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Current policy emphasises the importance of ‘living well’ with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1–0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.
Xpert MTB/RIF (Xpert) is the preferred first-line test for all persons with tuberculosis (TB) symptoms in South Africa in line with a diagnostic algorithm. This study evaluates pre- and post-implementation trends in diagnostic practices for drug-sensitive, pulmonary TB in adults in an operational setting, following the introduction of the Xpert-based algorithm. We retrospectively analysed data from the national TB database for Greater Tzaneen sub-district, Limpopo Province. Trends in a number of cases, diagnosis and outcome and characteristics associated with death are reported. A total of 8407 cases were treated from 2008 until 2015, with annual cases registered decreasing by 31·7% over that time period (from 1251 to 855 per year). After implementation of Xpert, 69·9% of cases were diagnosed by Xpert, 29·4% clinically, 0·6% by smear microscopy and 0·1% by culture. Cases with a recorded microbiological test increased from 76·2% to 96·4%. Cases started on treatment without confirmation, but with a negative microbiological test increased from 7·1% to 25·7%. Case fatality decreased from 15·0% to 9·8%, remaining consistently higher in empirically treated groups, regardless of HIV status. Implementation of the algorithm coincided with a reduced number of TB cases treated and improved coverage of microbiological testing; however, a substantial proportion of cases continued to start treatment empirically.
Introduction: Understanding factors associated with increased use of nicotine replacement therapy (NRT) is critical to implementing cessation interventions for low-income individuals yet the factors associated with NRT use among low-income smokers are poorly understood.
Aims: Assess factors associated with NRT use among low-income public housing residents.
Methods: ‘Kick it for Good’ was a randomised smoking cessation intervention study conducted among residents of public housing sites in Boston, MA. Secondary, cross-sectional analyses were conducted on smokers from a community-based intervention cessation intervention who reported making a quit attempt and use of NRT in the past 12 months (n = 234).
Results: Among smokers who made a quit attempt in the past year, 29% reported using NRT. Black (prevalence ratio, PR = 0.52, 95% CI: 0.38–0.71) and Hispanic (PR = 0.52, 95% CI: 0.31–0.88) participants were less likely to report use of NRT compared with Whites. The prevalence of recent NRT use was greatest among those both asking for and receiving provider advice (PR = 1.90, 95% CI: 0.96–3.78).
Conclusions: Minority race and ethnicity and low provider engagement on NRT use were associated with lower NRT use. Providing barrier-free access to NRT and facilitating provider engagement with smokers regarding NRT use can increase NRT use among low-income populations.
Objectives: Visuospatial processing deficits have been reported in Huntington’s disease (HD). To date, no study has examined associations between visuospatial cognition and posterior brain findings in HD. Methods: We compared 119 premanifest (55> and 64<10.8 years to expected disease onset) and 104 early symptomatic (59 stage-1 and 45 stage-2) gene carriers, with 110 controls on visual search and mental rotation performance at baseline and 12 months. In the disease groups, we also examined associations between task performance and disease severity, functional capacity and structural brain measures. Results: Cross-sectionally, there were strong differences between all disease groups and controls on visual search, and between diagnosed groups and controls on mental rotation accuracy. Only the premanifest participants close to onset took longer than controls to respond correctly to mental rotation. Visual search negatively correlated with disease burden and motor symptoms in diagnosed individuals, and positively correlated with functional capacity. Mental rotation (“same”) was negatively correlated with motor symptoms in stage-2 individuals, and positively correlated with functional capacity. Visual search and mental rotation were associated with parieto-occipital (pre-/cuneus, calcarine, lingual) and temporal (posterior fusiform) volume and cortical thickness. Longitudinally, visual search deteriorated over 12 months in stage-2 individuals, with no evidence of declines in mental rotation. Conclusions: Our findings provide evidence linking early visuospatial deficits to functioning and posterior cortical dysfunction in HD. The findings are important since large research efforts have focused on fronto-striatal mediated cognitive changes, with little attention given to aspects of cognition outside of these areas. (JINS, 2016, 22, 595–608)
The possibility that life, primitive or advanced, might exist in other places of the Universe has occupied the minds of scientists and lay-people for thousands of years. It is only in the last 25 years, however, that we have finally begun to search for answers to this profound question using experimental techniques. The goal of Astronomy is to understand the origin and evolution of planets, stars, galaxies and of the Universe as a whole. The appearance of life is an integral part of this whole process and our picture of the Universe will never be complete until we will comprehend also the significance of life in the process of Cosmic Evolution.
HR 6469 consists of an evolved G5 star and a close pair of fainter stars, probably both on the main sequence. The period of the close pair is just over two days, and shallow eclipses have been detected (Boyd et al. 1985), although no analysis of the light curve has been published. The wide system has a period of about 5.5 years, and has been resolved by speckle interferometry (McAlister et al. 1983). The G5 star and the primary of the close pair are detectable in the spectrum, with the latter showing modest rotational broadening. Spectral types and rotational velocities for the evolved star and the brighter component of the close pair have been published by Strassmeier & Fekel (1990).
