A Neptune-mass exoplanet in close orbit around a very low-mass star challenges formation models.

Theories of planet formation predict that low-mass stars should rarely host exoplanets with masses exceeding that of Neptune. We used radial velocity observations to detect a Neptune-mass exoplanet orbiting LHS 3154, a star that is nine times less massive than the Sun. The exoplanet's orbital period is 3.7 days, and its minimum mass is 13.2 Earth masses. We used simulations to show that the high planet-to-star mass ratio (>3.5 × 10-4) is not an expected outcome of either the core accretion or gravitational instability theories of planet formation. In the core-accretion simulations, we show that close-in Neptune-mass planets are only formed if the dust mass of the protoplanetary disk is an order of magnitude greater than typically observed around very low-mass stars.

Precision Nutrition Opportunities to Help Mitigate Nutrition and Health Challenges in Low- and Middle-Income Countries: An Expert Opinion Survey.

Precision nutrition involves several data collection methods and tools that aim to better inform nutritional recommendations and improve dietary intake, nutritional status, and health outcomes. While the benefits of collecting precise data and designing well-informed interventions are vast, it is presently unclear whether precision nutrition is a relevant approach for tackling nutrition challenges facing populations in low- and middle-income countries (LMIC), considering infrastructure, affordability, and accessibility of approaches. The Swiss Food & Nutrition Valley (SFNV) Precision Nutrition for LMIC project working group assessed the relevance of precision nutrition for LMIC by first conducting an expert opinion survey and then hosting a workshop with nutrition leaders who live or work in LMIC. The experts were interviewed to discuss four topics: nutritional problems, current solutions, precision nutrition, and collaboration. Furthermore, the SFNV Precision Nutrition for LMIC Virtual Workshop gathered a wider group of nutrition leaders to further discuss precision nutrition relevance and opportunities. Our study revealed that precision public health nutrition, which has a clear focus on the stratification of at-risk groups, may offer relevant support for nutrition and health issues in LMIC. However, funding, affordability, resources, awareness, training, suitable tools, and safety are essential prerequisites for implementation and to equitably address nutrition challenges in low-resource communities.

Green inhibitors reduce unwanted calcium carbonate precipitation: Implications for technical settings.

Mineral scale deposits in water drainage and supply systems are a common and challenging issue, especially by clogging the water flow. The removal of such unwanted deposits is cost intensive arguing for case-specific and sustainable prevention strategies. In the present study, a novel on-site approach to prevent calcium carbonate (CaCO3) scale formation was assessed in two road tunnel drainages: Application of the eco-friendly green inhibitor polyaspartate (PASP) caused (i) a significant inhibition of CaCO3 precipitation, (ii) a more porous or even unconsolidated consistence of the deposits, and (iii) a shift from calcite to the metastable aragonite and vaterite polymorphs. Even relatively low PASP concentrations (1-33 mg/l) can significantly decrease CaCO3 scale deposition, removing up to ∼7 t CaCO3/year at an efficiency up to 84%. Application of PASP for water conditioning should also consider case-specific microbial activity effects, where consumption of PASP, e.g. by Leptothrix ochracea, can limit inhibition effects.

3D-M3: high-spatial-resolution spectroscopy with extreme AO and 3D-printed micro-lenslets.

By combining integral field spectroscopy with extreme adaptive optics, we are now able to resolve objects close to the diffraction limit of large telescopes, exploring new science cases. We introduce an integral field unit designed to couple light with a minimal plate scale from the SCExAO facility at NIR wavelengths to a single-mode spectrograph. The integral field unit has a 3D-printed micro-lens array on top of a custom single-mode multi-core fiber, to optimize the coupling of light into the fiber cores. We demonstrate the potential of the instrument via initial results from the first on-sky runs at the 8.2 m Subaru Telescope with a spectrograph using off-the-shelf optics, allowing for rapid development with low cost.

