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TwinsUK is the largest cohort of community-dwelling adult twins in the UK. The registry comprises over 14,000 volunteer twins (14,838 including mixed, single and triplets); it is predominantly female (82%) and middle-aged (mean age 59). In addition, over 1800 parents and siblings of twins are registered volunteers. During the last 27 years, TwinsUK has collected numerous questionnaire responses, physical/cognitive measures and biological measures on over 8500 subjects. Data were collected alongside four comprehensive phenotyping clinical visits to the Department of Twin Research and Genetic Epidemiology, King’s College London. Such collection methods have resulted in very detailed longitudinal clinical, biochemical, behavioral, dietary and socioeconomic cohort characterization; it provides a multidisciplinary platform for the study of complex disease during the adult life course, including the process of healthy aging. The major strength of TwinsUK is the availability of several ‘omic’ technologies for a range of sample types from participants, which includes genomewide scans of single-nucleotide variants, next-generation sequencing, metabolomic profiles, microbiomics, exome sequencing, epigenetic markers, gene expression arrays, RNA sequencing and telomere length measures. TwinsUK facilitates and actively encourages sharing the ‘TwinsUK’ resource with the scientific community — interested researchers may request data via the TwinsUK website (http://twinsuk.ac.uk/resources-for-researchers/access-our-data/) for their own use or future collaboration with the study team. In addition, further cohort data collection is planned via the Wellcome Open Research gateway (https://wellcomeopenresearch.org/gateways). The current article presents an up-to-date report on the application of technological advances, new study procedures in the cohort and future direction of TwinsUK.
The purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.
Language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.
We conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.
Physicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.
Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.
To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.
A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.
191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.
In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
In this prospective study of upper middle class youth, we document frequency of alcohol and drug use, as well as diagnoses of abuse and dependence, during early adulthood. Two cohorts were assessed as high school seniors and then annually across 4 college years (New England Study of Suburban Youth younger cohort [NESSY-Y]), and across ages 23–27 (NESSY older cohort [NESSY-O]; ns = 152 and 183 at final assessments, respectively). Across gender and annual assessments, results showed substantial elevations, relative to norms, for frequency of drunkenness and using marijuana, stimulants, and cocaine. Of more concern were psychiatric diagnoses of alcohol/drug dependence: among women and men, respectively, lifetime rates ranged between 19%–24% and 23%–40% among NESSY-Os at age 26; and 11%–16% and 19%–27% among NESSY-Ys at 22. Relative to norms, these rates among NESSY-O women and men were three and two times as high, respectively, and among NESSY-Y, close to one among women but twice as high among men. Findings also showed the protective power of parents’ containment (anticipated stringency of repercussions for substance use) at age 18; this was inversely associated with frequency of drunkenness and marijuana and stimulant use in adulthood. Results emphasize the need to take seriously the elevated rates of substance documented among adolescents in affluent American school communities.
Field investigation of six medial moraines on glaciers near Arolla, Valais, Switzerland, has revealed that all are nourished by englacial till. This is probably derived from supraglacial point-sources on the accumulation zones of the glaciers, and is released in increasing quantities on the ablation zones, where it emerges diffusely or by way of clearly defined transverse or longitudinal debris bands. Possible mechanisms of formation of these debris bands are reviewed, and it is proposed that the transverse bands originated as crevasse fillings on the accumulation zones. Morphologically all six moraines display waxing sections (of increasing height and breadth), related to development of a protective till cover and resultant differential ablation of the glacier surface. Two only display waning sections (of decreasing height), resulting from lateral sliding of till and “inverted” differential ablation resulting from extreme attenuation of till cover. Four “moraine-types” (related to nature of debris supply and detailed morphology) are identified in the Arolla area. It is believed that these may form the basis for a classification of medial moraines.
The two medial moraines of the Glacier de Tsidjiore Nouve are nourished by rock debris revealed at the surface by progressive ablation down-glacier. The sources of the moraine appear to be rock outcrops marginal to or above the Pigne d’Arolla ice fall, much of the detritus entering the glacier via crevasses either at the summit or the base of the ice fall. The role of differential ablation in the emergence of the moraines as relief features is illuminated by measurements made in the late summers of 1971 and 1972. The eventual decline of the moraines down-glacier is related to factors of reducing debris supply, lateral sliding and accelerated ablation due to attenuation of the detrital cover to a mean thickness of 1 cm or less. A model of moraine development, different in several respects from that proposed by Loomis (1970) for the Kaskawulsh Glacier, Alaska, is outlined.
