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ABSTRACT We present the results of a Chandra observation of the galaxy cluster Abell 689 ( z = 0.279). Abell 689 is one of the most luminous clusters detected in the ROSAT All Sky Survey (RASS), but was flagged as possibly including significant point source contamination. The small point spread function of the Chandra telescope allows us to confirm this and separate the point source from the extended cluster X-ray emission. For the cluster, we determine a bolometric luminosity of Lbol= (3.3 ± 0.3) × 1044 erg s−1 and a temperature of kT = 5.1+2.2− 1.3 keV when including a physically motivated background model. We compare our measured luminosity for A689 to that quoted in the RASS, and find L0.1−2.4 keV= 2.8 × 1044 erg s−1, a value ∼10 times lower than the ROSAT measurement. Our analysis of the point source shows evidence for significant pile-up, with a pile-up fraction of ≃60 per cent. Sloan Digital Sky Survey spectra and Hubble Space Telescope ( HST) images lead us to the conclusion that the point source within Abell 689 is a BL Lac object. Using radio and optical observations from the Very Large Array and HST archives, we determine αro= 0.50, αox= 0.77 and αrx= 0.58 for the BL Lac, which would classify it as being of 'high-energy peak BL Lac' type. Spectra extracted of A689 show a hard X-ray excess at energies above 6 keV that we interpret as inverse-Compton emission from aged electrons that may have been transported into the cluster from the BL Lac. [ABSTRACT FROM AUTHOR]

Background/objective: The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures., Design: Retrospective cohort analysis., Setting: Forty-four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012., Participants: We included 2,494 community-dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee-for-service Medicare coverage., Measurements: The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post-acute periods and by cost category. We included 48 variables in a standardized risk-adjustment model to generate adjusted cost estimates., Results: The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was $26,143 (interquartile range (IQR) = $9,634-$68,086), including acute care median $1,957 (IQR = $1,298-$12,924) and post-acute median $20,560 (IQR = $5,673-$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479-$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of $12,682 (IQR = -$185 to $51,189)., Conclusion: Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs., (© 2020 The American Geriatrics Society.)

Background: Existing evidence points to a substantial rise in psychosocial disorders affecting young people over the past 50 years (Rutter & Smith, 1995). However, there are major methodological challenges in providing conclusive answers about secular changes in disorder. Comparisons of rates of disorder at different time points are often affected by changes in diagnostic criteria, differences in assessment methods, and changes in official reporting practices. Few studies have examined this issue using the same instruments at each time point., Methods: The current study assessed the extent to which conduct, hyperactive and emotional problems have become more common over a 25-year period in three general population samples of UK adolescents. The samples used in this study were the adolescent sweeps of the National Child Development Study and the 1970 Birth Cohort Study, and the 1999 British Child and Adolescent Mental Health Survey. Comparable questionnaires were completed by parents of 15-16-year-olds at each time point (1974, 1986, and 1999)., Results and Conclusions: Results showed a substantial increase in adolescent conduct problems over the 25-year study period that has affected males and females, all social classes and all family types. There was also evidence for a recent rise in emotional problems, but mixed evidence in relation to rates of hyperactive behaviour. Further analyses using longitudinal data from the first two cohorts showed that long-term outcomes for adolescents with conduct problems were closely similar. This provided evidence that observed trends were unaffected by possible changes in reporting thresholds.