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The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia.
A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses.
A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance.
Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
Sub-Saharan Africa has the highest natural twinning rate in the world. Unfortunately, due to lack of adequate care during pregnancy, labor and postnatally, twin mortality in Sub-Saharan Africa also remains very high. Thus, it has been estimated that one in five twins dies during the childhood years. In spite of this, surprisingly few twin studies have been conducted in the region, making additional epidemiological data much needed. In 2009, we established one of the first twin registries in Sub-Saharan Africa at the Bandim Health Project in Guinea-Bissau. The registry had two main objectives. First, we wanted to describe the twinning rate and mortality patterns among newborn twins, including mortality risk factors and hospitalization patterns. Such studies can help the local clinicians improve twin health by identifying the most vulnerable children. Second, and in light of the rapidly increasing diabetes rates in Africa, we wanted to use the registry to particularly focus on metabolic disorders. Twins are often born with low birth weight, which according to the ‘thrifty phenotype hypothesis’ could predispose them to metabolic disorders later in life. Yet, no such ‘fetal programming’ data have previously been available from African twins despite the fact that nutritional patterns and influences from other factors (e.g., infections) could be markedly different here compared to high-income settings. In this article, we summarize the findings and current status of the Guinea-Bissau twin registry.
Anisocotyly, the unequal development of cotyledons post germination, is a unique trait observed only in Old World Gesneriaceae (Lamiales). New World Gesneriaceae have isocotylous seedlings. In both Old and New World Gesneriaceae, cotyledons initially grow equally for a short period just after germination. In the New World species, both cotyledons cease their growth at the same time early on, whereas in Old World species one cotyledon continues to expand to become a macrocotyledon while the other withers away. In this study, cotyledon growth was observed in two European Old World Gesneriaceae: Haberlea rhodopensis and Ramonda myconi. The results were compared with those for the typical anisocotylous species Streptocarpus rexii and the typical isocotylous species Corytoplectus speciosus. We found that the cotyledon growth patterns in Haberlea rhodopensis and Ramonda myconi were intermediate between the typical anisocotylous or isocotylous species. Haberlea rhodopensis and Ramonda myconi showed irregular growth patterns, with some plants being slightly anisocotylous but most being isocotylous. The developmental basis for the residual anisocotyly, the extended basal meristem activity in the macrocotyledon, appeared to be identical in the European species to that in the typical Old World Streptocarpus rexii but weakly expressed, rare and terminated early. In conclusion, European Gesneriaceae retain a reduced anisocotylous growth that may be linked to their early plumule development.
As part of ongoing molecular phylogenetic work on the large Gesneriaceae genus Cyrtandra, new insights into the taxonomy and relationships of the Cyrtandra of Japan, Taiwan and Batan Island in the northern Philippines have emerged. Cyrtandra umbellifera is confirmed as a species with a distribution that includes both Taiwan and Batan Island. Cyrtandra yaeyamae is found to be distinct from the widespread C. cumingii, with a distribution that includes both the Ryukyu Islands in Japan and Batan Island.
Towards a comprehensive revision of Gesneriaceae in Sri Lanka, 12 names are here typified, of which 11 are lectotypifications, including one second-step lectotypification, and the other is a neotypification.
Two new species of Oreocharis, O. tribracteata and O. rufescens, are described and a key to the species in Vietnam is provided. The new species have distinct features not previously, or rarely, observed in the genus, both showing the partial fusion of the calyx lobes into a tube, and the presence of three bracts in Oreocharis tribracteata.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
In 2015, Denmark launched an automated surveillance system for hospital-acquired infections, the Hospital-Acquired Infections Database (HAIBA).
To describe the algorithm used in HAIBA, to determine its concordance with point prevalence surveys (PPSs), and to present trends for hospital-acquired bacteremia
Private and public hospitals in Denmark
A hospital-acquired bacteremia case was defined as at least 1 positive blood culture with at least 1 pathogen (bacterium or fungus) taken between 48 hours after admission and 48 hours after discharge, using the Danish Microbiology Database and the Danish National Patient Registry. PPSs performed in 2012 and 2013 were used for comparison.
