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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.
This study directly assessed, for the first time, whether, as expected under the membrane phospholipid hypothesis of schizophrenia, there was a change in brain cell motion-restricted membrane phospholipids in vivo in male forensic patients with schizophrenia who had seriously and violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic, by quantification of the broadband resonance signal from 31-phosphorus neurospectroscopy scans.
Cerebral 31-phosphorus magnetic resonance spectroscopy was carried out in 15 male patients with schizophrenia who had seriously and violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic and in 12 age- and sex-matched normal control subjects. Data were obtained using a 1.5 T Marconi Eclipse system with a birdcage quadrature head coil dual-tuned to proton (64 MHz) and 31P (26 MHz). T1-weighted magnetic resonance images were acquired for spectral localization. Spectra were obtained using an image-selected in vivo spectroscopy sequence (TR = 10 s; 64 signal averages) localized on a 70 x 70 x 70 mm3 voxel.
There was no significant difference in the broad resonances between the two groups, with the mean (standard error) percentage broadband signal for the patients being 57.8 (5.6) and that for the control subjects 57.7 (6.0). The phosphomonoesters and phosphodiesters narrow signals also did not differ between the groups.
Our data suggest that the membrane phospholipid hypothesis of schizophrenia may not apply to the subgroup of schizophrenia patients who have seriously and violently offended.
Suicide is one of the leading causes of death worldwide, and the third leading cause of death among people aged below 25. Mental health promotion is a central aspect of the battle against suicide and mental ill-health. The internet and the media are effective tools for disseminating information and education to adolescents and improving their mental health and well-being. in 2011 there were 2.1 billion Internet users world-wide. in a random sample of over 3000 American adults, it was found that 58% of the Internet users reported searching for health information for themselves (Atkinson et al. 2009).
The main objective of the SUPREME project is to develop a website aimed at mental health promotion and to investigate its efficacy. A secondary goal is to compare two different strategies for promoting the use of the website: one where peers are the main promoters and another with mental health professionals. The study is partly funded by the EACH and comprises 7 European countries: Estonia, Hungary, Italy, Spain, United Kingdom, Lithuania and Sweden.
Adolescents in this study approached in a random sample of schools, in each participating country, yielding a total of 2100 participants. The schools were randomized into control (minimal intervention), and intervention conditions (minimal intervention + website access). Pre-, post- and follow-up measures are used to test the efficacy of the intervention. Each intervention school is also randomized into peer and pro dissemination groups for comparison of recruitment efficiency. Preliminary results are presented.
Electrochemical reduction of CO2 to formic acid is a good strategy to address both environmental and energy issues. However, some drawbacks including low activity, selectivity, and stability of electrocatalysts must be overcome. We propose a method for tailoring Bi2O2CO3-coated carbon fiber electrodes with higher selectivity and stability for electrochemical CO2 reduction to formic acid. We evaluated the effect of Bi2O2CO3 and Nafion contents on the electrocatalysts performance for CO2 reduction reaction (CO2RR). All electrodes produced only HCOO− in the liquid phase with a maximum faradaic efficiency (FE) of 69%. The electrocatalysts were stable under 24 h of continuous CO2RR operation. The FE increased with the increasing electrolyte concentration and cation radius size, which indicates that the anion stabilization in solution is critical for adequate formate generation. The CO2RR mechanism was proposed with basis on the literature. The structural carbonate of Bi2O2CO3 acts as an intermediate species in the formate production from CO2.
MUSIC treatises from the Middle Ages frequently begin by rehearsing a genealogical narrative for the authorities in music. Often these are intertwined with myths and legends inherited from previous generations. Boethius is cited as an authority for the division of a tone. Guido is considered the father of the monochord. Isidore gives the ultimate definition of musica. A number of theorists also felt it important to establish a story for the origins of music. In the narrative of origins, some theorists opt for a story of the Muses, while others lean towards tales of biblical heritage. De origine et effectu musicae, a late fourteenth- to early fifteenth-century music treatise from England, offers slight variants to both options in a combination story of music's origin. In addition to the tales of Tubal from the Old Testament and mythical accounts of Pythagoras, De origine et effectu musicae records numerous authorities that make up the musical tradition from Boethius, Isidore and Guido, to Franco and Philippe de Vitry. Among what is expected, one source includes a poem that strategically places English singers among the authorities of the past (Table 3.1).
