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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.
The phase and elemental distributions on zirconium alloys containing 5, 10, 25, 35, and 50 at.%. yttrium, oxidized in dry air at 1200 and 1600°C, have been studied by X-ray diffraction, fluorescence, and electron-microprobe techniques. Zirconium-yttrium alloys, which are entirely solid at 1200°C, and zirconium 5 and 25 at.% yttrium alloys, which aire two-phase solid plus liquid at 1600°C, form a multiphase scale of ZrO2, Y2O3, and ZrN. The phase distribution varies with yttrium content, while the average metal composition remains constant throughout the oxide scale and base metal. In contrast, zirconium 35 and 50 at.% yttrium alloys, which are entirely liquid at 1600°C, form a single-phase Y2O3 layer.
The mechanism of air oxidation of solid zirconium-yttrium alloys, up to 50 at. % yttrium, is one of anion diffusion to the oxide-metal interface with little or no diffusion of the metallic elements. The oxidation of liquid alloys differs in that, as a result of yttrium diffusion to the oxide-liquid interface, Y2O3 is the only oxide formed. Ternary Zr-Y-O isotherms are presented to illustrate the phase distribution and mode of formation.
The Rockefeller Clinical Scholars (KL2) program began in 1976 and transitioned into a 3-year Master’s degree program in 2006 when Rockefeller joined the National Institute of Health Clinical and Translational Science Award program. The program consists of ∼15 trainees supported by the Clinical and Translational Science Award KL2 award and University funds. It is designed to provide an optimal environment for junior translational investigators to develop team science and leadership skills by designing and performing a human subjects protocol under the supervision of a distinguished senior investigator mentor and a team of content expert educators. This is complemented by a tutorial focused on important translational skills.
Since 2006, 40 Clinical Scholars have graduated from the programs and gone on to careers in academia (72%), government service (5%), industry (15%), and private medical practice (3%); 2 (5%) remain in training programs; 39/40 remain in translational research careers with 23 National Institute of Health awards totaling $23 million, foundation and philanthropic support of $20.3 million, and foreign government and foundation support of $6 million. They have made wide ranging scientific discoveries and have endeavored to translate those discoveries into improved human health.
The Rockefeller Clinical Scholars (KL2) program provides one model for translational science training.
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.
Antarctic and Southern Ocean science is vital to understanding natural variability, the processes that govern global change and the role of humans in the Earth and climate system. The potential for new knowledge to be gained from future Antarctic science is substantial. Therefore, the international Antarctic community came together to ‘scan the horizon’ to identify the highest priority scientific questions that researchers should aspire to answer in the next two decades and beyond. Wide consultation was a fundamental principle for the development of a collective, international view of the most important future directions in Antarctic science. From the many possibilities, the horizon scan identified 80 key scientific questions through structured debate, discussion, revision and voting. Questions were clustered into seven topics: i) Antarctic atmosphere and global connections, ii) Southern Ocean and sea ice in a warming world, iii) ice sheet and sea level, iv) the dynamic Earth, v) life on the precipice, vi) near-Earth space and beyond, and vii) human presence in Antarctica. Answering the questions identified by the horizon scan will require innovative experimental designs, novel applications of technology, invention of next-generation field and laboratory approaches, and expanded observing systems and networks. Unbiased, non-contaminating procedures will be required to retrieve the requisite air, biota, sediment, rock, ice and water samples. Sustained year-round access to Antarctica and the Southern Ocean will be essential to increase winter-time measurements. Improved models are needed that represent Antarctica and the Southern Ocean in the Earth System, and provide predictions at spatial and temporal resolutions useful for decision making. A co-ordinated portfolio of cross-disciplinary science, based on new models of international collaboration, will be essential as no scientist, programme or nation can realize these aspirations alone.
Among 1,036 patients, residential proximity within 1 mile of large swine facilities was associated with nearly double the risk of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission (relative risk, 1.8786 [95% confidence interval, 1.0928-3.2289]; P = .0239) and, after controlling for multiple admissions and age, was associated with 1.2nearly triple the odds of MRSA colonization (odds ratio, 2.76 [95% confidence interval, 1.2728-5.9875]; P = .0101).
The effects of vascular rarefaction (the loss of small arteries) on the circulation of blood are studied using a multiscale mathematical model that can predict blood flow and pressure in the systemic and pulmonary arteries. We augmented a model originally developed for the systemic arteries by Olufsen and coworkers and Ottesen et al. (2004) to (a) predict flow and pressure in the pulmonary arteries, and (b) predict pressure propagation along the small arteries in the vascular beds. The systemic and pulmonary arteries are modelled as separate bifurcating trees of compliant and tapering vessels. Each tree is divided into two parts representing the ‘large’ and ‘small’ arteries. Blood flow and pressure in the large arteries are predicted using a nonlinear cross-sectional-area-averaged model for a Newtonian fluid in an elastic tube with inflow obtained from magnetic resonance measurements. Each terminal vessel within the network of the large arteries is coupled to a vascular bed of small ‘resistance’ arteries, which are modelled as asymmetric structured trees with specified area and asymmetry ratios between the parent and daughter arteries. For the systemic circulation, each structured tree represents a specific vascular bed corresponding to major organs and limbs. For the pulmonary circulation, there are four vascular beds supplied by the interlobar arteries. This paper presents the first theoretical calculations of the propagation of the pressure and flow waves along systemic and pulmonary large and small arteries. Results for all networks are in agreement with published observations. Two studies were done with this model. First, we showed how rarefaction can be modelled by pruning the tree of arteries in the microvascular system. This was done by modulating parameters used for designing the structured trees. Results showed that rarefaction leads to increased mean and decreased pulse pressure in the large arteries. Second, we investigated the impact of decreasing vessel compliance in both large and small arteries. Results showed that the effects of decreased compliance in the large arteries far outweigh the effects observed when decreasing the compliance of the small arteries. We further showed that a decrease of compliance in the large arteries results in pressure increases consistent with observations of isolated systolic hypertension, as occurs in ageing.
