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Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD).
A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function.
Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline.
These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms – particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.
To characterise subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
Questionnaires assessing symptom severity and impact on function and quality of life were administered to patients before superior semicircular canal dehiscence surgery, between June 2011 and March 2016. Questionnaire sections included general quality of life, internal amplified sounds, dizziness and tinnitus, with scores of 0–100 points.
Twenty-three patients completed the questionnaire before surgery. Section scores (mean±standard deviation) were: 38.2 ± 25.2 for general quality of life, 52.5 ± 23.9 for internal amplified sounds, 35.1 ± 28.8 for dizziness, 33.3 ± 30.7 for tinnitus, and 39.8 ± 22.2 for the composite score. Cronbach's α statistic averaged 0.93 (range, 0.84–0.97) across section scores, and 0.83 for the composite score.
The Gopen–Yang Superior Semicircular Canal Dehiscence Questionnaire provides a holistic, patient-centred characterisation of superior semicircular canal dehiscence symptoms. Internal consistency analysis validated the questionnaire and provided a quantitative framework for further optimisation in the clinical setting.
Streptococcus pyogenes (or Group A Streptococcus, GAS) is a Gram-positive human pathogen responsible for a diverse array of superficial, invasive and immune-related diseases. GAS infections have historically been diseases of poverty and overcrowding, and remain a significant problem in the developing world and in disadvantaged populations within developed countries. With improved living conditions and access to antibiotics, the rates of GAS diseases in developed societies have gradually declined during the 20th century. However, genetic changes in circulating GAS strains and/or changes in host susceptibility to infection can lead to dramatic increases in the rates of specific diseases. No situations exemplify this more than the global upsurge of invasive GAS disease that originated in the 1980s and the regional increases in scarlet fever in north-east Asia and the UK. In each case, increased disease rates have been associated with the emergence of new GAS strains with increased disease-causing capability. Global surveillance for new GAS strains with increased virulence is important and determining why certain populations suddenly become susceptible to circulating strains remains a research priority. Here, we overview the changing epidemiology of GAS infections and the genetic alterations that accompany the emergence of GAS strains with increased capacity to cause disease.
Host–parasite dynamics can play a fundamental role in both the establishment success of invasive species and their impact on native wildlife. The net impact of parasites depends on their capacity to switch effectively between native and invasive hosts. Here we explore host-switching, spatial patterns and simple fitness measures in a slow-expanding invasion: the invasion of Asian house geckos (Hemidactylus frenatus) from urban areas into bushland in Northeast Australia. In bushland close to urban edges, H. frenatus co-occurs with, and at many sites now greatly out-numbers, native geckos. We measured prevalence and intensity of Geckobia mites (introduced with H. frenatus), and Waddycephalus (a native pentastome). We recorded a new invasive mite species, and several new host associations for native mites and geckos, but we found no evidence of mite transmission between native and invasive geckos. In contrast, native Waddycephalus nymphs were commonly present in H. frenatus, demonstrating this parasite's capacity to utilize H. frenatus as a novel host. Prevalence of mites on H. frenatus decreased with distance from the urban edge, suggesting parasite release towards the invasion front; however, we found no evidence that mites affect H. frenatus body condition or lifespan. Waddycephalus was present at low prevalence in bushland sites and, although its presence did not affect host body condition, our data suggest that it may reduce host survival. The high relative density of H. frenatus at our sites, and their capacity to harbour Waddycephalus, suggests that there may be impacts on native geckos and snakes through parasite spillback.
The accurate clinical characterisation of mild cognitive impairment (MCI) is becoming increasingly important. The aim of this study was to compare the neuropsychiatric symptoms and cognitive profile of MCI with Lewy bodies (MCI-LB) with Alzheimer's disease MCI (MCI-AD).
