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The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia.
Our aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia.
We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018.
Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent.
Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.
To profile discretionary food and beverage (DF) consumption among Australian adults.
Cross-sectional analysis. Dietary and sociodemographic data were used to profile DF intake. Prevalence of DF consumption, DF servings (1 serving=600 kJ), nutrient contribution from DF and top DF food groups by self-reported eating occasions were determined. DF consumers (>0 g) were classified according to quartile of DF intake and general linear models adjusted for age and sex were used to determine associations.
2011–12 National Nutrition and Physical Activity Survey (NNPAS).
Adults aged ≥19 years (n 9341) who participated in the NNPAS 2011–12.
Most adults consumed DF (98 %) and over 60 % exceeded 3 DF servings/d, with a mean of 5·0 (se 0·0) DF servings/d. Cakes, muffins, scones, cake-type desserts contributed the most DF energy (8·4 %) of all food groups, followed by wines (8·1 %), pastries (8·0 %) and beers (6·1 %), with all these food groups consumed in large portions (2·3–3·0 DF servings). Lunch and dinner together contributed 45 % of total DF energy intake. High DF consumers had an average of 10 DF servings, and this group contained more younger adults, males, low socio-economic status, lower usual fruit intake and higher mean waist circumference, but not higher BMI.
A focus on DF consumed in large portions at lunch and dinner may help improve interventions aimed at reducing DF intake and addressing negative adiposity-related measures found in high DF consumers.
A gap exists between the evidence for reducing risk of knee osteoarthritis (KOA) progression and its application in patients’ daily lives. We aimed to bridge this gap by identifying patient and family physician (FP) self-management priorities to conceptualize and develop a mobile-health application (m-health app). Our co-design approach combined priorities and concerns solicited from patients and FPs with evidence on risk of progression to design and develop a KOA self-management tool.
Parallel qualitative research of patient and FP perspectives was conducted to inform the co-design process. Researchers from the Enhancing Alberta Primary Care Research Networks (EnACT) evaluated the mental models of FPs using cognitive task analysis through structured interviews with four FPs. Using grounded theory methods, patient researchers from the Patient and Community Engagement Research (PaCER) program interviewed five patients to explore their perspectives about needs and interactions within primary care. In three co-design sessions relevant stakeholders (four patients, five FPs, and thirteen researchers) participated to: (i) identify user needs with regard to KOA self-management; and (ii) conceptualize and determine design priorities and functionalities of an m-health app using a modified nominal group process.
Priority measures for symptoms, activities, and quality of life from the user perspective were determined in the first two sessions. The third co-design session with our industry partner resulted in finalization of priorities through interactive patient and FP feedback. The top three features were: (i) a symptoms graph and summary; (ii) information and strategies; and (iii) setting goals. These features were used to inform the development of a minimum viable product.
The novel use of co-design created directive dialog around the needs of patients, highlighting the contrasting views that exist between patients and FPs and emphasizing how exploring these differences might lead to strong design options for patient-oriented m-health apps. Characterizing these disjunctions has important implications for operationalizing patient-centered health care.
The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment.
This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions.
A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions.
Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
The Clean Sky Joint Undertaking is currently managing two large-scale research and innovation programmes under FP7 and Horizon 2020 to contribute to the strengthening of the European aeronautical sector ensuring global leadership and competitiveness. This paper describes the research and demonstration programmes in Clean Sky (2008–2017) and Clean Sky 2 (2014–2024) related to propulsion technologies for the next-generation aircraft. The bulk of this work is addressed in Clean Sky 1 under the “Sustainable And Green Engines” (SAGE) programme and under the “ENGINES” programme in Clean Sky 2. The High-Level Objectives are described for each engine architecture as well as the targets in terms of CO2 and noise reduction versus a year 2000 reference unless stated otherwise. An overview of the new engine concepts that would satisfy the ACARE objectives is presented, including the main technologies which are to be developed to ensure the successful demonstration of each of those new engine concepts.
