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Patients with essential tremor exhibit heterogeneous cognitive functioning. Although the majority of patients fall under the broad classification of cognitively “normal,” essential tremor is associated with increased risk for mild cognitive impairment and dementia. It is possible that patterns of cognitive performance within the wide range of normal functioning have predictive utility for mild cognitive impairment or dementia. These cross-sectional analyses sought to determine whether cognitive patterns, or “clusters,” could be identified among individuals with essential tremor diagnosed as cognitively normal. We also determined whether such clusters, if identified, were associated with demographic or clinical characteristics of patients.
Elderly subjects with essential tremor (age >55 years) underwent comprehensive neuropsychological testing. Domain means (memory, executive function, attention, visuospatial abilities, and language) from 148 individuals diagnosed as cognitively normal were partitioned using k-means cluster analysis. Individuals in each cluster were compared according to cognitive functioning (domain means and test scores), demographic factors, and clinical variables.
There were three clusters. Cluster 1 (n = 64) was characterized by comparatively low memory scores (p < .001), Cluster 2 (n = 39) had relatively low attention and visuospatial scores (p < .001), and Cluster 3 (n = 45) exhibited consistently high performance across all domains. Cluster 1 had lower Montreal Cognitive Assessment scores and reported more prescription medication use and lower balance confidence.
Three patterns of cognitive functioning within the normal range were evident and tracked with certain clinical features. Future work will examine the extent to which such patterns predict conversion to mild cognitive impairment and/or dementia.
In this paper, we revisit our previous work in which we derive an effective macroscale description suitable to describe the growth of biological tissue within a porous tissue-engineering scaffold. The underlying tissue dynamics is described as a multiphase mixture, thereby naturally accommodating features such as interstitial growth and active cell motion. Via a linearization of the underlying multiphase model (whose nonlinearity poses a significant challenge for such analyses), we obtain, by means of multiple-scale homogenization, a simplified macroscale model that nevertheless retains explicit dependence on both the microscale scaffold structure and the tissue dynamics, via so-called unit-cell problems that provide permeability tensors to parameterize the macroscale description. In our previous work, the cell problems retain macroscale dependence, posing significant challenges for computational implementation of the eventual macroscopic model; here, we obtain a decoupled system whereby the quasi-steady cell problems may be solved separately from the macroscale description. Moreover, we indicate how the formulation is influenced by a set of alternative microscale boundary conditions.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
The St. Louis aerosol was sampled during the period 16-22 August 1973 simultaneously at two locations using cascade impactors for sequential 12-hour samples. The six particle size fractions of each sampling were individually analyzed using PIXE for elements from S to Br and beyond and for heavy elements including Pb which permitted time variations of concentrations and particle size distributions to be followed and related to meteorological changes during the sampling period. In addition, the data were compared with average levels of the elements in coastal north Florida and maritime Bermuda as well as at a third St. Louis site. From this it appeared that some of the concentrations in St. Louis were at natural levels whereas others appeared to be higher and linked to air pollution sources. These relationships and others in this study may lead to criteria for distinguishing between pollutants and natural background in urban aerosols.