National trends showed an increase in HA bacteremia cases between 2010 and 2014. Incidence was higher for men than women (9.6 vs 5.4 per 10,000 risk days) and was highest for those aged 61–80 years (9.5 per 10,000 risk days). The median daily prevalence was 3.1% (range, 2.1%–4.7%). Regional incidence varied from 6.1 to 8.1 per 10,000 risk days. The microorganisms identified were typical for HA bacteremia. Comparison of HAIBA with PPS showed a sensitivity of 36% and a specificity of 99%. HAIBA was less sensitive for patients in hematology departments and intensive care units. Excluding these departments improved the sensitivity of HAIBA to 44%.
Although the estimated sensitivity of HAIBA compared with PPS is low, a PPS is not a gold standard. Given the many advantages of automated surveillance, HAIBA allows monitoring of HA bacteremia across the healthcare system, supports prioritizing preventive measures, and holds promise for evaluating interventions.
Strong absorption lines in quasar spectra primarily probe low-mass galaxies and detecting these in emission has previously been difficult. Dedicated surveys for the host galaxies of damped Lyman-α (DLA) systems have often resulted in non-detections and upper limits. Targeting the most metal-rich absorbers has proven to be a viable method, because these galaxies are brighter. By combining DLA metallicities and deriving host galaxy stellar masses, we find that metal-rich DLAs (with >10% solar metallicity) and their host galaxies follow the same redshift-dependent scaling relation between stellar mass and metallicity as luminosity-selected galaxies. We derive a prediction for an absorber galaxy mass that depends on the DLA metallicity.
The aim of this study was to determine the genetic background of longitudinal residual feed intake (RFI) and BW gain in farmed mink using random regression methods considering heterogeneous residual variances. The individual BW was measured every 3 weeks from 63 to 210 days of age for 2139 male+female pairs of juvenile mink during the growing-furring period. Cumulative feed intake was calculated six times with 3-week intervals based on daily feed consumption between weighing’s from 105 to 210 days of age. Genetic parameters for RFI and BW gain in males and females were obtained using univariate random regression with Legendre polynomials containing an animal genetic effect and permanent environmental effect of litter along with heterogeneous residual variances. Heritability estimates for RFI increased with age from 0.18 (0.03, posterior standard deviation (PSD)) at 105 days of age to 0.49 (0.03, PSD) and 0.46 (0.03, PSD) at 210 days of age in male and female mink, respectively. The heritability estimates for BW gain increased with age and had moderate to high range for males (0.33 (0.02, PSD) to 0.84 (0.02, PSD)) and females (0.35 (0.03, PSD) to 0.85 (0.02, PSD)). RFI estimates during the growing period (105 to 126 days of age) showed high positive genetic correlations with the pelting RFI (210 days of age) in male (0.86 to 0.97) and female (0.92 to 0.98). However, phenotypic correlations were lower from 0.47 to 0.76 in males and 0.61 to 0.75 in females. Furthermore, BW records in the growing period (63 to 126 days of age) had moderate (male: 0.39, female: 0.53) to high (male: 0.87, female: 0.94) genetic correlations with pelting BW (210 days of age). The result of current study showed that RFI and BW in mink are highly heritable, especially at the late furring period, suggesting potential for large genetic gains for these traits. The genetic correlations suggested that substantial genetic gain can be obtained by only considering the RFI estimate and BW at pelting, however, lower genetic correlations than unity indicate that extra genetic gain can be obtained by including estimates of these traits during the growing period. This study suggests random regression methods are suitable for analysing feed efficiency and BW gain; and genetic selection for RFI in mink is promising.
