Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA)

BACKGROUND

Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear.

OBJECTIVES

This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP.

DESIGN

A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted.

SETTING

Home based aged care services, national cohort.

METHODS

Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP.

RESULTS

The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years.

CONCLUSION

Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes.

Setting maximum limits for trace elements in baby food in European legislation: the outcome of International Measurement Evaluation Programme®-33

The Institute for Reference Materials and Measurements (IRMM) of the Joint Research Centre (JRC), a Directorate-General of the European Commission, operates the International Measurement Evaluation Programme® (IMEP). It organises various types of inter-laboratory comparisons in support of European Union policies. This paper presents the results of a proficiency testing exercise (PT) focusing on the determination of total cadmium (Cd) and total lead (Pb) mass fractions in baby food in support to Commission Regulation (EC) 1881/2006 of 19 December 2006 setting maximum levels for certain contaminants in foodstuffs. The test material used in this exercise was soya-based baby food formula purchased in a local pharmacy and prepared by the Reference Materials Unit of the IRMM for this exercise. Sixty-six laboratories from 23 countries registered to the exercise and 61 of them reported results. Each participant received one bottle containing approximately 15 g of test material. Participants were asked to quantify the measurands in the powder and in the reconstituted formula. Reference values independent from the participants' results were established using isotope dilution inductively coupled plasma mass spectrometry. The total Cd mass fraction was determined by IRMM and LGC Ltd (UK), while the total Pb was determined by IRMM. The standard deviation for proficiency assessment σ^ was set at 22% of the assigned value for all measurands. Laboratories were rated with z- and ζ- (zeta) scores in accordance with ISO 13528. The outcome of this exercise is clearly influenced by the very low level of Cd and Pb content in the test material which triggered: a high number of 'less than' values; overestimated values especially for Pb very likely due to contamination; and a visible method influence in the case of Pb (methods based on atomic absorption were not sensitive enough to attain such low limits of detection). The results were also evaluated with regard to the reported limit of detection and some incoherencies were observed.

SU-E-T-92: on the Use of High-Sensitivity Thermoluminescent Dosimeters (TLDs) for Dosimetric Characterization of Low-Energy Brachytherapy Sources

PURPOSE

To investigate the utility and accuracy of high-sensitivity TLD for dosimetric characterization of low-energy brachytherapy sources.

METHODS

One hundred high-sensitivity (TLD-100H) and 100 normal-sensitivity (TLD-100) TLDs were used in this study. The TLD-100s were annealed at 400°C for one hour and then kept at room temperature for 45 minutes followed by 80°C heating for 24 hours. To prevent temperature overshot from reducing the sensitivity of TLD-100Hs, a novel thermal reservoir was built, tested, and used to anneal TLD-100H at 240 0C for 15 minutes and then kept at room temperature for 45 minutes followed by 100 0C heating for one hour. These TLDs were then irradiated uniformly in a large cavity Cs-137 irradiator for biomedical research (Shepherd, Mark III) to test their reproducibility and to establish their relative sensitivities. The radial dose function of a Model AgX100 125I source was measured using both types of TLDs in water-equivalent solid phantoms as a test case. The radial dose function measured by the TLD-100H was compared with that measured by TLD-100 to determine its utility in brachytherapy dosimetry characterization.

RESULTS

Consistent and accurate annealing of high-sensitivity TLDs was achieved by using a custom-built thermal reservoir system. TLD-100H was found to be about 18 times more sensitive than TLD-100. For a 125I source with a source-strength of 2.7U, the irradiation time for radial dose function characterization up to 7 cm can be cut down from 38 days to 3 days. The radial dose function measured by TLD-100H agreed well (within ±6%) with that measured by TLD-100.

CONCLUSIONS

A novel thermal reservoir was used for consistent annealing of high-sensitivity TLDs. TLD-100H can significantly shorten the irradiation time needed for a complete characterization of radial dose function. Investigation of TLD-100H for complete brachytherapy source characterization is in progress. Supported in part by NIH grant R01-CA134627.

SU-E-T-112: Experimental Characterization of a Novel Thermal Reservoir for Consistent and Accurate Annealing of High-Sensitivity TLDs

PURPOSE

To develop and characterize a novel thermal reservoir for consistent and accurate annealing of high-sensitivity thermoluminescence dosimeters (TLD-100H) for dosimetry of brachytherapy sources.

