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Older adults with dementia are particularly vulnerable to adverse outcomes resulting from anticholinergic use. We aimed to: (i) Examine the anticholinergic burden of patients with dementia attending a Psychiatry of Later Life (PLL) service (ii) Examine concomitant prescription of acetylcholinesterase inhibitors (AChEIs) and anticholinergics and (iii) Compare the Anticholinergic Cognitive Burden (ACB) scale with a recently published composite list of anticholinergics.
Retrospective chart review of new referrals with a diagnosis of dementia (n = 66) seen by the PLL service, Tallaght University Hospital, Dublin, Ireland, over a consecutive period of 4 months.
The mean ACB score was 2.2 (range = 0–9, SD = 2.1). 37.9% (n = 25) had a clinically significant ACB score (>3) and 42.1% (n = 8) of those taking AChEIs had a clinically significant ACB score. A significantly greater number of medications with anticholinergic activity were identified using the composite list versus the traditional ACB scale (2.3 v.1.5, p = 0.001).
We demonstrated a significant anticholinergic burden amongst patients with dementia attending a specialist PLL service. There was no difference in anticholinergic burden between groups prescribed and not prescribed AChEIs, indicating that these medications are being prescribed without discontinuation of potentially inappropriate medications with anticholinergic activity. The true anticholinergic burden experienced by patients may be underestimated by the use of the ACB score alone, although the clinical significance of this finding is unclear. Calculation of true clinical anticholinergic burden load and its translation to a specific rating scale remains a challenge.
Two high-temperature X-ray diffraction cameras are described which have been employed at Battelle to determine thermal expansion of metals and ceramic materials. Specimen preparation and temperature measurement and control are described. Lattice-parameter data vs. temperature are presented for uranium, uranium dioxide, and magnesium oxide.
Dietary fatty acid (FA) composition may influence metabolism, possibly affecting weight management. The purpose of this study was to compare the effects of a 5-d diet rich in PUFA v. MUFA. A total of fifteen normal-weight men participated in a randomised cross-over design with two feeding trials (3 d lead-in diet, pre-diet visit, 5-d PUFA- or MUFA-rich diet, post-diet visit). The 5-d diets (50 % fat) were rich in either PUFA (25 % of energy) or MUFA (25 % of energy). At pre- and post-diet visits, subjects consumed breakfast and lunch test meals, rich in the FA for that 5-d diet. Indirect calorimetry was used for 4 h after each meal. There were no treatment differences in fasting metabolism acutely or after the 5-d diet. For acute meal responses before diet, RER was higher for PUFA v. MUFA (0·86 (sem 0·01) v. 0·84 (sem 0·01), P<0·05), whereas diet-induced thermogenesis (DIT) was lower for PUFA v. MUFA (18·91 (SEM 1·46) v. 21·46 (SEM 1·34) kJ, P<0·05). After the 5-d diets, the change in RER was different for PUFA v. MUFA (−0·02 (sem 0·01) v. 0·00 (sem 0·01), P<0·05). Similarly, the change in fat oxidation was greater for PUFA v. MUFA (0·18 (sem 0·07) v. 0·04 (sem 0·06) g, P<0·05). In conclusion, acutely, a MUFA-rich meal results in lower RER and greater DIT. However, after a 5-d high-fat diet, the change in metabolic responses was greater in the PUFA diet, showing the metabolic adaptability of a PUFA-rich diet.