The poem runs through a typical list of protagonists in the origin story, albeit with slight alteration to the chronology. Such deviation is not entirely uncommon in medieval texts. The border between legend and myth is sometimes difficult to distinguish in the different stories surrounding the origin of music, leading theorists to pen perplexing interpretations in their treatises. The elusive nature of these interpretations has resulted in a general dismissal of small deviations that do not fit into a so-called urtext narrative as unimportant and insignificant, sometimes for good reason. Noel Swerdlow is especially critical of the medieval authors, whose common sense seems to have escaped them when they wrote etymologies of music, altering the stories in various extremes. According to Swerdlow, historical facts were often replaced by mythical understanding of stories based on a pure trust in ancient texts, sometimes giving ‘the impression that they were not really understood by the writers themselves’.
In De origine et effectu musicae, there is a unique addition to the common ancient list of authorities which is of significant interest: ‘Now England gives birth to the greatest number of singers.
Psychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service.
To improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department.
Thirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital. Teaching was evaluated using Kirkpatrick's model, and patient transfer numbers were acquired by reviewing in-patient Datix reports and emergency department case notes for 6 months before and after teaching.
The proportion of patients transferred to the emergency department decreased significantly from 90% 6 months before the workshop to 30% 6 months after (P < 0.05). Trainees engaged positively and there was a significant increase in self-confidence rating following the workshop (P < 0.05). The estimated cost saving per transfer was £183.76.
The combination of a peer-led workshop and on-site suturing kit box was effective in reducing transfers to the emergency department and provided a substantial cost saving.
Background: The interaction between mutations in two or more genes is increasingly recognised as an important contributor to the phenotypic variability in genetic disorders. Co-occurrence of variants in SQSTM1 and TIA1 is reported as a cause of myopathy in 3 prior cases, but limited clinical data were presented. We present detailed clinical features of a family with two siblings having a distal myopathy with rimmed vacuoles (DMRV), and genetic variants in SQSTM1 and TIA1. Methods: Clinicopathologic study of a family with DMRV to describe clinical features, laboratory and neurophysiology studies, neuroimaging, and genetic sequencing. Results: Two siblings with variants in SQSTM1 and TIA1 developed myopathy in their early 60’s, with early involvement of ankle dorsiflexors and finger extensors. A decade after onset, patients remain ambulatory and have not developed cardiac or respiratory complications. MRI of the legs showed selective involvement of adductor magnus, vastus lateralis, and in lower legs the anterior compartment and medial gastrocnemius. Muscle pathology demonstrated rimmed vacuoles, disrupted myofibrillar architecture, and mislocalised TDP43. Two unaffected family members had one genetic variant but not both. Conclusions: We describe a fourth family with co-occurrence of TIA1 and SQSTM1 genetic variants and describe their detailed phenotype. Future study should address the mechanism of the interaction between these two variants.
Collagen associated with bone samples is frequently used for radiocarbon (14C) dating of bones recovered from archaeological sites. However, submersion and exposure to moisture favors the degradation of collagen, which leads to difficulty in reliably dating bones from tropical, humid, or previously submerged archaeological sites. In this paper, we characterized the preservation state of a series of bones, through parameters such as %C, %N, C/N ratio, and collagen recovery. We performed 14C analyses of three collagen fractions obtained through the pretreatment steps (total, ultrafiltered, and insoluble collagen) in order to link the preservation state and the reproducibility of 14C values obtained from the three fractions. Collagen ultrafiltration resulted in a decrease of C/N ratio, although collagen yield was reduced. When two or three collagen fractions were obtained, ages were reproducible and consistent with expected values, according to archaeological or hydrogeological criteria. The pretreatment steps were monitored by infrared spectroscopy in order to analyze the collagen fractions at the molecular level. The presence of collagen in the total and insoluble fractions was confirmed. Since many of the Mexican samples had poor ultrafiltered collagen yield (<3%) or nonexistent yield, our results show that if additional contextual information is carefully considered, the remnant collagen in the total and insoluble fraction can be dated, especially from sites where no other datable fraction exists.
Bone is frequently dated in archaeological studies and, especially for very old bones (more than 40,000 years old), it is critical to have an accurate and precise measure of the material-specific background value and its associated uncertainty. The SUERC Radiocarbon Laboratory has obtained a mammoth bone as a background bone standard and an appropriate number are now routinely prepared and measured in each AMS batch, resulting in the accumulation of a large number of background bone results over a two-year period. Additionally, information on which of the two accelerator mass spectrometry (AMS) instruments was used to make the radiocarbon (14C) measurements, and which sample pretreatment method (modified Longin or modified ultrafiltration) was used to extract and purify the collagen, is recorded for each sample. These data have been used to estimate the laboratory bone background (to be subtracted from each unknown bone sample prepared in the laboratory) and its associated analytical uncertainty. The statistical analysis of the bone results has made use of a linear mixed effects model to examine the variation, and to apportion the overall variation between and within batches on both AMS instruments, and the different pretreatment methods used at SUERC.