Participants were ⩾60 years old with MCI. Each had a thorough clinical and neuropsychological assessment and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single photon emission computed tomography FP-CIT SPECT). MCI-LB was diagnosed if two or more diagnostic features of dementia with Lewy bodies were present (visual hallucinations, cognitive fluctuations, motor parkinsonism, rapid eye movement sleep behaviour disorder or positive FP-CIT SPECT). A Lewy body Neuropsychiatric Supportive Symptom Count (LBNSSC) was calculated based on the presence or absence of the supportive neuropsychiatric symptoms defined by the 2017 DLB diagnostic criteria: non-visual hallucinations, delusions, anxiety, depression and apathy.
MCI-LB (n = 41) had a higher LBNSSC than MCI-AD (n = 24; 1.8 ± 1.1 v. 0.7 ± 0.9, p = 0.001). 67% of MCI-LB had two or more of those symptoms, compared with 16% of MCI-AD (Likelihood ratio = 4.2, p < 0.001). MCI-LB subjects scored lower on tests of attention, visuospatial function and verbal fluency. However, cognitive test scores alone did not accurately differentiate MCI-LB from MCI-AD.
MCI-LB is associated with neuropsychiatric symptoms and a cognitive profile similar to established DLB. This supports the concept of identifying MCI-LB based on the presence of core diagnostic features of DLB and abnormal FP-CIT SPECT imaging. The presence of supportive neuropsychiatric clinical features identified in the 2017 DLB diagnostic criteria was helpful in differentiating between MCI-LB and MCI-AD.
SnO2 doped with Sb and Nb has been investigated for its use as catalyst support materials replacing carbon to enhance PEM fuel cells stability. Nanostructured powders of various doping levels were prepared by flame spray pyrolysis (FSP). The specific requirements of surface area >50 m2g-1 and electronic conductivity >0.01 Scm-1 were obtained, and pore sizes ranging mainly from 10 to 100 nm. Pt particles (9-20 wt.% in loading targeted) of ∼1 nm well dispersed in Sb-doped SnO2 was prepared by a one-step FSP procedure providing microstructures of high interest for further investigations as cathode in PEM fuel cells.
During natural disasters, hospital evacuation may be necessary to ensure patient safety and care. We aimed to examine perceptions of stakeholders involved in these decisions throughout the Mid-Atlantic region of the United States during Hurricane Sandy in October 2012.
Semistructured interviews were conducted from March 2014 to February 2015 to characterize stakeholders’ perceptions about authority and responsibility for acute care hospital evacuation/shelter-in-place decision-making in Delaware, Maryland, New Jersey, and New York during Hurricane Sandy. Interviews were recorded, transcribed, and thematically analyzed using a framework approach.
We interviewed 42 individuals from 32 organizations. Hospital executives from all states reported having authority and responsibility for evacuation/shelter-in-place decision-making. In New York and Maryland, government officials stated that they could order hospital evacuation, whereas officials in Delaware and New Jersey said the government lacked enforcement capacity and therefore could not mandate evacuation.
Among government officials, perceived authority for hospital evacuation/shelter-in-place decision-making was viewed as a prerequisite to ordering evacuation. When both hospital executives and government officials perceive themselves to possess decision-making authority, there is the potential for inaction. Future work should examine whether a single entity bearing ultimate responsibility or regional emergency response coalitions would improve decision-making. (Disaster Med Public Health Preparedness. 2016;10:320–324)
The ability to perform microbial detection and characterization in-field at extreme environments, rather than on returned samples, has the potential to improve the efficiency, relevance and quantity of data from field campaigns. To date, few examples of this approach have been reported. Therefore, we demonstrate that the approach is feasible in subglacial environments by deploying four techniques for microbial detection: real-time polymerase chain reaction; microscopic fluorescence cell counts, adenosine triphosphate bioluminescence assay and recombinant Factor C assay (to detect lipopolysaccharide). Each technique was applied to 12 subglacial ice samples, 12 meltwater samples and two snow samples from Engabreen, Northern Norway. Using this multi-technique approach, the detected biomarker levels were as expected, being highest in debris-rich subglacial ice, moderate in glacial meltwater and low in clean ice (debris-poor) and snow. Principal component analysis was applied to the resulting dataset and could be performed in-field to rapidly aid the allocation of resources for further sample analysis. We anticipate that in-field data collection will allow for multiple rounds of sampling, analysis, interpretation and refinement within a single field campaign, resulting in the collection of larger and more appropriate datasets, ultimately with more efficient science return.
