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The direct costs of care were evaluated prospectively in a sample of people with Parkinson's disease (PD) in the United Kingdom in 1998. The subjects were drawn from a random sample of general practitioner practices within a representative sample of 36 Regional Health Authorities and the equivalent. A total of 444 resource use questionnaires with usable data were returned (response rate, 59%). The total mean annual cost of care per patient for all patients by age was 5,993 pounds (9,554 euro, n = 432). Hoehn and Yahr stage significantly (P < 0.001) influenced expenditure by stage as follows: 0 and I, 2,971 pounds (4,736 euro, n = 110); II, pound 3,065 (4,886 euro, n = 89); III, 6,183 pounds (9,857 euro, n = 120); IV, 10,134 pounds (euro;16,155, n = 87); V, 18,358 pounds (29,265 euro, n = 17). National Health Service costs accounted for approximately 38% and social services for 34% of the direct costs of care. Drug expenditure accounted for 24% of overall costs in the <65 years age group and 10% in patients aged >85 years. A move from home to residential care was associated with an approximately 500% cost increase. In conclusion, PD imposes significant direct costs on public services and on individuals. These costs should be taken into account when allocating public funds.

the practicality of acquiring information on care home residents has been demonstrated. The care needs of people in care homes are largely determined by progressive chronic diseases. A single assessment and commissioning at the point of entry to care services is unlikely to address changing needs. Alternatives to institutional long-term care should only be considered in the context of current resident profiles, the practicality of providing alternative models and likely projected population needs.

Mite digestive processes are inferred from gut expansion and contraction time in the free-living predatory soil mite Pergamasus longicornis (Berlese), estimated using a temporal series of histological sections. Gut regions (bar the rectal vesicle) behave broadly in unison for rapid initial filling (ingestion half-life about 2-3 min; max 8 min), but behave heterogeneously when slowly emptying (digestion/egestion half-life from about 2-3 h; max 8.5 h). Anterior gut regions fill and empty the earliest. Posterior gut regions take the longest to fill and to empty. Switching first from filling-predominating to emptying-predominating in the gut occurs around 2 h from the start of feeding. Median time for the initial completion of gut filling and for the commencement of gut emptying is 10 min and 12.5 h, respectively, from the start of feeding. Three phases of gut changes are critically discussed: rapid filling, concentration by fluid loss (via coxal glands), and slow emptying. Independent corroboration of coxal droplet formation is included. Predictions to confirm or refute postulated mechanisms of salivary, coxal or rectal water balance are given. Overall total gut filling (ingestion) plus gut emptying (digestion/egestion) time in this poikilotherm is approximately 29-52.5 h (1+ - 2+ days) at room temperature from the start of feeding on large dipteran prey ([Formula: see text] gut emptyings per day). Pergamasus longicornis exhibits the stiff digestive system of an intermittent 'bolus' feeder.

This pilot study demonstrated that use of RAMP was associated with a statistically significant decrease in total antibiotic consumption and has the potential to be an important antimicrobial stewardship tool for NHs.

BackgroundCare home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes.MethodsWe conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group.ResultsStrategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change.ConclusionHow relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported.

A model based upon mechanics is used in a re-analysis of historical acarine morphological work augmented by an extra seven zoophagous mesostigmatid species. This review shows that predatory mesostigmatids do have cheliceral designs with clear rational purposes. Almost invariably within an overall body size class, the switch in predatory style from a worm-like prey feeding (‘crushing/mashing’ kill) functional group to a micro-arthropod feeding (‘active prey cutting/slicing/slashing' kill) functional group is matched by: an increased cheliceral reach, a bigger chelal gape, a larger morphologically estimated chelal crunch force, and a drop in the adductive lever arm velocity ratio of the chela. Small size matters. Several uropodines (Eviphis ostrinus, the omnivore Trachytes aegrota, Urodiaspis tecta and, Uropoda orbicularis) have more elongate chelicerae (greater reach) than their chelal gape would suggest, even allowing for allometry across mesostigmatids. They may be: plesiosaur-like high-speed strikers of prey, scavenging carrion feeders (like long-necked vultures), probing/burrowing crevice feeders of cryptic nematodes, or small morsel/fragmentary food feeders. Some uropodoids have chelicerae and chelae which probably work like a construction-site mechanical excavator-digger with its small bucket. Possible hoeing/bulldozing, spore-cracking and tiny sabre-tooth cat-like striking actions are discussed for others. Subtle changes lead small mesostigmatids to be predator–scavengers (mesocarnivores) or to be predator–fungivores (hypocarnivores). Some uropodines (e.g., the worm-like prey feeder Alliphis siculus and, Uropoda orbicularis) show chelae similar in design to astigmatids and cryptostigmatids indicating possible facultative saprophagy. Scale matters—obligate predatory designs (hypercarnivory) start for mesostigmatids with chelal gape > 150 μm and cheliceral reach > 350 μm (i.e., about 500–650 μm in body size). Commonality of trophic design in these larger species with solifugids is indicated. Veigaia species with low chelal velocity ratio and other morphological strengthening specialisms, appear specially adapted in a concerted way for predating active soft and fast moving springtails (Collembola). Veigaia cerva shows a markedly bigger chelal gape than its cheliceral reach would proportionately infer suggesting it is a crocodile-like sit-and-wait or ambush predator par excellence. A small chelal gape, low cheliceral reach, moderate velocity ratio variant of the worm-like feeding habit design is supported for phytoseiid pollenophagy. Evidence for a resource partitioning model in the evolution of gnathosomal development is found. A comparison to crustacean claws and vertebrate mandibles is made. Alliphis siculus and Rhodacarus strenzkei are surprisingly powerful mega-cephalics for their small size. Parasitids show a canid-like trophic design. The chelicera of the nematophagous Alliphis halleri shows felid-like features. Glyphtholaspis confusa has hyaena-like cheliceral dentition. The latter species has a markedly smaller chelal gape than its cheliceral reach would suggest proportionately, which together with a high chelal velocity ratio and a high estimated chelal crunch force matches a power specialism of feeding on immobile tough fly eggs/pupae by crushing (durophagy). A consideration of gnathosomal orientation is made. Predatory specialisms appear to often match genera especially in larger mesostigmatids, which may scale quite differently. Comparison to holothyrids and opilioacarids indicates that the cheliceral chelae of the former are cutting-style and those of the latter are crushing-style. A simple validated easy-to-use ‘2:1 on’ predictive algorithm of feeding habit type is included based on a strength-speed tradeoff in chelal velocity ratio for ecologists to test in the field.