Broadband Stability of the Habitable Zone Planet Finder Fabry-Pérot Etalon Calibration System: Evidence for Chromatic Variation.

The comblike spectrum of a white light-illuminated Fabry-Pérot etalon can serve as a cost-effective and stable reference for precise Doppler measurements. Understanding the stability of these devices across their broad (hundreds of nanometers) spectral bandwidths is essential to realizing their full potential as Doppler calibrators. However, published descriptions remain limited to small bandwidths or short time spans. We present an ~6 month broadband stability monitoring campaign of the Fabry-Pérot etalon system deployed with the near-infrared Habitable Zone Planet Finder (HPF) spectrograph. We monitor the wavelengths of each of ~3500 resonant modes measured in HPF spectra of this Fabry-Pérot etalon (free spectral range = 30 GHz, bandwidth = 820-1280 nm), leveraging the accuracy and precision of an electro-optic frequency comb reference. These results reveal chromatic structure in the Fabry-Pérot mode locations and their evolution with time. We measure an average drift on the order of 2 cm s-1 day-1, with local departures up to ±5 cm s-1 day-1. We discuss these behaviors in the context of the Fabry-Pérot etalon mirror dispersion and other optical properties of the system and the implications for the use of similar systems for precise Doppler measurements. Our results show that this system supports the wavelength calibration of HPF at the ≲10 cm s-1 level over a night and the ≲30 cm s-1 level over ~10 days. Our results also highlight the need for long-term and spectrally resolved study of similar systems that will be deployed to support Doppler measurement precision approaching ~10 cm s-1.

Scale deposits in tunnel drainage systems - A study on fabrics and formation mechanisms.

Rapid deposition of chemical sediments, particularly calcium carbonate, is a widespread phenomenon in tunnel constructions, which can significantly disturb water draining. The removal of the scale deposits in the drainage setting is labor and cost intensive. Prediction or prevention of these unwanted scale deposits are challenging and require detailed knowledge on their site-specific source, formation mechanisms and environmental dependencies. This case study combines a mineralogical, (micro)structural, isotopic, microbiological, and hydrochemical approach to understand the formation of scale deposits in an Austrian motorway tunnel. Chemical and isotopic results revealed that all investigated solutions originate from a distinct local aquifer. High pH (11), indicative high alkaline element concentrations (Na 26 mg/l; K 67 mg/l), originated from concrete leaching, and a strong supersaturation in respect to calcite (SI > 1) are representative for the environmental setting of scaling type 1. This type is characterized by the formation of calcite, aragonite, and rarely documented dypingite (Mg5(CO3)4(OH)2*5H2O), and yields in a highly porous material showing minor indications of microbial presence. In contrast, scale deposits of type 2 are strongly microbially influenced, yielding dense and layered mineral deposits, typically consisting of calcite. The corresponding aqueous solution revealed elevated Mg concentration (38 mg/l) and a high molar Mg/Ca ratio (0.8). Scale deposits containing distinct aragonite precipitates next to calcite, mostly growing in pore spaces of the scale fabric, are accounted as type 3. Therein, dypingite is always growing on top of aragonite needles, indicative for prior CaCO3 precipitation. The composition of corresponding solutions shows the highest Mg/Ca ratio (1.1). Scale type 4 is characterized as a compact deposit consisting entirely of calcite. Its corresponding solution exhibits a molar Mg/Ca ratio of 0.6. From the obtained data sets a conceptual model was developed describing the distinct operative and (micro)environmental conditions responsible for the distinct diversity of scale deposits.

Item distribution, internal consistency, and structural validity of the German version of the DEMQOL and DEMQOL-proxy.

