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Additional file 1. Staff Workload.

Down syndrome (DS), the most common form of intellectual disability with a known genetic etiology, is associated with global cognitive impairments, as well as specific memory difficulties including weaknesses in retrospective and prospective memory. However, longitudinal research on memory abilities of youth with DS remains scarce and research has yet to investigate factors that influence prospective memory skills of youth with DS. Gaining a better understanding of retrospective and prospective memory abilities across childhood and adolescence may provide an important benchmark against which age-related memory decline can be compared for adults with DS as well as a reference for research examining longitudinal change in memory secondary to behavioral or pharmacological interventions. Consequently, the current study aimed to provide a comprehensive analysis of short-term (STM), working (WM), and long-term memory (LTM) abilities of youth with DS across two time points (T1 and T2, 18 months apart), as well as examine prospective memory (PM) abilities in this population. The study included 22 children with DS and 18 typically developing (TD) peers, matched on mental age at T1. Participants completed a battery of memory tests at the two time points. The results indicated that youth with DS performed worse than TD peers on a verbal STM task at T1 and T2, and although the DS group improved across time, the gain in scores from T1 to T2 was smaller than for the TD group. Additionally, youth with DS performed below their TD peers on a nonverbal LTM task at T1 and T2, and on a WM task at T2. PM analyses indicated that youth with DS performed marginally better on PM tasks involving social engagement in comparison to standard PM tasks, although these abilities were below the TD group performance. The clinical implications of these findings are discussed, with a focus on cognitive, behavioral, and pharmacological treatment for the DS population.

Table S3. Sensitivity analysis of diagnostic test accuracy of 4AT versus CAM for diagnosis of delirium assuming all indeterminates are delirium present. Legend: numbers are estimate (95% CI). Difference in proportions is for 4AT-CAM. Abbreviations: CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; OR, odds ratio. Youden’s Index is equal to sensitivity + specificity − 1, a value of zero indicates no value, and a value of 1 indicates a perfect test. (DOCX 14 kb)

Table S5. Diagnostic test accuracy of 4AT versus CAM for diagnosis of delirium, assuming test scored delirium present for those with a missing 4AT or CAM score. Legend: numbers are estimate (95% CI). Difference in proportions is for 4AT-CAM. Abbreviations: CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; OR, odds ratio. Youden’s Index is equal to sensitivity + specificity − 1, a value of zero indicates no value, and a value of 1 indicates a perfect test. (DOCX 14 kb)

Table S4. Sensitivity analysis of diagnostic test accuracy of 4AT versus CAM for diagnosis of delirium assuming all indeterminates are delirium absent. Legend: numbers are estimate (95% CI). Difference in proportions is for 4AT-CAM. Abbreviations: CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; OR, odds ratio. Youden’s Index is equal to sensitivity + specificity − 1, a value of zero indicates no value, and a value of 1 indicates a perfect test. (DOCX 14 kb)

Down syndrome (DS), the most common form of intellectual disability with a known genetic etiology, is associated with significant memory deficits beyond overall global impairment. Although a number of studies have examined memory abilities in adults and teens with DS, very few studies have examined memory abilities in children with DS. Additionally, research has yet to examine prospective memory (i.e., remembering to carry out an action in the future) in youth with DS. Consequently, the current study aimed to comprehensively examine the memory profile, including short-term memory, long-term memory, and prospective memory, of youth with DS in comparison to typically-developing, mental-age (MA) matched children. Additionally, this study explored relations between memory abilities and adaptive functioning skills in children and adolescents with DS to begin to explore cognitive skills that may underlie everyday functioning challenges faced by individuals with DS. The results highlight the strengths and deficits of the memory profile of youth with DS and should be considered by educators and caregivers of this population.

Focus Group Topic Guide. Topic guide for focus groups. (DOCX 13Â kb)

Interview Topic Guide. Topic guide for interviews. (DOCX 13Â kb)

Effect size data descriptions. (DOCX 46Â kb)

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 123Â kb)

Progression criteria for continuation to the definitive randomised controlled trial. This document details guidelines for progression to a definitive randomised controlled trial (RCT) which are based on a traffic light system of green (proceed to RCT design), amber (review RCT design and/or implementation, then proceed), or red (stop and do not proceed). (DOCX 20Â kb)

REACH trial information and consent documentation. This document includes all information sheets and consent forms provided to the care home manager, residents, relatives, and staff members involved in the trial. (PDF 1306Â kb)

Standard Protocol Items Recommendations for Interventional Trials (SPIRIT) 2013 checklist recommended items to address in a clinical trial protocol and related documents. (DOC 121Â kb)

In the UK, women’s beliefs, attitudes and behaviours around breastfeeding are shaped by myriad influences and by changing social and structural factors and cultural mores. Whilst public health discourse equates breastfeeding with ‘good mothering’ and health professionals emphasise ‘breast as best’, these normative values compete with other standards or criteria of ‘good mothering’ held by others within women’s social networks that exert influence on them. Moreover, cultural and structural factors affecting the pattern of women’s labour market participation, specifically public policy emphasis on return to paid work aligned with policies directed at reconciling work and family act as constraints on sustaining optimal breastfeeding i.e. exclusive breastfeeding for six months as advised by the World Health Organisation (2003).\ud For women in this study, initiating and sustaining breastfeeding was subject of a complex process that contributed to multiple valued outcomes: nurturing thriving and healthy babies, experiencing themselves as ‘competent’ mothers, successfully managing shifting identities and negotiating competing pressures in the real life context of their daily lives and relationships with ‘significant others’. Even as women struggled to present and see themselves as ‘good mothers’, they were active agents and not just acted upon. They sought to reconcile the value they placed on breastfeeding with seeing themselves and being seen by others as ‘good mothers’. Thus, they sought out situations where breastfeeding was highly valued (such as support groups), and developed strategies to counter or avoid threats to their sense of themselves as nurturing and competent mothers that was related to, but not synonymous with sustaining breastfeeding.\ud Midwives and health visitors in this study encouraged women to breastfeed but not in the way that this is generally portrayed in much of the current literature. Analysis of observed interactions between women who had chosen to breastfeed and midwives and health visitors suggests more of a negotiated encounter in which these health professional considered the whole situation of the woman and her struggle to be a ‘good mother’.

This project forms part of the national evaluation of intermediate care services in England commissioned by the Department of Health. Information on the National Intermediate Care Evaluation Project (NICEP) and the work being carried out by the other two research teams at Leicester / Birmingham Universities and the Bradford Hospital NHS Trust with Bradford and York Universities. This study examined the structure, content, outcomes and costs of intermediate care. The research questions guiding the study were: What is intermediate care? What are its effects and outcomes?