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Objectives: The cognitive indicators of preclinical behavioral variant Frontotemporal Dementia (bvFTD) have not been identified. To investigate these indicators, we compared cross-sectional performance on a range of cognitive measures in 12 carriers of pathogenic MAPT mutations not meeting diagnostic criteria for bvFTD (i.e., preclinical) versus 32 demographically-matched familial non-carriers (n = 44). Studying preclinical carriers offers a rare glimpse into emergent disease, environmentally and genetically contextualized through comparison to familial controls. Methods: Evaluating personnel blinded to carrier status administered a standardized neuropsychological battery assessing attention, speed, executive function, language, memory, spatial ability, and social cognition. Results from mixed effect modeling were corrected for multiplicity of comparison by the false discovery rate method, and results were considered significant at p < .05. To control for potential interfamilial variation arising from enrollment of six families, family was treated as a random effect, while carrier status, age, gender, and education were treated as fixed effects. Results: Group differences were detected in 17 of 31 cognitive scores and spanned all domains except spatial ability. As hypothesized, carriers performed worse on specific measures of executive function, and social cognition, but also on measures of attention, speed, semantic processing, and memory storage and retrieval. Conclusions: Most notably, group differences arose on measures of memory storage, challenging long-standing ideas about the absence of amnestic features on neuropsychological testing in early bvFTD. Current findings provide important and clinically relevant information about specific measures that may be sensitive to early bvFTD, and advance understanding of neurocognitive changes that occur early in the disease. (JINS, 2019, 25, 184–194)
In the recent years, many benchmark author profiling corpora have been developed for various genres including Twitter, social media, blogs, hotel reviews and e-mail, etc. However, no such standard evaluation resource has been developed for Short Messaging Service (SMS), a popular medium of communication, which is very useful for author profiling. The primary aim of this study is to develop a large multilingual (English and Roman Urdu) benchmark SMS-based author profiling corpus. The proposed corpus contains 810 author profiles, wherein each profile consists of an aggregation of SMS messages as a single document of an author, along with seven demographic traits associated with each author profile: gender, age, native language, native city, qualification, occupation and personality type (introvert/extrovert). The secondary aims of this study include the following: (1) annotating the proposed corpus for code-switching annotations at the lexical level (approximately 0.69 million tokens are manually annotated for code-switching) and (2) applying the stylometry-based method (groups of sixty-four features) and the content-based method (twelve features) for gender identification in order to demonstrate how our proposed corpus can be used for the development and evaluation of various author profiling methods. The results show that the content-based character 5-gram feature outperformed all the other features by obtaining the accuracy score of 0.975 and F1 score of 0.947 for gender identification while using the entire corpus. Furthermore, our proposed corpora (SMS–AP–18 and code-switched SMS–AP–18) are freely and publicly available for research purpose.
Introduction: Over 1 million patients with head injuries (HIs) are seen every year at emergency departments (EDs) in North America, with over 90% being minor HIs. Over-utilization of computed tomography (CT) scans in these patients results in unnecessary exposure to radiation and increases health-care resource utilization. Using recommendations from the Choosing Wisely Campaign (CWC) and quality improvement (QI) methodology, we developed a local initiative targeting this issue. Our aim was to reduce the CT scan rate for patients presenting with HIs by 10% over a 6-month period at two academic EDs. This was considered both achievable and meaningful by our stakeholders. Methods: Baseline CT scan rates for patients with HIs were determined through a 10-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and PDSA cycles, which included: 1) Assessing and improving provider knowledge about the CWC recommendations; 2) Testing, refining and implementing a modified Canadian CT Head Rule checklist in the ED; 3) Developing and giving patients CWC-themed handouts pertaining to HI best practice; 4) Bimonthly reporting of CT scan rates to providers. Our primary outcome measure was the number of CT scans performed for patients with HIs. Process measures included the number of checklists completed and ED length of stay (LOS). Our balance measure was return ED visits within 72 hours. Results: Baseline rate of CT scans prior to our interventions was 47.9%. Our QI initiative resulted in a significant shift in the run chart of the weekly CT scan rates, associated with the second PDSA cycle cluster. We observed a 16% relative decrease in CT scans at 3 months (47.9% to 40.5%, P=0.005) and 10.4% at 8 months (47.9% to 43.1%, P=0.02). Non-sustained trends and shifts were seen in the run chart of median ED LOS for HI patients, but overall before-and-after median times were not significantly different (237min to 225min, P=0.18). 33% of total checklists were completed. 72-hr return visits did not change during the 8-month study period (4.0% to 4.16%, P=0.85). Conclusion: Our local QI initiative was successful in decreasing CT rates for patients presenting with a HI. The decrease in effect at 8 months suggests the need for continued feedback and reminders to ensure long-term sustainability. Other centres could use similar QI methods, as well as the materials we developed, to achieve similar results of improved evidence-based utilization of diagnostic tests.