The relationship between supraglacial lateral moraines and lateral dump moraines at Arolla. Switzerland, is discussed. A detailed study of the lateral moraines of glacier de Tsidjiore Nouve reveals their complex form (as superimposed and nested ridges) and the current mode of development (possibly related to the passage of a kinematic wave). Sedimentological analysis indicates that much of the constituent debris is of supraglacial origin; it is transported either directly from the base of slopes flanking the Pigne d’Arolla ice-fall or via englacial septa comprising marginal sediment incorporated in the accumulation zone. A calculation of the volume of debris in the lateral moraines suggests that glacier de Tsidjiore Nouve has recently been more active in transporting and depositing supraglacial debris than in glacial erosion sensu stricto.
In the last decade deposition on lateral moraine embankments of glacier de Tsidjiore Nouve has been re-activated on a large scale. An attempt has been made to reconstruct, from the dimensions of the embankments, average rates of debris accumulation on the moraines during the Neoglacial period. These are compared with rates of deposition over the period 1977–82, calculated from detailed changes in moraine profiles (surveyed by ground- and air-based photogrammetry) and measured rates of ice-margin ablation. At present total output of sediment, by marginal deposition and transport by melt-water streams, from glacier de Tsidjiore Nouve is in the order of 6400–9500m3/a; this suggests the possibility of a high average erosion rate within the glacier catchment of 1.55–2.29 mm/a.
The development of medial moraines on the Glacier de Tsidjiore Nouve is related to numerous englacial debris layers of limited dimensions, which are exposed at the glacier surface below the Pigne d’Arolla ice fall. Previous research has suggested that such layers result either from high-level transport of debris, derived from rock weathering and/or glacial erosion in the accumulation zone, or from shearing up of subglacial debris owing to intense compressive stresses in the glacier. The morphology of the debris layers is investigated in the field, and samples are subjected to particle-size analysis. It is concluded that constituent debris is derived largely from exposed faces of rock between the upper and lower firn basins, but that a subglacial component is present. Entry of the debris into the glacier is possibly by way of crevasses on the lower firn basin.
Hippocampal volume reductions in major depression have been frequently reported. However, evidence for functional abnormalities in the same region in depression has been less clear. We investigated hippocampal function in depression using functional magnetic resonance imaging (fMRI) and neuropsychological tasks tapping spatial memory function, with complementing measures of hippocampal volume and resting blood flow to aid interpretation.
A total of 20 patients with major depressive disorder (MDD) and a matched group of 20 healthy individuals participated. Participants underwent multimodal magnetic resonance imaging (MRI): fMRI during a spatial memory task, and structural MRI and resting blood flow measurements of the hippocampal region using arterial spin labelling. An offline battery of neuropsychological tests, including several measures of spatial memory, was also completed.
The fMRI analysis showed significant group differences in bilateral anterior regions of the hippocampus. While control participants showed task-dependent differences in blood oxygen level-dependent (BOLD) signal, depressed patients did not. No group differences were detected with regard to hippocampal volume or resting blood flow. Patients showed reduced performance in several offline neuropsychological measures. All group differences were independent of differences in hippocampal volume and hippocampal blood flow.
Functional abnormalities of the hippocampus can be observed in patients with MDD even when the volume and resting perfusion in the same region appear normal. This suggests that changes in hippocampal function can be observed independently of structural abnormalities of the hippocampus in depression.
The relationship between subjective memory complaints (SM) and objective memory (OM) performance in aging has been variably characterized in a substantial literature, to date. In particular, cross-sectional studies often observe weak or no associations. We investigated whether subjective memory complaints and objectively measured cognition influence each other over time, and if so, which is the stronger pathway of change—objective to subjective, or subjective to objective—or whether they are both important. Using bivariate latent change score modeling in data from a population study (N=1980) over 5 annual assessment cycles, we tested four corresponding hypotheses: (1) no coupling between SM and OM over time; (2) SM as leading indicator of change in OM; (3) OM as leading indicator of change in SM; (4) dual coupling over time, with both SM and OM leading subsequent change in the other. We also extended objective cognition to two other domains, language and executive functions. The dual-coupling models best fit the data for all three objective cognitive domains. The SM–OM temporal dynamics differ qualitatively compared to other domains, potentially reflecting changes in insight and self-awareness specific to memory impairment. Subjective memory and objective cognition reciprocally influence each other over time. The temporal dynamics between subjective and objective cognition in aging are nuanced, and must be carefully disentangled to shed light on the underlying processes. (JINS, 2015, 21, 732–742)
The preceding papers of this series have demonstrated (1) that there is a progressive increase of average Dp‐age in the subdivisions of Compositæ which can be correlated with geological age as determined from other data (Small and Johnston, 1937); (2) that these Dp‐ages, when placed on a time‐scale of years, follow a peculiar exponential curve, called the BAT curve (Small, 1937, Q.E. II); (3) that the measure of age in years which is given by the BAT curve can be used successfully for the Grasses (Small, 1937, Q.E. III).