METHODS

The sensitivity of TLD-100H is about 18 times that of TLD-100 which has clear advantages in for interstitial brachytherapy sources. However, the TLD-100H requires a short high temperature annealing cycle (15 min.) and opening and closing the oven door causes significant temperature fluctuations leading to unreliable measurements. A new thermal reservoir made of aluminum alloy was developed to provide stable temperature environment in a standard hot air oven. The thermal reservoir consisted of a 20 cm × 20 cm × 8 cm Al block with a machine-milled chamber in the middle to house the aluminum TLD holding tray. The thermal reservoir was placed inside the oven until it reaches thermal equilibrium with oven chamber. The temperatures of the oven chamber, heat reservoir, and TLD holding tray were monitored by two independent thermo-couples which interfaced digitally to a control computer. A LabView interface was written for monitoring and recording the temperatures in TLD holding tray, the thermal reservoir, and oven chamber. The temperature profiles were measured as a function of oven-door open duration. The settings for oven chamber temperature and oven door open-close duration were optimized to achieve a stable temperature of 240 0C in the TLD holding tray. Complete temperature profiles of the TLD annealing tray over the entire annealing process were obtained.

RESULTS

A LabView interface was written for monitoring and recording the temperatures in TLD holding The use of the thermal reservoir has significantly reduced the temperature fluctuations caused by the opening of oven door when inserting the TLD holding tray into the oven chamber. It has enabled consistent annealing of high-sensitivity TLDs.

CONCLUSIONS

A comprehensive characterization of a custom-built novel thermal reservoir for annealing high-sensitivity TLD has been carried out. It enabled consistent and accurate annealing of high- sensitivity TLDs which could significantly improve the efficiency of brachytherapy source characterizations. Supported in part by NIH grant R01-CA134627.

Development of a direct procedure for the measurement of sulfur isotope variability in beers by MC-ICP-MS

In this work, a multi-collector inductively coupled plasma mass spectrometer (MC-ICP-MS) was evaluated for the direct measurement of sulfur stable isotope ratios in beers as a first step toward a general study of the natural isotope variability of sulfur in foods and beverages. Sample preparation consisted of a simple dilution of the beers with 1% (v/v) HNO(3). It was observed that different sulfur isotope ratios were obtained for different dilutions of the same sample indicating that matrix effects affected differently the transmission of the sulfur ions at masses 32, 33, and 34 in the mass spectrometer. Correction for mass bias related matrix effects was evaluated using silicon internal standardization. For that purpose, silicon isotopes at masses 29 and 30 were included in the sulfur cup configuration and the natural silicon content in beers used for internal mass bias correction. It was observed that matrix effects on differential ion transmission could be corrected adequately using silicon internal standardization. The natural isotope variability of sulfur has been evaluated by measuring 26 different beer brands. Measured delta(34)S values ranged from -0.2 to 13.8 per thousand. Typical combined standard uncertainties of the measured delta(34)S values were < or = 2 per thousand. The method has therefore great potential to study sulfur isotope variability in foods and beverages.

Determination of tributyltin in marine sediment: Comité Consultatif pour la Quantité de Matière (CCQM) pilot study P-18 international intercomparison

The capabilities of National Metrology Institutes (NMIs-those which are members of the Comité Consultatif pour la Quantité de Matière (CCQM)of the CIPM) and selected outside "expert" laboratories to quantitate (C(4)H(9))(3)Sn(+) (TBT) in a prepared marine sediment were assessed. This exercise was sanctioned by the 7th CCQM meeting, April 4-6, 2001, as an activity of the Inorganic Analysis Working Group and was jointly piloted by the Institute for National Measurement Standards of the National Research Council of Canada (NRC) and the Laboratory of the Government Chemist (LGC), UK. A total of 11 laboratories submitted results (7 NMIs, and 4 external labs). Two external laboratories utilized a standard calibration approach based on a natural abundance TBT standard, whereas all NMIs relied upon isotope dilution mass spectrometry for quantitation. For this purpose, a species specific (117)Sn-enriched TBT standard was supplied by the LGC. No sample preparation methodology was prescribed by the piloting laboratories and, by consequence, a variety of approaches was adopted by the participants, including mechanical shaking, sonication, accelerated solvent extraction, microwave assisted extraction and heating in combination with Grignard derivatization, ethylation and direct sampling. Detection techniques included ICP-MS (with GC and HPLC sample introduction), GC-MS, GC-AED and GC-FPD. Recovery of TBT from a control standard (NRCC CRM PACS-2 marine sediment) averaged 93.5+/-2.4% ( n=14). Results for the pilot material averaged 0.680+/-0.015 micro mol kg(-1) ( n=14; 80.7+/-1.8 micro g kg(-1)) with a median value of 0.676 micro mol kg(-1). Overall, performance was substantially better than state-of-the-art expectations and the satisfactory agreement amongst participants permitted scheduling of a follow-up Key comparison for TBT (K-28), a Pilot intercomparison for DBT (P-43), and certification of the test sediment for TBT content and its release as a new Certified Reference Material (HIPA-1) with a TBT content of 0.679+/-0.089 micro mol kg(-1) (expanded uncertainty, k=2, as Sn) (80.5+/-10.6 micro g kg(-1)).

Proceedings: Stimulation and inhibition of acid secretion from the rat isolated gastric mucosa

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