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The aim of this study was to identify any relationship between hearing loss and mild cognitive impairment.
This was a systematic review and meta-analysis of randomised controlled trials conducted using Medline and the Cochrane Library up to 24 June 2020. Prospective, cohort and cross-sectional, and observational studies that reported on the relationship between mild cognitive impairment and hearing loss were included.
A total of 34 studies reporting data on 48 017 participants were included. Twenty-three studies observed a significant association between hearing loss and mild cognitive impairment. The pooled risk ratio across all studies of prevalence of mild cognitive impairment in people with hearing loss was 1.44 (random-effects; 95 per cent CI = 1.27–1.64; p < 0.00001; I2 = 0 per cent). Significantly more people with mild cognitive impairment had peripheral hearing loss compared with those without (risk ratio, 1.40 random-effects; 95 per cent CI = 1.10–1.77; p = 0.005; I2 = 0 per cent). When the incidence was studied, significantly more people with peripheral hearing loss had mild cognitive impairment compared with those without (risk ratio = 2.06 random-effects; 95 per cent CI = 1.35–3.15; p = 0.0008; I2 = 97 per cent); however; a high level of statistical heterogeneity was evident.
Most of the studies included in this systematic review observed a significant association between hearing loss and mild cognitive impairment.
To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.
Retrospective cohort study.
Two affiliated academic medical centers in Los Angeles, California.
Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.
We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.
Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.
Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
This chapter compares the Trans-Pacific Partnership Agreement (TPP) with the Australia -- United States Free Trade Agreement (AUSFTA), reflecting on relevant developments in the Australia -- United States relationship, including with respect to agriculture and biologic medicines. The chapter focuses on the Chapters on services and investment, addressing areas such as electronic commerce, investor--state dispute settlement (ISDS), and the "carve-out" of tobacco control measures from ISDS in the TPP. The comparison of investment in the two treaties is particularly of interest given the exclusion of ISDS in the AUSFTA and its inclusion (except as between Australia and New Zealand) in the TPP. We conclude that the TPP is a more modern agreement than the AUSFTA with several improvements that provide greater regulatory policy space. However, the inclusion of ISDS as between Australia and the United States in the TPP is questionable.
Laws and regulations hindering data flows across borders are trade-restrictive, and some of these measures can violate WTO and PTAs' obligations. The chapter starts by exploring the multi-layered policy framework governing data flows and cross-border data flows identifying various policy goals typically associated with data restrictions.
This includes exploring the various elements required within the WTO framework to address the policy ramifications of data restrictive measures, focusing on General Agreement on Trade in Services (GATS). The chapter then explains the trade-related aspects of data flow regulation by focusing on two interconnected topics: (i) the special nature of digital trade and trade in data that makes it harder to apply existing GATS provisions to digital services; and (ii) those aspects of data flows that are trade-related and, thus, should be addressed in a trade law framework. Finally, the chapter proposes a novel WTO framework on data flows by identifying the foundational principles for data regulation and the legal provisions necessary to enable security, predictability and certainty in data flows.
Discrepancies exist in reports of social cognition deficits in individuals with premanifest Huntington’s disease (HD); however, the reason for this variability has not been investigated. The aims of this study were to (1) evaluate group- and individual-level social cognitive performance and (2) examine intra-individual variability (dispersion) across social cognitive domains in individuals with premanifest HD.
Theory of mind (ToM), social perception, empathy, and social connectedness were evaluated in 35 individuals with premanifest HD and 29 healthy controls. Cut-off values beneath the median and 1.5 × the interquartile range below the 25th percentile (P25 – 1.5 × IQR) of healthy controls for each variable were established for a profiling method. Dispersion between social cognitive domains was also calculated.
Compared to healthy controls, individuals with premanifest HD performed worse on all social cognitive domains except empathy. Application of the profiling method revealed a large proportion of people with premanifest HD fell below healthy control median values across ToM (>80%), social perception (>57%), empathy (>54%), and social behaviour (>40%), with a percentage of these individuals displaying more pronounced impairments in empathy (20%) and ToM (22%). Social cognition dispersion did not differ between groups. No significant correlations were found between social cognitive domains and mood, sleep, and neurocognitive outcomes.
Significant group-level social cognition deficits were observed in the premanifest HD cohort. However, our profiling method showed that only a small percentage of these individuals experienced marked difficulties in social cognition, indicating the importance of individual-level assessments, particularly regarding future personalised treatments.