The average ages in doubling periods (Dp‐ages) of the tribes and subtribes of Compositæ have been collated with geological time (Small, 1937, Q.E. II), but the Dp‐ages of individual tribes and sub‐tribes show considerable variation within each of the geological periods. When plotted as Dp‐ages against a time‐scale the tribes and the sub‐tribes show rather scattered positions, and the sub‐tribes within each tribe follow rather zigzag lines instead of being points on a straight line for each tribe.
Previous communications have established the formula for the Bat curve as - Dp.k + n.d = tk · 2n, where k is a constant Dp-age, d is a constant difference of Dp-age, tk is the time value in m.y. at the Dp-age k. For Compositæ (Small, 1937, Q.E. II) and apparently also for the Grasises (Small, 1937, Q.E. III) k = 0·6, d = 0·9, tk = 1·09375 m.y.
The current study examined independent and interactive effects between Apolipoprotein E (APOE) genotype and two types of cognitively-stimulating lifestyle activities (CSLA)—integrated information processing (CSLA-II) and novel information processing (CSLA-NI)—on concurrent and longitudinal changes in cognition. Three-wave data across 6 years of follow-up from the Victoria Longitudinal Study (n=278; ages 55–94) and linear mixed model analyses were used to characterize the effects of APOE genotype and participation in CSLA-II and CSLA-NI in four cognitive domains. Significant CSLA effects on cognition were observed. More frequent participation in challenging activities (i.e., CSLA-NI) was associated with higher baseline scores on word recall, fact recall, vocabulary and verbal fluency. Conversely, higher participation in less cognitively-challenging activities (i.e., CSLA-II) was associated with lower scores on fact recall and verbal fluency. No longitudinal CSLA-cognition effects were found. Two significant genetic effects were observed. First, APOE moderated CSLA-II and CSLA-NI associations with baseline verbal fluency and fact recall scores. Second, APOE non-ɛ4 carriers’ baseline performance were more likely to be moderated by CSLA participation, compared to APOE-ɛ4 carriers. Our findings suggest APOE may be a “plasticity” gene that makes individuals more or less amenable to the influence of protective factors such as CSLA. (JINS, 2014, 20, 1–9)
The Sahel in West Africa is a major wintering area for many western Palearctic migrants. The breeding populations of many of these have declined over the past 50 years. However, there have been few intensive field studies on migrant ecology in the Sahel and these were generally within a very restricted area. Consequently our knowledge of the distribution of species within this extensive area and the habitat associations of these species is limited. Understanding these habitat associations is essential for the effective conservation management of populations. We brought together a group of experts and consulted a wider group by email to assess the main Sahelian habitat types used by 68 African-Eurasian migrant bird species. Those species that showed strongest declines during 1970–1990 were associated with more open habitats than those newly declining during 1990–2000, when declining species were associated with habitats with more shrubs and trees. Populations of species that winter in the Sahel are generally stable or increasing now as rainfall has increased and is now near the long-term average for the Sahel. Those which use the Sahel only as a staging area are, in many cases, in rapid decline at present.
Impending malignant spinal cord compression (IMSCC) may be defined as compression of the thecal sac, without any visible pressure on the spinal cord itself. Although there is a perception that IMSCC patients have a better prognosis and less severe clinical symptoms than true malignant spinal cord compression (MSCC) patients, these factors have never been documented in the literature.
To record the characteristics, management and functional outcome of a group of patients with IMSCC, who were treated with radiotherapy in our institution, and compare these parameters with similar data on MSCC patients.
Materials and methods
Data (gender, age, primary oncological diagnosis, pain, performance status and neurological status) were prospectively collected for 28 patients. Patients were then followed up post treatment to document their response to treatment and treatment-related toxicity.
The median survival of our group of IMSCC patients is similar to that of an MSCC patient. In addition, the IMSCC group exhibits significant clinical symptoms including neurological deficit.
Although further studies are necessary, we have found that IMSCC patients in this study share similar prognosis and clinical symptoms with MSCC patients. Clinicians should be aware of this when communicating with IMSCC patients and their families, and short-course radiotherapy should be considered.