BACKGROUND: Accurate assessment of health-related quality of life as an endpoint in intervention studies is a major challenge in dementia research. The DEMQOL (29 items) and the proxy version (32 items), which is partly based on the DEMQOL, are internationally used instruments. To date, there is no information on the structural validity, item distribution, or internal consistency for the German language version of these questionnaires. METHODS: This psychometric study is based on a secondary data analysis of a sample of 201 outpatients with a mild form of Alzheimer's disease (AD) and their informal caregivers. The informal caregivers who were interviewed were involved in the care of the person with AD several times per week. The analysis for the evaluation of the structural validity was performed using Mokken scale analysis. The internal consistency was calculated using the ρ of the Molenaar Sijtsma statistic and Cronbach's α. RESULTS: For both versions, four subscales were identified: [A] "positive emotions", [B] "negative emotions", [C] "physical and cognitive functioning", and [D] "daily activities and social relationships". For both instruments, the internal consistency of all subscales was considered "good" (ρ = 0.71-0.88, α = 0.72-0.87). CONCLUSIONS: The results are a first indication of good construct validity of the instruments used for the German setting. We recommend further investigations of the test-retest reliability and the inter-rater reliability of the proxy instrument.

Item distribution and inter-rater reliability of the German version of the quality of life in Alzheimer's disease scale (QoL-AD) proxy for people with dementia living in nursing homes.

BACKGROUND: The Quality of Life in Alzheimer's disease scale (QoL-AD) is a widely used Health Related Quality of Life (HRQoL) instrument. However, studies investigating the instrument's inter-rater reliability (IRR) are missing. This study aimed to determine the item distribution and IRR of the German proxy version of the QoL-AD (13 Items) and a nursing home-specific instrument version (QoL-AD NH, 15 Items). METHODS: The instruments were applied to 73 people with dementia living in eight nursing homes in Germany. Individuals with dementia were assessed two times by blinded proxy raters. The IRR analyses were based on methodological criteria of the quality appraisal tool for studies of diagnostic reliability (QAREL), the COSMIN group and the single-measure Intra-Class Correlation Coefficient (ICC) for absolute agreement ≥0.70. RESULTS: All items for both instrument versions demonstrated acceptable item difficulty, with the exception of one item (QoL-AD proxy). The IRR was moderate for the QoL-AD (ICC: 0.65) and insufficient for the QoL-AD NH (ICC: 0.18). The additional computation of the average measure ICC for two proxy-raters demonstrated a strong IRR (ICC: 0.79) for the QoL-AD and a weak IRR for the QoL-AD NH (ICC: 0.31). The detailed analysis of the IRR for each item underpinned the need for the further development of both instruments. CONCLUSIONS: The unsatisfactory IRRs for both instruments highlight the need for the development of a user guide including general instructions for instrument application as well as definitions and examples reflecting item meaning. Priority should be given to the development of reliable proxy-person versions of both instruments. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462 , Date of registration: 11-20-2014.

Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial.

BACKGROUND: The Dementia Care Mapping (DCM) method is an internationally recognized complex intervention in dementia research and care for implementing person-centered care. The Leben-QD II trial aimed to evaluate the effectiveness of DCM with regard to caregivers. METHODS: The nine participating nursing home units were allocated to three groups: (1) DCM method experienced ≥ 1 year, (2) DCM newly introduced during this trial, and (3) regular rating of residents' quality of life (control group). Linear mixed models were fit to cluster-aggregated data after 0, 6, and 18 months, adjusting for repeated measurements and confounders. The primary outcome was the Approaches to Dementia Questionnaire (ADQ) score; the secondary outcomes were the Copenhagen Psychosocial Questionnaire (COPSOQ) and the Copenhagen Burnout Inventory (CBI). RESULTS: The analysis included 201 caregivers with 290 completed questionnaires (all three data collection time points). The ADQ showed a significant time and time*intervention effect. At baseline, the estimated least-square means for the ADQ were 71.98 (group A), 72.46 (group B), and 71.15 (group C). The non-linear follow-up of group A indicated an estimated-least square means of 69.71 (T 1) and 68.97 (T 2); for group B, 72.80 (T 1) and 72.29 (T 2); and for group C, 66.43 (T 1) and 70.62 (T 2). CONCLUSIONS: The DCM method showed a tendency toward negatively affecting the primary and secondary outcomes; this finding could be explained by the substantial deviation in adherence to the intervention protocol.

