and related disorders (PDRD) have consequences for quality of life (QoL) and are the 14th leading cause of death in the United States. Despite growing interest in palliative care (PC) for persons with PDRD, few studies are available supporting its effectiveness. OBJECTIVE To determine if outpatient PC is associated with improvements in patient-centered outcomes compared with standard care among patients with PDRD and their caregivers. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial enrolled participants at 3 academic tertiary care centers between November 1, 2015, and September 30, 2017, and followed them up for 1 year. A total of 584 persons with PDRD were referred to the study. Of those, 351 persons were excluded by phone and 23 were excluded during in-person screenings. Patients were eligible to participate if they had PDRD and moderate to high PC needs. Patients were excluded if they had urgent PC needs, another diagnosis meriting PC, were already receiving PC, or were unable or unwilling to follow the study protocol. Enrolled participants were assigned to receive standard care plus outpatient integrated PC or standard care alone. Data were analyzed between November 1, 2018, and December 9, 2019. INTERVENTIONS Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner. MAIN OUTCOMES AND MEASURES The primary outcomes were the differences in patient quality of life (QoL; measured by the Quality of Life in Alzheimer Disease scale) and caregiver burden (measured by the Zarit Burden Interview) between the PC intervention and standard care groups at 6 months. RESULTS A total of 210 patients with PDRD (135 men [64.3%]; mean [SD] age, 70.1 [8.2] years) and 175 caregivers (128 women [73.1%]; mean [SD] age, 66.1 [11.1] years) were enrolled in the study; 193 participants (91.9%) were white and non-Hispanic. Compared with participants receiving standard care alone at 6 months, participants receiving the PC intervention had better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, 0.47-3.27; P = .009). No significant difference was observed in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, −1.62; 95% CI, −3.32 to 0.09; P = .06). Other significant differences favoring the PC intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. No outcomes favored standard care alone. Secondary analyses suggested that benefits were greater for persons with higher PC needs. CONCLUSIONS AND RELEVANCE Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone. This study supports efforts to integrate PC into PDRD care. The lack of diversity a...

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IntroductionNumerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions.MethodsWe systematically searched the following databases: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified.ResultsA total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge.ConclusionsReducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people.

Terrestrial laser scanning (TLS) has been used extensively in Earth Science for acquisition of digital outcrop data over the past decade. Structure-frommotion (SfM) photogrammetry has recently emerged as an alternative and competing technology. The real-world performance of these technologies for ground-based digital outcrop acquisition is assessed using outcrops from North East England and the United Arab Emirates. Both TLS and SfM are viable methods, although no single technology is universally best suited to all situations. There are a range of practical considerations and operating conditions where each method has clear advantages. In comparison to TLS, SfM benefits from being lighter, more compact, cheaper, more easily replaced and repaired, with lower power requirements. TLS in comparison to SfM provides intrinsically validated data and more robust data acquisition in a wide range of operating conditions. Data post-processing is also swifter. The SfM data sets were found to contain systematic inaccuracies when compared to their TLS counterparts. These inaccuracies are related to the triangulation approach of the SfM, which is distinct from the time-of-flight principle employed by TLS. An elaborate approach is required for SfM to produce comparable results to TLS under most circumstances.

The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. suggests that the primary control on relay aspect ratio (overlap/separation) is a scale-12 invariant process, such as the stress interaction between the overlapping fault tips as 13 suggested by previous authors. Within the compiled global dataset host rock lithology does 14 not appear to be a first-order control. Much of the observed scatter can be attributed to the 15 spread of measurements recorded from individual relay zones, which relates to the evolving 16 three-dimensional geometry of the relay zone as displacements on the bounding faults 17 increase. Relay ramps exposed at two localities where the faults cut layered sedimentary 18 sequences display mean aspect ratios of 8.20 and 8.64 respectively, more than twice the 19 global mean (4.2). Such high aspect ratios can be attributed to the relay-bounding faults 20 having initially been confined within competent layers, facilitating the development of large 21 overlap lengths. The presence of pre-existing structures (veins) at fault tips may also 22 enhance fault propagation, giving rise to increased overlap lengths. 23 Keywords: 24Relay zone scaling; mechanical stratigraphy; fault interaction; aspect ratio; and stress field. 25 26 27

Additional information:Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.

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