A narrow bridge of floating ice that connected the Wilkins Ice Shelf, Antarctica, to two confining islands eventually collapsed in early April 2009. In the month preceding the collapse, we observed deformation of the ice bridge by means of satellite imagery and from an in situ GPS station. TerraSAR-X images (acquired in stripmap mode) were used to compile a time series. The ice bridge bent most strongly in its narrowest part (westerly), while the northern end (near Charcot Island) shifted in a northeasterly direction. In the south, the ice bridge experienced compressive strain parallel to its long axis. GPS position data were acquired a little south of the narrowest part of the ice bridge from 19 January 2009. Analysis of these data showed both cyclic and monotonic components of motion. Meteorological data and re-analysis of the output of weather-prediction models indicated that easterly winds were responsible for the cyclic motion component. In particular, wind stress on the rough ice melange that occupied the area to the east exerted significant pressure on the ice bridge. The collapse of the ice bridge began with crack formation in the southern section parallel to the long axis of the ice bridge and led to shattering of the southern part. Ultimately, the narrowest part, only 900 m wide, ruptured. The formation of many small icebergs released energy of >125 ×106 J.
This paper presents an overview of internal layering across Pine Island Glacier, West Antarctica, as measured from airborne-radar data acquired during a survey conducted by the British Antarctic Survey and the University of Texas in the 2004/05 season. Internal layering is classified according to type (continuous/discontinuous/missing) and the results compared with InSAR velocities. Several areas exhibit disruption of internal layers that is most likely caused by large basal shear stresses. Signs of changes in flow were identified in a few inter-tributary areas, but overall the layering classification and distribution of layers indicate that only minor changes in ice-flow regime have taken place. This is supported by bed-topography data that show the main trunk of the glacier, as well as some of the tributaries, are topographically controlled and located in deep basins.
The acoustic impedance of the subglacial material beneath 7.2 km profiles on four ice streams in Antarctica has been measured using a seismic technique. The ice streams span a wide range of dynamic conditions with flow rates of 35–464 m a–1. The acoustic impedance indicates that poorly lithified or dilated sedimentary material is ubiquitous beneath these ice streams. Meanacoustic impedance across each profile correlates well with basal shear stress and the slipperiness of the bed, indicating that acoustic impedance is a good diagnostic not only for the porosity of the subglacial material, but also for its dynamic state (deforming or non-deforming). Beneath two of the ice streams, lodged (non-deforming) and dilated (deforming) sediment coexist but their distribution is not obviously controlled by basal topography or ice thickness. Their distribution may be controlled by complex material properties or the deformation history. Beneath Rutford Ice Stream, lodged and dilated sediment coexist and are distributed in broad bands several kilometres wide, whileon Talutis Inlet there is considerable variability over much shorter distances; this may reflect differences in the mechanism of drainage beneath the ice streams. The material beneath the slow-moving Carlson Inlet is probably lodged but unlithified sediment; this is consistent with the hypothesis that Carlson Inlet was once a fast-flowing ice stream but is now in a stagnant phase, which could possibly be revivedby raised basal water content. The entire bed beneath fast-flowing Evans Ice Stream is dilated sediment.
The basic theory of crevasse formation suggests that crevasses initiate at or near the surface. However, due to variations in stress with depth, it has been suggested that it is possible for crevasses to initiate at depths of 10–30m. From December 2006 to January 2007, hot-water drilling on Pine Island Glacier, West Antarctica, was found to trigger crevasses. Satellite imagery and field investigations in 2008, including ice cores, radar and GPS, revealed that these formed a new band of arcuate (curvilinear) crevasses around 70 km long and 100 m deep. This new band is located 10 km upstream from the previous limit of the arcuate crevasse zone. The crevasses were triggered on drilling through an exceptional ice layer at >20m depth. Ice layers within the firn will change both the strength and stress intensity. As the firn changes spatially and temporally (e.g. with the burial of an ice layer), it is possible for the position of crevasse initiation to change whilst the along-stream strain-rate profile remains constant. However, the main cause of an upstream migration of the arcuate crevasse zone on Pine Island Glacier is still likely to be an increase in strain rate.