[Assessment of the significance and the requirements of medical postdoctoral lecture qualifications in Germany by the assessment committees]. / Bewertung des Stellenwerts und der Voraussetzungen der medizinischen Habilitation in Deutschland durch die beurteilenden Kommissionen.

OBJECTIVE: The postdoctoral medical lecture qualification (Habilitation) represents the highest academic qualification in Germany, which is successfully completed by approximately 850 candidates in medicine and health sciences per year. However, there is only a limited number of respective academic positions available. In addition, structures in education and society have changed over the last years, challenging the importance of this specific German qualification. The aim of this study was to elicit the opinions of members of German habilitation committees concerning the requirements, processes and the overall importance of the postdoctoral medical lecture qualification. Furthermore we wanted to evaluate potential needs for reforms. METHODS: The online survey was conducted asking for biographic parameters, subjective ratings and potential needs for reforms concerning the postdoctoral medical lecture qualification (PLQ). RESULTS: The PLQ was rated high in significance by 71.3 % of the committee members. According to the medical understanding of the Humboldt triad (research, teaching, patient care), research (94.3 %) and teaching (89.7 %) have been rated as the most important requirements for a PLQ. Asked for the motivation to undertake a PLQ, 91.0 % of the members gave the joy of doing research, 78.2 % the joy of teaching and 65.5 % better career prospects perspectives as their reason. The recognition of a Ph.D. degree as being equivalent to a German PQL was clearly rejected by the survey respondents (58.6 %: no equivalence). The majority is against the abolition of the German PLQ. However, there is a definite desire for reform, preferably concerning internal obstacles such as the dependence on full professors, more transparency in the PLQ process, but also the demand for a federal standard PLQ regulation. CONCLUSION: From the committee members' point of view the German PLQ has still a role to play and, despite controversy, is still regarded as a timely qualification. However, there is clear-cut evidence for local, national and international reforms in order to create equality of opportunity for the candidates and to open up suitable career options.

Item distribution, internal consistency and inter-rater reliability of the German version of the QUALIDEM for people with mild to severe and very severe dementia.

BACKGROUND: The QUALIDEM is a dementia-specific Quality of life (Qol) instrument that is recommended for longitudinal studies and advanced stages of dementia. Our study aimed to develop a user guide for the German version of the QUALIDEM and to determine the item distribution, internal consistency and inter-rater reliability (IRR) of the German QUALIDEM. METHODS: A user guide was developed based on cognitive interviews with ten professional caregivers and a focus group with six professional caregivers. The item distribution, internal consistency and IRR were evaluated through a field test including n = 55 (mild to severe dementia) and n = 36 (very severe dementia) residents from nine nursing homes. Individuals with dementia were assessed four times by blinded proxy raters. RESULTS: A user guide with instructions for the application of the QUALIDEM and definitions and examples for each item was created. Based on the single-measure intra-class correlation coefficient (ICC for absolute agreement), we observed strong IRR for nearly all of the QUALIDEM subscales, with ICCs of at least 0.79. A lower ICC (ICC = 0.64) was only obtained for people with very severe dementia on the 'negative affect' subscale. CONCLUSIONS: The IRR improved based on the application of the QUALIDEM user guide developed in this study. We demonstrated a sufficient IRR for all subscales of the German version of the QUALIDEM, with the exception of the 'negative affect' subscale in the subsample of people with very severe dementia. The item distribution and internal consistency results highlight the need to develop new informative items for some subscales.