Introduction: A cost-minimization analysis (CMA) was performed comparing IVIg and PLEX in the management of patients with exacerbation of myasthenia gravis (MG). Methods: This study combines Ontario-based health costing data with clinical data from a randomized clinical trial where patients with moderate/severe MG received either IVIg or PLEX. The CMA was undertaken under the perspective of a public health care insurer and under the perspective of a tertiary hospital payer. Results: The IVIg group (n=32) was comparable with the PLEX group (n=38) regarding demographics, disease characteristics and severity. PLEX was less costly than IVIg among patients with body mass index (BMI) ≤15.7 Kg/m2, under the perspective of a public health care insurer (CAN$6,271.18 versus CAN$8,309.72, p<0.0001). However, PLEX was more costly than IVIg under the perspective of the hospital payer when the costs of blood products were excluded (CAN$4,815.36 versus CAN$1,486.12, p<0.0001). Conclusions: PLEX may be a short-term cost-minimizing therapy when compared with IVIg for treatment of MG exacerbation among patients with BMI ≤15.7 Kg/m2, under the perspective of a public health care insurer. However, when the costs of blood products are absorbed by a third party, the hospital administration may see IVIg as a more attractive therapeutic alternative.
Glyphosate-resistant (GR) weeds are most challenging for growers to control in cotton in the midsouth region of the United States. As a result, growers in these states are transitioning from a glyphosate-based system to a glufosinate-based system. A field study was conducted in 2010 and 2011 in Georgia, North Carolina, and Tennessee to determine the effect of repeated glufosinate applications to WideStrike cotton applied at various application timings. One to three glufosinate applications at 594 g ai ha−1 were applied to cotton at the two-leaf, seven-leaf, bloom, or 2 wk after bloom stages. Visual estimates of crop injury were evaluated after each application, in addition to crop height, development, and yield. Crop injury after each glufosinate application typically ranged from 3 to 11%, with higher injury observed where multiple glufosinate applications were made. Crop height differences were noted after the bloom and 2 wk after bloom applications. Treatments that had one, two, or three glufosinate applications had reduced crop height when compared with the weed-free control. Node above cracked boll ratings also indicated that glufosinate treatments may have stressed the cotton. Ultimately, yield was reduced where three glufosinate treatments were applied to WideStrike cotton. In addition, one glufosinate application at the bloom stage or two glufosinate applications at the bloom and 2 wk after bloom stages reduced yield when compared with the weed-free control. Although it is a legal application, growers should use caution when applying glufosinate to WideStrike cotton because the manufacturer of glufosinate and the manufacturer of WideStrike cotton do not recommend this application. However, where GR Palmer amaranth is present, these applications may be necessary.
Flame spray pyrolysis (FSP) was applied to produce nanopowders of Ti1-xMxO2 and Sn1-xMxO2, where x = 0.05 and M = Nb/Sb, for use as catalyst support materials in PEM fuel cells/ electrolysers. FSP powders in the SnO2-IrO2 system were produced for the same applications. Homogenous particle size distribution (5-20 nm) was demonstrated by TEM, supported by BET and XRD analysis. Whereas two polymorphs were indicated for the Ti-based oxides, the Sb/Nb-doped SnO2 powders were single phase. FSP powders of Mn3O4 intended for supercapacitors were produced and the influence of the precursor/solvent mixtures on the physical and electrochemical properties evaluated.