To examine the relationships between objectively measured sleep patterns
(sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage
(SSB) consumption (regular soft drinks, energy drinks, sports drinks and
fruit juice) among children from all inhabited continents of the world.
Multinational, cross-sectional study.
The International Study of Childhood Obesity, Lifestyle and the Environment
Children (n 5873) 9–11 years of age.
Sleep duration was 12 min per night shorter in children who reported
consuming regular soft drinks ‘at least once a day’
compared with those who reported consuming ‘never’ or
‘less than once a week’. Children were more likely to
sleep the recommended 9–11 h/night if they reported
lower regular soft drink consumption or higher sports drinks consumption.
Children who reported consuming energy drinks ‘once a week or
more’ reported a 25-min earlier bedtime than those who reported
never consuming energy drinks. Children who reported consuming sports drinks
‘2–4 d a week or more’ also reported a
25-min earlier bedtime compared with those who reported never consuming
sports drinks. The associations between sleep efficiency and SSB consumption
were not significant. Similar associations between sleep patterns and SSB
consumption were observed across all twelve study sites.
Shorter sleep duration was associated with higher intake of regular soft
drinks, while earlier bedtimes were associated with lower intake of regular
soft drinks and higher intake of energy drinks and sports drinks in this
international study of children. Future work is needed to establish
causality and to investigate underlying mechanisms.
Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.
In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.
After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).
PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
Examining neurometabolic abnormalities in critical brain areas in schizophrenia and major depressive disorder (MDD) may help guide future pharmacological interventions including glutamate-modulating treatments.
To measure metabolite concentrations within the anterior cingulate cortex (ACC) and thalamus of people with schizophrenia and people with MDD.
Spectra were acquired from 16 volunteers with schizophrenia, 17 with MDD and 18 healthy controls using magnetic resonance spectroscopy on a 7 Tesla scanner.
In the thalamus, there were lower glycine concentrations in the schizophrenia group relative to control (P=0.017) and MDD groups (P=0.012), and higher glutamine concentrations relative to healthy controls (P=0.009). In the thalamus and the ACC, the MDD group had lower myo-inositol concentrations than the control (P=0.014, P=0.009, respectively) and schizophrenia (P=0.004, P=0.002, respectively) groups.
These results support the glutamatergic theory of schizophrenia and indicate a potential glycine deficiency in the thalamus. In addition, reduced myo-inositol concentrations in MDD suggest its involvement in the disorder.
Transient storage and erosion of valley fills, or sediment buffering, is a fundamental but poorly quantified process that may significantly bias fluvial sediment budgets and marine archives used for paleoclimatic and tectonic reconstructions. Prolific sediment buffering is now recognized to occur within the mountainous upper Indus River headwaters and is quantified here for the first time using optically stimulated luminescence dating, petrography, detrital zircon U-Pb geochronology, and morphometric analysis to define the timing, provenance, and volumes of prominent valley fills. This study finds that climatically modulated sediment buffering occurs over 103–104 yr time scales and results in biases in sediment compositions and volumes. Increased sediment storage coincides with strong phases of summer monsoon and winter westerlies precipitation over the late Pleistocene (32–25 ka) and mid-Holocene (~8–6 ka), followed by incision and erosion with monsoon weakening. Glacial erosion and periglacial frost-cracking drive sediment production, and monsoonal precipitation mediates sediment evacuation, in contrast to the arid Transhimalaya and monsoonal frontal Himalaya. Plateau interior basins, although volumetrically large, lack transport capacity and are consequently isolated from the modern Indus River drainage. Marginal plateau catchments that both efficiently produce and evacuate sediment may regulate the overall compositions and volumes of exported sediment from the Himalayan rain shadow.
To identify, using a novel enhanced method of recovery, environmental sites where spores of Clostridium difficile persist despite cleaning and hydrogen peroxide aerial decontamination.
Tertiary referral center teaching hospital.
