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To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.
13 geographically dispersed Alzheimer’s Disease Centers across the United States.
431 racially diverse caregivers of persons with dementia.
Survey on “Care Planning for Individuals with Dementia.”
The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.
Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.
An instrument is described which is intended to perform a dual purpose (elemental-structural) analysis consistent with the environmental conditions implied by lunar or planetary operation. The dififractometer section is based on a modified Seeman-Bohlin focusing principle in which a sharp-line focus target, a powdered sample, and a movable detector slit all lie on the focusing circle. The convolution of the projections on the focal circle, of a narrow receiving slit on the detector, the line focus target, combined with a high dispersion produce higher resolution and intensity than is common with Bragg focusing diflfractorneters with simitar instrumental parameters. The range of d-spacings covered is from 1 to 7 Å (chromium target). The chemical analysis section of the instrument utilizes the fluorescent X-rays produced in the specimen by the primary beam. A proportional counter and pulse-height anaiyzer accomplish detection and energy discrimination. Resolution is low, but the analysis can distinguish between elements in the range of atomic numbers 11 to 29. Data from a breadboard model is presented. The entire unit, although primarily intended to meet the requirements of space, performs equally well as a routine laboratory analyzer. The horizontal, stationary nature of the specimen holder suggests several specific applications.
The conventional dependency ratio based on cohort-invariant cutoff points could overstate the true burden of population aging. Using optimal cohort-varying years of schooling and retirement age in a life-cycle model, we propose a modified definition of dependency ratio. We compare the proposed economic-demographic dependency ratio (EDDR) with the conventional definition and find that the conventional dependency ratio of the USA is projected to increase by 0.105 from 2010 to 2060, which is an over-projection of 86% when compared with the projected increase of 0.015 in the EDDR over the same period. Sensitivity analysis suggests that our finding is quite robust to reasonable changes in parameter values (except for one parameter), and the magnitude of over-projection ranges mainly from 0.079 to 0.102 (i.e., 75% to 97%). We follow the well-established Lee–Carter model to forecast stochastic mortality and employ the method of expanding duration to decompose the sources of over-projection.
Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.
Retrospective analysis of HCAHPS survey results over 5 years.
A 1,165-bed, tertiary-care, academic medical center.
Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.
Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and “top-box” experience scores. Dose response to increasing percentage of days in isolation was also analyzed.
Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P = .0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P < .0001), but they reported similar experience in other domains. No dose-response effect was observed.
Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.
Understanding temporal patterns in biodiversity is an enduring question in paleontology. Compared with studies of taxonomic diversity, long-term perspectives on ecological diversity are rare, particularly in terrestrial systems. Yet ecological diversity is critical for the maintenance of biodiversity, especially during times of major perturbations. Here, we explore the ecological diversity of Cretaceous herbivorous dinosaurs leading up to the K-Pg extinction, using dental and jaw morphological disparity as a proxy. We test the hypothesis that a decline in ecological diversity could have facilitated their rapid extinction 66 Ma. We apply three disparity metrics that together capture different aspects of morphospace occupation and show how this approach is key to understanding patterns of morphological evolution. We find no evidence of declining disparity in herbivorous dinosaurs as a whole—suggesting that dinosaur ecological diversity remained high during the last 10 Myr of their existence. Clades show different disparity trends through the Cretaceous, but none except sauropods exhibits a long-term decline. Herbivorous dinosaurs show two disparity peaks characterized by different processes; in the Early Cretaceous by expansion in morphospace and in the Campanian by morphospace packing. These trends were only revealed by using a combination of disparity metrics, demonstrating how this approach can offer novel insights into macroevolutionary processes underlying patterns of disparity and ecological diversity.
There is increasing evidence of an association between depressive symptoms and mild cognitive impairment (MCI) in cross-sectional studies, but the longitudinal association between depressive symptoms and risk of MCI onset is less clear. The authors investigated whether baseline symptom severity of depression was predictive of time to onset of symptoms of MCI.
These analyses included 300 participants from the BIOCARD study, a cohort of individuals who were cognitively normal at baseline (mean age = 57.4 years) and followed for up to 20 years (mean follow-up = 2.5 years). Depression symptom severity was measured using the Hamilton Depression Scale (HAM-D). The authors assessed the association between dichotomous and continuous HAM-D and time to onset of MCI within 7 years versus after 7 years from baseline (reflecting the mean time from baseline to onset of clinical symptoms in the cohort) using Cox regression models adjusted for gender, age, and education.
At baseline, subjects had a mean HAM-D score of 2.2 (SD = 2.8). Higher baseline HAM-D scores were associated with an increased risk of progression from normal cognition to clinical symptom onset ≤ 7 years from baseline (p = 0.043), but not with progression > 7 years from baseline (p = 0.194). These findings remained significant after adjustment for baseline cognition.