Airborne radio-echo sounding investigations in the upper reaches of Bailey Ice Stream and Slessor Glacier, Coats Land, East Antarctica, have shown that enhanced-flow tributaries are associated with well-defined areas of relatively thicker ice, and are separated from each other by areas of relatively thinner ice. A numerical modelling study has revealed that while internal ice deformation might account for all the observed flow in inter-tributary areas and the majority in the Slessor tributaries, a significant proportion of the flow of Bailey tributary is attributable to basal motion. Further, investigations of depth-corrected basal reflection power indicate that the bed underlying both Bailey and Slessor enhanced-flow tributaries is significantly smoother than in the slower-moving inter-tributary areas. It is thus proposed that enhanced motion within Bailey tributary (and also perhaps Slessor) may be facilitated by a reduction in basal roughness, caused by the accumulation of water and/or sediments within subglacial valleys, or by the erosion and smoothing of bed obstacles.
Rutford Ice Stream and Carlson Inlet are neighbouring glaciers in West Antarctica. Rutford Ice Stream flows at speeds greater than 350 m a−1, whereas Carlson Inlet, which has some similar dimensions and supports a similar driving stress, flows 10–50 times slower. We discuss a range of observations concerning Carlson Inlet, and conclude that there is good indirect evidence that it is a relict ice stream, which ceased streaming more than 240 years BP, but sufficiently recently that its surface morphology, basal water content and basal morphology still retain characteristics produced by streaming. An analysis of expected subglacial drainage pathways indicates that Carlson Inlet is not streaming because it is currently starved of subglacial water, which is currently directed beneath Rutford Ice Stream. This current state of water piracy by Rutford Ice Stream is, however, sensitive to minor thickness changes on the ice streams; a ∼120 m (<4%) thickening of Rutford Ice Stream would divert almost all the subglacial water in the system towards Carlson Inlet and could reactivate its flow. The result highlights the importance of subglacial drainage in controlling ice-stream evolution and the requirement for ice-sheet models to couple ice flow with subglacial drainage.
We present newly acquired airborne radar data showing ice thickness and surface elevation for Pine Island Glacier, Antarctica. These data, when combined with earlier measurements, suggest the presence of a lightly grounded area immediately above the grounding line of Pine Island Glacier. We identify this region as an “ice plain”. It lies close to the centre line of the glacier, has an elevation above buoyancy of <50 m and extends inland for >28 km. The upstream edge of the ice plain is defined by a “coupling line”. The configuration of the ice plain implies that nearby thinning of the ice stream would result in substantial grounding-line retreat. We suggest that the grounding-line retreat of Pine Island Glacier, observed between 1992 and 1996, probably commenced sometime after 1981.
The potential for future dynamical instability of Pine Island Glacier, West Antarctica, has been addressed in a number of studies, but information on its past remains limited. In this study we use airborne radio-echo sounding (RES) data acquired over Pine Island Glacier to investigate past variations in accumulation pattern. In the dataset a distinctive pattern of layers was identified in the central part of the glacier basin. We use these layers as chronological identifiers in order to construct elevation maps of the internal stratigraphy. The observed internal layer stratigraphy is then compared to calculated stratigraphy from a three-dimensional ice-flow model that has been forced with different accumulation scenarios. The model results indicate that the accumulation pattern is likely to have changed at least twice since the deposition of the deepest identified layer. Additional RES data linked to the Byrd ice core provide an approximate timescale. This timescale suggests that the layers were deposited at the beginning of or during the Holocene period. Thus the widespread changes occurring in the coastal extent of the West Antarctic ice sheet at the end of the last glacial period could have been accompanied by changes in accumulation pattern.
