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Cognitive reserve (CR) can prevent the risk of incident cognitive impairment in the elderly. However, the moderator effects of CR on the link between hearing difficulties (HDs) and the risk of incident cognitive impairment are not well understood.
This cohort study obtained data from the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The baseline samples included 6309 participants aged 65 years and older at baseline. Cognitive impairment was assessed using the Chinese version of the Mini Mental State Examination. A composite measure of CR was calculated based on education, occupational complexity, and leisure activities of the participants. The marginal structural model was utilized to investigate whether CR moderates the association between HD and incident cognitive impairment. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were calculated.
Of the 6309 participants at baseline, 1936 (30.7%) developed cognitive impairment during the 6-year follow-up period and 2562 (40.6%) reported HD. The risk of incident cognitive impairment was 1.90-fold (95% CI 1.69–2.14) for participants developing HD compared to those without. Those with middle CR had lower OR (0.72, 95% CI 0.62–0.82) that further decreased to 0.58 (95% CI 0.49–0.69) for those with high CR. Participants with HD with low CR showed the highest OR (4.32, 95% CI 3.42–5.47). In addition, individuals with HD with low education levels or low complex occupations had the highest risk of incident cognitive impairment.
CR moderates the negative association between HD and cognitive function. Education and occupation complexity may be more sensitive proxies for CR.
Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.
Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria.
When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure.
The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.
Fluid–structure interaction is fundamental to the characteristics of the induced flows due to the motion of structures in fluids and also is crucial to the performance of submerged structures. This paper presents a three-dimensional analytical study of the intrinsic free vibration of an elastic multilayered hollow sphere interacting with an exterior non-Newtonian fluid medium. The fluid is assumed to be characterized by a compressible linear viscoelastic model accounting for both the shear and compressional relaxation processes. For small-amplitude vibrations, the equations governing the viscoelastic fluid can be linearized, which are then solved by introducing appropriate potential functions. The solid is assumed to exhibit a particular material anisotropy, i.e. spherical isotropy, which includes material isotropy as a special case. The equations governing the anisotropic solid are solved in spherical coordinates using the state-space formalism, which finally establishes two separate transfer relations correlating the state vectors at the innermost surface with those at the outermost surface of the multilayered hollow sphere. By imposing the continuity conditions at the fluid–solid interface, two separate analytical characteristic equations are derived, which characterize two independent classes of vibration. Numerical examples are finally conducted to validate the theoretical derivation as well as to investigate the effects of various factors, including fluid viscosity and compressibility, fluid viscoelasticity, solid anisotropy and surface effect, as well as solid intrinsic damping, on the vibration characteristics of the submerged hollow sphere. Particularly, our theoretically predicted vibration frequencies and quality factors of gold nanospheres with intrinsic damping immersed in water agree exceptionally well with the available experimentally measured results. The reported analytical solution is truly and fully three-dimensional, covering from the purely radial breathing mode to the torsional mode to any general spheroidal mode as well as being applicable to various simpler situations, and hence can be a broad-spectrum benchmark in the study of fluid–structure interaction.
There is evidence indicating that using the current UK energy feeding system to ration the present sheep flocks may underestimate their nutrient requirements. The objective of the present study was to address this issue by developing updated maintenance energy requirements for the current sheep flocks and evaluating if these requirements were influenced by a range of dietary and animal factors. Data (n = 131) used were collated from five experiments with sheep (5 to 18 months old and 29.0 to 69.8 kg BW) undertaken at the Agri-Food and Biosciences Institute of the UK from 2013 to 2017. The trials were designed to evaluate the effects of dietary type, genotype, physiological stage and sex on nutrient utilization and energetic efficiencies. Energy intake and output data were measured in individual calorimeter chambers. Energy balance (Eg) was calculated as the difference between gross energy intake and a sum of fecal energy, urine energy, methane energy and heat production. Data were analysed using the restricted maximum likelihood analysis to develop the linear relationship between Eg or heat production and metabolizable energy (ME) intake, with the effects of a range of dietary and animal factors removed. The net energy (NEm) and ME (MEm) requirements for maintenance derived from the linear relationship between Eg and ME intake were 0.358 and 0.486 MJ/kg BW0.75, respectively, which are 40% to 53% higher than those recommended in energy feeding systems currently used to ration sheep in the USA and the UK. Further analysis of the current dataset revealed that concentrate supplement, sire type or physiological stage had no significant effect on the derived NEm values. However, female lambs had a significantly higher NEm (0.352 v. 0.306 or 0.288 MJ/kg BW0.75) or MEm (0.507 v. 0.441 or 0.415 MJ/kg BW0.75) than those for male or castrated lambs. The present results indicate that using present energy feeding systems in the UK developed over 40 years ago to ration the current sheep flocks could underestimate maintenance energy requirements. There is an urgent need to update these systems to reflect the higher metabolic rates of the current sheep flocks.