Drought stress ‘particularly at seedling stage’ causes morpho-physiological differences in wheat which are crucial for its survival and adaptability. In the present study, 209 recombinant inbred lines (RILs) from synthetic wheat (W7984)× ‘Opata’ (also known as SynOpRIL) population were investigated under well-watered and water-limited conditions to identify quantitative trait loci (QTL) for morphological traits at seedling stage. Analysis of variance revealed significant differences (P < 0.01) among RILs, and water treatments for all traits with moderate to high broad sense heritability. Pearson's coefficient of correlation revealed positive correlation among all traits except dry root weight that showed poor correlation with fresh shoot weight (FSW) under water-limited conditions. A high-density linkage map was constructed with 2639 genotyping-by-sequencing markers and covering 5047 cM with an average marker density of 2 markers/cM. Composite interval mapping identified 16 QTL distributed over nine chromosomes, of which six were identified under well-watered and 10 in water-limited conditions. These QTL explained from 4 to 59% of the phenotypic variance. Six QTL were identified on chromosome 7B; three for shoot length under water-limited conditions (QSL.nust-7B) at 64, 104 and 221 cM, two for fresh root weight (QFRW.nust-7B) at 124 and 128 cM, and one for root length (QRL.nust-7B) at 122 cM positions. QFSW.nust-7B appeared to be the most significant QTL explaining 59% of the phenotypic variance and also associated with FSW at well-watered conditions. These QTL could serve as target regions for candidate gene discovery and marker-assisted selection in wheat breeding.
In this paper, we present the electromagnetic modeling of a performance-enhanced planar Schottky diode for applications in terahertz (THz) frequencies. We provide a systematic simulation approach for analyzing our Schottky diode based on finite element method and lumped equivalent circuit parameter extraction. Afterward, we use the developed model to investigate the effect of design parameters of the Schottky diode on parasitic capacitive and resistive elements. Based on this model, device design has been improved by deep-trench formation in the substrate and using a closed-loop junction to reduce the amount of parasitic capacitance and spreading resistance, respectively. The results indicate that cut-off frequency can be improved from 4.1 to 14.1 THz. Finally, a scaled version of the diode is designed, fabricated, and well characterized to verify the validity of this modeling approach.
Synthesis of Ni and Zn substituted nano-greigite,
Fe3S4, is achieved from single source
diethyldithiocarbamato precursor compounds, producing particles typically
50–100 nm in diameter with plate-like pseudohexagonal morphologies. Up to 12
wt.% Ni is incorporated into the greigite structure, and there is evidence
that Zn is also incorporated but Co is not substituted into the lattice. The
Fe L3 X-ray absorption spectra for these materials have a narrow
single peak at 707.7 eV and the resulting main X-ray magnetic circular
dichroism (XMCD) has the same sign at 708.75 eV. All XMCD spectra also have
a broad positive feature at 711 eV, a characteristic of covalent mixing. The
greigite XMCD spectra contrast with the three clearly defined XMCD site
specific peaks found in the ferrite spinel, magnetite. The Fe
L2,3X-ray absorption spectra and XMCD spectra of the
greigite reflect and reveal the high conductivity of greigite and the very
strong covalency of the Fe–S bonding. The electron hopping between
Fe3+ and Fe2+ on octahedral sites results in an
intermediate oxidation state of the Fe in the Oh site of
Fe2.5+ producing an effective formula of [Fe3+
↑]A-site[2Fe2.5+ ↓]B-siteS42–]. The Ni L2,3 X-ray absorption spectra and XMCD reveal substitution on the
Oh site with a strongly covalent character and an
oxidation state <Ni1.5+ in a representative formula
[Fe3+ ↑]A[[(2 – x)Fe2.5+
The aim of this feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Group Problem Management Plus (PM+) intervention for women in the conflict affected settings in Swat, Pakistan.
