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The Montreal Cognitive Assessment (MoCA) is a popular and simple-to-administer screening instrument to detect cognitive impairment. The MoCA generates a total score and six domain-specific index scores: (1) Memory, (2) Executive Functioning, (3) Attention, (4) Language, (5) Visuospatial, and (6) Orientation. It is unclear whether these MoCA scores can differentiate between distinct clinical dementia syndromes. This study compared MoCA Index scores between amnestic dementia of the Alzheimer’s type (DAT) and primary progressive aphasia (PPA), a language-based dementia.
Baseline MoCA data were analyzed from 33 DAT, 37 PPA, and 83 cognitively normal individuals enrolled in the Clinical Core of the Northwestern Alzheimer’s Disease Center. A one-way analysis of covariance adjusted for age was used to compare MoCA scores among groups. A logistic regression model was implemented to observe individual likelihood of group affiliation based on MoCA Index scores.
The mean MoCA total score was significantly higher in controls compared to both patient groups (p < .001) but did not differ between DAT and PPA groups. However, in accordance with salient clinical features commonly observed in DAT versus PPA, Memory and Orientation Index scores were lowest in the DAT group (p < .001), whereas Language and Attention Index scores were lowest in the PPA group (p < .001). Multivariate logistic regression analysis showed that the individual effects of Memory (p = .001), Language (p = .002), and Orientation (p = .025) Indices were significant.
MoCA Index scores can help differentiate among distinct cognitive syndromes, suggesting it may be a useful brief screening tool to detect domain-specific cognitive impairment.
Creating landscapes with connectivity is vital for protecting biodiversity and meeting the environmental targets embedded in the United Nations Sustainable Development Goals, with connectivity specifically mentioned in Target 11 of the Convention on Biological Diversity Aichi Targets. Costa Rica created the National Biological Corridor Program (NBCP) in 2006 to enhance connectivity among protected areas. Targeted investments of payments for environmental services (PES) are the main tools used within the designated biological corridors. We conducted spatially explicit analyses to determine whether Costa Rica’s NBCP, using PES, enhanced landscape connectivity within the Paso de las Nubes Biological Corridor. We conducted landscape modelling in order to determine the connectivity held within PES’s properties by developing connectivity resistance surfaces and electrical current models. The results indicate that PES properties established after the NBCP contributed more to areas with intermediate values of connectivity and less to areas with high connectivity values as compared to properties before the NBCP. Although overall connectivity within the corridor has decreased since NBCP establishment, our results confirm the importance of PES properties for landscape connectivity, but emphasize the need for spatially targeted PES in order to improve viable paths of landscape connectivity among protected areas. Future targeted PES investments could contribute greatly to meeting connectivity goals.
While prototypes are critical to the creation of successful products and innovative solutions, building a prototype is characterized by large sunk costs and a plethora of unknowns. The versatility and effectiveness of prototypes paired with the ambiguous nature of developing a prototype can lead to wasted resources. Recent studies support this claim, demonstrating that under certain circumstances, designers often prototype without a clear purpose, building prototypes as a function of the design process rather than as a function of the design. These findings motivated the creation of the Prototyping Canvas, a tool to aid designers in planning for purposeful prototypes by identifying critical assumptions and questions to guide development. Business and engineering design literature influenced the development of the canvas, which was first tested with a client project in the SUTD-MIT International Design Centre (IDC). The feedback and insights from the design team guided revisions to the canvas. The updated canvas was then validated with 55 professionals during a design project sprint. The purpose of this paper is to present the Prototyping Canvas as a valid and effective design tool.
Species distribution models (SDMs) are statistical tools used to develop continuous predictions of species occurrence. ‘Integrated SDMs’ (ISDMs) are an elaboration of this approach with potential advantages that allow for the dual use of opportunistically collected presence-only data and site-occupancy data from planned surveys. These models also account for survey bias and imperfect detection through the use of a hierarchical modelling framework that separately estimates the species–environment response and detection process. This is particularly helpful for conservation applications and predictions for rare species, where data are often limited and prediction errors may have significant management consequences. Despite this potential importance, ISDMs remain largely untested under a variety of scenarios. We performed an exploration of key modelling decisions and assumptions on an ISDM using the endangered Baird’s tapir (Tapirus bairdii) as a test species. We found that site area had the strongest effect on the magnitude of population estimates and underlying intensity surface and was driven by estimates of model intercepts. Selecting a site area that accounted for the individual movements of the species within an average home range led to population estimates that coincided with expert estimates. ISDMs that do not account for the individual movements of species will likely lead to less accurate estimates of species intensity (number of individuals per unit area) and thus overall population estimates. This bias could be severe and highly detrimental to conservation actions if uninformed ISDMs are used to estimate global populations of threatened and data-deficient species, particularly those that lack natural history and movement information. However, the ISDM was consistently the most accurate model compared to other approaches, which demonstrates the importance of this new modelling framework and the ability to combine opportunistic data with systematic survey data. Thus, we recommend researchers use ISDMs with conservative movement information when estimating population sizes of rare and data-deficient species. ISDMs could be improved by using a similar parameterization to spatial capture–recapture models that explicitly incorporate animal movement as a model parameter, which would further remove the need for spatial subsampling prior to implementation.
