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Recent studies have tried to find a reliable way of predicting the development of Alzheimer´s Disease (AD) among patients with mild cognitive impairment (MCI), often focusing on olfactory dysfunction or semantic memory. Our study aimed to validate these findings while also comparing the predictive accuracy of olfactory and semantic assessments for this purpose.
Six hundred fifty patients (median age 68, 58% females) including controls, SCD (subjective cognitive decline), non-amnestic MCI (naMCI), amnestic MCI (aMCI), and AD patients were tested for olfactory dysfunction by means of odor identification testing and semantic memory. Of those 650 patients, 120 participants with SCD, naMCI, or aMCI at baseline underwent a follow-up examination after two years on average. Of these 120 patients, 12% had developed AD at follow-up (converters), while 88% did not develop AD at follow-up (non-converters).
Analysis showed a significant difference only for initial olfactory identification between converters and non-converters. Sensitivity of impairment of olfactory identification for AD prediction was low at 46.2%, although specificity was high at 81.9%. Semantic memory impairment at baseline was not significantly related to AD conversion, although, when naming objects, significant differences were found between AD patients and all other groups and between naMCI and aMCI patients compared to controls and SCD patients.
Objective olfactory assessments are promising instruments for predicting the conversion to AD among MCI patients. However, due to their low sensitivity and high specificity, a combination with other neuropsychological tests might lead to an improved predictive accuracy. Further longitudinal studies with more participants are required to investigate the usefulness of semantic memory tests in this case.
We argue that triple-mode RR Lyrae pulsation with low amplitudes might be quite common. It is shown that until very accurate abundance data become available, triple-mode RR Lyrae stars are the only hope to estimate reliable stellar parameters from the periods alone.
It has been well established that milk yield is affected both by milking frequency and due to the removal of residual milk, but the influence of a combination of these factors is unclear. In this study, four mid-lactation cows were used in a 4 × 4 Latin square design to test the hypothesis that the effects of more frequent milking and residual milk removal on milk yield and composition are additive and alter milk fatty acid composition. Treatments comprised two or four times daily milking in combination with (or without) residual milk removal over a 96 h interval preceded by a 2 d pretreatment period and followed by a 8 d washout in each 14 d experimental period. Milk was sampled at each milking for the analysis of gross composition and SCC. Samples of available and residual milk collected on the last milking during each treatment period were collected and submitted for fatty acid composition analysis. Increases in milking frequency and residual milk removal alone or in combination had no effect on milk yield or on the secretion of lactose and protein in milk. However, residual milk removal during more frequent milking increased milk fat yield. Milking treatments had no major influence on the fatty acid composition of available milk, but resulted in rather small changes in the relative abundance of specific fatty acids, with no evidence that the additive effects of treatments were due to higher utilisation of preformed fatty acids relative to fatty acid synthesis de novo. For all treatments, fat composition of available and residual milk was rather similar indicating a highly uniform fatty acid composition of milk fat within the mammary gland.
Objectives: The Priorities and Evaluation Committee (PEC) funding recommendations for new cancer drugs in British Columbia, Canada have been based on both clinical and economic evidence. The British Columbia Ministry of Health makes funding decisions. We assessed the association between cost-effectiveness of cancer drugs considered from 1998 to 2008 and the subsequent funding decisions.
Methods: All proposals submitted to the PEC between 1998 and 2008 were reviewed, and the association between cost-effectiveness and funding decisions was examined by (i) using logistic regression to test the hypothesis that interventions with higher incremental cost-effectiveness ratios (ICERs) have a lower probability of receiving a positive funding decision and (ii) using parametric and nonparametric tests to determine if a statistically significant difference exists between the mean cost-effectiveness of funded versus not funded proposals. A sub-analysis was conducted to determine if the findings varied across different outcome measures.
Results: Of the 149 proposals reviewed, 78 reported cost-effectiveness using various outcome measures. In the proposals that used life-years gained as the outcome (n = 22), a statistically significant difference of nearly $115,000 was observed between the mean ICERs for funded proposals ($42,006) and for unfunded proposals ($156,967). An odds ratio indicating higher ICERs have a lower probability of being funded was also found to be statistically significant (p < .05).
