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Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort.
Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis.
Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD.
MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.
The Emergency Medicine (EM) Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) specifies that resuscitation entrustable professional activities (EPAs) can be assessed in the workplace and simulated environments. However, limited validity evidence for these assessments in either setting exists. We sought to determine if EPA ratings improve over time and whether an association exists between ratings in the workplace v. simulation environment.
All Foundations EPA1 (F1) assessments were collected for first-year residents (n = 9) in our program during the 2018–2019 academic year. This EPA focuses on initiating and assisting in the resuscitation of critically ill patients. EPA ratings obtained in the workplace and simulation environments were compared using Lin's concordance correlation coefficient (CCC). To determine whether ratings in the two environments differed as residents progressed through training, a within-subjects analysis of variance was conducted with training environment and month as independent variables.
We collected 104 workplace and 36 simulation assessments. No correlation was observed between mean EPA ratings in the two environments (CCC(8) = -0.01; p = 0.93). Ratings in both settings improved significantly over time (F(2,16) = 18.8; p < 0.001; η2 = 0.70), from 2.9 ± 1.2 in months 1–4 to 3.5 ± 0.2 in months 9–12. Workplace ratings (3.4 ± 0.1) were consistently higher than simulation ratings (2.9 ± 0.2) (F(2,16) = 7.2; p = 0.028; η2 = 0.47).
No correlation was observed between EPA F1 ratings in the workplace v. simulation environments. Further studies are needed to clarify the conflicting results of our study with others and build an evidence base for the validity of EPA assessments in simulated and workplace environments.
We agree that the emergence of cumulative technological culture was tied to nonsocial cognitive skills, namely, technical-reasoning skills, which allowed humans to constantly acquire and improve information. Our concern is with a reading of the history of cumulative technological culture that is based largely on modern experiments in simulated settings and less on phenomena crucial to the long-term dynamics of cultural evolution.
Recent work has demonstrated that Goshen points overlap in time with another group of unfluted lanceolate points from the Plains, Plainview points. This has raised the question of whether the two types should be kept separate or consolidated into a single type. We sought to resolve this issue by applying geometric morphometric methods to a sample of points from well-documented Goshen and Plainview assemblages. We found that their shapes were statistically indistinguishable, which indicates that Goshen and Plainview points should be assigned to the same type. Because Plainview points were recognized before Goshen points, it is the latter type name that should be dropped. Sinking Goshen into Plainview allows us to move beyond taxonomic issues and toward understanding both the spatiotemporal variation that exists among Plainview assemblages and what it can tell us about the adaptations and social dynamics of Plainview groups.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
It has long been assumed that Folsom points are more standardized than Clovis points, although an adequate test of this proposition has yet to be undertaken. Here, we address that deficiency by using data from a sample of Folsom and Clovis points recovered from sites across the western United States. We used geometric morphometric techniques to capture point shape and then conducted statistical analyses of variability associated with Clovis and Folsom point bases and blades. Our results demonstrate that Folsom bases and blades are less variable than those on earlier Clovis points, indicating an increase in point standardization during the Early Paleoindian period. In addition, despite published claims to the contrary, Clovis and Folsom point bases are no more variable than blades. Based on these results, we conducted additional analyses to examine the modularity and size of Clovis and Folsom points. The results suggest Clovis points have more integrated base and blade segments than Folsom points. We suggest that several classes of Clovis points—intended for different functions—might have been in use during the Clovis period and that the later Folsom points might have served only as weapon tips, the shape of which were constrained by the fluting process.
We compared sepsis “time zero” and Centers for Medicare and Medicaid Services (CMS) SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 of 80 (36%) cases. Perceived pass rates ranged from 9 of 80 cases (11%) to 19 of 80 cases (23%). Variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
The insurance hypothesis is a reasonable explanation for the current obesity epidemic. One alternative explanation is that the marketing of high-sugar foods, especially sugar-sweetened beverages, drives the rise in obesity. Another prominent hypothesis is that obesity spreads through social influence. We offer a framework for estimating the extent to which these different models explain the rise in obesity.
Imaging biomarkers for Alzheimer's disease include medial temporal lobe
atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance
imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose
positron emission tomography (FDG-PET).