In total, 16 sites representing high-frequency contact or difficult-to-clean surfaces in a single-isolation room or bed area in patient bed bays were sampled before and after terminal or hydrogen peroxide disinfection using a sponge swab. In some rooms, individual sites were not present (eg, there were no en-suite rooms in the ICU). Swab contents were homogenized, concentrated by membrane-filtration, and plated onto selective media. Results of C. difficile sampling were used to focus cleaning.
Over 1 year, 2,529 sites from 146 rooms and 44 bays were sampled. Clostridium difficile was found on 131 of 572 surfaces (22.9%) before terminal cleaning, on 105 of 959 surfaces (10.6%) after terminal cleaning, and on 43 of 967 surfaces (4.4%) after hydrogen peroxide disinfection. Clostridium difficile persisted most frequently on floor corners (97 of 334; 29.0%) after disinfection. Between the first and third quarters, we observed a significant decrease in the number of positive sites (25 of 390 vs 6 of 256). However, no similar change in the number of isolates before terminal cleaning was observed.
Persistence of C. difficile in the clinical environment was widespread. Although feedback of results did not improve the efficacy of manual disinfection, numbers of C. difficile following hydrogen peroxide gradually declined.
The Storfjorden (Svalbard) ice cover has been observed via European remote-sensing satellite (ERS-2) synthetic aperture radar (SAR) over two winters from 1997 to 1999 that showed a high interannual variability in atmospheric forcing. This has resulted in different scenarios in the formation of the ice cover. We reconstruct the ice-cover evolution with a simple ice-drift and polynya model consistent in parameterization for both winters and with ERS-2 SAR and ground-truth observations. The observations showed that, during the rather cold winter of 1997/98, a fast-ice cover developed over the whole northern part of Storfjorden that closed the ice advection through two sounds. A polynya of up to 6000 km2 developed persistently under northerly winds. The mild winter of 1998/99 showed a different pattern in the Storfjorden ice cover: the fast-ice extent was reduced to the coastal region, so ice motion was more important than in the previous winter. A larger thin-ice and open-water area over the whole fjord resulted in lower total ice production, but relocated the strong ice production sites to shallower waters. Thus, freezing in a large region of shallow waters in the north of Storfjorden in 1998/99 produced denser waters than freezing in a smaller polynya over the deeper centre of Storfjorden during the colder winter 1997/98.
The physical properties of eight ice cores recovered from along a flowline at Glacier de Tsanfleuron, Switzerland, have led to the identification of three distinctive internal zones. We use variations in the bulk ionic chemistry of these zones to approximate their relative liquid-water concentrations and ice viscosities. Results suggest that relative bulk water concentration and ice softness vary by over an order of magnitude between the zones. Implications of this variability for predictions of the glacier’s response to climate change are evaluated by incorporating these relative softnesses into a multi-layered (two-dimensional) model of ice flow. Model output is compared with that from an identical model constrained with a spatially uniform ice viscosity under advance and retreat modelling scenarios. The former scenario is used to tune viscosity by growing a glacier to its present long-section geometry, resulting in best-fit ice hardness values of 1.2 a1 bar–3 for the englacial ice in the multi-layered model and 7.0 a–1 bar–3 for all of the ice in the single-layered model. Both result in close approximations to the current long profile, yielding rms deviationsbetween measured and modelled ice thicknesses that are 5 5 m. In contrast, a single-layered model constrained with a hardness of 1.2 a–1 bar–3 overestimates the current measured long-section area by 31%, having a rms ice-thickness error of 15.0 m. Under the retreat modelling scenario, which gauges the response of the glacier to an imposed 75 m rise in equilibrium-line altitude (ELA), the multi-layered model predicts a long-section area reduction of 78%. This contrasts with a reduction of 64% for the single-layered model (hardness = 7.0 a–1 bar–3) and 85% for the single-layered model (hardness = 1.2 a–1 bar–3).