Internal consistency and construct validity of the Quality of Life in Alzheimer's Disease (QoL-AD) proxy ­ a secondary data analysis / Interne Konsistenz und Konstrukt-validität des Quality of Life in Alzheimer's Disease (QoL-AD) proxy Instruments - eine Sekundärdatenanalyse

Background: The maintenance and promotion of Quality of Life (QoL) of people with dementia is a major outcome in intervention studies and health care. The Quality of Life Alzheimer's Disease (QoL-AD) is an internationally recommended QoL measurement also available in German language. Until now, only a few results on the psychometric properties of the German QoL-AD were available. Objective: Evaluation of internal consistency and construct validity of the QoL-AD proxy. Method: A principal component analysis (secondary data analysis) of the 13 QoL-AD items was carried out based on the total sample of 234 people with dementia from nine nursing homes in Germany. Subsequently, the internal consistency of the identified factors was examined using Cronbach's alpha. Results: Two factors physical and mental health and social network were determined. Both factors explain 53 % of the total variance. The stability of both factors was validated in two sensitivity analyses. The internal consistency is good for both factors with a Cronbach's alpha of 0.88 (physical and mental health) and 0.75 (social network). Conclusion: The QoL-AD proxy allows the assessment of two relevant health-related QoL domains of people with dementia. However, in future studies especially the inter-rater reliability of the QoL-AD proxy has to be examined.

People with dementia in nursing home research: a methodological review of the definition and identification of the study population.

BACKGROUND: There are various definitions and diagnostic criteria for dementia, leading to discrepancies in case ascertainment in both clinical practice and research. We reviewed the different definitions, approaches and measurements used to operationalize dementia in health care studies in German nursing homes with the aim of discussing the implications of different approaches. METHODS: We conducted a systematic search of the MEDLINE and CINAHL databases to identify pre-2016 studies conducted in German nursing homes that focused on residents with dementia or cognitive impairment. In- or exclusion of studies were consented by all authors; data extraction was independently carried out by 2 authors (RP, SJ). The studies' sampling methods were compared with respect to their inclusion criteria, assessment tools and methods used to identify the study population. RESULTS: We summarized case ascertainment methods from 64 studies. Study participants were identified based on a diagnosis that was evaluated during the study, or a recorded medical dementia diagnosis, or a recorded medical diagnosis either with additional cognitive screenings or using screening tests exclusively. The descriptions of the diagnostics that were applied to assess a diagnosis of dementia were not fully transparent in most of the studies with respect to either a clear reference definition of dementia or applied diagnostic criteria. If reported, various neuropsychological tests were used, mostly without a clear rationale for their selection. CONCLUSION: Pragmatic considerations often determine the sampling strategy; they also may explain the variances we detected in the different studies. Variations in sampling methods impede the comparability of study results. There is a need to consent case ascertainment strategies in dementia studies in health service research in nursing homes. These strategies should consider resource constraints and ethical issues that are related to the vulnerable population of nursing home residents. Additionally, reporting about dementia studies in nursing homes need to be improved. If a diagnosis cannot be evaluated based on either ICD or DSM criteria, the study population may not be reported as having dementia. If a diagnosis is evaluated based on ICD or DSM criteria within the study, there is a need for more transparency of the diagnostic process.

Linguistic validation and reliability properties are weak investigated of most dementia-specific quality of life measurements-a systematic review.

OBJECTIVE: For people with dementia, the concept of quality of life (Qol) reflects the disease's impact on the whole person. Thus, Qol is an increasingly used outcome measure in dementia research. This systematic review was performed to identify available dementia-specific Qol measurements and to assess the quality of linguistic validations and reliability studies of these measurements (PROSPERO 2013: CRD42014008725). STUDY DESIGN AND SETTING: The MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Methodology Register databases were systematically searched without any date restrictions. Forward and backward citation tracking were performed on the basis of selected articles. RESULTS: A total of 70 articles addressing 19 dementia-specific Qol measurements were identified; nine measurements were adapted to nonorigin countries. The quality of the linguistic validations varied from insufficient to good. Internal consistency was the most frequently tested reliability property. Most of the reliability studies lacked internal validity. CONCLUSION: Qol measurements for dementia are insufficiently linguistic validated and not well tested for reliability. None of the identified measurements can be recommended without further research. The application of international guidelines and quality criteria is strongly recommended for the performance of linguistic validations and reliability studies of dementia-specific Qol measurements.