Adolescent risk for self-injurious thoughts and behaviors (STBs) involves disturbance across multiple systems (e.g., affective valence, arousal regulatory, cognitive and social processes). However, research integrating information across these systems is lacking. Utilizing a multiple-levels-of-analysis approach, this person-centered study identified psychobiological stress response profiles and linked them to cognitive processes, interpersonal behaviors, and STBs. At baseline, adolescent girls (N = 241, Mage = 14.68 years, Range = 12–17) at risk for STBs completed the Trier Social Stress Test (TSST), questionnaires, and STB interviews. Positive affect (PA), negative affect (NA), and salivary cortisol (SC) were assessed before and after the TSST. STBs were assessed again during 3, 6, and 9 month follow-up interviews. Multitrajectory modeling of girls’ PA, NA, and SC revealed four profiles, which were compared on cognitive and behavioral correlates as well as STB outcomes. Relative to normative, girls in the affective distress, hyperresponsive, and hyporesponsive subgroups were more likely to report negative cognitive style (all three groups) and excessive reassurance seeking (hyporesponsive only) at baseline, as well as nonsuicidal self-injury (all three groups) and suicidal ideation and attempt (hyporesponsive only) at follow-up. Girls’ close friendship characteristics moderated several profile–STB links. A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.
ABSTRACT IMPACT: Understanding dietary patterns and nutrient intakes of the aging population may help address concerns and dietary guidelines regarding their nutritional needs. OBJECTIVES/GOALS: The objective of this study is to test the hypothesis that a healthy dietary pattern in the oldest old (aged 80 years and older) is related to greater compliance with dietary recommendations and better nutrient intake profiles. METHODS/STUDY POPULATION: We conducted a cross-sectional study of 122 participants aged 82 to 97 years old from the Geisinger Rural Aging Study (GRAS) cohort in rural Pennsylvania (n = 56 men and 66 women). The main outcome measures of the investigation were the daily nutrient intakes and food group intakes evaluated from the average of three 24-hour dietary recalls. The dietary patterns were determined by cluster analysis from 28 food groups. Diet quality and adherence to the Dietary Guidelines for Americans was assessed by the Healthy Eating Index (HEI)-2015 and the Dietary Screening Tool (DST). Recommended intakes were determined by the Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs). RESULTS/ANTICIPATED RESULTS: Less than 50% of participants met the dietary recommended intakes for vitamins D, E, K, B6, dietary fiber, zinc, potassium, and calcium. The more-nutrient-dense cluster was characterized by higher intakes of fruits and vegetables. The less-nutrient-dense cluster was characterized by higher intakes of foods including desserts and sweets. After adjusting for age, sex, and energy intake, participants in the more-nutrient-dense dietary pattern had a higher intake of vitamins A, D, K, C, fiber, and potassium (p < 0.05 for all). After adjusting for age and sex, participants in the more-nutrient-dense pattern had better diet quality assessed by the (HEI)-2015 (p < 0.001) and DST (p = 0.006). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among the oldest old, many participants were found to have nutrient intakes lower than the recommended levels for fundamental nutrients suggesting that dietary guidance in addition to a dietary pattern more aligned with dietary guidelines may be beneficial for supporting healthy aging.
Paleosols formed in direct contact with the Earth's atmosphere, so they can record the composition of the atmosphere through weathering processes and products. Herein we critically review a variety of different approaches for reconstructing atmospheric O2 and CO2 over the past three billion years. Paleosols indicate relatively low CO2 over that time, requiring additional greenhouse forcing to overcome the 'faint young Sun' paradox in the Archean and Mesoproterozoic, as well as low O2 levels until the Neoproterozoic. Emerging techniques will revise the history of Earth's atmosphere further and may provide a window into atmospheric evolution on other planets.
In this article the erratic coupling that can occur in screeching supersonic twin jets is characterised. Non-stationary acoustic analysis is used to investigate the temporal behaviour of the coupling phenomena. The results show that where the phase between the jets is time varying, the screech tone experiences interruptions. The interruptions are either correlated and experienced by both jets or are anti-correlated and only by one. During the anti-correlated interruption, the uninterrupted jet screeches as an isolated jet. The instantaneous velocity field shows that for the majority of snapshots during an acoustic interruption, the jets do not exhibit a coupled oscillation. When the jets are uninterrupted, they are oscillating in either a coupled symmetric or anti-symmetric mode. This behaviour manifests at a condition between two operating points characterised by different coupling modes. It suggests the interruptions arise due to a competition between two global modes of the flow. Despite the existence of multiple acoustic tones in the region where these modes are competing, analysis of the individual jets reveals energetic structures with only a single wavelength. It is found that jets whose own oscillation is characterised by a single wavelength can, through coupling either symmetrically or anti-symmetrically about their symmetry plane, produce different acoustic tones. These findings are consistent across three experimental facilities. The observed modes are a function of the jet spacing and nozzle pressure, therefore future studies investigating other spacings must recharacterise the encountered coupled modes. This article provides the signatures to characterise the behaviour for future studies.
Institutional violence and associated risk factors within state hospitals have largely remained unexamined in the literature in spite of high violence prevalence rates: almost one-third (31.4%) of state hospital inpatients will engage in a violent assault during their hospitalization course. This dearth of research is particularly true for state hospital inpatients adjudicated not guilty by reason of insanity (NGRI). An NGRI status indicates that an individual has been evaluated and deemed guilty of a criminal act but, due to mental disease or defect, was incapable of either knowing or understanding the nature of their act or was incapable of distinguishing between right and wrong at the time of their crime.
I argue that diversity and pluralism are valuable not just for science but for philosophy of science. Given the partiality and perspectivism of representation, pluralism preserving integration can increase accuracy. Perspectivism is often supported by appeal to visual representation. I draw further insights from multimodel sensory integration for understanding experiment-based predictions of protein structure. The epistemic lessons learned from the scientific case also apply to philosophy of science itself. Finally, I suggest that a critical, nuanced philosophical view of legitimate sources of pluralism in science has an important role to play in public discourse.
Optical tracking systems typically trade off between astrometric precision and field of view. In this work, we showcase a networked approach to optical tracking using very wide field-of-view imagers that have relatively low astrometric precision on the scheduled OSIRIS-REx slingshot manoeuvre around Earth on 22 Sep 2017. As part of a trajectory designed to get OSIRIS-REx to NEO 101955 Bennu, this flyby event was viewed from 13 remote sensors spread across Australia and New Zealand to promote triangulatable observations. Each observatory in this portable network was constructed to be as lightweight and portable as possible, with hardware based off the successful design of the Desert Fireball Network. Over a 4-h collection window, we gathered 15 439 images of the night sky in the predicted direction of the OSIRIS-REx spacecraft. Using a specially developed streak detection and orbit determination data pipeline, we detected 2 090 line-of-sight observations. Our fitted orbit was determined to be within about 10 km of orbital telemetry along the observed 109 262 km length of OSIRIS-REx trajectory, and thus demonstrating the impressive capability of a networked approach to Space Surveillance and Tracking.
Toxoplasma gondii (T. gondii) is an important human disease-causing parasite. In the USA, T. gondii infects >10% of the population, accrues economic losses of US$3.6 billion/year, and ranks as the second leading culprit of foodborne illness-related fatalities. We assessed toxoplasmosis risk among the Old Order Amish, a mostly homogenous population with a high prevalence of T. gondii seropositivity, using a questionnaire focusing on food consumption/preparation behaviours and environmental risk factors. Analyses were conducted using multiple logistic regression. Consuming raw meat, rare meat, or unpasteurised cow or goat milk products was associated with increased odds of seropositivity (unadjusted Odds Ratios: 2.192, 1.613, and 1.718 , respectively). In separate models by sex, consuming raw meat, or consuming unpasteurised cow or goat milk products, was associated with increased odds of seropositivity among women; washing hands after touching meat with decreased odds of seropositivity among women (adjusted OR (AOR): 0.462); and cleaning cat litterbox with increased odds of seropositivity among men (AOR: 5.241). This is the first study to assess associations between behavioural and environmental risk factors and T. gondii seropositivity in a US population with high seroprevalence for T. gondii. Our study emphasises the importance of proper food safety behaviours to avoid the risk of infection.
The sparse record of Cretaceous crocodyliforms in Australia comprises only three species, all within the genus Isisfordia. Isisfordia duncani Salisbury et al., 2006 is from the Albian–Turonian Winton Formation of Queensland, and both Isisfordia molnari Hart et al., 2019 and Isisfordia selaslophensis Etheridge, 1917 have been described from opalized material from the Cenomanian Griman Creek Formation of New South Wales. Here, we describe new cranial and postcranial material, including the most complete crocodyliform skeleton from the Cretaceous of New South Wales, which is assigned to Isisfordia cf. I. selaslophensis. We also reappraise previously described crocodyliform material from the same locality. We find that much of this material displays features that are consistent with Isisfordia.