The transformation of ocean water masses at high latitudes is closely related to the freezing and melting processes during the year. Downward salt fluxes from brine rejection during freezing increase the salinity and density of the water column underneath. Fresh-water input from river run-off and melting of sea ice reduces the density, mainly of the surface layer. Hydrographic profiles collected in Storfjorden, Svalbard, in spring and summer, show the strong seasonal and interannual variability of the water masses. Using, in addition, data from moorings, a ship-borne acoustic Doppler current profiler and drifting buoys, and results from models of ice drift, polynya evolution, ice formation and convection processes during freezing, we document the seasonal water-mass transformation and try to explain its interannual variability. The advection of ice and water through the two northern sounds and over the sill in the south of the fjord is examined. The release of brine-enriched bottom water over the sill must be balanced by advection from the Barents Sea in the upper layers. The interannual variability of the brine-enriched bottom layer is very high, and higher salinities are observed in a milder winter. The density anomaly resulting from freezing might depend more on the ice cover and geographical position of the polynya than on the total atmospheric forcing during winter.
Work on thermal pools at Poggetti Vecchi in Grosseto, Italy, exposed an up to 3-meter-thick succession of seven sedimentary units. Unit 2 in the lower portion of the succession contained vertebrate bones, mostly of the straight-tusked elephant, Palaeoloxodon antiquus, commingled with stone, bone, and wooden tools. Thermal carbonates overlying Unit 2 are radiometrically dated to the latter part of the middle Pleistocene. This time span indicates that early Neanderthals produced the human artifacts from Poggetti Vecchi. The elephant bones belong to seven individuals of different ages. Sedimentary facies analysis and paleoecological evidence suggest a narrow lacustrine-palustrine embayment affected by water-level fluctuations and, at times, by hydrothermal water. Cyclic lake-level variations were predominantly forced by the rapid climatic fluctuations that occurred at Marine Isotope Stage (MIS) 6–7 transition and throughout the MIS 6. Possibly an abrupt, intense, and protracted cold episode during the onset of MIS 6 led to the sudden death of the elephants, which formed an unexpected food resource for the humans of the area. The Poggetti Vecchi site adds new information on the behavioral plasticity and food procurement strategies that early Neanderthals were able to develop in Italy during the middle to the late Pleistocene transition.
The claim that rudist bivalves competitively displaced corals from reef frameworks in the Cretaceous combines two assertions: (1) that rudist formations commonly developed as reefs; and (2) that the autecology of rudists was convergent with that of hermatypic corals. We dispute both assertions, and thus reject the hypothesis of competitive displacement. We argue instead that mobile sediments, rather than frameworks, dominated the margins of most of the extensive carbonate platforms of the period, and that it was on these non-reefal biotopes that the rudists flourished.
Definitions of reefs tend to combine two major elements: (1) a robust biogenic framework (with accompanying sedimentary and diagenetic components); and (2) topographical relief. Such definitions are clearly rooted in Recent coral reefs, in which endosymbiotic zooxanthellae permit the extensive growth of colonial coral frameworks in shallow but relatively nutrient-poor waters and topography is largely the legacy of Pleistocene changes in sea-level. In rudist formations, in contrast, individual rudist aggregations are volumetrically limited, relative to sediment, often loosely constructed, and evidently showed little relief. Tabular and small lenticular units predominate.
Differences in structure and palaeoenvironmental situation between rudist and coralgal associations are the effect of the different autecologies of the constituent organisms. While the clonal growth of corals predisposed them to framework development, the aclonal development of rudists was better suited to the opportunistic occupation of a variety of temporarily available substrata. Moreover, the tolerances and growth responses of rudists to such factors as water turbidity, nutrients and current regime were quite different from those of hermatypic corals. Despite repeated assertions in the literature that rudists possessed zooxanthellae, only a few species show any evidence for such a symbiosis and other evidence suggests that most lacked them.
Rudist/coral competition is therefore doubtful, even though members of both groups co-occur in many areas. The relative demise and migration into deeper water of coral frameworks in the Cretaceous was thus probably independently caused.
Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment.
Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs’ attitude of “trying to establish a diagnosis of dementia on their own.”
Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28–5.23).
Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.
The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers.