Phylogenetic analysis reveals geographical clustering of UK viruses. Isolates from Stokesay Castle are more closely related to one another than to viruses from other regions. Daubenton's bats from Stokesay Castle represent a unique opportunity to study a natural population that appears to maintain EBLV-2 infection and may represent endemic infection at this site. Although the risk to public health from EBLV-2 is low, consequences of infection are severe and effective communication on the need for prompt post-exposure prophylaxis for anyone that has been bitten by a bat is essential.
The frequency response of the shear layers separating from a circular cylinder subject to small-amplitude rotational oscillations has been investigated experimentally in water for the Reynolds number (Re) range 250 to 1200. A hot-film anemometer was placed in the separated shear layers from 1 to 1.5 diameters downstream of the cylinder, and connected to a lock-in analyser. by referencing the lock-in analyser to the cylinder oscillations, the amplitude and phase of the response to different frequency oscillations were measured directly. It is shown that rotational oscillations corresponding to cylinder peripheral speeds between 0.5 and 3% of the free stream can be used to influence the primary (Kármán) mode of vortex generation. For Re greater than ≈ 500, such oscillations can also force the shear-layer vortices associated with the instability of the separating shear layers. Corresponding to the primary and shear-layer modes are two distinct peaks in response amplitude versus frequency curves, and two very different phase versus frequency curves. The response of the shear layers (and near wake) in the range of Kármán frequency suggests qualitative similarities with the response of an oscillator near resonance. Forced oscillations in the higher-frequency shear-layer mode range are simply convected by the shear layers. Close to the cylinder, the shear-layer response is shown to be comparable to that of generic free shear layers studied by others.
Massive stars have profound effects on their surroundings, influencing them by their energetic stellar winds, and finally by supernova explosions. We present a CO 2-1 map of the surroundings of the Wolf-Rayet star WR16, taken with AST/RO at the South Pole, which shows some of these effects.
To study vancomycin-resistant Enterococcus (VRE) prevalence, risk factors, and clustering among hospital inpatients.
Design:
Rectal-swab prevalence culture survey conducted from February 5 to March 22,1996.
Setting:
The Veterans' Affairs Medical Center, Atlanta, Georgia.
Patients:
Hospital (medical and surgical) inpatients.
Results:
The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6; P <.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found.
Conclusions:
At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.
For high-temperature performance of ceramic composites, interfaces are designed to provide toughness through debonding while resisting thermal oxidation in aggressive environments. Thus, the evaluation of interfacial properties at high temperatures is of critical importance. In recent work at USC, interfacial properties were measured at high temperatures by single fiber pushout tests. Six advanced ceramic composites were selected to perform pushout testing at 20–1000°C. Variation in interface designs and effects of thermal history were evaluated with respect to interface failure strength. At higher temperatures, the average interfacial bond strength was often higher. SEM observations were correlated with pushout measurements to evaluate the interfacial behavior.
We have been conducting multi-color observations of a sample of classical ring galaxies with the aim of using them to study the formation and evolution of massive stars. We compare theoretical predictions for the expected color of the material inside the rings assuming that massive stars are created in the wake of the expanding wave. We present ground based data for VIIZw466 and HST data for IIZw28 and the Cartwheel which show strong color gradients.
Colliding ring galaxies provide a remarkable testbed for the study of star formation in perturbed galaxies. In the process of passing through a disk system, a small perturbing galaxy generates a density wave of stars and gas which expands into the host disk. This triggers a wave of star formation. As the star forming wave passes through the host galaxy, progressively older burst populations may be found interior to the ring. As part of a multiwavelength study of ring galaxies, we have performed optical and infrared imaging using the Kitt Peak 2.1m telescope. These images are used to explore the relation between stellar density wave amplitude and star formation rate. Color gradients are searched for which would indicate the presence of an aging burst population interior to the ring.
The world economy has been greatly influenced over the past 10 years by the monetary and fiscal policies of the industrialized nations. Looking back at U.S. economic policy in particular, we see that expansionary monetary policy kept inflation at a high level over the latter half of the 1970s. It was with the aim of curbing this inflation that tight monetary policy was brought into play over the period 1979–82. This restrictive monetary policy, which brought about recession not only in the U.S. but throughout the world, was clearly successful in the sense that it managed to reduce the rate of inflation.
With monetary policy being eased after 1982, large-scale expansionary fiscal policy, including various tax cuts, was implemented. This resulted in an increase in fiscal and trade deficits, high interest rates, a d a strong dollar.
The rising fiscal and trade deficits, in turn, shifted economists' attention to studying the effects of fiscal policy in an open economy context. These studies suggest that the largest factor behind the U.S. current account deficit (or the Japanese current account surplus) is the increase in the U.S. fiscal deficit. As a result, it has become apparent that the U.S. fiscal deficit must be reduced and that Japan must pursue expansionary fiscal policy if the U.S.–Japanese trade imbalance is to decline.
In an attempt to resolve their trade imbalance, the United States and Japan held the historic G5 meeting. While the participants at that meeting recognized the need for the directions in fiscal policy outlined above, political realities suggested that the implementation of such policies would not be easy.
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