This mixed-methods study incorporated a quantitative component consisting of a two arm cluster randomised controlled feasibility trial, and qualitative evaluation of the acceptability of the Group PM+ to a range of stakeholder groups. For the quantitative component, on average from each of the 20 Lady Health Workers (LHWs) catchment area (20 clusters), six women were screened and recruited for the trial with score of >2 on the General Health Questionnaire and score of >16 on the WHO Disability Assessment Schedule. These LHW clusters were randomised on a 1 : 1 allocation ratio using a computer-based software through a simple randomisation method to the Group PM+ intervention or Enhanced Usual Care. The Group PM+ intervention consisted of five weekly sessions of 2 h duration delivered by local non-specialist females under supervision. The primary outcome was individual psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale at 7th week after baseline. Secondary outcomes include symptoms of depression, post-traumatic stress disorder (PTSD), general psychological profile, levels of functioning and generalised psychological distress. Intervention acceptability was explored through in-depth interviews.
The results show that lay-helpers with no prior mental health experience can be trained to achieve the desired competency to successfully deliver the intervention in community settings under supervision. There was a good intervention uptake, with Group PM+ considered useful by participants, their families and lay-helpers. The outcome evaluation, which was not based on a large enough study to identify statistically significant results, indicated statistically significant improvements in depression, anxiety, general psychological profile and functioning. The PTSD symptoms and depressive disorder scores showed a trend in favour of the intervention.
This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.
Introduction: Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. Methods: This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. Results: There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P=0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P=0.72) or admission rates (9.85% vs 11.26%, P=0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P<0.001). Conclusion: Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.
The poultry industry is currently facing a serious problem of controlling coccidiosis, owing to the development of drug resistance against commonly available anticoccidials. Furthermore, an increasing demand in the consumers for drug residue free poultry and poultry products has led to the development of alternative strategies for the treatment and control of avian coccidiosis. In response to the invasion of Eimeria species in coccidiosis, oxidative stress is created by host cellular response which imparts pathology to the host tissue besides damaging the parasite. Hence, in order to alleviate the damage caused by oxidative stress during coccidiosis, the use of essential oils (EOs) rich in antioxidant compounds is being considered as an appealing approach. However, results are very divergent and often not as satisfactory as expected. Essential oils, as natural products, obtained from aromatic plants have the potential to serve as an alternate to anticoccidials. The present work aims to review the current state of knowledge, informative collection of results obtained over the years and to attain a critical decision in aspects of the use of EOs as anticoccidials.
Traditional and advanced magnetic resonance imaging techniques are often unable to differentiate progressive central nervous system neoplasm from post-treatment radiation effect (PTRE). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with delayed imaging has been shown to increase the specificity of PET imaging for cerebral neoplasm in small studies. We sought to further evaluate the potential diagnostic benefits of delayed imaging at 5 hours versus standard imaging at 1 hour to differentiate progressive disease (PD) from PTRE in patients with primary or metastatic brain tumors treated with radiation therapy.
