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To evaluate the association between neuropsychiatric symptoms and apolipoprotein E (APOE) ϵ4 allele among older people in Central African Republic (CAR) and the Republic of Congo (ROC).
Multicenter population-based study following a two-phase design.
From 2011 to 2012, rural and urban areas of CAR and ROC.
People aged 65 and over.
Following screening using the Community Screening Interview for Dementia, participants with low cognitive scores (CSI-D ≤ 24.5) underwent clinical assessment. Dementia diagnosis followed the DSM-IV criteria and Peterson’s criteria were considered for Mild Cognitive Impairment (MCI). Neuropsychiatric symptoms were evaluated through the brief version of the Neuropsychiatric Inventory (NPI-Q). Blood samples were taken from all consenting participants before APOE genotyping was performed by polymerase chain reaction (PCR). Logistic regression models were used to evaluate the association between the APOE ϵ4 allele and neuropsychiatric symptoms.
Overall, 322 participants had complete information on both neuropsychiatric symptoms and APOE status. Median age was 75.0 years and 81.1% were female. Neuropsychiatric symptoms were reported by 192 participants (59.8%) and at least 1 APOE ϵ4 allele was present in 135 (41.9%). APOE ϵ4 allele was not significantly associated with neuropsychiatric symptoms but showed a trend toward a protective effect in some models.
This study is the first one investigating the association between APOE ϵ4 and neuropsychiatric symptoms among older people in sub-Saharan Africa (SSA). Preliminary findings indicate that the APOE ϵ4 allele was not associated with neuropsychiatric symptoms. Further research seems, however, needed to investigate the protective trend found in this study.
By the Hellenistic period, monumental stone theaters were being built throughout the Greek world in such great number that Pausanias later suggested that a polis without a theater (and from his context it is likely that he means a stone-built theater rather than a place in or near a sanctuary where wooden seats could be erected) was hardly worthy. Western Greek cities took part in this urban development, in some cases as early as the fourth century. Archaeological remains of eighteen stone theaters have been identified in Sicily and South Italy and at least ten others are suggested by literary sources (Map 6.1).
The comic playwright Epicharmus produced original dramas acclaimed and influential for many centuries thereafter. His dramas can be better understood in the framework of contemporary Sicilian poetry and performance genres and also with the help of the exiguous records about the context of performance in early Syracuse.
The plays of Epicharmus are often described as mythological burlesques without political relevance. The accidents of preservation and the scholarly assumption that Athens was unique in its encouragement of real social dialogue through theater have contributed to a widely held view that Syracusan playwrights were entertainers without serious social concerns or roles.
Studies of ancient theater have traditionally taken Athens as their creative center. In this book, however, the lens is widened to examine the origins and development of ancient drama, and particularly comedy, within a Sicilian and southern Italian context. Each chapter explores a different category of theatrical evidence, from the literary (fragments of Epicharmus and cult traditions) to the artistic (phylax vases) and the archaeological (theater buildings). Kathryn G. Bosher argues that, unlike in classical Athens, the golden days of theatrical production on Sicily coincided with the rule of tyrants, rather than with democratic interludes. Moreover, this was not accidental, but plays and the theater were an integral part of the tyrants' propaganda system. The volume will appeal widely to classicists and to theater historians.
Although the first 100 years of the history of theater in Sicily can be roughly sketched by following scattered references in texts and piecemeal archaeological clues, as I have tried to do in the first four chapters of this book, the most important and well-known pieces of evidence for Sicilian theater, and perhaps for much of early Greek theater in general, come from the fourth century. It was at this juncture of the classical and Hellenistic periods that both theaters and theatrical vases began to be produced in great number.
In recent years, scholars have argued for a profound connection between the cult of Demeter and the early development of theater in Greek Sicily. On close examination, however, the connection appears not to be organic, but an accident of local politics.
Aeschylus and Aristophanes wrote for a crowd. Like Shakespeare, they did not only cater to the sophisticated and educated, but also drew “music from the dullest heart” and offered speeches for the “dumb and unaccomplished.” It is perhaps for this reason that, in the absence of direct written evidence from most citizens of ancient Athens, plays have sometimes been tapped for the views of the audience, and, by extension, for a good segment of the population.
Gelon and especially Hieron I supported and encouraged an active literary circle, including the playwrights Epicharmus, Deinolochus, Phormis, and, more briefly, Aeschylus. Literary and historical evidence suggests that their plays were performed on a grand scale. When the Deinomenids fell, a democratic government came to power and there is little evidence of large-scale public theatrical events for more than half a century. This period of turbulent democracy was brought to an end by Dionysius I (405–367), who not only ruled Syracuse, but extended his control over most of Sicily and up the mainland as far as the gulf of Taras and beyond.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.