To investigate whether MTLA on head CT predicts the diagnostic usefulness
of an additional FDG-PET scan.
Participants had a clinical diagnosis of Alzheimer's disease
(n = 37) or dementia with Lewy bodies (DLB;
n = 30) or were similarly aged controls
(n = 30). We visually rated MTLA on coronally
reconstructed CT scans and, separately and blind to CT ratings, abnormal
appearances on FDG-PET scans.
Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0–8) scale, 0/30
controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET
performed well for diagnosing Alzheimer's disease v. DLB
in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the
high-MTLA group diagnostic performance of FDG-PET was not better than
In the presence of a high degree of MTLA, the most likely diagnosis is
Alzheimer's disease, and an FDG-PET scan will probably not provide
significant diagnostic information. However, in cases without MTLA, if
the diagnosis is unclear, an FDG-PET scan may provide additional
clinically useful diagnostic information.
Ronald Mason’s hypothesis from the 1960s that the southeastern United States possesses greater Paleoindian projectile-point diversity than other regions is regularly cited, and often assumed to be true, but in fact has never been quantitatively tested. Even if valid, however, the evolutionary meaning of this diversity is contested. Point diversity is often linked to Clovis “origins,” but point diversity could also arise from group fissioning and drift, admixture, adaptation, or multiple founding events, among other possibilities. Before archaeologists can even begin to discuss these scenarios, it is paramount to ensure that what we think we know is representative of reality. To this end, we tested Mason’s hypothesis for the first time, using a sample of 1,056 Paleoindian points from eastern North America arui employing paradigmatic classification and rigorous statistical tools used in the quantification of ecological biodiversity. Our first set of analyses, which compared the Southeast to the Northeast, showed that the Southeast did indeed possess significantly greater point-class richness. Although this result was consistent with Mason’s hypothesis, our second set of analyses, which compared the Upper Southeast to the Lower Southeast and the Northeast showed that in terms of point-class richness the Upper Southeast > Lower Southeast > Northeast. Given current chronometrie evidence, we suggest that this latter result is consistent with the suggestion that the area of the Ohio, Cumberland, and Tennessee River valleys, as well as the mid-Atlantic coastal plain, were possible initial and secondary “staging areas” for colonizing Paleoindian foragers moving from western to eastern North America.
Sustainability, culture change, inequality and global health are among the much-discussed challenges of our time, and rightly so, given the drastic effects such variables can have on modern populations. Yet with many populations today living in tightly connected geographic communities—cities, for example—or in highly networked electronic communities, can we still learn anything about societal challenges by studying simple farming communities from many thousands of years ago? We think there is much to learn, be it Malthusian pressures and ancient societal collapse, the devastating effects of European diseases on indigenous New World populations or endemic violence in pre-state societies (e.g. Pinker 2012). By affording a simpler, ‘slow motion’ view of processes that are greatly accelerated in this century, the detailed, long-term record of the European Neolithic can offer insight into many of these fundamental issues. These include: human adaptations to environmental change (Palmer & Smith 2014), agro-pastoral innovation, human population dynamics, biological and cultural development, hereditary inequality, specialised occupations and private ownership.
Northeastern North America has produced an incredible number of late Pleistocene faunal remains; however, many of these were discovered and excavated prior to the development of radiocarbon dating. Moreover, many of the 14C dates that do exist for such specimens were assayed prior to the development of purified collagen extraction methods, were performed on botanical remains of unspecified association with the faunal remains, or were accepted without concerns of young-carbon contamination from museum preservatives. Here, we present a set of high-precision accelerator mass spectrometry (AMS) dates obtained on Pleistocene faunal specimens from Connecticut, New Jersey, and Pennsylvania. Our data contain both newly discovered specimens and specimens that have resided in museum collections for over a century.
Wilson and colleagues are correct that a modern theory of evolution must go beyond reliance on natural selection. Niche-construction theory, although it does not ignore selection, emphasizes the capacity of organisms to modify environmental states, often in a manner that suits their genotypes. Such matches are the dynamic products of a two-way process that involves organisms both responding to “problems” posed by their environments through selection and setting themselves new problems by changing environments through niche construction.