Light element complex hydrides (e.g. NaBH4) together with metal hydrides (e.g. MgH2) are considered two primary classes of solid state hydrogen storage materials. In spite of drawbacks such as unfavourable thermodynamics and poor kinetics, enhancements may occur in reactive hydride composites by nanostructuring of reactant phases and formation of more stable product phases (e.g. MgB2) which lower overall reaction enthalpy and allow reversibility. One potential system is based on mixing NaBH4 and MgH2 and subsequent ball milling, which in a 2:1 molar ratio can store considerable amounts of hydrogen by weight (up to 7.8 wt%). A study of the 2NaBX4 + MgX2 → MgB2 + 2NaX + 4X2 (X=D,H) reaction is assessed by means of in-situ neutron diffraction with different combinations of hydrogen and deuterium on the X position. The desorption is established to begin at temperatures as low as 250 °C, starting with decomposition of nanostructured MgX2 due to joint effects of nanostructured MgX2 and its reducing effect at NaBX4. Analyses of background profile, due to the high incoherent neutron scattering of hydrogen, as a function of temperature demonstrate direct correlation of H/D desorption reactions with relative phases amount.
Using high-precision X-ray dilatometry, we have succeeded in directly measuring excess quenched-in free-volume Vf in metallic glasses. The method was applied to the very easy glass forming Zr57Nb5Cu15.4Ni12.6Al10 (Vit 106). The annealing out of the order of 0.5% free volume was observed during heat treatment of rapidly solidified glassy ribbons. Excess free volume was also generated by heavy deformation and observed to anneal out during heat treatment. Once the excess free volume anneals out, the glass transition Tg appears clearly as a break in the x-ray dilatation curves as the glass goes over to the supercooled liquid region prior to crystallization at Tx.
The structural evolution of the Ti40Zr10Cu34Pd14Sn2 bulk metallic glass (BMG) upon was investigated by means of in situ high-energy x-ray diffraction. The position, width, and intensity of the first peak in diffraction patterns are fitted through Voigt function below 800 K. All the peak position, width, and intensity values show a nearly linear increase with the increasing temperature to the onset temperature of structural relaxation, Tr = 510 K. However, these values start to deviate from the linear behavior between Tr and Tg (the glass transition temperature). The changes in free volume and the coefficient of volume thermal expansion prove that the aforementioned phenomenon is closely related to the structural relaxation releasing excess free volume arrested during rapid quenching of the BMG. Above 800 K, three crystallization events are detected and the first exothermic event is due to the formation of metastable nanocrystals.
Between 1966 and 1991, melioidosis, a disease caused by Pseudomonas pseudomallei that is mostly confined to tropical regions, occurred in farm animals and a farmer in temperate south-west Western Australia. Using an Escherichia coli probe containing a ribosomal RNA operon, P. pseudomallei DNA from isolates from 8 animals, a soil sample and the human case showed an identical ribotype on Southern blotting. The ribotype was different from the 3 commonest ribotypes seen in tropical Australia. This molecular typing supports the theory of clonal introduction of P. pseudomallei into a non-endemic region, with environmental contamination, local dissemination and persistence over 25 years. As melioidosis is often fatal in humans, such persistence in a temperate region is cause for concern.
Two children aged three and seven years presented to the department of Otolaryngology with total dysphagia following the accidental swallowing of a steel ball bearing and a plastic ball. These rare spherical foreign bodies were removed successfully by oesophagoscopy under general anaesthesia using an innovative method involving a balloon angiographic catheter.
Idiopathic Parkinson's disease (IPD), a progressive neurodegenerative disorder, is a common
cause of disability. No current therapies modify disease progression. The pathological hallmarks are
the presence of Lewy bodies and massive loss of dopaminergic neurons in the pars compacta of the
substantia nigra. Two genes (SNCA and parkin) as well as two gene loci have now been implicated
in the pathogenesis of familial PD. These represent significant progress in our understanding of the
disease, considering the rarity of large families, low heritability in the general population and genetic
heterogeneity. Mutations in a further gene, UCHL1, have been described in familial PD although the
evidence for its role in PD is less clear. Knowledge of the genes described in PD to date should help
to define molecular mechanisms of neurodegeneration in PD, as well as in other diseases where
defects in protein handling may be a common feature. Nigral degeneration with Lewy body
formation and the resulting clinical picture of PD may represent a final common pathway of a
multifactorial disease process in which both environmental and genetic factors have a role. This
review discusses the major advances in the field to date and illustrates how the existence of genetic
factors has now become firmly established.
What was burned in lamps in the prehistoric Mediterranean? Olive oil, as one would first suppose? Analysis of absorbed lipids preserved in the fabric of lamps and conical cups from the Minoan site of Mochlos in eastern Crete shows for the first time that beeswax was used as an illuminant.