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Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the students could consider the impact of the sessions on their clinical clerkship. Students felt that the sessions had assisted them in recognizing the key features of relevant diagnoses during clerkship as well as providing a helpful adjunct to their in-class learning.
The Parkes-MIT-NRAO (PMN) 4.85 GHz continuum radio survey of the southern sky was undertaken in 1990 June and November. This survey was performed on the Parkes 64 m telescope using the NRAO seven-beam receiver. A point-source catalogue of 36,640 radio sources has been produced for the Southern Survey zone −87.5° ≤δ ≤ −37° and for the Tropical Survey zone −29° ≤δ ≤ −9.5°. The flux limit of this survey varies with declination and is typically about 30 mJy.
We have begun to cross-correlate the PMN data with sources contained in catalogues compiled at radio, and other, wavelengths. We have found associations for 96% of the PKSCAT90 2700 MHz database sources, and 95% of the Molonglo 408 MHz Catalogue sources within in the PMN Southern and Tropical Survey zones.
A program to identify the optical counterparts of PMN Southern Survey point sources, S4.85 GHz ≥ 70 mJy, using the COSMOS database, is under way. To facilitate this programme we are improving the positional accuracy of PMN sources with observations made at the Australia Telescope National Facility compact array. We have developed a new “snapshot” mode of observing to process the large number of sources (~ 8000) in our sample. It is possible to obtain accurate positions from three snapshots efficiently with a total integration of < 3 minutes.
Nanostructures offer the opportunity to control the vibrational properties of via the scattering of phonons due to boundaries and mass disorder as well as through changes in the phonon dispersion due to spatial confinement. Advances in understanding these effects have the potential to lead to thermoelectrics with an improved figure of merit by lowering the thermal conductivity and to provide insight into electron-phonon scattering rates in nanoelectronics. Characterizing the phonon population in nanomaterials has been challenging because of their small volume and because optical techniques probe only a small fraction of reciprocal space. Recent developments in x-ray scattering now allow the phonon population to be evaluated across all of reciprocal space in samples with volumes as small as several cubic micrometers. We apply this approach, synchrotron x-ray thermal diffuse scattering (TDS), to probe the population of phonons within a Si/SiGe/Si trilayer nanomembrane. The distributions of scattered intensity from Si/SiGe/Si trilayer nanomembranes and Si nanomembranes with uniform composition are qualitatively similar, with features arising from the elastic anisotropy of the diamond structure. The TDS signal for the Si/SiGe/Si nanomembrane, however, has higher intensity than the Si membrane of the same total thickness by approximately 3.75%. Possible origins of the enhancement in scattering from SiGe in comparison with Si include the larger atomic scattering factor of Ge atoms within the SiGe layer or reduced phonon frequencies due to alloying.
It is the role of the eldest to direct the younger, if not the younger will grow up and go astray and direct their youngsters this wrong way … So this book is for carefully picking out relationships and seeking the heads of families. This book shows all the way, just as the leader on a journey marks the path for younger ones.
Waria in Haddon 1907, p. 192
This chapter is a case study compiled by Tagai State College executives who have courageously taken the lead as one team to change the reality and improve life choices for future generations in the Torres Strait. The Indigenous leadership at the college has kept the fire burning vibrantly as passed down from Elders and past leaders.
Judith Ketchell is a proud Torres Strait Islander woman who has balanced her own family of five wonderful children and two grandchildren. Ms Ketchell graduated as a teacher in Townsville in 1982 and has worked in remote, rural and urban school communities throughout Queensland. Teaching has always been her destiny, and her rewarding career has provided her with many opportunities to take on various leadership positions across the P–12 sectors of schooling; but more importantly, it has created a vehicle for Indigenous participation in decision making. Judith has worked extensively developing curriculum at the local, state and national level and more recently established a curriculum frame that builds upon the foundation of Torres Strait Yumi principles in education. Tagai State College has an obligation to the Torres Strait nation to restore the status of traditional language and culture within the Australian Curriculum.
Objectives: 1) To assess temporal patterns in historical patient arrival rates in an emergency department (ED) to determine the appropriate number of shift schedules in an acute care area and a fast-track clinic and 2) to determine whether physician scheduling can be improved by aligning physician productivity with patient arrivals using an optimization planning model.
Methods: Historical data were statistically analyzed to determine whether the number of patients arriving at the ED varied by weekday, weekend, or holiday weekend. Poisson-based generalized additive models were used to develop models of patient arrival rate throughout the day. A mathematical programming model was used to produce an optimal ED shift schedule for the estimated patient arrival rates. We compared the current physician schedule to three other scheduling scenarios: 1) a revised schedule produced by the planning model, 2) the revised schedule with an additional acute care physician, and 3) the revised schedule with an additional fast-track clinic physician.
Results: Statistical modelling found that patient arrival rates were different for acute care versus fast-track clinics; the patterns in arrivals followed essentially the same daily pattern in the acute care area; and arrival patterns differed on weekdays versus weekends in the fast-track clinic. The planning model reduced the unmet patient demand (i.e., the average number of patients arriving at the ED beyond the average physician productivity) by 19%, 39%, and 69% for the three scenarios examined.
Conclusions: The planning model improved the shift schedules by aligning physician productivity with patient arrivals at the ED.
Autobiographical memory (ABM), personal semantic memory (PSM), and autonoetic consciousness are affected in individuals with mild cognitive impairment (MCI) but their relationship with Alzheimer's disease (AD) biomarkers are unclear.
Forty-five participants (healthy controls (HC) = 31, MCI = 14) completed the Episodic ABM Interview and a battery of memory tests. Thirty-one (HC = 22, MCI = 9) underwent β-amyloid positron emission tomography (PET) and magnetic resonance (MR) imaging. Fourteen participants (HC = 9, MCI = 5) underwent one imaging modality.