Ten patients with primary (n=4) and metastatic (n=6) brain tumors were identified, with diagnostic confirmation of PD or PTRE provided by pathology or>3 month clinical and radiographic follow-up. Maximum standard uptake values (SUV) were calculated for suspicious areas of abnormal contrast enhancement (lesion) and compared to contralateral normal appearing brain (background) at both early and delayed time points. Seven patients were classified as having PD and 3 as having PTRE based pathology or clinical/radiographic follow up. The average lesion to background ratio (L/B) at the early time point (1.16+0.50) was significantly different than L/B for the later time point (1.72+1.10), p=0.030. The mean L/B for PD was 2.17+1.01 at the later time point compared to 0.65+0.06 for PTRE (p=0.010). For the earlier time point, L/B for PD was 1.40+0.42, compared to the L/B for PTRE which was 0.61+0.10 (p=0.003).L/B ratios at early and delayed time points successfully differentiated between patients with PD and PTRE, with significantly greater L/B ratios seen at delayed time points. These initial results are promising and further investigation is underway to evaluate the contribution of delayed imaging in differentiating PD from PTRE.
The need for an age-appropriate in-patient service for 16- to 17-year-olds led to the development of a 6-bed acute admissions unit in a non-metropolitan county in the UK. We provide a descriptive evaluation of the first 2 years of its operation. All admissions from April 2010 to March 2012 were reviewed, clinical details systematically recorded and descriptively analysed.
Ninety-seven young people were admitted during this period (a third were compulsorily detained under the Mental Health Act 1983). The average length of stay was 3–4 weeks. The most common presenting complaints were self-harm and low mood, usually in the context of life events and childhood adversity. Nearly half had substance misuse and other risk-taking behaviours. A third presented with psychotic symptoms. Adjustment and anxiety disorders were most common, followed by alcohol/substance use disorders, depressive illnesses and psychotic illnesses. Comorbidity was the rule rather than the exception. Most patients improved by the time of discharge.
The unit provides an accessible and effective age-appropriate service and is likely to constitute an important component of the comprehensive child and adolescent mental health service strategy in the county.
In patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility.
The objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up.
A total of 45 patients, with median age of 10 (2–27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension.
Device closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p<0.001). At a median follow-up of 80 (41–151) months, severe pulmonary hypertension persisted in four (9.7%) patients. Multivariate analysis showed pulmonary vascular resistance index ⩽6 WU m2 and pulmonary artery systolic and mean pressures ⩽75 and ⩽55 mmHg (all in oxygen), having 97.8% predictive value for regression of pulmonary hypertension (p<0.001) in the long term. In 24 patients with catheterisation-based criteria, regression of pulmonary hypertension was associated with pulmonary vascular resistance index <8 WU m2 (p=0.001) and its fall of >25% (both in oxygen) (p=0.007).
Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.
Introduction: Patients seen primarily for hypertension are common in the emergency department. The outcomes of these patients have not been described at a population level. In this study we describe the characteristics and outcomes of the patients making these visits, as well as changes over time. Methods: This retrospective cohort study used linked health databases from the province of Ontario, Canada, to assess emergency department visits made between April 1, 2002 and March 31, 2012 with a primary diagnosis of hypertension. We determined the annual number of visits as well as the age and sex standardized rates. We examined visit disposition and assessed mortality outcomes and potential hypertensive complications at 7, 30, 90, 365 days and 2 years subsequent to the ED visit. Results: There were 206,147 qualifying ED visits from 180 sites. Visits increased by 64% between 2002 and 2012, from 15793 to 25950 annual visits, respectively. The age- and sex-standardized rate increased from 170/100,000 persons to 228/100,000 persons over the same time period, a 34% increase. Eight percent of visits ended in hospitalization, but this proportion decreased from 9.9% to 7.1% over the study period. Mortality was very low, at less than 1% within 90 days, 2.5% within 1 year, and 4.1% within 2 years. Among subsequent hospitalizations for potential hypertensive complications, stroke was the most frequent admitting diagnosis, but the frequency was still <1% within 1 year. Together hospitalizations for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy and dissection were <1% at 30 days. Conclusion: The number of visits made primarily for hypertension has increased dramatically over the last decade. While some of the increase is due to aging of the population, other forces are contributing to the increase. Subsequent mortality and complication rates are low and have declined. With current practice patterns, the feared complications of hypertension are extremely infrequent.