This study examined the comminution of fresh herbage, subsequent nutrient release, and the characteristics of swallowed boli from three physically and chemically contrasting forages during ingestive mastication by dairy cows. The extent and pattern of nutrient release will determine their availability to rumen microflora, and potentially influence their efficiency of use. The forages evaluated were perennial ryegrass (ryegrass, Lolium perenne L., cv Alto AR37), lucerne (Medicago sativa L., cv Torlesse) and chicory (Cichorium intybus L., cv Choice). Experimental design was a 3×3 cross-over with three forages and three consecutive 1-day measurement periods, conducted twice. Six non-lactating, pregnant, multiparous Holstein-Friesian×Jersey cows (Bos taurus) were used, with the first cross-over applied to three mature (10.1±0.61 years old; BW 631±64 kg) cows, and the second to three young (4.8±0.02 years; BW 505±19 kg) cows. Fresh cut forage was offered to the cows following partial rumen evacuation. Swallowed boli were collected directly at the cardia at the commencement, middle and end of the first feeding bout of the first meal of the day. Forage species did not affect the fresh weight of ingested boli (mean 169 g, P=0.605) but the proportion of saliva in boli varied between forage. Boli of chicory contained the greatest amount of herbage material and least amount of saliva, whereas ryegrass boli were the opposite. Boli fresh weight tended to increase as time in the meal progressed, but the age of the cow was not shown to affect any boli characteristics or nutrient release. Particle size reduction was affected by forage, with 31%, 38% and 35% of chicory, lucerne and ryegrass herbage reduced to <2 mm. There was little evidence of relationship between comminution and any physical or chemical characteristic of the forage, except in ryegrass where extent of comminution was moderately correlated with herbage strength. Proportional release of herbage soluble carbohydrate exceeded that of N during mastication. Differences in loss of N were moderately correlated with the amount of N in the herbage (R2=0.53) but herbage comminution was not strongly correlated with release of either N or carbohydrate. These findings illustrate the complex animal×forage interactions that occur during mastication, and that it is not possible to infer nutrient loss from herbage based on herbage characteristics as the driver for this differ between species.
Ernst Troeltsch and the ‘Systematic Theology of the History of Religion School’
Although he was an extraordinary polymath who dabbled in many different areas of theology, philosophy and history, Ernst Troeltsch spent most of his career as a teacher of systematic theology. At Heidelberg University, where he was professor from 1894 to 1915, Troeltsch lectured regularly (usually five times per week) on systematic theology beginning in the summer semester of 1894 with a lecture course on ‘Christliche Dogmatik’. This course was continued as ‘Dogmatik’ along with lectures on Friedrich Schleiermacher's life and teaching (winter semester of 1894– 95). In the summer semester of 1895 he taught history of Protestant theology in the nineteenth century and ethics. This was followed by the ‘History of Dogma’ (winter semester of 1895– 96) and then ‘Glaubenslehre’ (Teaching of the faith) in the summer semester of 1896. This course was continued in the next semester (‘Glaubenslehre’ II) along with a course on ‘Symbolik’, or study of the distinct confessions of the faith. He also offered a course on ‘Theologische Encyclopädie’ (which might best be translated as ‘Outline of Theology’) from the winter semester of 1897– 98. These courses, along with regular lectures on ethics and philosophy of religion, were repeated on an annual basis right through his time in Heidelberg, with the final lectures on ‘Glaubenslehre’ II being given in the winter semester of 1914– 15. In total the lectures on ‘Glaubenslehre’ or ‘Dogmatik’ were given eleven times; ‘History of Dogma’ six times (finishing in the winter semester of 1905– 6); ‘Symbolik’ nine times (finishing in the summer semester of 1913); ‘History of Protestant Theology in the Nineteenth Century’ (five times until summer semester of 1909); and ‘Theologische Encyclopädie’ (five times until winter semester of 1905– 6).
Although his publications in other areas certainly outnumbered his writings on dogmatics, Troeltsch's reputation as a teacher depended on his lectures on systematic theology and ethics (which in the German division of theology is also usually included as a branch of systematic theology). He also contributed many articles on dogmatic themes to the first edition of the magnum opus of the history of religion school, Die Religion in Geschichte und Gegenwart, which was published between 1909 and 1913 by J. C. B. Mohr (Paul Siebeck) and edited by Friedrich Michael Schiele und Leopold Zscharnack.
Because of the metastability of the 23S level of He I, a variety of effects can change the line strengths from pure recombination values in Seyfert galaxies (see Feldman and MacAlpine 1978). This occurs because the population which builds up in the 23S level can be collisionally excited to the 23P level, enhancing λ10830. The expected ratios of λ10830/λ5876 can be altered by internal or external reddening and vary with temperature, density and optical depth.
