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A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.
To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).
Design and Setting:
This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.
Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.
Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.
This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.
The primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.
In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses’ death anxiety and improve nurses’ skills, knowledge, and attitude towards palliative care.
Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.
There was a significant improvement in nurses’ knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.
Significance of results
The multimodal palliative care workshop was useful in improving nurses’ EOL knowledge and reducing their anxiety towards death. The positive change in nurses’ attitudes and practices were noted to be sustained for at least six weeks after the intervention.
Excess energy intake is recognised as a strong contributing factor to the global rise of being overweight and obese. The aim of this paper was to investigate if oral sensitivity to complex carbohydrate relates to ad libitum consumption of complex carbohydrate foods in a sample group of female adults. Participants’ [(n = 51 females): age 23.0 ± 0.6 years (range 20.0 – 41.0 years); excluding restrained eaters] sensitivity towards maltodextrin (oral complex carbohydrate) and glucose (sweet taste) were assessed by measuring detection threshold (DT) and suprathreshold intensity perception (ST). A crossover design was used to assess consumption of two different iso-caloric preload milkshakes and ad libitum milkshakes – 1) glucose based milkshake, 2) maltodextrin based milkshake. Ad libitum intake (primary outcome) and eating rate, liking, hunger, fullness, and prospective consumption ratings were measured. Participants who were more sensitive towards complex carbohydrate (maltodextrin DT) consumed significantly more maltodextrin based milkshake in comparison to less sensitive participants (P=0.01) and this was independent of liking. Participants who had higher liking for glucose based milkshake consumed significantly more glucose based milkshake in comparison to participants with lower hedonic ratings (P=0.049). The results provide support regarding the role of the oral system sensitivity (potentially taste) to complex carbohydrate and the prospective to overconsume complex carbohydrate based milkshake in a single sitting. The trial was registered at the ANZCTR as ACTRN12617000551392.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Patent retrieval and analytics have become common tasks in engineering design and innovation. Keyword-based search is the most common method and the core of integrative methods for patent retrieval. Often searchers intuitively choose keywords according to their knowledge on the search interest which may limit the coverage of the retrieval. Although one can identify additional keywords via reading patent texts from prior searches to refine the query terms heuristically, the process is tedious, time-consuming, and prone to human errors. In this paper, we propose a method to automate and augment the heuristic and iterative keyword discovery process. Specifically, we train a semantic engineering knowledge graph on the full patent database using natural language processing and semantic analysis, and use it as the basis to retrieve and rank the keywords contained in the retrieved patents. On this basis, searchers do not need to read patent texts but just select among the recommended keywords to expand their queries. The proposed method improves the completeness of the search keyword set and reduces the human effort for the same task.
Low socioeconomic status (SES) is a barrier for cardiovascular disease (CVD) risk screening and a determinant of poor CVD outcomes. This study examined the associations between access to health-promoting facilities and participation in a CVD risk screening program among populations with low SES residing in public rental flats in Singapore.
Data from Health Mapping Exercises conducted from 2013 to 2015 were obtained, and screening participation rates of 66 blocks were calculated. Negative binomial regression was used to test for associations between distances to four nearest facilities (i.e., subsidized private clinics, healthy eateries, public polyclinics, and parks) and block participation rate in CVD screening. We also investigated potential heterogeneity in the association across regions with an interaction term between distance to each facility and region.
The analysis consisted of 2069 participants. The associations were only evident in the North/North-East region for subsidized private clinic and park. Specifically, increasing distance to the nearest subsidized private clinic and park was significantly associated with lower [incidence rate ratio (IRR) = 0.88, 95% confidence interval (CI): 0.80–0.98] and higher (IRR = 1.93, 95%CI: 1.15–3.25) screening participation rates respectively.
Our findings could potentially inform the planning of future door-to-door screenings in urban settings for optimal prioritization of resources. To increase participation rates in low SES populations, accessibility to subsidized private clinics and parks in a high population density region should be considered.