This paper evaluates 30-year (2013–2042) projections of the selected climatic parameters in cotton/wheat agro-climatic zone of Pakistan. A statistical bias correction procedure was adopted to eliminate the systematic errors in output of three selected general circulation models (GCM) under A2 emission scenario. A transfer function was developed between the GCM outputs and the observed time series of the climatic parameters (base period: 1980–2004) and applied to GCM future projections. The predictions detected seasonal shifts in rainfall and increasing temperature trend which in combination can affect the crop water requirements (CWR) at different phonological stages of the two major crops (i.e. wheat and cotton). CROPWAT model is used to optimize the shifts in sowing dates as a climate change adaptation option. The results depict that with reference to the existing sowing patterns, early sowing of wheat and late sowing of cotton will favour decreased CWR of these crops.
Personal health budgets (PHBs) were piloted in the National Health Service (NHS) in England between 2009 and 2012 and were found to have greater positive effects on quality of life and psychological well-being for those with mental health problems than commissioned service, as well as reducing their use of unplanned care. The government intends to extend PHBs in England for long-term conditions, including mental health, from April 2015. Given the importance of engaging clinicians in the next phase of PHB development, we provide an overview of the approach, synthesise the evidence from the national pilot and debate some of the opportunities and challenges. Balancing individual choice and recovery with concerns for risk, equity and the sustainability of existing community services is the central tension underpinning this innovation in mental health service delivery.
Few studies have described clinical characteristics of patients subject to an involuntary detention in an Irish context. The Irish Mental Health Act 2001 makes provision under Section 23(1), whereby a person who has voluntary admission status can be detained.
This study aimed to describe all involuntary admissions to St Patrick’s University Hospital (SPUH) (2011–2013) and to evaluate clinical characteristics of voluntary patients who underwent Mental Health Act assessment during 2011 to determine differences in those who had involuntary admission orders completed and those who did not.
All uses of Mental Health Act 2001 within SPUH 2011–2013 were identified. All uses of Section 23(1) during 2011 were reviewed and relevant documents/case-notes examined using a pro forma covering clinical data, factors recognized to influence involuntary admissions and validated scales were used to determine diagnoses, insight, suicide and violence risk.
Over 2011–2013, 2.5–3.8% of all admissions were involuntary with more detained after use of Section 23(1) than Section 14(2). The majority of initiations of Section 23(1) did not result in an involuntary admission (72%), occurred out of hours (52%) and many occurred early after admission (<1 week, 43%). Initiation of Section 23(1) by a consultant psychiatrist (p=0.001), suicide risk (p=0.03) and lack of patient insight into treatment (p=0.007) predicted conversion to involuntary admission.
This study predicts a role for patient insight, suicide risk and consultant psychiatrist decision making in the initiation of Mental Health Act assessment of voluntary patients. Further data describing the involuntary admissions process in an Irish setting are needed.
We investigate the low-frequency (by comparison with the ion Larmor frequency) electrostatic solitary structures in a spatially non-uniform electron–positron–ion (e–p–i) magnetoplasma with non-Maxwellian electrons. A linear dispersion relation for the obliquely propagating ion acoustic drift wave is derived and it is shown that the non-Maxwellian electron population modifies the dispersion characteristics of the wave under consideration. We also carry out a nonlinear analysis and derive the modified Zakharov–Kuznetsov (MZK) equation for the coupled drift acoustic wave in a non-uniform magnetized plasma. We highlight the differences between the MZK equation and its homogeneous counterpart. We also find the solution of the MZK equation using the tangent hyperbolic method. It is observed that the electron spectral index
, positron concentration, and propagation angle
alter the structure of the ion acoustic drift solitary waves. The results obtained in this paper may be beneficial to understanding the propagation characteristics of electrostatic drift solitary structures in the interstellar medium and in laboratory experiments where electron–positron plasmas have recently been created by impinging ultra-intense laser pulses on a solid density target at the Lawrence Livermore National Laboratory (LLNL).