Invasive pneumococcal disease (IPD), caused by infection with Streptococcus pneumoniae, has a substantial global burden. There are over 90 known serotypes of S. pneumoniae with a considerable body of evidence supporting serotype-specific mortality rates immediately following IPD. This is the first study to consider the association between serotype and longer-term mortality following IPD. Using enhanced surveillance data from the North East of England we assessed both the short-term (30-day) and longer-term (⩽7 years) independent adjusted associations between individual serotypes and mortality following IPD diagnosis using logistic regression and extended Cox proportional hazards models. Of the 1316 cases included in the analysis, 243 [18·5%, 95% confidence interval (CI) 16·4–20·7] died within 30 days of diagnosis. Four serotypes (3, 6A, 9N, 19 F) were significantly associated with overall increased 30-day mortality. Effects were observable only for older adults (⩾60 years). After extension of the window to 12 months and 36 months, one serotype was associated with significantly increased mortality at 12 months (19 F), but no individual serotypes were associated with increased mortality at 36 months. Two serotypes had statistically significant hazard ratios (HR) for longer-term mortality: serotype 1 for reduced mortality (HR 0·51, 95% CI 0·30–0·86) and serotype 9N for increased mortality (HR 2·30, 95% CI 1·29–4·37). The association with serotype 9N was no longer observed after limiting survival analysis to an observation period starting 30 days after diagnosis. This study supports the evidence for associations between serotype and short-term (30-day) mortality following IPD and provides the first evidence for the existence of statistically significant associations between individual serotypes and longer-term variation in mortality following IPD.
The last three years have witnessed a growing interest in the physical properties of the small bodies in the solar system. Perhaps the most significant impetus to research on small bodies has been the imminent arrival of Comet Halley in the inner solar system. This famous comet, which was recovered in autumn 1982, has been the object of intense study during the past year as it has approached the sun and developed a tail. Much of the international, ground-based astronomical research on Halley has been coordinated through the International Halley Watch program. Spacecraft from several nations have been successfully launched (or soon will be, we hope) and are on their way to intercept the comet and make close-up observations and in situ measurements. The commencement of spacecraft study of small bodies marks a new era in comet/asteroid science and, in coordination with ground-based and Earth-orbital observations, will result in unprecedented new knowledge about the origin of the solar system and about solar system processes. Although Halley is receiving the most attention, interest is also high in Comet Giacobini-Zinner, the vicinity of which will be probed by a diverted American spacecraft in September 1985. Upcoming spacecraft studies of comets through 1986 are described at the end of the comet section of this report. Asteroid exploration by spacecraft is also anticipated to begin in the near future. The trajectory of the NASA Gailieo Mission to Jupiter has been changed to permit close-encounter observations of the large main-belt asteroid 29 Amphitrite in December 1986; these observations will be conducted on a “best effort” basis only a few months after launch of Galileo. Interest is also high in Europe, the Soviet Union, and the United States in possible spacecraft missions to additional comets and asteroids during the 1990’s. If these efforts are pursued, there will be a concomitant ground-based effort. The last three years have also witnessed extremely productive efforts to observe small bodies from Earth orbit. For example, the Infrared Astronomical Satellite discovered a comet in 1983, which made the closest approach to the Earth of any comet in centuries. IRAS made important discoveries and measurements of other comets and also assembled an immense database on infrared brightnesses of thousands of numbered and unnumbered asteroids. The planned launch of the Hubble Space Telescope next year highlights the continuing potential for applying extremely powerful instrumental techniques to the study of comets and asteroids from above the Earth’s atmosphere.