Consumer recovery processes refer to social Connectedness, Hope, Identity, Meaning in life, and Empowerment (“CHIME”). This study examined if expectations of change in depression could mediate the relationship between CHIME recovery processes and depression severity. Participants were patients who consulted clinical psychologists at primary care clinics. Measures of depression change expectancy, CHIME recovery processes, and depression symptoms were administered. Change expectancy partially mediated the relationship between Hope and depression severity. The same was found for Identity, but Identity also mediated the relationship between change expectancy and depression. Thus, Hope may reduce depression by improving change expectancies, whereas Identity and change expectancy may have reciprocal influences that alter depression. Findings suggest that the CHIME recovery processes may facilitate recovery from depression.
During the century of massive expansion of the Qin state in China (ca. 316–222 BCE), and the subsequent fifteen years of the empire (221–207 BCE), it is recorded that millions of persons were forcibly relocated and resettled throughout the empire and along its frontiers. For example, the historian Sima Qian (ca. 145–86 BCE) states that in just the years between 213 and 210 BCE, the First Emperor relocated more than a million people from interior counties of the empire to settle newly-conquered lands on the northern and southern frontiers. Yet this was only one type of forced resettlement carried out by the Qin. The Qin state also relocated thousands of aristocratic households from conquered states to the Qin capital of Xianyang, captured large numbers of non-Chinese peoples and assigned them to localities as slaves to open up agricultural land, exiled wealthy iron industrialists from the interior to the periphery, intentionally expelled the entire populations of conquered cities to replace them with amnestied criminals, and pooled and redirected the labor of convicts gathered from throughout the empire to labor on huge projects such as the First Emperor's tomb. This article seeks to analyze and categorize these various Qin forced resettlements to uncover the ideological and policy motivations behind them and the role they played in the larger project of Qin imperial expansion and colonization.
Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of the survival motor neuron (SMN1) gene. In the phase 1 trial (NCT02122952), SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of 15 symptomatic SMA1 patients (3 at a lower dose [cohort 1] and 12 at the proposed therapeutic dose [cohort 2]). This report describes long-term follow-up study design and data from the phase 1 study. Methods: Patients in the phase 1 study could rollover into a long-term follow-up study (NCT03421977). The primary objective is to collect long-term safety data (serious adverse events, hospitalizations, and adverse events of special interest). Annual follow-up will occur for 15 years. Additionally, patient record transfers from local clinician(s) will be requested. Safety assessments include medical history and record review, physical examination, clinical laboratory evaluation, and pulmonary assessments. Efficacy assessments include physical examination to assess developmental milestones. Results: As of September 27, 2018, the oldest patients are 59.2 (cohort 1) and 52.1 (cohort 2) months old and free of permanent ventilation. Preliminary data, including survival and developmental milestones, will be presented. Conclusions: Patients treated with a one-time dose of AVXS-101 continue to gain strength, develop, and achieve new milestones, demonstrating a long-term, durable response.
The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive screening tool designed for use in culturally diverse populations without the need for translations or adaptations. While it has been established to be language-neutral, the VCAT’s construct validity has not been investigated.
471 participants were recruited, comprising 233 healthy comparisons, 117 mild cognitive impairment (MCI), and 121 mild Alzheimer’s disease (AD) patients. VCAT and domain-specific neuropsychological tests were administered in the same sitting. Construct validity was assessed by analyzing domain-specific associations between the VCAT and well-established cognitive assessments. Reliability (internal consistency) was measured by Cronbach’s alpha. Diagnostic ability (area under the curve) and recommended cutoffs were determined by receiver operating characteristic (ROC) analysis.
The VCAT and its subdomains demonstrated good construct validity in terms of both convergent and divergent validity and good internal consistency (α = .74). ROC analysis found that the VCAT was on par with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at distinguishing between healthy comparisons, MCI, and mild AD. Consistent with previous studies, VCAT scores were not affected by language of administration or ethnicity in our cohort. Findings suggest the following cutoffs: Dementia 0–19, MCI 20–24, Normal 25–30.