These results suggest that low levels of depressive symptoms may be predictive of clinical symptom onset within approximately 7 years among cognitively normal individuals and may be useful in identifying persons at risk for MCI due to Alzheimer’s disease.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
How flexible is bilingual language control and how does it adapt to the linguistic context of a conversation? We address this by looking at the pattern of switch costs in contexts involving mostly the use of a dominant or non-dominant language. This linguistic context affected switching patterns: switching was equally costly for both languages in a dominant (L1) context, while switching was harder for the weaker language in the non-dominant (L2) context. Also, naming latencies for each language were affected by the linguistic contexts: only the dominant L1 context led to slower latencies for the dominant language. This latter finding was also present when looking at the LPC component, which may reveal differences in the way inhibitory control is applied depending on the linguistic context. These results reveal that the bilingual language control system is flexible and that it adapts to the linguistic context in which the speaker is placed.
There is no recorded maize (Zea mays spp. mays) from sites predating circa cal AD 800 in the northern Lake Michigan or Lake Superior basins of the western Great Lakes, despite the presence of maize microbotanicals including phytoliths and starches in Michigan, New York, and Quebec as early as 400 cal BC. To evaluate the potential for an earlier maize presence in the northern Lake Michigan basin, samples of carbonized food residues adhering to 16 ceramic vessels were obtained from the Winter site (20DE17) located on the Garden Peninsula in the northern Lake Michigan basin. Each sample was split and sent to two analysts. Both analysts identified low incidences of maize starch and phytoliths in multiple samples, with overlapping identifications on several. Three direct accelerator mass spectrometry dates on the carbonized residues reveal maize incorporated into the residues as early as the second century cal BC, 800 years before any regional macrobotanical evidence. Although the method of dispersal cannot be determined, these results support the proposition that initial northern dispersal of maize in the region may have been nearly 800 years earlier than macrobotanical evidence would suggest and is consistent with the timing of its introduction to the lower Great Lakes area.
The microstructure of snow and firn controls the transport of chemical species from the atmosphere into and out of the underlying firn. Permeability and thick-section microstructure measurements have been made from snow-pit and firn-core samples retrieved near the proposed deep-drilling site for the inland West Antarctic ice sheet. Measurements in past investigations of polar firn show that the permeability of the snow gradually increases with depth into the core to about 2 m, then decreases. In this core, there is a second maximum in permeability at approximately 12 m that is likely due to changes in meteorological conditions at the site. Either lower temperatures or higher accumulation rates in the most recent three to four decades could cause the changes in microstructure and permeability in this core. We suggest that climate shifts may alter gas records ultimately preserved in the ice because of the local climate’s effect on the permeability profile.
Persistent katabatic winds form widely distributed localized areas of near-zero net surface accumulation on the East Antarctic ice sheet (EAIS) plateau. These areas have been called 'glaze' surfaces due to their polished appearance. They are typically 2-200 km2 in area and are found on leeward slopes of ice-sheet undulations and megadunes. Adjacent, leeward high-accumulation regions (isolated dunes) are generally smaller and do not compensate for the local low in surface mass balance (SMB). We use a combination of satellite remote sensing and field-gathered datasets to map the extent of wind glaze in the EAIS above 1500 m elevation. Mapping criteria are derived from distinctive surface and subsurface characteristics of glaze areas resulting from many years of intense annual temperature cycling without significant burial. Our results show that 11.2 ± 1.7%, or 950 ± 143 × 103km2, of the EAIS above 1500 m is wind glaze. Studies of SMB interpolate values across glaze regions, leading to overestimates of net mass input. Using our derived wind-glaze extent, we estimate this excess in three recent models of Antarctic SMB at 46-82 Gt. The lowest-input model appears to best match the mean in regions of extensive wind glaze.
Introduction: Emergency physicians increasingly encounter young patients with protracted, forceful hyperemesis associated with heavy cannabis use, previously termed “cyclic vomiting.” The national discourse on liberalization of cannabis has largely ignored this poorly understood condition. We wondered to what degree hyperemesis cannabis is an idiosyncratic reaction, like motion sickness or migraine, versus a more predictable dose-response effect of heavy, prolonged use. Methods: As part of a larger case-control study using structured interviews, we measured cannabinoid concentrations in scalp hair of both cases and controls. Cases were required to have an emergency visit for vomiting, 2+ episodes of severe vomiting in the previous year, history of near-daily use of cannabis for 6+ months, positive urine Δ9-tetrahydrocannabinol (THC) and age 16-55 years; exclusion criteria were chronic opioid use, synthetic cannabinoid use, or established alternative diagnosis. Age- and sex-matched chronic cannabis-using controls without vomiting were identified via social referral primarily from the cases themselves. Scalp hair was analyzed for THC, cannabinol (CBN), cannabidiol (CBD) and 11-nor-9-carboxy-THC (THC-COOH) by LC-MS/MS (limit of quantification ~15 pg/mg hair; accuracy <5%) in an independent laboratory blinded to subject classification. Results: We obtained satisfactory hair and urine samples from 18 cases (median [IQR] age 27 [20,31] years; 12 male) and 13 controls. THC and CBN concentrations were higher in cases than controls (THC 240 [120,820] vs 99 [73, 290] pg/mg; CBN 63 [33, 260] vs 15 [negative, 76] pg/mg; each P<0.05). CBD and THC-COOH were often unquantifiable to undetectable in both cases and controls. Conclusion: Hyperemesis cannabis patients have substantially higher hair cannabinoid concentrations than their peers without vomiting, although there is some overlap. The association cannot demonstrate a direct dose-response with THC--confounding (e.g. other cannabinoids, external smoke deposition), altered metabolism and reverse causation (e.g. seeking temporary symptom relief by using more cannabis) could also yield a positive association. Nevertheless, these findings support counselling patients with hyperemesis to reduce or discontinue using cannabis. They also support national regulatory initiatives including education, labelling, and progressive taxation based on potency intended to discourage excessive use.