A large eddy simulation framework is used to explore the structure of the turbulent flow in a thermally stratified wind turbine array boundary layer. The flow field is driven by a constant geostrophic wind with time-varying surface boundary conditions obtained from a selected period of the CASES-99 field experiment. Proper orthogonal decomposition is used to extract coherent structures of the turbulent flow under the considered thermal stratification regimes. The flow structure is discussed in the context of three-dimensional representations of key modes, which demonstrate features ranging in size from the wind turbine wakes to the atmospheric boundary layer. Results demonstrate that structures related to the atmospheric boundary layer flow dominate over those introduced by the wind farm for the unstable and neutrally stratified regimes; large structures in atmospheric turbulence are beneficial for the wake recovery, and consequently the presence of the turbulent wind turbine wakes is diminished. Contrarily, the flow in the stably stratified case is fully dominated by the presence of the turbines and highly influenced by the Coriolis force. A comparative analysis of the test cases indicates that during the stable regime, higher-order modes contribute less to the overall character of the flow. Under neutral and unstable stratification, important turbulence dynamics are distributed over a larger range of basis functions. The influence of the wind turbines on the structure of the atmospheric boundary layer is mainly quantified via the turbulence kinetic energy of the first ten modes. Linking the new insights into structure of the wind turbine/atmospheric boundary layer and their interaction addressed here will benefit the formulation of new simplified models for commercial application.
We identified human paleodietary changes from inhabitants of the Guanzhong basin since 8000 BP, based on published carbon and nitrogen isotopic measurements on bones, fauna and plant remains. We also directly measured 14C ages, δ13C and δ15N values from bones unearthed at the Zhouyuan site, west of Guanzhong, in order to reconstruct paleodietary changes of the ancient inhabitants. We found that during the Laoguantai period, animal foods were the main source of nourishment with supplementary plant-derived foods. After this period, plant-derived foods became the main food source, with supplementary animal sources. The development of dry farming led to increased consumption of foxtail millet and broomcorn millet. This trend persisted and marked a fundamental shift from hunting, gathering, and fishing to farming and animal domestication. The dietary trends of the ancient inhabitants also show pronounced regional differences through time. The use of domestic animals was proportionally higher in the eastern part of the Guanzhong region, while wild animals were more common in the west.
The SUERC Radiocarbon Laboratory employs a one-step “background subtraction” method when calculating 14C ages. An interglacial wood (VIRI Sample K) is employed as the non-bone organic background standard, while a mammoth bone (LQH12) from Latton Quarry is used as the bone background standard. Results over several years demonstrate that the bone background is consistently around a factor of two higher and more variable than the wood background. As a result, the uncertainty on routine bone measurements is higher than for other sample types. This study investigates the factors that may contribute to the difference in F14C values and the higher variability. Preparations of collagen using modified Longin or ultrafiltration methods show no significant difference, nor does eliminating the collagen dissolution step. Two bone samples of known infinite age with respect to radiocarbon are compared and again no significant difference is observed. Finally, the quantity and age of the organic matter in the water used during the pretreatment is investigated and it is shown that there is insufficient organic matter in the reverse osmosis water to influence background values significantly. The attention is now on determining if incomplete demineralization could lead to contaminants being retained by the phosphate in the hydroxyapatite.
Terrestrial gastropods are problematical for radiocarbon (14C) measurement because they tend to incorporate carbon from ancient sources as a result of their dietary behavior. The 14C ecology of the pulmonate land snail, Helix melanostoma in Cyrenaica, northeastern Libya, was investigated as part of a wider study on the potential of using terrestrial mollusk shell for 14C dating of archaeological deposits. H. melanostoma was selected out of the species available in the region as it has the most predictable 14C ecology and also had a ubiquitous presence within the local archaeology. The ecological observations indicate that H. melanostoma has a very homogenous 14C ecology with consistent variations in F14C across sample sites controlled by availability of dietary vegetation. The majority of dated specimens from non-urbanized sample locations have only a small old-carbon effect, weighted mean of 476±48 14C yr, with between ~1% and 9% of dietary F14C from non-organic carbonate sources. Observed instabilities in the 14C ecology can all be attributed to the results of intense human activity not present before the Roman Period. Therefore, H. melanostoma and species with similar ecological behavior are suitable for 14C dating of archaeological and geological deposits with the use of a suitable offset.
Radiocarbon (14C) dating is used widely in many projects as a basis for the creation and testing of chronological constructs. 14C measurements are by their nature complex and the degree of sample pretreatment varies considerably depending on the material. Within the United Kingdom and Europe, there are a number of well-established laboratories and increasingly, archaeologists are not just commissioning new dates, but also using statistical modelling of assemblages of dates, perhaps measured in different laboratories, to provide formal date estimates for their sites. The issue of comparability of measurements (and thus bias, accuracy and precision of measurement) from the diverse laboratories is one which has been the focus of some attention both within the 14C community and the wider user communities for some time. As a result of this but also as part of laboratory benchmarking and quality assurance, the 14C community has undertaken a wide-scale, far-reaching, and evolving program of intercomparisons, to the benefit of laboratories and users alike. This paper summarizes the most recent exercise, the Sixth International Radiocarbon Intercomparison (SIRI).
Mental health stigma and discrimination are significant problems. Common coping orientations include: concealing mental health problems, challenging others and educating others. We describe the use of common stigma coping orientations and explain variations within a sample of English mental health service users.
Cross-sectional survey data were collected as part of the Viewpoint survey of mental health service users’ experiences of discrimination (n = 3005). Linear regression analyses were carried out to identify factors associated with the three stigma coping orientations.
The most common coping orientation was to conceal mental health problems (73%), which was strongly associated with anticipated discrimination. Only 51% ever challenged others because of discriminating behaviour, this being related to experienced discrimination, but also to higher confidence to tackle stigma.
Although stigma coping orientations vary by context, individuals often choose to conceal problems, which is associated with greater anticipated and experienced discrimination and less confidence to challenge stigma. The direction of this association requires further investigation.
Targets have been developed to measure supersonic radiation transport in aerogel foams using absorption spectroscopy. The target consists of an aerogel foam uniformly doped with either titanium or scandium inserted into an undoped aerogel foam package. This creates a localized doped foam region to provide spatial resolution for the measurement. Development and characterization of the foams is a key challenge in addition to machining and assembling the two foams so they mate without gaps. The foam package is inserted into a beryllium sleeve and mounted on a gold hohlraum. The target is mounted to a holder created using additive manufacturing and mounted on a stalk. The manufacturing of the components, along with assembly and metrology of the target are described here.
Background: Treatment of adult patients with hydrocephalus is often undertaken with a ventriculoperitoneal shunt (VPS). Failure rates have been reported as high as 50% in the first year. Methods: A Quality Improvement (QI) model was used to evaluate and modify VPS-insertion techniques to improve outcome. Malfunction was defined as a change in neurological shunt-related function with correlated diagnostic imaging studies. Prospectively collected data from 2012-2015 was reviewed. Results: 146 patients underwent a new VPS insertion. Diagnoses were: normal pressure hydrocephalus 101 patients, acquired hydrocephalus 28 patients and chronic-congenital hydrocephalus 17 patients. 103 patients had traditional insertion of a ventricular catheter using surface landmarks with 2 catheter misplacements requiring surgery. Image guidance with electromagnetic tracking was instituted with 0 catheter misplacements in 43 consecutive patients. 121 patients had traditional minilaparotomy/trocar placement of the peritoneal catheter with 59/121 (49%) experiencing shunt malfunction and 35/59 (59%) experiencing a second malfunction requiring surgery. Laparoscopic insertion of the peritoneal catheter was instituted in 25 consecutive patients with 3 (12%) distal obstructions. Laparoscopy was also used in 13 patients undergoing VPS revision with 2 (15%) experiencing subsequent malfunction. Conclusions: Changes to standard VPS surgical treatment including the addition of image-guidance and laparoscopic surgical techniques were associated with a significant decrease in shunt malfunction requiring surgery.
The use of bowel preparation strategies to reduce the degree of rectal distension during prostate radiotherapy is well documented. This retrospective pilot study analysed and compared a probiotic agent against a psyllium-supplemented diet to establish the feasibility of probiotics as a bowel preparation for patients receiving radical radiotherapy for prostate cancer.
A retrospective chart review of five patients taking probiotics and five taking psyllium husk (psyllium) during their course of radiotherapy treatment was conducted. On treatment, cone beam computed tomography (CBCT) scans were compared with planning CTs to quantify inter-fractional variation in rectal volume and distension.
Forty-five CBCT scans were available in both the psyllium and probiotics groups for analysis. Variation in mean difference in rectal volume from planning (ΔRV), mean rectal cross-section area (CSA) and mean relative cross-section area (CSArel) was significantly increased for the probiotics group compared with the psyllium group (p=0·001, 0·008 and 0·007, respectively). No statistically significant differences in mean ΔRV, CSA and CSArel were detected between the two groups.
This retrospective analysis suggests that a probiotics-based bowel preparation that utilises Lactobacillus acidophilus and Bifidobacterium lactis may result in increased rectal volume and CSA variation throughout treatment in comparison with a psyllium-supplemented diet.