This study established the construct validity of the VCAT, which is vital to ensure its subdomains effectively measure the cognitive processes they were designed to. The VCAT is capable of detecting early cognitive impairments and allows for meaningful cross-cultural comparisons, especially useful for international collaborations and clinical trials, and for clinical use in diverse multiethnic populations.
Widely different views have been held concerning the structure of Plautus’ Menaechmi. On the one hand, the sequence of misunderstandings arising from the presence in the same city of a pair of identical twins with the same name has been likened to clockwork and attributed in essentials to an unknown Greek dramatist. On the other hand, E. Stärk has stressed features of the play which are typical of improvised comedy and put forward the bold theory that it was constructed by Plautus himself, following traditions of pre-literary Italic drama but using stock motifs of Greek New Comedy. I wish to suggest that the truth lies between these extreme positions.
A panel of eight leadership scholars was convened to participate in a panel at the 20th International Leadership Association Conference to discuss the benefits and the pitfalls of applying authentic leadership theory to the classroom setting. Inspired by Ken Parry's masterful teaching and the authenticity that he displayed in the classroom, this paper provides an overview of the panel's discussion as they grappled with the attractions, the challenges and the risks that are posed to both teacher-scholars and student-scholars in bringing their full selves into the classroom.
We compared elastic moduli in polar firn derived from diving wave refraction seismic velocity analysis, firn-core density measurements and microstructure modelling based on firn-core data. The seismic data were obtained with a small electrodynamic vibrator source near Kohnen Station, East Antarctica. The analysis of diving waves resulted in velocity–depth profiles for different wave types (P-, SH- and SV-waves). Dynamic elastic moduli of firn were derived by combining P- and S-wave velocities and densities obtained from firn-core measurements. The structural finite-element method (FEM) was used to calculate the components of the elastic tensor from firn microstructure derived from X-ray tomography of firn-core samples at depths of 10, 42, 71 and 99 m, providing static elastic moduli. Shear and bulk moduli range from 0.39 to 2.42 GPa and 0.68 to 2.42 GPa, respectively. The elastic moduli from seismic observations and the structural FEM agree within 8.5% for the deepest achieved values at a depth of 71 m, and are within the uncertainty range. Our observations demonstrate that the elastic moduli of the firn can be consistently obtained from two independent methods which are based on dynamic (seismic) and static (tomography and FEM) observations, respectively, for deeper layers in the firn below ~10 m depth.
This study sought to examine the role of death anxiety as a transdiagnostic predictor of social anxiety symptomatology compared to self-esteem and intolerance of uncertainty, and to examine the relationship between measures of intrinsic and extrinsic religiosity and death anxiety. A total of 591 participants, 445 females, average age 38.0 years (SD = 14.5), completed an online survey including background questions, the Depression, Anxiety and Stress Scale, the Social Interaction Anxiety and Social Phobia Scale, the Rosenberg Self-Esteem Scale, the Intolerance of Uncertainty Scale, the Santa Clara Strength of Religious Faith Questionnaire, the Spirituality Scale, and the Death Anxiety Scale. No significant, independent relationship was found between death anxiety and social anxiety symptomatology, although self-esteem and intolerance of uncertainty were significant predictors of both measures of social anxiety, confirming the importance of these key transdiagnostic mediators as predictors of social anxiety symptomatology. A strong negative correlation was found between death anxiety and measures of both intrinsic and extrinsic religiosity in this general population sample not selected for high religious affiliation.
I explore the bases of a ‘distributionalist’ approach to syntactic categories, that is, an approach that makes distinctions on the basis of purely syntactic (as opposed to, say, semantic) criteria. I focus on the phenomenon of ‘mixed projections’, where a syntactic phrase appears to display properties of more than one syntactic category, as analysed within the framework of Lexical-Functional Grammar. I argue that of the three syntactic criteria called upon in the definition of syntactic categories within this approach, only one, the internal syntactic structure of a phrase, is a sufficient criterion for syntactic categorization. This leads to a more restricted definition of category mixing and implies a more restricted approach to categorization in general.