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The existence of a frontotemporal dementia phenocopy (phFTD) syndrome remains controversial. Opinions differ on whether the phenocopy presentation represents the neuropsychological manifestation of a mid-life decompensation in vulnerable pre-morbid personalities or an indolent prodrome of behavioral-variant FTD (bvFTD). Literature on this topic is sparse and clinicians and patients have little guidance around prognosis and management.
To describe the demographic, neuropsychological and biomarker profiles of a case series of phFTD patients, attending the memory clinic and review relevant literature.
Retrospective review of all cases diagnosed with phFTD.
Eleven cases were identified (male = 9, female = 2). Mean age 55.8 years. Subjective complaints comprised memory and language difficulties. Collateral reports described apathy, aggression, impulsivity, disinhibition, hyperorality. Function was relatively preserved though motivation or supervision for higher-level tasks was sometimes required. All had non-neurodegenerative MRI and PET scans. Neuropsychological test (NPT) findings predominantly showed executive dysfunction and fluency impairment. A total of 3/11 had non-amnestic memory impairment. Follow-up imaging and NPT were invariably unchanged; 1/11 had a pre-morbid psychiatric diagnosis; 5/11 had unusual personality traits pre-morbidly. Major psychosocial stressors were documented in 7/11. Management consisted of psychosocial interventions to support function and interpersonal relationships.
The literature describes the phFTD syndrome as predominantly affecting males though we include 2 females who meet the criteria. In keeping with our findings, personality traits and psychosocial stressors may be more common in phFTD than bvFTD. More severe symptoms, memory impairment at presentation and C9ORF72 gene mutation may predict eventual progression. Those who do not progress have minimal long-term functional impairment though behavioral symptoms persist.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
Computerised cognitive-behavioural therapy (CCBT) helps improve mental health outcomes in White populations. However, no studies have examined whether CCBT is acceptable and beneficial for African Americans.
We studied differences in CCBT use and self-reported change in depression and anxiety symptoms among 91 African Americans and 499 White primary care patients aged 18–75, enrolled in a randomised clinical trial of collaborative care embedded with an online treatment for depression and anxiety.
Patients with moderate levels of mood and/or anxiety symptoms (PHQ-9 or GAD-7≥10) were randomised to receive either care-manager-guided access to the proven-effective Beating the Blues® CCBT programme or usual care from their primary care doctor.
Compared with White participants, African Americans were less likely to start the CCBT programme (P=0.01), and those who did completed fewer sessions and were less likely to complete the full programme (P=0.03). Despite lower engagement, however, African Americans who started the CCBT programme experienced a greater decrease in self-reported depressive symptoms (estimated 8-session change: −6.6 v. −5.5; P=0.06) and similar decrease in anxiety symptoms (−5.3 v. −5.6; P=0.80) compared with White participants.
CCBT may be an efficient and scalable first-step to improving minority mental health and reducing disparities in access to evidence-based healthcare.
Hemihedrite from the Florence Lead-Silver mine in Pinal County, Arizona, USA
was first described and assigned the ideal chemical formula
based upon a variety of chemical and crystal-structure analyses. The primary
methods used to determine the fluorine content for hemihedrite were
colorimetry, which resulted in values of F that were too high and
inconsistent with the structural data, and infrared (IR) spectroscopic
analysis that failed to detect OH or H2O. Our reinvestigation
using electron microprobe analysis of the type material, and additional
samples from the type locality, the Rat Tail claim, Arizona, and Nevada,
reveals the absence of fluorine, while the presence of OH is confirmed by
Raman spectroscopy. These findings suggest that the colorimetric
determination of fluorine in the original description of hemihedrite
probably misidentified F due to the interferences from PO4 and
SO4, both found in our chemical analyses. As a consequence of
these results, the study presented here proposes a redefinition of the
chemical composition of hemihedrite to the ideal chemical formula
Hemihedrite is isotypic with iranite with substitution of Zn for Cu, and
raygrantite with substitution of Cr for S. Structural data from a sample
from the Rat Tail claim, Arizona, indicate that hemihedrite is triclinic in
space group P1, a = 9.4891(7),
b = 11.4242(8), c = 10.8155(7) Å, α =
120.368(2)°, β = 92.017(3)°, γ = 55.857(2)°, V = 784.88(9)
Å3, Z= 1, consistent with previous
investigations. The structure was refined from singlecrystal X-ray
diffraction data to R1 = 0.022 for 5705 unique observed reflections, and the ideal
was assumed during the refinement. Electron microprobe analyses of this
sample yielded the empirical chemical formula
6.00 Si1.97O34H2.16 based on 34 O
atoms and six (Cr + S + P) per unit cell.
Deep borehole disposal (or DBD) is now seen as a viable alternative to the (comparatively shallow) geologically repository concept for disposal of high level waste and spent nuclear fuel. Based on existing oil and geothermal well technologies, we report details of investigations into cementitious grouts as sealing/support matrices (SSMs) for waste disposal scenarios in the DBD process where temperatures at the waste package surface do not exceed ∼190ºC. Grouts based on Class G oil well cements, partially replaced with silica flour, are being developed, and the use of retarding admixtures is being investigated experimentally. Sodium gluconate appears to provide sufficient retardation and setting characteristics to be considered for this application and also provides an increase in grout fluidity. The quantity of sodium gluconate required in the grout to ensure fluidity for 4 hours at 90, 120 and 140°C is 0.05, 0.25 and 0.25 % by weight of cement respectively. A phosphonate admixture only appears to provide desirable retardation properties at 90°C. The presence of either retarder does not affect the composition of the hardened cement paste over 14 days curing and the phases formed are durable under conditions of high temperature and pressure.
Geological disposal of HLW and spent nuclear fuel (SNF) in very deep boreholes is a concept whose time has come. The alternative – disposal in a mined, engineered repository is beset with difficulties not least of which are the constraints placed upon the engineered barriers by the high thermal loading. The deep borehole concept offers a potentially safer, faster and more cost-effective solution. Despite this, international interest has been slow to materialize, largely due to perceived problems with retrievability and uncertainty about the ability to drill accurate vertical holes with diameters greater than 0.5 m to a depth of 4-5 km. The closure of Yucca Mountain and the subsequent recommendations of the Blue Ribbon Commission have lead to a renewed interest in deep borehole disposal (DBD) and the US DoE has commissioned Sandia National Labs, working with industrial and academic partners (including the University of Sheffield), to undertake a program of R&D leading to a demonstration borehole being drilled somewhere in the continental USA by 2016.
In this paper, we focus on some of the key safety and engineering features of DBD including methods of sealing the boreholes, sealing and support matrices for the waste packages. Numerical modeling has, and continues to play, a significant role in expanding and validating the DBD concept. We report on progress in the use of modeling in the above contexts, paying particular attention to constraints on the engineering materials resulting from high heat loading.
To assess the effect of adenosine triphosphate (ATP) device measurement of hospital room cleaning and feedback of pooled results to environmental service workers (EVS) to improve cleaning efficacy.
Nonrandomized controlled trial conducted over 20 months.
Three hospitals of varying size.
EVS workers, randomly selected on the basis of convenience sample of rooms.
Environmental cleanliness composite scores were combined with layered educational interventions and used to provide feedback to EVS workers on specific hospital units. Trends in cleaning efficacy were observed after the interventions.
Cleaning efficacy improved significantly with each intervention (P < .01) and decreased during the washout period.
The ATP detection device combined with educational feedback for EVS workers resulted in significant improvement in cleaning efficacy of the hospital room environment.
Growth rates of newly-metamorphosed urchins from a single spawning event (three males and three females) were highly variable, despite being held en masse under identical environmental and nutritional conditions. As individuals reached ~5 mm diameter (0.07–0.10 g wet weight), they were placed in growth trials (23 dietary treatments containing various nutrient profiles). Elapsed time from the first individual entering the growth trials to the last individual entering was 121 days (N = 170 individuals). During the five-week growth trials, urchins were held individually and proffered a limiting ration to evaluate growth rate and production efficiency. Growth rates among individuals within each dietary treatment remained highly variable. Across all dietary treatments, individuals with an initially high growth rate (entering the study first) continued to grow at a faster rate than those with an initially low growth rate (entering the study at a later date), regardless of feed intake. Wet weight gain (ranging from 0.13–3.19 g, P <0.0001, R2 = 0.5801) and dry matter production efficiency (ranging from 25.2–180.5%, P = 0.0003, R2 = 0.6162) were negatively correlated with stocking date, regardless of dietary treatment. Although canalization of growth rate during en masse early post-metamorphic growth is possible, we hypothesize that intrinsic differences in growth rates are, in part, the result of differences (possibly genetic) in production efficiencies of individual Lytechinus variegatus. That is, some sea urchins are more efficient in converting feed to biomass. We further hypothesize that this variation may have evolved as an adaptive response to selective pressure related to food availability.
Brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of psychiatric and neurological disorders and in the mechanisms of antidepressant pharmacotherapy. Psychiatric and neurological conditions have also been associated with reduced brain levels of N-acetyl-aspartate (NAA), which has been used as a putative marker of neural integrity. However, few studies have explored the relationship between BDNF polymorphisms and NAA levels directly. Here, we present data from a single-voxel proton magnetic resonance spectroscopy study of 64 individuals and explore the relationship between BDNF polymorphisms and prefrontal NAA level. Our results indicate an association between a single nucleotide polymorphism (SNP) within BDNF, known as rs1519480, and reduced NAA level (p = 0.023). NAA levels were further predicted by age and Asian ancestry. There was a significant rs1519480 × age interaction on NAA level (p = 0.031). Specifically, the effect of rs1519480 on NAA level became significant at age ⩾34.17 yr. NAA level decreased with advancing age for genotype TT (p = 0.001) but not for genotype CT (p = 0.82) or CC (p = 0.34). Additional in silico analysis of 142 post-mortem brain samples revealed an association between the same SNP and reduced BDNF mRNA expression in the prefrontal cortex. The rs1519480 SNP influences BDNF mRNA expression and has an impact on prefrontal NAA level over time. This genetic mechanism may contribute to inter-individual variation in cognitive performance seen during normal ageing, as well as contributing to the risk for developing psychiatric and neurological conditions.
In 2010, an outbreak of cyclosporiasis affected passengers and crew on two successive voyages of a cruise ship that departed from and returned to Fremantle, Australia. There were 73 laboratory-confirmed and 241 suspected cases of Cyclospora infection reported in passengers and crew from the combined cruises. A case-control study performed in crew members found that illness was associated with eating items of fresh produce served onboard the ship, but the study was unable conclusively to identify the responsible food(s). It is likely that one or more of the fresh produce items taken onboard at a south-east Asian port during the first cruise was contaminated. If fresh produce supplied to cruise ships is sourced from countries or regions where Cyclospora is endemic, robust standards of food production and hygiene should be applied to the supply chain.
The Dominican Republic is located in the Caribbean Sea and comprises three-quarters of the island Hispaniola, which it shares with Haiti. According to the 2002 census, approximately 8.5 million people live in the Republic, with 64% residing in urban areas (Oficina Nacional Estadística, n.d.). During 1990 and 2000, the Dominican Republic was a leader in economic development for Latin America and the Caribbean; however, this was not reflected in the areas of human and social development (Pan American Health Organization & World Health Organization, 2007). Less than 1 % of the health budget administered by the Ministry of Public Health and Social Assistance (MISPAS) is allocated to mental health and the public system is generally underfunded (Pan American Health Organization & World Health Organization, 2008). However, there is an array of mental health services within the country when privately funded facilities are taken into account.