This paper discusses the evidence for periodic human activity in the Cairngorm Mountains of Scotland from the late 9th millennium to the early 4th millennium cal bc. While contemporary paradigms for Mesolithic Europe acknowledge the significance of upland environments, the archaeological record for these areas is not yet as robust as that for the lowland zone. Results of excavation at Chest of Dee, along the headwaters of the River Dee, are set into a wider context with previously published excavations in the area. A variety of site types evidences a sophisticated relationship between people and a dynamic landscape through a period of changing climate. Archaeological benefits of the project include the ability to examine novel aspects of the archaeology leading to a more comprehensive understanding of Mesolithic lifeways. It also offers important lessons in site survival, archaeological investigation, and the management of the upland zone.
Bipolar disorder (BD) is a familial psychiatric disorder associated with frontotemporal and subcortical brain abnormalities. It is unclear whether such abnormalities are present in relatives without BD, and little is known about structural brain trajectories in those at risk.
Neuroimaging was conducted at baseline and at 2-year follow-up interval in 90 high-risk individuals with a first-degree BD relative (HR), and 56 participants with no family history of mental illness who could have non-BD diagnoses. All 146 subjects were aged 12–30 years at baseline. We examined longitudinal change in gray and white matter volume, cortical thickness, and surface area in the frontotemporal cortex and subcortical regions.
Compared to controls, HR participants showed accelerated cortical thinning and volume reduction in right lateralised frontal regions, including the inferior frontal gyrus, lateral orbitofrontal cortex, frontal pole and rostral middle frontal gyrus. Independent of time, the HR group had greater cortical thickness in the left caudal anterior cingulate cortex, larger volume in the right medial orbitofrontal cortex and greater area of right accumbens, compared to controls. This pattern was evident even in those without the new onset of psychopathology during the inter-scan interval.
This study suggests that differences previously observed in BD are developing prior to the onset of the disorder. The pattern of pathological acceleration of cortical thinning is likely consistent with a disturbance of molecular mechanisms responsible for normal cortical thinning. We also demonstrate that neuroanatomical differences in HR individuals may be progressive in some regions and stable in others.
The aim of this study is to determine the species of parasite that infected the population of Brussels during the Medieval and Renaissance periods, and determine if there was notable variation between different households within the city. We compared multiple sediment layers from cesspits beneath three different latrines dating from the 14th–17th centuries. Helminths and protozoa were detected using microscopy and enzyme-linked immunosorbent assay (ELISA). We identified Ascaris sp., Capillaria sp., Dicrocoelium dendriticum, Entamoeba histolytica, Fasciola hepatica, Giardia duodenalis, Taenia sp. and Trichuris sp. in Medieval samples, and continuing presence of Ascaris sp., D. dendriticum, F. hepatica, G. duodenalis and Trichuris sp. into the Renaissance. While some variation existed between households, there was a broadly consistent pattern with the domination of species spread by fecal contamination of food and drink (whipworm, roundworm and protozoa that cause dysentery). These data allow us to explore diet and hygiene, together with routes for the spread of fecal–oral parasites. Key factors explaining our findings are manuring practices with human excrement in market gardens, and flooding of the polluted River Senne during the 14th–17th centuries.
To make a power spectrum (PS) detection of the 21-cm signal from the Epoch of Reionisation (EoR), one must avoid/subtract bright foreground sources. Sources such as Fornax A present a modelling challenge due to spatial structures spanning from arc seconds up to a degree. We compare modelling with multi-scale (MS) CLEAN components to ‘shapelets’, an alternative set of basis functions. We introduce a new image-based shapelet modelling package, SHAMFI. We also introduce a new CUDA simulation code (WODEN) to generate point source, Gaussian, and shapelet components into visibilities. We test performance by modelling a simulation of Fornax A, peeling the model from simulated visibilities, and producing a residual PS. We find the shapelet method consistently subtracts large-angular-scale emission well, even when the angular resolution of the data is changed. We find that when increasing the angular resolution of the data, the MS CLEAN model worsens at large angular scales. When testing on real Murchison Widefield Array data, the expected improvement is not seen in real data because of the other dominating systematics still present. Through further simulation, we find the expected differences to be lower than obtainable through current processing pipelines. We conclude shapelets are worthwhile for subtracting extended galaxies, and may prove essential for an EoR detection in the future, once other systematics have been addressed.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.
The full neurologic examination is described with attention to components that can be performed virtually.
A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).
During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.