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Much of the global dialogue around policies for health today focuses on the need for community participation in health systems to ultimately improve health among populations. Participation is not only promoted in the context of provision and utilization of health services but also as a key factor in the wider context of social determinants of health and health as a human right (World Health Organization, 2008a). Despite the growing interest in the role of participation, the evidence that links participation directly to better health remains weak (Rifkin, 2014), which creates barriers to gaining full support of governments, funding agencies and health professionals to promote this concept (Atkinson et al., 2011).
Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning.
Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination – Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed.
Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment.
The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.
Criteria for mild cognitive impairment (MCI) consider impairment in instrumental activities of daily living (IADL) as exclusionary, but cross-sectional studies suggest that some high-level functional deficits are present in MCI. This longitudinal study examines informant-rated IADL in MCI, compared with cognitively normal (CN) older individuals, and explores whether functional abilities, particularly those with high cognitive demand, are predictors of MCI and dementia over a 2-year period in individuals who were CN at baseline.
A sample of 602 non-demented community dwelling individuals (375 CN and 227 with MCI) aged 70–90 years underwent baseline and 24-month assessments that included cognitive and medical assessments and an interview with a knowledgeable informant on functional abilities with the Bayer Activities of Daily Living Scale.
Significantly more deficits in informant-reported IADL with high cognitive demand were present in MCI compared with CN individuals at baseline and 2-year follow-up. Functional ability in CN individuals at baseline, particularly in activities with high cognitive demand, predicted MCI and dementia at follow-up. Difficulties with highly cognitively demanding activities specifically predicted amnestic MCI but not non-amnestic MCI whereas those with low cognitive demand did not predict MCI or dementia. Age, depressive symptoms, cardiovascular risk factors and the sex of the informant did not contribute to the prediction.
IADL are affected in individuals with MCI, and IADL with a high cognitive demand show impairment predating the diagnosis of MCI. Subtle cognitive impairment is therefore likely to be a major hidden burden in society.
Chapter 11 describes how teams of wireless nodes can work together to improve the reliability of signaling. Due to the inherent uncertain, time-varying, and shared nature of the wireless environment (reflected in shadowing, small-scale fading, and interference), it is difficult to achieve extremely high reliability over a single wireless link even when advanced signal-processing techniques such as diversity and multiuser detection are employed. However, since wireless transmissions are inherently broadcast – overheard by all nodes within range – a natural approach to reliability is to develop cooperative techniques. Cooperative techniques exploit in parallel many helper nodes, called relays, to increase the diversity of the available wireless links. These techniques can yield large improvements in reliability and throughput as well as large decreases in energy consumption.
The chapter starts with an overview of various cooperative communications methods that can be employed depending on the level of channel state information (CSI) and device synchronization. The chapter then considers two techniques in more detail: relaying using virtual beamforming and rateless codes. In both cases, we start out with an analysis of a “fundamental building block” that consists of one source, a number of parallel relays, and one destination. In the virtual beamforming technique, the relays rebroadcast the source signal that they have decoded. Relays adjust their transmission amplitudes and phases to ensure that their transmissions interfere constructively, maximizing the destination's signal-to-noise ratio (SNR). In the rateless coding approach, the relays individually decode the source message.
Multicolour imaging polarimetry of the main sequence star BD+31°643 shows that the Kalas & Jewitt (1997) disc extends to at least 13000AU. A disc of this radius must be dynamically very young compared to the central star, unlike the situation found in the β Pictoris system. A striking linear filament of 850μm emission detected 50″ south, that parallels the dust disk, is probably not physically associated.
In early 2002, the Tennessee Valley Authority (TVA) completed a revision of its Environmental Management System (EMS). The new EMS is designed to fully align with the International Organization for Standardization (ISO) 14001 EMS standards. The EMS incorporated a new Environmental Review Process as an integral component. It established clear roles and responsibilities for the agency NEPA (National Environmental Policy Act) staff and organizations across TVA, introduced process improvements and standardization measures, and made structural changes to bring about increased efficiency and effectiveness in NEPA reviews. The NEPA process was further strengthened by its integration into the revised comprehensive EMS. A new Environmental Policy and Principles was adopted that reestablished the TVA commitments to environmental protection and stewardship, to assess and minimize the effects of TVA operations on the environment, and to involve the public. An Achievement Plan was developed to assure that TVA meets its corporate environmental commitment; that plan recognized the EMS as the principal tool for achieving that goal. Corporate environmental objectives and targets were established, and new methods to measure the overall environmental performance of TVA were introduced. Significantly, the NEPA process was directly linked to other EMS processes, including those for environmental training, communication and stakeholder involvement, records management, environmental auditing, corrective and preventive action, performance monitoring and reporting, and management review. These systematic linkages work together to reinforce all aspects of NEPA performance and to provide improved environmental compliance, cost savings in environmental management programs, and measurable improvements in achievement of TVA environmental objectives. The TVA experience, which takes an agency-wide rather than a facility-based approach to EMS development, may offer insights and an alternative strategy to other agencies addressing NEPA/EMS implementation issues.