Recently, the usage of optical fiber coils has increased significantly, especially in the design of physic and chemical sensors. Therefore, it is important to test the theoretical current models developed to predict the power loss throughout optical fiber. In this paper a pioneer and popular model, the Marcuse model of power loss, was studied and evaluated for optical fiber coils of small radii. Power attenuation in a bent fiber data was collected using an Optical Time Domain Reflectometer (OTDR), and it was compared to the theoretical predictions of the Marcuse model. It was observed that the model predicts correctly the attenuation behavior for usual curvature radii, however, it fails to predict accurately the attenuation behavior for small curvature radii, underestimating considerably the actual power loss. Also, it has been observed that at small radii the power loss parameter 2α and the mode propagation constant of the wave guide β stop being constants and become functions of the optical path, particularly of the number of loops in the coil. It is possible that new mechanisms of light leaking are present, due to the extreme distortion of the modes configuration into the fiber at small radii. Those mechanisms cannot be described by a model that considers a power loss parameter 2α, and more specifically the mode propagation constant of the wave guide (β) as constants. Then it is important to develop other models where the previous parameters can be considered as functions of the optical path.
The oscillating piezoelectric field of a surface acoustic wave (SAW) is employed to transport photoexcited electrons and holes in GaAs nanowires (NWs) transferred to a SAW beam line on a LiNbO3 crystal. We show that carriers generated in the NW by a focused light spot can be acoustically transported to a second location, where they recombine emitting short light pulses. The results presented here demonstrate the high-frequency manipulation of carriers in NWs without the use of electrical contacts, which opens new perspectives for applications in opto-electronic devices operating at GHz frequencies.
Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which most of the disability and neurobiological deficits of schizophrenia have not yet occurred.
To investigate the effects of an integrated psychological intervention (IPI), combining individual cognitive–behavioural therapy, group skills training, cognitive remediation and multifamily psychoeducation, on the prevention of psychosis in the EIPS.
A randomised controlled, multicentre, parallel group trial of 12 months of IPI v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up.
A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P = 0.019).
Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS.
Percutaneous tracheotomy (PT) is beneficial in decreasing dead space and reducing airway resistance when compared with intubation. Absolute contraindications include the need for an emergent airway or inability to intubate the patient. All current PT methods are based upon the Seldinger technique of dilators placed over a guidewire. It is recommended that PT be performed under simultaneous video bronchoscopy. Techinques for PT are: Ciaglia method (percutaneous dilating technique), Griggs technique (guidewire dilating forceps (GWDF) technique), Fantoni's technique (translaryngeal approach), and PercTwist (screw-action dilator). Two important issues specific to PT that may arise during the course of the procedure are accidental penetration of the endotracheal tube cuff with the introducer needle during initial puncture of the anterior tracheal wall and possible dislocation of the endotracheal tube. The most common immediate postoperative complication is bleeding. Long-term complications have been reported extensively in a number of studies and metaanalyses.
Individuals with body dysmorphic disorder (BDD) may have perceptual distortions for their appearance. Previous studies suggest imbalances in detailed relative to configural/holistic visual processing when viewing faces. No study has investigated the neural correlates of processing non-symptom-related stimuli. The objective of this study was to determine whether individuals with BDD have abnormal patterns of brain activation when viewing non-face/non-body object stimuli.
Fourteen medication-free participants with DSM-IV BDD and 14 healthy controls participated. We performed functional magnetic resonance imaging (fMRI) while participants matched photographs of houses that were unaltered, contained only high spatial frequency (HSF, high detail) information or only low spatial frequency (LSF, low detail) information. The primary outcome was group differences in blood oxygen level-dependent (BOLD) signal changes.
The BDD group showed lower activity in the parahippocampal gyrus, lingual gyrus and precuneus for LSF images. There were greater activations in medial prefrontal regions for HSF images, although no significant differences when compared to a low-level baseline. Greater symptom severity was associated with lower activity in the dorsal occipital cortex and ventrolateral prefrontal cortex for normal spatial frequency (NSF) and HSF images.
Individuals with BDD have abnormal brain activation patterns when viewing objects. Hypoactivity in visual association areas for configural and holistic (low detail) elements and abnormal allocation of prefrontal systems for details are consistent with a model of imbalances in global versus local processing. This may occur not only for appearance but also for general stimuli unrelated to their symptoms.
Early improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.
To develop a valid definition of early improvement and test its predictive validity regarding response and remission.
We examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.
Reasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.
Patients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.