The north-west European population of Bewick’s Swan Cygnus columbianus bewickii declined by 38% between 1995 and 2010 and is listed as ‘Endangered’ on the European Red List of birds. Here, we combined information on food resources within the landscape with long-term data on swan numbers, habitat use, behaviour and two complementary measures of body condition, to examine whether changes in food type and availability have influenced the Bewick’s Swan’s use of their main wintering site in the UK, the Ouse Washes and surrounding fens. Maximum number of Bewick’s Swans rose from 620 in winter 1958/59 to a high of 7,491 in winter 2004/05, before falling to 1,073 birds in winter 2013/14. Between winters 1958/59 and 2014/15 the Ouse Washes supported between 0.5 and 37.9 % of the total population wintering in north-west Europe (mean ± 95 % CI = 18.1 ± 2.4 %). Swans fed on agricultural crops, shifting from post-harvest remains of root crops (e.g. sugar beet and potatoes) in November and December to winter-sown cereals (e.g. wheat) in January and February. Inter-annual variation in the area cultivated for these crops did not result in changes in the peak numbers of swans occurring on the Ouse Washes. Behavioural and body condition data indicated that food supplies on the Ouse Washes and surrounding fens remain adequate to allow the birds to gain and maintain good body condition throughout winter with no increase in foraging effort. Our findings suggest that the recent decline in numbers of Bewick’s Swans at this internationally important site was not linked to inadequate food resources.
Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.
Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.
Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.
Significance of results:
Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.
To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy.
Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval.
Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009–July 2013.
One hundred and fifty-eight asthmatic pregnant women.
Three dietary patterns were identified: (i) ‘high protein/fruit’ (strong food group loadings for fish, meat, chicken, fruit); (ii) ‘high fat/sugar/takeaway’ (takeaway foods, crisps, refined grains); and (iii) ‘vegetarian-type’ (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05).
Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.
We outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.
Be able to diagnose a paraphilic disorder according to DSM-5 criteria.
Understand the epidemiology, comorbidity and theories of aetiology of paraphilic disorders.
Know how to assess the need for disclosure if the patient presents with illegal paraphilias.
Human interaction with the land biosphere has contributed to climate change. The land biosphere can play an important role in climate mitigation, through measures such as the management of forests and other carbon sinks, management of agricultural practices, and shifts from fossil-fuel energy to renewable forms of bioenergy. The potential for mitigation must be assessed with regard to the multiple demands for land and the services that ecosystems provide to human society.
Introduction: from human perturbation to biosphere management
Living organisms have co-evolved with the atmosphere, oceans and land surface, contributing to the climate that supports life on Earth today. The increasing human appropriation of the biosphere for food, energy and construction materials, which has brought enormous benefits, has also inadvertently contributed to a loss of biodiversity, widespread pollution, environmental degradation, and climate change.
Human activities have altered the balance of terrestrial greenhouse-gas sources and sinks. The replacement of forests and other natural ecosystems with crops, pastures and urban settlements has caused emissions of CO 2 due to losses from the carbon stock in vegetation and soils, and increased emissions of nitrous oxide (N 2 O ) and methane (CH 4 ) due to diverse agricultural practices.
This article investigates the relationship between biography and authenticity within the aesthetics of grunge musician Kurt Cobain, using the 2002 Riverhead Press volume of his journals as a primary source. Focusing on Cobain's fascination with the human form and with bodily fluids, I argue that his idea of the ‘sick body’ functioned as a central metaphor that shaped his approach to various media (prose, lyrics, drawing and singing) such that there was a homology between these different forms. I draw on excerpts from the Journals to show the meanings that he associated with the ‘sick body’, including the ways in which it indexed his own biography of physical pain and social marginalisation. Using the Nirvana song ‘Hairspray Queen’ as a case study, I then show the interactions between musical and linguistic signs of the sick body and how these interactions reveal Cobain's ideas on music's meaning. Ultimately, I argue that in song lyrics and performance, Cobain prized scatological imagery, eviscerating vocals and unintelligible lyrics as a means to signal the ‘authenticity’ of his art.
Consistent with international obligations, marine biodiversity protection in Australia is achieved primarily through the establishment of protected areas or sanctuaries, the sustainable management of fisheries and the protection of indigenous and endangered marine species. Australia historically has had a multiplicity of legislative regimes at a federal and state level that addressed the protection the marine environment. However, in recent years, with the adoption of Australia's Oceans Policy in 1998 and the passing of the Environment Protection and Biodiversity Conservation Act 1999 (C'th) (EPBC Act), the federal and state governments have begun to develop complementary management approaches for marine ecosystems and to put in place strong legal sanctions to enhance the protection of the marine environment. This essay provides an overview of the current legal and policy framework for the protection of marine biodiversity in Australia, with special reference to the enforcement of that protection through the EPBC Act. It reflects the state of the ongoing legal preceedings as at the time of writing. Using the recent decisions of the Federal Court in Humane Society International Inc. v. Kyodo Senpaku Kaisha Ltd. and Humane Society International v. Minister for Environment and Heritage as case studies, this chapter explores the effectiveness of the protection afforded by Australian laws in circumstances in which politics and complex international relations can undermine conservation objectives.