Initially termed “dementia praecox,” schizophrenia was first described by the German psychiatrist Emil Kraepelin in the late 19th century. Kraepelin distinguished dementia praecox from manic depressive illness, primarily a mood disorder, on the basis of differences in course and outcome: schizophrenia was observed to have a chronic and deteriorating course with a poor outcome, while manic depression was seen to have a cyclic “relapsing-remitting” course, with a more favourable long-term outcome. The name schizophrenia (literally “split mind”) was coined in the early 20th century by the Swiss psychiatrist Eugen Bleuler, and much later manic depression was renamed bipolar disorder. However, problems in the distinctions between these two conditions were soon identified and noted by Kraepelin himself in his later writings. Considerable overlap was seen in clinical features, course, and outcome. The more recent diagnostic category of schizoaffective disorder may be seen to encompass composite forms of mood and schizophrenic disorders. Schizophrenia is now more commonly regarded as a clinical syndrome rather than a single disease entity; there is significant heterogeneity in clinical expression, and considerable overlap of both clinical and biological features with other psychiatric conditions. Scientific efforts are yet to delineate the causes and pathophysiology of schizophrenia, although some significant advances in understanding the neurobiology and treatment mechanisms have been made in the past 50 years.
A strong genetic basis for schizophrenia is indicated by family and molecular genetic studies. However, a clear role for environmental influences in the development of schizophrenia is also well established. Current molecular genetic studies of schizophrenia encompassing worldwide consortia have been able to account for an increasing but minor fraction of risk for schizophrenia in common genetic loci. Rare genetic variations, such as copy number deletions and duplications, are also emerging as important risk indicators. High overlap in the heritability of bipolar and schizoaffective disorder within families has also been shown in large-scale epidemiological research.
In terms of impact and incidence, schizophrenia ranks among the top 10 causes of disability in developed countries and incidence is estimated at 15.2/100 000, with current prevalence estimated at 4.6/1000 (McGrath et al., 2008).
Level-line surveys at a number of sites on the Antarctic Peninsula since the early 1970s have shown a lowering of the ice surface elevation in areas where the climate is warm enough for melting to occur during summer. Results are presented here from annual surveys on the ice ramp at Rothcra Point. Over an 8 year period, a large proportion of the ramp shows a generally steady reduction in surface elevation. The uppermost part of the ramp shows no clear trend. The ice ramp has suffered a mean rate ofsurfaee lowering of 0.32 ma−1 w.e. over the period of the surveys, which is similar to that seen at other sites on the Antarctic Peninsula. Measured ice velocities on the ramp are low, so the surface lowering can be attributed directly to changes in surface mass balance. The Surveys coincide with a period of long-term increase in temperature and ablation seen in meteorological records. Comparison of the observed surface lowering with temperature data shows a good agreement, and we conclude that increasing air temperatures in the region will raise ablation and increase the recession rate of the ice ramp.
Objectives: The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Methods: Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Results: Latent class analysis categorized participants into “high” (44%) and “low” (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Conclusions: Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038–1049)
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
Lithium is a mood stabilizer rarely associated with drug-induced parkinsonism (DIP). We present a case of an elderly woman with bipolar disorder who developed parkinsonian symptoms after chronic lithium administration despite therapeutic serum levels. Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. Initially, she was diagnosed with Parkinson's disease (PD); however, DaTscan SPECT imaging clarified the diagnosis as DIP. As the daily lithium dosage was reduced, the patient's motor symptoms improved. This report emphasizes close monitoring of lithium levels in geriatric populations and the need to consider lithium-induced parkinsonism when PD symptoms appear in chronic lithium users.
A comprehensive theory which can reduce massive amounts of detailed evidence to simple and pleasing clarity has the ability to survive long after critics have damaged or destroyed essential portions of its arguments or evidence. A radically new comprehensive thesis may arise to displace it, but even then quibbles with details of the new continue to breathe life into the old. Such is at least partially the case with study of the prophets' episode in the twelfth-century Anglo-Norman Adam (Ordo representacionis Ade). Perhaps the single most edited piece of twelfth-century literature, the play has an established importance: linguistically, dramatically, theatrically, and theologically, it deserves the close attention it has been given. And not only is it important, it is also an enjoyable and imaginative work that delights the reader as much as it fascinates the scholar. However, it is a victim of being assigned a fundamental role in a comprehensive theory regarding the development of medieval vernacular drama.