The volatilization of polycarbosilanes is important to the processing and performance of polymer infiltration and pyrolysis‐based ceramic matrix composites. Low molecular weight (MW) polycarbosilane ...is often present in preceramic polymers and enhances viscosity for the purpose of composite infiltration. Due to the volatility of low MW chains, a model was developed to semi‐empirically determine the MW distribution and then predict the mass yield and evolution of the MW distribution as a function of temperature and time for StarPCS™ SMP‐10. The enthalpy of vaporization, the temperature dependence of the enthalpy of vaporization, the temperature dependence of the normal boiling point and a representation of the molecular weight distribution were fit using a series of thermogravimetric measurements, involving isothermal holds on a particular batch of SMP‐10. Once calibrated for SMP‐10 in this fashion, the molecular weight distribution of different batches of SMP‐10 could be fit using a thermogravimetric measurement involving a reduced temperature‐time series. The model was then predictive of mass loss over time for temperatures below the onset of curing (>90°C). Understanding this volatilization enables improved SiC yield, reduced processing time and minimizing void/bubble formation.
Many countries worldwide have experienced reductions in provision of formal long-term care services amidst rising need for care. Provision of unpaid care, meanwhile, has grown. This includes care ...provided by young people. Care responsibilities can affect a young people's health, education and employment. We aimed to investigate the impacts on the employment and health of young people aged 16 to 25 of providing care, and the associated individual and public expenditure costs.
We examined employment, earnings and health impacts for individuals, and a range of economic impacts for society, focusing on young people aged 16 to 25 providing unpaid care in England. We applied regression analysis to data from three waves of the UK Household Longitudinal Study (2013/2015, 2014/2016, and 2015/2017) to compare employment and health outcomes among carers and non-carers, and two-part Generalised Linear Models to estimate costs. To address potential selection bias, we then used propensity score matching methods to explore outcomes for a matched sub-sample of young adult carers who started providing care at baseline (2014/16).
Young people aged 16 to 25 who provided care at baseline (2014/16) were less likely to be in employment, had lower earnings from paid employment, and had poorer mental and physical health at follow-up (2015/17) compared to young people of the same age who were not providing care at baseline.. There were substantial costs to the state of young adults providing care from lower tax revenue, welfare benefit payments, and health service use. In aggregate, these costs amounted to £1048 million annually in 2017.
High individual impacts and costs to the state of providing unpaid care, and the potential of such impacts to compound existing inequalities, have many implications for policy and practice in the health, social care, employment and welfare benefits sectors. In particular, the findings reinforce the case for reducing the need for young people to provide unpaid care, for example through better provision of formal care services, and to provide ongoing support for those young people who do provide care. As impacts are seen in a number of domains, support needs to be multidimensional.
The paper explores Pascal’s idea according to which the teachings of the Church assume the hiddenness of God, and, hence, there is nothing surprising in the fact of the occurrence of nonresistant ...nonbelief. In order to show it the paper invokes the doctrines of the Incarnation, the Church as the Body of Christ, and the Original Sin. The first one indicates that there could be greater than nonbelief obstacle in forming interpersonal bonds with God, namely the ontological chasm between him and human persons. The assumption of the human nature by the Son of God could be seen as a cure for this problem. The doctrine of the Church shows it as an end in itself, and in order for the Church to have meaning and to exist there has to be nonbelief in the world. Finally, the dogma of the Original Sin shows that there is no category of purely nonresistant nonbelief. The paper also addresses Schellenberg’s “accommodationist strategy” from the perspective of the Christian theology and in the last part it investigates what should be the influence of the fact of the hiddenness on theology’s take on the divine revelation.
The costs of dementia in England Wittenberg, Raphael; Knapp, Martin; Hu, Bo ...
International journal of geriatric psychiatry,
July 2019, Letnik:
34, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Objectives
This study measures the average per person and annual total costs of dementia in England in 2015.
Methods/Design
Up‐to‐date data for England were drawn from multiple sources to identify ...prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic impacts, and other costs of dementia. These data were used in a refined macrosimulation model to estimate annual per‐person and aggregate costs of dementia.
Results
There are around 690 000 people with dementia in England, of whom 565 000 receive unpaid care or community care or live in a care home. Total annual cost of dementia in England is estimated to be £24.2 billion in 2015, of which 42% (£10.1 billion) is attributable to unpaid care. Social care costs (£10.2 billion) are three times larger than health care costs (£3.8 billion). £6.2 billion of the total social care costs are met by users themselves and their families, with £4.0 billion (39.4%) funded by government. Total annual costs of mild, moderate, and severe dementia are £3.2 billion, £6.9 billion, and £14.1 billion, respectively. Average costs of mild, moderate, and severe dementia are £24 400, £27 450, and £46 050, respectively, per person per year.