Dementia care mapping: effects on residents' quality of life and challenging behavior in German nursing homes. A quasi-experimental trial.

BACKGROUND: Person-centered care (PCC) is a widely recognized concept in dementia research and care. Dementia Care Mapping (DCM) is a method for implementing PCC. Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia (PwD). We aimed to investigate the effectiveness of DCM with regard to quality of life (QoL) and challenging behavior in PwD in nursing homes (NHs). METHODS: Leben-QD II is an 18-month, three-armed, pragmatic quasi-experimental trial. The sample of PwD was divided into three groups with three living units per group: (A) DCM applied since 2009, (B) DCM newly introduced during the study, and (C) a control intervention based on a regular and standardized QoL rating. The primary outcome was QoL measured with the Quality of Life-Alzheimer's Disease (QoL-AD) proxy, and the secondary outcomes were QoL (measured with QUALIDEM) and challenging behavior (measured with the Neuropsychiatric Inventory Nursing Home version, NPI-NH). RESULTS: There were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes. At baseline, the estimated least square means of the QoL-AD proxy for groups A, B, and C were 32.54 (confidence interval, hereafter CI: 29.36-35.72), 33.62 (CI: 30.55-36.68), and 30.50 (CI: 27.47-33.52), respectively. The DCM groups A (31.32; CI: 28.15-34.48) and B (27.60; CI: 24.51-30.69) exhibited a reduction in QoL values, whereas group C exhibited an increase (32.54; CI: 29.44-35.64) after T2. CONCLUSIONS: DCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

Measuring the quality of life in mild to very severe dementia: testing the inter-rater and intra-rater reliability of the German version of the QUALIDEM.

BACKGROUND: Quality of life (Qol) is an increasingly used outcome measure in dementia research. The QUALIDEM is a dementia-specific and proxy-rated Qol instrument. We aimed to determine the inter-rater and intra-rater reliability in residents with dementia in German nursing homes. METHODS: The QUALIDEM consists of nine subscales that were applied to a sample of 108 people with mild to severe dementia and six consecutive subscales that were applied to a sample of 53 people with very severe dementia. The proxy raters were 49 registered nurses and nursing assistants. Inter-rater and intra-rater reliability scores were calculated on the subscale and item level. RESULTS: None of the QUALIDEM subscales showed strong inter-rater reliability based on the single-measure Intra-Class Correlation Coefficient (ICC) for absolute agreement ≥ 0.70. Based on the average-measure ICC for four raters, eight subscales for people with mild to severe dementia (care relationship, positive affect, negative affect, restless tense behavior, social relations, social isolation, feeling at home and having something to do) and five subscales for very severe dementia (care relationship, negative affect, restless tense behavior, social relations and social isolation) yielded a strong inter-rater agreement (ICC: 0.72-0.86). All of the QUALIDEM subscales, regardless of dementia severity, showed strong intra-rater agreement. The ICC values ranged between 0.70 and 0.79 for people with mild to severe dementia and between 0.75 and 0.87 for people with very severe dementia. CONCLUSIONS: This study demonstrated insufficient inter-rater reliability and sufficient intra-rater reliability for all subscales of both versions of the German QUALIDEM. The degree of inter-rater reliability can be improved by collaborative Qol rating by more than one nurse. The development of a measurement manual with accurate item definitions and a standardized education program for proxy raters is recommended.

Longitudinal evaluation of dementia care in German nursing homes: the "DemenzMonitor" study protocol.

BACKGROUND: In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents' behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. METHODS/DESIGN: The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. DISCUSSION: The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents' outcome measurements, making it possible to evaluate different aspects and concepts of care.