Conclusions: Economic evidence appears to play a role in British Columbia cancer funding decisions from 1998 to 2008; other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.
The numerically generated dynamical evolution of an RR Lyrae model from different initial conditions is subjected to a time-dependent Fourier analysis, which yields the temporal behavior of the amplitudes and phases of the few longlived transient modes in addition to the ultimate winner. It is shown that the amplitude equation formalism of Buchler and Goupil gives an almost perfect fit to the observed transient behavior of the amplitudes and phases of the excited modes. Prospects and applications are discussed.
The environmental conditions in the southern Beaufort Sea are described with special emphasis on pressure ridges and ice islands. Techniques for determining the geometric configurations and the physical and mechanical properties of sea-ice structures and ice islands are described. Profiles of pressure ridges were determined by surface surveys, drill-hole probes and side-looking sonar scanning. Multi-year pressure ridges with thicknesses up to 20 m and widths up to 120 m were examined in detail. The first-year ridge of 22 m thickness and 100 m width was studied. Results are given for several multi-year and the first-year ridges. Information obtained from dives under the ice is also given. Corresponding data are given for grounded ice islands with particular attention being given to contact between the ice and sea bed. A 20 m thick ice-island fragment grounded in 15 m of water was one of several investigated. Measurements of temperature, salinity, tensile strength, and compressive strength are given for ice taken from old pressure ridges and factors influencing the interpretation of test data were discussed. The data obtained in this study will be used in engineering design studies for offshore structures for drilling and production of hydrocarbons from the Beaufort Sea area. Exploratory drilling in shallow water has already been carried out and offshore drilling from drillships is scheduled to commence in the study area during the open water season of 1976.
The deformation of a strain triangle (≈6 km × 8 km × 11 km) located on first-year ice in the Beaufort Sea was observed over a two-week period in March 1971. Significant strain events (≈ 1.5%) were observed to occur during short (≈6 h) time periods. The long-term (one day or more) divergence rate varied between 0.04 and 0.08 × 10−3 h−1. Short-term divergence rates showed values as high as 0.29 × 10−3 h−1. The observed shearing motion indicated that the floes to the east were moving to the south relative to the floes to the west. This agrees with the shear pattern that might be expected considering the location of the station in the Pacific Gyre. Studies of fracture (lead and crack) orientations in the vicinity of the strain triangle indicate reasonable correlations with the orientation of the strain-rate ellipse. A qualitative relation is suggested between the fracture density and the long-term divergence rate. Correlations were also observed between the divergence of the wind field as computed from the surface pressure field and the ice divergence.
The environment conditions in the southern Beaufort Sea are described with special emphasis on pressure ridges and ice islands. Techniques for determining the geometric configurations and the physical and mechanical properties of sea-ice structures and ice islands are described. Profiles of pressure ridges were determined by surface surveys, drill-hole probes and side-looking sonar scanning. Multi-year pressure ridges with thicknesses up to 18 m and widths up to 110 m were examined in detail. The first-year ridge of 22 m thickness and 100 m width was studied. Results are given for several multi-year ridges and the first-year ridge. Information obtained from dives under the ice is also given. Corresponding data are given for grounded ice islands with particular attention being given to contact between the ice and sea bed. A 19 m thick ice-island fragment grounded in 13 m of water was one of several investigated. Measurements of temperature, salinity, tensile strength and compressive strength are given for ice taken from old pressure ridges and factors influencing the interpretation of test data are discussed. The data obtained in this study will be used in engineering design studies for off-shore structures for drilling and production of hydrocarbons from the Beaufort Sea area. Exploratory drilling in shallow water has already been carried out and off-shore drilling from drill ships is scheduled to commence in the study area during the open-water season of 1976.
This paper will be published in full in a future issue of Journal of Glaciology.