The present study aimed to examine the role of health in consumers’ food purchasing decisions through investigating the nature of people’s discourse regarding health while conducting their food shopping.
The study employed the think-aloud technique as part of an accompanied shop. All mentions of health and terms relating to health were identified from the data set. Inductive thematic analysis was conducted to examine how health was talked about in relation to people’s food choice decisions.
Supermarkets in Dublin, Republic of Ireland and Belfast, Northern Ireland.
Participants (n 50) were aged over 18 years and represented the main household shopper.
Responsibility for others and the perceived need to illicit strict control to avoid ‘unhealthy’ food selections played a dominant role in how health was talked about during the accompanied shop. Consequently healthy shopping was viewed as difficult and effort was required to make the healthy choice, with shoppers relating to product-based inferences to support their decisions.
This qualitative exploration has provided evidence of a number of factors influencing the consideration of health during consumers’ food shopping. These results highlight opportunities for stakeholders such as public health bodies and the food industry to explore further ways to help enable consumers make healthy food choices.
The development of crops resistant to 2,4-D, dicamba, and glufosinate may provide new options for the management of glyphosate-resistant (GR) giant ragweed and other herbicide-resistant weeds. A fallow field study was conducted in 2011 and 2012 to determine the control of GR giant ragweed with 2,4-D and dicamba applied alone and in combination with glufosinate or fomesafen. Dicamba and 2,4-D tank-mixed with glufosinate or fomesafen provided the highest level of control at 10 or 20 days after application (DAA). At 30 DAA, all herbicide treatments provided > 88% control of giant ragweed except glyphosate, glufosinate, and 2,4-D alone at 0.56 kg ae ha−1. Glyphosate, glufosinate, and 2,4-D alone at 0.56 kg ae ha−1 also had the highest number of giant ragweed plants (> 5.8 plants m−2) and highest biomass (> 19.2 g m−2). Contrast statements between 2,4-D and dicamba indicated no differences among treatments containing these herbicides. However, contrast analysis indicated that herbicides applied alone resulted in 56, 58, and 61% control while tank-mix combinations of 2,4-D or dicamba with glufosinate or fomesafen resulted in 86, 91, and 93% control, respectively. Herbicides applied alone also had more giant ragweed plants and biomass per m−2 than herbicides applied in tank-mix combinations. Tank-mixing combinations of 2,4-D and dicamba will be important for effective control of GR giant ragweed.
Glyphosate-resistant (GR) weeds, especially GR Palmer amaranth, are very problematic for cotton growers in the Southeast and Midsouth regions of the United States. Glufosinate can control GR Palmer amaranth, and growers are transitioning to glufosinate-based systems. Palmer amaranth must be small for consistently effective control by glufosinate. Because this weed grows rapidly, growers are not always timely with applications. With widespread resistance to acetolactate synthase-inhibiting herbicides, growers have few herbicide options to mix with glufosinate to improve control of larger weeds. In a field study using a WideStrike® cotton cultivar, we evaluated fluometuron at 140 to 1,120 g ai ha−1 mixed with the ammonium salt of glufosinate at 485 g ae ha−1 for control of GR Palmer amaranth 13 and 26 cm tall. Standard PRE- and POST-directed herbicides were included in the systems. Glufosinate alone injured the WideStrike® cotton less than 10%. Fluometuron increased injury up to 25% but did not adversely affect yield. Glufosinate controlled 13-cm Palmer amaranth at least 90%, and there was no improvement in weed control nor a cotton yield response to fluometuron mixed with glufosinate. Palmer amaranth 26 cm tall was controlled only 59% by glufosinate. Fluometuron mixed with glufosinate increased control of the larger weeds up to 28% and there was a trend for greater yields. However, delaying applications until weeds were 26 cm reduced yield 22% relative to timely application. Our results suggest fluometuron mixed with glufosinate may be of some benefit when attempting to control large Palmer amaranth. However, mixing fluometuron with glufosinate is not a substitute for a timely glufosinate application.