Background: Ross syndrome is diagnosed by the presence of segmental anhidrosis, areflexia, and tonic pupils. Fewer than 60 cases have been described in literature so far. There have been reports of presence of antibodies in such patients, suggesting an autoimmune pathogenesis. Methods: We describe the clinical profile in this case series of 11 patients with Ross syndrome and discuss the current status of autoimmunity in its pathogenesis and the management. Results: Of the 11 patients with Ross syndrome there was an almost equal sex distribution (male:female ratio was 1.17:1) and the mean age of onset of symptoms was 26 years. Patients took an average of 6 years to present to a tertiary center. Sixty-three percent of the patients presented with complaints of excessive sweating, whereas only 27% had complaints of decreased sweating over a particular area of the body. Only 45% of the patients had the complete triad of Ross syndrome, which included segmental anhidrosis, tonic pupil, and absent reflexes. Eighty-nine percent of the patients had documented absent sympathetic skin response on electromyography. The various markers of autoimmunity were negative in all patients who were investigated for the same in this series. Ninety percent of the patients were managed conservatively. Conclusions: These findings suggest that, in Ross syndrome, generalized injury to ganglion cells or their projections are not purely autoimmune-mediated.
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
Objectives: An increasing number of studies have presented evidence that various patient groups with acquired brain injury suffer from navigation problems in daily life. This skill is, however, scarcely addressed in current clinical neuropsychological practice and suitable diagnostic instruments are lacking. Real-world navigation tests are limited by geographical location and associated with practical constraints. It was, therefore, investigated whether virtual navigation might serve as a useful alternative. Methods: To investigate the convergent validity of virtual navigation testing, performance on the Virtual Tübingen test was compared to that on an analogous real-world navigation test in 68 chronic stroke patients. The same eight subtasks, addressing route and survey knowledge aspects, were assessed in both tests. In addition, navigation performance of stroke patients was compared to that of 44 healthy controls. Results: A correlation analysis showed moderate overlap (r=.535) between composite scores of overall real-world and virtual navigation performance in stroke patients. Route knowledge composite scores correlated somewhat stronger (r=.523) than survey knowledge composite scores (r=.442). When comparing group performances, patients obtained lower scores than controls on seven subtasks. Whereas the real-world test was found to be easier than its virtual counterpart, no significant interaction-effects were found between group and environment. Conclusions: Given moderate overlap of the total scores between the two navigation tests, we conclude that virtual testing of navigation ability is a valid alternative to navigation tests that rely on real-world route exposure. (JINS, 2016, 22, 467–477)
We describe in this work the BASS survey for brown dwarfs in young moving groups of the solar neighborhood, and summarize the results that it generated. These include the discovery of the 2MASS J01033563–5515561 (AB)b and 2MASS J02192210–3925225 B young companions near the deuterium-burning limit as well as 44 new low-mass stars and 69 new brown dwarfs with a spectroscopically confirmed low gravity. Among those, ~20 have estimated masses within the planetary regime, one is a new L4 γ bona fide member of AB Doradus, three are TW Hydrae candidates with later spectral types (L1–L4) than all of its previously known members and six are among the first contenders for low-gravity ≥ L5 β/γ brown dwarfs, reminiscent of WISEP J004701.06+680352.1, PSO J318.5338–22.8603 and VHS J125601.92–125723.9 b. Finally, we describe a future version of this survey, BASS-Ultracool, that will specifically target ≥ L5 candidate members of young moving groups. First experimentations in designing the survey have already led to the discovery of a new T dwarf bona fide member of AB Doradus, as well as the serendipitous discoveries of an L9 subdwarf and an L5 + T5 brown dwarf binary.
The need for higher energy density batteries has spawned recent renewed interest in alternatives to lithium ion batteries, including multivalent chemistries that theoretically can provide twice the volumetric capacity if two electrons can be transferred per intercalating ion. Initial investigations of these chemistries have been limited to date by the lack of understanding of the compatibility between intercalation electrode materials, electrolytes, and current collectors. This work describes the utilization of hybrid cells to evaluate multivalent cathodes, consisting of high surface area carbon anodes and multivalent nonaqueous electrolytes that are compatible with oxide intercalation electrodes. In particular, electrolyte and current collector compatibility was investigated, and it was found that the carbon and active material play an important role in determining the compatibility of PF6-based multivalent electrolytes with carbon-based current collectors. Through the exploration of electrolytes that are compatible with the cathode, new cell chemistries and configurations can be developed, including a magnesium-ion battery with two intercalation host electrodes, which may expand the known Mg-based systems beyond the present state of the art sulfide-based cathodes with organohalide-magnesium based electrolytes.