During March-May 1976, a combination of laser and radar ranging systems was used to study the motion of both the fast ice and the pack ice near Narwhal and Cross Islands, two barrier islands located 16 and 21 km offshore in the vicinity of Prudhoe Bay, Alaska. Laser measurements of targets on the fast ice near Narwhal Island indicate small net displacements of approximately 1 m over the period of study (71 d) with short-term displacements of up to 40 cm occurring over 3 d periods. The main motion was outward normal to the coast and was believed to be the result of thermal expansion of the ice. The radar records of fast-ice sites farther offshore show a systematic increase in the standard deviation of the displacements as measured parallel to the coast, reaching a value of ±6.6 m at 31 km. The farthest fast-ice sites show short-term displacements of up to 12 m. There are also trends in the records that are believed to be the result of the general warming of the fast ice with time.
Radar targets located on the pack ice showed large short-term displacements (up to 2.7 km) but negligible net ice drift along the coast. There was no significant correlation between the movement of the pack and the local wind, suggesting that coastal ice prediction models can only succeed if handled as part of a regional model which incorporates stress transfer through the pack. The apparent fast-ice-pack-ice boundary in the study area was located in 30-35 m of water.
During the austral summers of 1976–77 and 1978–79, several ice cores were taken from the McMurdo Ice Shelf brine zone to investigate its thermal, physical, and chemical properties. This brine zone consists of a series of superimposed brine layers (waves) that originate at the seaward edge of the ice shelf and migrate at various rates, depending on their age and position in the ice shelf. The brine in these layers becomes increasingly concentrated as the waves migrate inland through the permeable ice-shelf firn. Chemical analyses of brine samples from the youngest (uppermost) brine wave show that, except for the advancing front, it contains sea salts in normal sea-water proportions. Further inland, deeper and older brine layers, though highly saline (S > 200°/00), are severely depleted in SO42-, with the SO42-/Na+ ratio being an order of magnitude less than that of normal sea-water. Consideration of the solubility of alternative salts, together with analyses of Na+, K+, Ca2+, Mg2+, SO42-, and Cl- concentrations, shows that the sulfate depletion is probably due to selective precipitation of mirabilite, Na2SO4·10H2O. The location of the inland boundary of brine penetration is closely related to the depth at which the brine encounters the firn/ice transition. However, a small but measureable migration of brine is still occurring in otherwise impermeable ice; this is attributed to eutectic dissolution of the ice by concentrated brine as it moves into deeper and warmer parts of the McMurdo Ice Shelf.
Infiltration of brine into the McMurdo Ice Shelf is dominated by wave-like intrusions of sea-water triggered by periodic break-outs of the ice front. Observations of a brine step 4.4 m in height in the McMurdo Ice Shelf show that it has migrated about 1.2 kin in four years. The present brine wave is overriding an older brine-soaked layer. This migration is proof of the dynamic nature of the step, which is the leading edge of a brine wave that originated at the ice front after a major break-out of the McMurdo Ice Shelf. The inland boundary of brine penetration is characterized by a series of descending steps that are believed to represent terminal positions of separate intrusions of brine of similar origin. The inland boundary of brine percolation is probably controlled largely by the depth at which brine encounters the firn/ice transition (43 m). However, this boundary is not fixed by permeability considerations alone, since measurable movement of brine is still occurring at the inland boundary. Freeze-fraction-ation of the sea-water as it migrates through the ice shelf precipitates virtually all sodium sulfate, and preferentially concomitant removal of water by freezing in the pore spaces of the infiltrated firn produces residual brines approximately seven times more concentrated than the original sea-water.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.
A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from “always” to “never” to capture usual practice.
The survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would “always/often” be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would “always/often” administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00).
Most EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.
The Gothard Astrophysical Observatory of Loránd Eötvös University was founded in 1881 by Eugene von Gothard, the first astronomer in the world who took a photo of the central star of Ring nebula. After nearly 80 years interregnum, the observatory was revitalized by Eötvös University in 1992 and its equipment is used both for education and for research.
We describe the design and current status of the Degree Angular Scale Interferometer (DASI), a compact cm-wave interferometer operating at the Amundsen-Scott South Pole research station. With 20-cm diameter primary antenna elements operating over the frequency range 26 − 36 GHz, DASI is optimized to measure the power spectrum of the cosmic microwave background radiation (CMBR) over the multipole range 140 − 920, (corresponding to scales of 25′ − 2°.6), as well as make high-sensitivity maps of the microwave sky. The telescope was built at the University of Chicago and deployed at the South Pole during the 1999-2000 austral summer.