The study of dexterous manipulation has provided important insights into human sensorimotor control as well as inspiration for manipulation strategies in robotic hands. Previous work focused on experimental environment with restrictions. Here, we describe a method using the deformation and color distribution of the fingernail and its surrounding skin to estimate the fingertip forces, torques, and contact surface curvatures for various objects, including the shape and material of the contact surfaces and the weight of the objects. The proposed method circumvents limitations associated with sensorized objects, gloves, or fixed contact surface type. In addition, compared with previous single finger estimation in an experimental environment, we extend the approach to multiple finger force estimation, which can be used for applications such as human grasping analysis. Four algorithms are used, c.q., Gaussian process, convolutional neural networks, neural networks with fast dropout, and recurrent neural networks with fast dropout, to model a mapping from images to the corresponding labels. The results further show that the proposed method has high accuracy to predict force, torque, and contact surface.
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
Experiments are presented on the deformation of free surface induced by water exit of axisymmetric bodies, particular at the moment before body detaching from water. A set of experimental apparatus is designed to provide driving force for the bodies. A high-speed camera is adopted to capture the motion and deformation of the free surface. Bodies of various shapes, including a stretched spheroid, a sphere, a circular cone and a combination of cylinder and circular cone, are lifted out of water with different velocities, by using a straight rod attached on the top of models. It is found that free-surface deformation is affected by the moving velocity a lot. Three wake flow or free-surface spike patterns are generated corresponding to different velocities. When the velocity is larger than a critical velocity, cavitation incepts and bubble is entrapped inside the water spike, which changes the flow pattern and shape of the spike. It is aimed to explore the spike phenomenon of free surface and explain the reasons behind it.
Attrition modeling is a direct application of extant turnover research that can favorably impact workforce planning and action planning. However, while academic research enables practitioners insights into understanding turnover phenomena, there is no single document that comprehensively translates this work to give guidance as to the many practical decisions that must be made when modeling turnover, as well as how to apply psychological research to messier operational data. This focal article introduces and provides guidance on attrition modeling by outlining early considerations when planning a study, describing how to mesh theory with operational considerations when identifying turnover predictors within organizational settings, highlighting analytical strategies to model turnover, and considering how to appropriately share results. Collectively, this article serves as a guide to conducting attrition modeling within organizations and offers suggestions for future research to inform best practices.
Shortening or omitting the dry period improves the energy balance and metabolic status of dairy cows in early lactation. Metabolic, behaviour and welfare effects throughout lactation, however, are unclear. The current paper reviews long-term metabolic and welfare consequences of short and no dry period, as well as feeding strategies and individual cow characteristics that could support in optimising management of cows with a short or no dry period. The paper will conclude with impacts of short and no dry periods at herd level and in practice. Energy balance after no or a short dry period is more positive during the complete subsequent lactation. After the initial improvement in early lactation, cows after no dry period tend to fatten and may have a too low lactation persistency to be continuously milked until the onset of the subsequent lactation. Reducing dietary energy level for cows with no dry period reduced fattening during the complete lactation but did not improve lactation persistency. Feeding a more lipogenic diet for cows with a short or no dry period did not affect the energy balance or lactation persistency during the complete lactation, although a lipogenic diet resulted in lower plasma insulin and IGF-1 concentration and greater plasma growth hormone concentration, compared with a glucogenic diet. Effects of dry period length on udder health are ambiguous, whereas short and no dry periods improved fertility in most studies. Omission of the dry period changed behaviour of cows both before and after calving, with a longer lying time and greater feed intake after calving, suggesting a better adaptation to a new lactation. Individual cow characteristics like parity, genotype, prepartum body condition score, and milk yield level determined the metabolic response of cows to a short or no dry period. In conclusion, short or no dry periods increase the energy balance in the complete lactation. Feeding strategies can be used to limit fattening of cows with no or short dry period, but the studied feeding strategies did not increase lactation persistency. Improved fertility and behavioural changes around calving suggest a better adaptation to a new lactation in case of no dry period. Customised dry period lengths for individual cows could improve metabolic status of cows at risk of a severe negative energy balance while minimising milk losses.
Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking.
We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987–2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives.
The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79–7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33–13.52); suicide 13.09 (8.54–20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31–2.92); inpatient only 3.45 (2.96–4.02); suicide 2.31 (1.16–4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27–11.37); inpatient only 13.42 (11.87–15.18); suicide 14.26 (6.03–33.72); males, suicide attempts 5.55 (5.10–6.05); inpatient only 11.33 (9.98–12.86); suicide 12.72 (7.77–20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour.
Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.