Conclusions
Dementia has huge economic impacts on people living with the illness, their carers, and society as a whole. Better support for people with dementia and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dementia.
Friction welding or electron/laser beam welding of nickel superalloys compromises the microstructure with localized melting and heat-affected zones (HAZ). In this work, Field-Assisted Sintering ...Technology (FAST) is studied as an alternative method for solid-state diffusion bonding of superalloys CM247LC and Inconel 718. Bonding microstructures and room-temperature tensile strengths are evaluated. Preliminary results suggest that FAST bonding leads to an interface with a compositional gradient without producing a HAZ and without losing tensile strength.
Two-thirds of people with dementia live at home, receiving most care from family carers, about 40% of whom have clinically significant depression or anxiety. This impacts on the person with dementia, ...families and society, predicting care breakdown. There are currently no clinically effective and cost-effective NHS family carer interventions.
To assess the STrAtegies for RelaTives (START) intervention in the short (4 and 8 months) and long term (1 and 2 years) compared with treatment as usual (TAU).
Randomised, parallel-group, superiority trial with blinded assessment recruiting participants 2:1 (intervention to TAU) to allow for therapist clustering.
Three UK mental health services and one neurological service.
Family carers of people with dementia.
Eight-session manual-based coping intervention delivered by supervised psychology graduates to individuals.
Affective symptoms Hospital Anxiety and Depression Scale-total (HADS-T) and cost-effectiveness. Secondary measures: anxiety and depression symptoms and caseness, quality of life (QoL), abusive behaviour and long-term care home admission.
Two hundred and sixty participants were randomised (173 intervention, 87 TAU). We used intention-to-treat analysis in the short term (152 intervention, 77 TAU) and in the long term (140 intervention, 69 TAU). In the short term, the intervention group had lower HADS-T mean difference -1.80, 95% confidence interval (CI) -3.29 to -0.31; p=0.02 and higher quality-adjusted life-years (QALYs) (mean difference 0.03, 95% CI -0.01 to 0.08). Costs were no different between groups mean £ 252 (95% CI -£ 28 to £ 565) for intervention group. The cost-effectiveness acceptability curve showed a greater than 99% chance of being cost-effectiveness at a £ 30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score. Carers in the intervention group had less case-level depression odds ratio (OR) 0.24, 95% CI 0.07 to 0.76, a trend towards reduced case-level anxiety (OR 0.30, 95% CI 0.08 to 1.05), lower Hospital Anxiety and Depression Scale-anxiety (HADS-A) (-0.91, 95% CI -1.76 to -0.07; p = 0.03) and Hospital Anxiety and Depression Scale-depression (HADS-D) (-0.91, 95% CI -1.71 to -0.10; p = 0.03) and higher Health Status Questionnaire (HSQ) QoL (mean difference 4.09, 95% CI 0.34 to 7.83). Group differences in abusive behaviour (OR 0.48, 95% CI 0.18 to 1.27) and the person with dementia's quality of life-Alzheimer's disease (QoL-AD) (mean increase 0.59, 95% CI -0.72 to 1.89) were not significant. In the long term, the intervention group had lower HADS-T (mean difference -2.58, 95% CI -4.26 to -0.90; p = 0.03) and higher QALYs (mean difference 0.03, 95% CI -0.01 to 0.06). Carers in the intervention group had less case-level depression (OR 0.14, 95% CI 0.04 to 0.53), a trend towards reduced case-level anxiety (OR 0.57, 95% CI 0.26 to 1.24), lower HADS-A (-1.16, 95% CI -2.15 to -0.18) and HADS-D (1.45, 95% CI -2.32 to -0.57), and higher HSQ (mean difference 7.47, 95% CI 2.87 to 12.08). Thirty-two (18.7%) people with dementia in the intervention group and 17 (20.2%) in TAU were admitted to a care home (hazard ratio 0.83, 95% CI 0.44 to 1.56; p = 0.56). There were no significant differences between groups in abusive behaviour (OR 0.83, 95% CI 0.36 to 1.94), the person with dementia's QoL-AD (0.17, 95% CI -1.37 to 1.70) or costs (£ 336, 95% CI -£ 223 to £ 895) for intervention group. The probability that the intervention would be seen as cost-effective at £ 30,000/QALY threshold and cost-effectiveness on the HADS-T remained high.
The START intervention was clinically effective and cost-effective in the short and longer term. The results are robust to the sensitivity analyses performed. Future work is needed to consider mechanism of action; the effects on people with dementia in clinical terms (cognition, neuropsychiatric symptoms, longer-term care home admission); and on health and social care costs. In addition, we will explore the effects of carer abusive behaviour on the care recipient's care home admission and if this then reduces abusive behaviour. We would also like to implement START and evaluate this implementation in clinical practice.
Current Controlled Trials ISCTRN70017938.
Solidification of welded SiC–ZrB2–ZrC ceramics King, Derek S.; Watts, Jeremy L.; Cissel, Kathleen S. ...