Unlike PSM, ABM differentiated between diagnostic categories but did not relate to AD biomarkers. Personal semantic memory was related to neocortical β-amyloid burden after adjusting for age and apolipoprotein E (APOE) ɛ4. Autonoetic consciousness was not associated with AD biomarkers, and was not impaired in MCI.
Autobiographical memory was impaired in MCI participants but was not related to neocortical amyloid burden, suggesting that personal memory systems are impacted by differing disease mechanisms, rather than being uniformly underpinned by β-amyloid. Episodic and semantic ABM impairment represent an important AD prodrome.
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.
To date evidence of the relationship between cognition and Aβ amyloid during the early stages of Alzheimer's Disease (AD) has been inconsistent. This study aimed to describe the nature and magnitude of the relationship between Aβ amyloid and cognitive performance of individuals without dementia.
Composite cognitive measures were developed from the Australian Imaging Biomarkers and Lifestyle study neuropsychological test battery using data from 768 healthy older adults and 133 adults with mild cognitive impairment (MCI). A subgroup of this sample (174 healthy, 53 MCI) underwent neuroimaging for Aβ amyloid.
Within the MCI group individuals with high Aβ amyloid showed selective impairment for memory compared with those with low Aβ amyloid; however, this difference was not evident in the healthy group.
The current findings provide further evidence of the relationship between Aβ amyloid and cognition, with memory impairment being the primary symptom of the underlying disease during the prodromal phases of AD.
Reconnaissance survey in the Murzuq area, some 150 km south-east of Jarma, was carried out as part of the 2011 field programme of the Desert Migrations Project, with separate funding from the Leverhulme Trust for this element of work entitled the ‘Peopling the Desert Project’. This survey was designed to provide field verification of details of settlement systems identified and mapped from high-resolution satellite images in an area of c. 600 km2 immediately east of the oasis town of Murzuq. Examination of high-resolution QuickBird and Ikonos satellite imagery has permitted identification of a large dossier of more than 200 sites (fortified buildings known as qsur, other settlements, cemeteries, wells, fields/gardens and linear irrigation works called foggaras). The majority of these sites have never been previously noted or mapped and the date of the sites was unknown at the outset, though they clearly pertained to the historic periods. While further study of the finds and scientific dating evidence is required, the initial results of the brief field visit have major implications for our understanding of Garamantian and early Islamic settlement in south-eastern Fazzan.
Survey and excavation by the Burials and Identity team of the Desert Migrations Project (DMP) focused in 2011 on the so-called Royal Cemetery of the Garamantes close to the Jarma escarpment, a few km south of Old Jarma. This Late Garamantian cemetery contains two distinct zones (GSC030 and GSC031) of monumental rectangular stepped tombs, which were plaster-coated and fronted by massive offering tables and stelae. Previous dating evidence has suggested they span the fourth to sixth centuries AD. However, many questions remain about the cemetery and the overall recording of the monuments had hitherto been left incomplete. The 2011 work focused on the excavation of one of the larger monuments in GSC030 and several of the smaller tombs in the neighbouring GSC031, along with an overall survey of both cemetery areas and a detailed record of the stelae and offering tables still present in considerable numbers. In addition, the team made a survey along the escarpment between the Royal Cemetery and Zinkekrā, completing and uniting the various surveys carried out by the DMP around Zinkekrā, Watwāt and the Jarma Escarpment. A survey of foggaras and settlement in the ad-Dīsa embayment was also undertaken.
The fourth season of the Burials and Identity component of the Desert Migrations Project in 2010 focused on completion of excavation work at two main cemeteries (TAG001 and TAG012) and smaller-scale sampling work at a number of nearby cemeteries. The investigation of a number of burials in a semi-nucleated escarpment cemetery TAG063 produced interesting new information on Proto-Urban Garamantian funerary rites, dating to the latter centuries BC. The excavations at TAG001 were extended to two areas of the cemetery characterised by different burial types to the stepped tombs that were excavated in 2009. A second type of fairly monumental burial was identified, but these had been heavily robbed and it was not possible to demonstrate conclusively that these pre-dated the stepped tombs. Most of the other burials excavated were simple shaft burials and were relatively sparsely furnished with imported goods, in comparison with the larger tombs, though quite a lot of organic material was identified (matting, wood, gourds, textiles and leather). At TAG012, a series of additional mudbrick tombs was emptied. All had been robbed, but pockets of the original fill and associated finds survived intact, yielding some interesting assemblages. The majority of these tombs appear to be Late Garamantian, though some contained artefacts from much earlier times.
Survey by the DMP Burials and Identity team around the Tāqallit headland in 2009–2010 has revealed in exceptional detail a well-preserved Garamantian landscape, comprising extensive cemeteries, foggara irrigation systems and numerous oasis settlements. However, this remarkable survival of the Garamantian landscape was found in 2010 to be under direct and imminent threat of destruction. This report describes the landscape features recorded and the steps taken to try to preserve the evidence from obliteration in the face of modern agricultural development. Important new information was recorded about the date and furnishing of some key types of Proto-Urban tombs, linking with a refined view of the relationship of these cemeteries to contemporary foggara construction and the creation of pioneer farming settlement in the Tāqallit region. Significant additional details of the foggara systems were recorded through a combination of satellite image interpretation, surface observation and selective descent into rock-cut shafts. The discovery of an unexpected number of ancient settlements and structures of Garamantian date represents another major achievement of the work. The composite picture of the Garamantian landscape encompassing cemeteries, foggaras and settlements is arguably the most complete yet recorded in the FP/DMP work.