III Zw 35 is a pair of galaxies characterised by intense OH maser emission, and powerful far-infrared and radio continuum. We have made a detailed study of the galaxy pair based on optical, infrared and radio observations. The brighter northern component is identified as a LINER or Seyfert galaxy and contains an active nuclear region from which radio continuum, OH maser and thermal dust emission are detected. We propose that the northern component has a compact active nucleus deeply embedded in an obscured region of diameter ~ 210 pc within which enhanced star-formation occurs. The lower luminosity, southern component is of low mass and is undergoing starburst activity over an extended region of diameter ~ 5.5 kpc. The origin of the starburst and non-thermal activity appears to be an interaction between the two components.
Ultraviolet studies, originally undertaken to ascertain the state of the atmosphere of the K-supergiant component of the zeta Aurigae system, have been sidetracked by the discovery of significant accretion effects. An analysis of the phase dependence of the profiles of resonance lines in Mg II and C IV has led to a qualitative model of the wind flow from the K star. At the position of the B star, the flow velocity is about 100 km/sec and the density is 3 x 10-6 cm-3 , leading to a mass loss rate of 2 x 10-8 solar masses per year. This wind interacts with the B star in a shock, which will be described, leading to accretion on the B star at a rate of 4 x 10-10 solar masses per year.
The ultraviolet observations of four Zeta Aurigau stars are reviewed. A, probably oversimplified, interpretation of the observations points to a straight forward connection between the spectral type of the B star and the amount of high temperature plasma in the systems.
Undernutrition is prevalent among pregnant women in Cambodia. The provision of fortified dietary supplements is one strategy to help pregnant women meet their nutritional needs. Corn Soya Blend Plus (CSBP) is a widely used prenatal dietary supplement in areas with high rates of undernutrition and food insecurity. However, little is known about its acceptability during pregnancy. The present study aimed to identify factors that affected the acceptability and consumption of CSBP supplements among pregnant women.
Women completed a structured interview designed to provide information on facilitators of and barriers to utilization. In addition, six focus groups were conducted with a subset of women (n 70) to further explore attitudes, perceptions and experiences related to CSBP use.
Two districts in Kampong Chhnang Province, Cambodia.
Pregnant women (n 288) participating in a cluster-randomized trial of CSBP.
The acceptability of CSBP was influenced by sensory attributes, family support, peer influences, and attitudes related to diet, nutritional status and weight gain in pregnancy. Attaining adequate nutrition was considered less important than other concerns during pregnancy, particularly anxiety related to the costs of delivery and postpartum care. Acceptance was lower among new mothers due to fears of weight gain. Health benefits were common reasons for continued use and minor side-effects, such as nausea, were not major barriers to consumption.
CSBP was generally well accepted in this population. However, organoleptic factors and perceptions regarding nutrition and weight gain in pregnancy, particularly for first-time mothers, were barriers to increasing acceptance among Cambodian women.
Background: For adolescents with epilepsy, there is often a poor system in place to meet their individualized transition needs. Our objectives were 1) to develop epilepsy-specific transition care management plans (TCMPs) to ensure access, and attachment to adult healthcare providers, and 2) to identify strategies for providing support during the transition period, including through the development of physician and patient (or caregiver) navigated web-based tools, resources and recommendations for health system improvements. Methods: Physicians and nurses with expertise in areas including adult and pediatric epilepsy, family medicine, psychiatry, and varied allied health professionals were engaged to generate epilepsy-related TCMPs. Results: Through an iterative process spanning the course of over a year, TCMPs were developed to cover areas including: treatment responsive and resistant epilepsy, ketogenic diet, epilepsy surgery, women’s issues, mental health, and psychosocial aspects of epilepsy. The TCMPs referenced established guidelines and best practices in the literature wherever possible. Caregiver roles and responsibilities were outlined, remaining cognoscent of available provincial resources. Conclusions: Epilepsy specific TCMPs can be developed through a collaborative approach between pediatric and adult healthcare providers, easing the patient experience, creating educated accountability, and providing a forum to identify and address gaps of care in adolescents with epilepsy.