Journal of the American Ceramic Society,
September 2018, 20180901, Letnik:
101, Številka:
9
Journal Article
Recenzirano
A silicon carbide‐based ceramic, containing 50 vol% SiC, 35 vol% ZrB2, and 15 vol% ZrC was plasma arc welded to produce continuous fusion joints with varying penetration depth. The parent material ...was preheated to 1450°C and arc welding was successfully implemented for joining of the parent material. A current of 138 A, plasma flow rate of ~1 L/min or ~0.5 L/min, and welding speed of ~8 cm/min were utilized for repeated joining, with full penetration fusion zones along the entire length of the joints. Solidification was determined to occur through the crystallization of β‐SiC (3C), then the simultaneous solidification of SiC and ZrB2, and lastly through the simultaneous solidification of SiC, ZrB2, and ZrC through a ternary eutectic reaction. The ternary eutectic composition was determined to be 35.3 ± 2.2 vol% SiC, 39.3 ± 3.8 vol% ZrB2, and 25.4 ± 3.0 vol% ZrC. A dual fusion zone microstructure was always observed due to convective melt pool mixing. The SiC content at the edge of the fusion zone was 57 vol%, while SiC content at the center of the fusion zone was 42 vol% although the overall SiC content was still nominally 50 vol% throughout the entire fusion zone.
Zirconium diboride and zirconium carbide‐based ceramics were joined by plasma arc welding to demonstrate the versatility of this technique. A parent material composition consisting of ZrB2 with ...20 vol% ZrC was hot pressed to near full density, sectioned to produce specimens for welding, and welded together to produce billets for mechanical property studies. The four‐point flexure strength of the parent material was ~660 MPa, while the strength of the welded specimens ranged from ~140 to ~250 MPa. Microstructural analysis revealed that decreased strength in the welded specimens was caused by volume flaws, microcracking of large ZrB2 grains (up to 1 mm in length), and residual tensile stresses that developed at the surface of weld pools during cooling. The versatility of plasma arc welding was demonstrated by joining of ZrC‐based ceramics and fabricating three ZrB2–ZrC components for potential applications, including a high‐temperature electrical contact, an ultra‐high‐temperature thermocouple, and a wedge that was a notional wing leading edge. These three applications demonstrated the ability to join ceramics to a refractory metal, fabricate a chemically inert high‐temperature thermocouple, and produce complex shapes for aerospace applications.
The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the ...public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, OR = 2.49, 95%CI = 1.44-4.30, p = 0.001, remittent OR = 2.16, 95%CI = 1.27-3.69, p = 0.005 or persistent OR = 3.01, 95%CI = 1.69-5.36, p<0.001), higher impact of symptoms on adolescent's life (OR = 1.32, 95%CI = 1.19-1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05-1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (beta = 0.25, 95%CI = 0.12-0.39, p<0.001), lower parental stigma (beta = 0.12, 95%CI = 0.02-0.23, p = 0.020) and white ethnicity (beta = 0.55, 95%CI = 0.04-1.07, p = 0.036). The impact of mental health problems on adolescents' daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.
IntroductionFrailty is a multidimensional syndrome in which multiple small physiological deficits accumulate gradually, resulting in a loss of physiological reserve and adaptability, putting a ...patient that is exposed to a stressor at a higher risk of adverse outcomes. Both pre-frailty and frailty are associated with poor patient outcomes and higher healthcare costs. The effect of a prehabilitation programme and standard care on the quality of recovery in pre-frail and frail patients undergoing elective cardiac surgery will be compared.Method and analysisA single-centre, superiority, stratified randomised controlled trial with a blinded outcome assessment and intention-to-treat analysis. Pre-frail and frail patients awaiting elective coronary artery bypass graft, with or without valvular repair/replacement, will be recruited. 164 participants will be randomly assigned to either prehabilitation (intervention) or standard care (no intervention) groups. The prehabilitation group will attend two sessions/week of structured exercise (aerobic and resistance) training, supervised by a physiotherapist, for 6–10 weeks before surgery with early health promotion advice in addition to standard care. The standard care group will receive the usual routine care (no prehabilitation). Frailty will be assessed at baseline, hospital admission and at 1 and 3 months after surgery. The primary outcomes will be participants' perceived quality of recovery (15-item Quality of Recovery questionnaire) after surgery (day 3), days at home within 30 days of surgery and the changes in WHO Disability Assessment Schedule 2.0 score between baseline and at 1 and 3 months after surgery. Secondary outcomes will include major adverse cardiac and cerebrovascular events, psychological distress levels, health-related quality of life and healthcare costs.Ethics and disseminationThe Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No. 2017.696 T). The findings will be presented at scientific meetings, in peer-reviewed journals and to study participants.Trial registration numberChiCTR1800016098; Pre-results.
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