The association between methicillin-resistant Staphylococcus aureus (MRSA) colonisation and/or infection with increased morbidity and mortality among hospital patients has long been recognised. We sought to build on previous studies to identify modifiable risk factors associated with the acquisition of MRSA colonisation and infection by conducting a retrospective cohort study on patients admitted through the Emergency Department of an acute tertiary-care general hospital in Singapore which implemented universal on-admission MRSA screening. Patients were assigned to the acquisition or non-acquisition group depending on whether they acquired MRSA during their admission. We used logistic regression models with a patient being in the acquisition group as the binary outcome to identify factors associated with MRSA acquisition. A total of 1302 acquisition and 37 949 non-acquisition group patients were analysed. Fifteen variables were included in the multivariate model. A dose–response relationship between length of stay and odds of MRSA acquisition was observed, with a length of stay 3 weeks or more (Adj OR 11.78–57.36, all P < 0.001) being the single biggest predictor of MRSA acquisition. Other variables significantly associated with MRSA acquisition were: male gender, age 65 or greater, previous MRSA colonisation or infection, exposure to certain antibiotics and surgery, and history of diabetes.
To compare the epidemiologic features (e.g. settings and transmission mode) and patient clinical characteristics associated with outbreaks of different norovirus (Nov) strains, we retrospectively analysed data of Nov outbreaks occurring in Guangzhou, China from 2012 to 2018. The results suggested that outbreaks of Nov GII.2, GII.17 and GII.4 Sydney exhibited different outbreak settings, transmission modes and symptoms. GII.2 outbreaks mainly occurred in kindergartens, elementary and high schools and were transmitted mainly through person-to-person contact. By contrast, GII.4 Sydney outbreaks frequently occurred in colleges and were primarily associated with foodborne transmission. Cases from GII.2 and GII.17 outbreaks reported vomiting more frequently than those from outbreaks associated with GII.4 Sydney.
A viscous damping model is proposed based on a simplified equation of fluid motion in a moonpool or the narrow gap formed by two fixed boxes. The model takes into account the damping induced by both flow separation and wall friction through two damping coefficients, namely, the local and friction loss coefficients. The local loss coefficient is determined through specifically designed physical model tests in this work, and the friction loss coefficient is estimated through an empirical formula found in the literature. The viscous damping model is implemented in the dynamic free-surface boundary condition in the gap of a modified potential flow model. The modified potential flow model is then applied to simulate the wave-induced fluid responses in a narrow gap formed by two fixed boxes and in a moonpool for which experimental data are available. The modified potential flow model with the proposed viscous damping model works well in capturing both the resonant amplitude and frequency under a wide range of damping conditions.
Guangxi, a province in southwestern China, has the second highest reported number of HIV/AIDS cases in China. This study aimed to develop an accurate and effective model to describe the tendency of HIV and to predict its incidence in Guangxi. HIV incidence data of Guangxi from 2005 to 2016 were obtained from the database of the Chinese Center for Disease Control and Prevention. Long short-term memory (LSTM) neural network models, autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models and exponential smoothing (ES) were used to fit the incidence data. Data from 2015 and 2016 were used to validate the most suitable models. The model performances were evaluated by evaluating metrics, including mean square error (MSE), root mean square error, mean absolute error and mean absolute percentage error. The LSTM model had the lowest MSE when the N value (time step) was 12. The most appropriate ARIMA models for incidence in 2015 and 2016 were ARIMA (1, 1, 2) (0, 1, 2)12 and ARIMA (2, 1, 0) (1, 1, 2)12, respectively. The accuracy of GRNN and ES models in forecasting HIV incidence in Guangxi was relatively poor. Four performance metrics of the LSTM model were all lower than the ARIMA, GRNN and ES models. The LSTM model was more effective than other time-series models and is important for the monitoring and control of local HIV epidemics.
Whereas genetic susceptibility increases the risk for major depressive disorder (MDD), non-genetic protective factors may mitigate this risk. In a large-scale prospective study of US Army soldiers, we examined whether trait resilience and/or unit cohesion could protect against the onset of MDD following combat deployment, even in soldiers at high polygenic risk.
Data were analyzed from 3079 soldiers of European ancestry assessed before and after their deployment to Afghanistan. Incident MDD was defined as no MDD episode at pre-deployment, followed by a MDD episode following deployment. Polygenic risk scores were constructed from a large-scale genome-wide association study of major depression. We first examined the main effects of the MDD PRS and each protective factor on incident MDD. We then tested the effects of each protective factor on incident MDD across strata of polygenic risk.
Polygenic risk showed a dose–response relationship to depression, such that soldiers at high polygenic risk had greatest odds for incident MDD. Both unit cohesion and trait resilience were prospectively associated with reduced risk for incident MDD. Notably, the protective effect of unit cohesion persisted even in soldiers at highest polygenic risk.
Polygenic risk was associated with new-onset MDD in deployed soldiers. However, unit cohesion – an index of perceived support and morale – was protective against incident MDD even among those at highest genetic risk, and may represent a potent target for promoting resilience in vulnerable soldiers. Findings illustrate the value of combining genomic and environmental data in a prospective design to identify robust protective factors for mental health.