Brain-type creatine phosphokinase isoenzyme (CPK BB) was measured by radioimmunoassay in the serum of 31 depressed patients undergoing bilateral ECT. Samples were taken shortly before and at one hour, two hours, and six hours following ECT. ECT did not cause a significant alteration in serum CPK BB concentration during the six hours following the treatment. Similarly, there was no difference in mean pre-ECT concentration of serum CPK BB between patients receiving the first ECT of their current admission and those receiving subsequent treatments. These findings do not support suggestions that ECT causes alteration in permeability of the blood-brain barrier, nor that it causes detectable brain injury.
Fourier series solutions have been obtained for the temperature distributions in melt spinning cooling belts and drums. These solutions have been used to determine drum and belt designs for producing 0.050 inch steel sheet. This paper discusses thermal design parameters for cooling drums used in melt spinning rapid solidification.
In a study of glycosylated hemoglobins in Friedreich's Ataxia patients and in family members, the level was found to be higher in insulin dependent diabetics than in healthy non-diabetic control subjects (p<0.01), but was similar to non-ataxic diabetic control subjects. Results for non-diabetic Friedreich's Ataxia patients and siblings were similar to those for non-diabetic control subjects while levels were slightly increased in the heterozygotes. It is concluded that in Friedreich's Ataxia patients and family members (apart from the insulin dependent diabetics), there was no hyperglycemia sufficient to be detected as an increase in glycosylated hemoglobins.
In a study of the lipid composition of erythrocyte membranes in Friedreich's ataxia, the concentration of the major membrane components (phosr pholipids, cholesterol and protein) in ataxie patients, family members, and control subjects were found to be the same. The total fatty acid distribution was also normal. However, an altered distribution of phospholipid classes in erythrocytes was noted (an increase of PI + PS and a decrease of P E in Friedreich's ataxia patients).
Detailed in vivo and in vitro studies of glucose and insulin metabolism in Friedreich's ataxia patients and unaffected family members have further defined the extent of the abnormalities in carbohydrate metabolism. The high incidence of glucose intolerance and a hyper-insulinemic response to a glucose challenge in a high percentage of Friedreich's ataxia patients has been confirmed. An increased incidence of glucose intolerance among hétérozygotes is suggested, while the siblings show a more normal distribution of diabetes and a nearly normal insulin response to the glucose tolerance test. Human growth hormone patterns are normal for all groups.
Preliminary studies of insulin binding to erythrocytes suggest a difference in the binding characteristics among diabetic Friedreich's ataxia patients, while the binding in the non-diabetic Friedreich's ataxia group is similar to that of non-diabetic controls. Results from a small group of non-diabetic siblings suggest a normal insulin binding, while a tendency toward increased binding at low insulin concentrations among diabetic family members is noted.
In a detailed investigation of nucleotide synthesis, intercom'ersion and degradation, no difference was found between subjects with Friedreich's Ataxia and normal controls. It appears improbable that this disorder is related to a primary defect in purine metabolism.
Thyroid activity was assessed in two groups of crossbred lambs and in Dorset Horn lambs fed ad libitum, by measuring the rate constant (K4) for the release of 131iodine from the gland. The results demonstrated a highly significant curvilinear correlation (P<0·001) between growth rate and the rate constant (K4) in experiments based on individual measurements in animals from three populations.
Separate work carried out on the measurements of both thyroid size and RNA/DNA ratio suggests a need for caution when these are interpreted as parameters of thyroid activity. In the growing animal these may be more reflective of the growth of the thyroid gland itself, differences which may be governed by factors not directly related to variations in hormone secretion rate.
The findings are discussed in terms of an explanation of the contradictory results obtained where attempts have been made to alter the thyroid status of growing animals by the use of thyroid hormone analogues and thyroid depressant drugs.