Increasing recognition of the extent to which nitrous oxide (N2O) contributes to climate change has resulted in greater demand to improve quantification of N2O emissions, identify emission sources and suggest mitigation options. Agriculture is by far the largest source and grasslands, occupying c. 0·22 of European agricultural land, are a major land-use within this sector. The application of mineral fertilizers to optimize pasture yields is a major source of N2O and with increasing pressure to increase agricultural productivity, options to quantify and reduce emissions whilst maintaining sufficient grassland for a given intensity of production are required. Identification of the source and extent of emissions will help to improve reporting in national inventories, with the most common approach using the IPCC emission factor (EF) default, where 0·01 of added nitrogen fertilizer is assumed to be emitted directly as N2O. The current experiment aimed to establish the suitability of applying this EF to fertilized Scottish grasslands and to identify variation in the EF depending on the application rate of ammonium nitrate (AN). Mitigation options to reduce N2O emissions were also investigated, including the use of urea fertilizer in place of AN, addition of a nitrification inhibitor dicyandiamide (DCD) and application of AN in smaller, more frequent doses. Nitrous oxide emissions were measured from a cut grassland in south-west Scotland from March 2011 to March 2012. Grass yield was also measured to establish the impact of mitigation options on grass production, along with soil and environmental variables to improve understanding of the controls on N2O emissions. A monotonic increase in annual cumulative N2O emissions was observed with increasing AN application rate. Emission factors ranging from 1·06–1·34% were measured for AN application rates between 80 and 320 kg N/ha, with a mean of 1·19%. A lack of any significant difference between these EFs indicates that use of a uniform EF is suitable over these application rates. The mean EF of 1·19% exceeds the IPCC default 1%, suggesting that use of the default value may underestimate emissions of AN-fertilizer-induced N2O loss from Scottish grasslands. The increase in emissions beyond an application rate of 320 kg N/ha produced an EF of 1·74%, significantly different to that from lower application rates and much greater than the 1% default. An EF of 0·89% for urea fertilizer and 0·59% for urea with DCD suggests that N2O quantification using the IPCC default EF will overestimate emissions for grasslands where these fertilizers are applied. Large rainfall shortly after fertilizer application appears to be the main trigger for N2O emissions, thus applicability of the 1% EF could vary and depend on the weather conditions at the time of fertilizer application.
Using semi-empirical isochrones, we find the age of the Taurus star-forming region to be 3-4 Myr. Comparing the disc fraction in Taurus to young massive clusters suggests discs survive longer in this low density environment. We also present a method of photometrically de-reddening young stars using iZJH data.
Observations of SS433 are consistent with the view that the Doppler-shifted line emission originates in a pair of oppositely-directed, precessing jets in which a gas outflow is maintained at the remarkably time- and space-invariant speed of 0.26c. A radiative acceleration mechanism is described for the jets and a detailed, numerical, relativistic flow calculation presented which explain this terminal velocity as the result of “line-locking”. The “line-locking” mechanism suggested here for SS433 may be important as well in extra-galactic radio sources in which the radio luminosity is similarly weak compared with the kinetic energy and optical luminosities.
General factors are found in the measurement of many human traits. The concept of dominant general factors (DGFs) is introduced to represent the magnitude of general factors within numerous content domains. DGFs are defined as coming from the largest sources of reliable variance and influencing every variable measuring the construct. Although these factors are most frequently found in measures of cognitive ability, they are not limited to cognitive abilities. Examples are provided for a variety of construct and content domains along with estimates of their DGF percentages, ranging from 38% to 92%. Several reasons for these results are offered, and a call for concerted research is made. Research that ignores DGFs by treating specific factors or constructs within a domain as if they were distinct and uncorrelated can lead to errors in interpretation.
A number of copy number variants (CNVs) have been suggested as
susceptibility factors for schizophrenia. For some of these the data
remain equivocal, and the frequency in individuals with schizophrenia is
To determine the contribution of CNVs at 15 schizophrenia-associated loci
(a) using a large new data-set of patients with schizophrenia
(n = 6882) and controls (n = 6316),
and (b) combining our results with those from previous studies.
We used Illumina microarrays to analyse our data. Analyses were
restricted to 520 766 probes common to all arrays used in the different
We found higher rates in participants with schizophrenia than in controls
for 13 of the 15 previously implicated CNVs. Six were nominally
significantly associated (P<0.05) in this new
data-set: deletions at 1q21.1, NRXN1, 15q11.2 and
22q11.2 and duplications at 16p11.2 and the Angelman/Prader–Willi
Syndrome (AS/PWS) region. All eight AS/PWS duplications in patients were
of maternal origin. When combined with published data, 11 of the 15 loci
showed highly significant evidence for association with schizophrenia
We strengthen the support for the majority of the previously implicated
CNVs in schizophrenia. About 2.5% of patients with schizophrenia and 0.9%
of controls carry a large, detectable CNV at one of these loci. Routine
CNV screening may be clinically appropriate given the high rate of known
deleterious mutations in the disorder and the comorbidity associated with
these heritable mutations.
Depressive symptoms are prominent psychopathological features of Huntington's disease (HD), making a negative impact on social functioning and well-being.
We compared the frequencies of a history of depression, previous suicide attempts and current subthreshold depression between 61 early-stage HD participants and 40 matched controls. The HD group was then split based on the overall HD group's median Hospital Anxiety and Depression Scale-depression score into a group of 30 non-depressed participants (mean 0.8, s.d. = 0.7) and a group of 31 participants with subthreshold depressive symptoms (mean 7.3, s.d. = 3.5) to explore the neuroanatomy underlying subthreshold depressive symptoms in HD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI).
Frequencies of history of depression, previous suicide attempts or current subthreshold depressive symptoms were higher in HD than in controls. The severity of current depressive symptoms was also higher in HD, but not associated with the severity of HD motor signs or disease burden. Compared with the non-depressed HD group DTI revealed lower fractional anisotropy (FA) values in the frontal cortex, anterior cingulate cortex, insula and cerebellum of the HD group with subthreshold depressive symptoms. In contrast, VBM measures were similar in both HD groups. A history of depression, the severity of HD motor signs or disease burden did not correlate with FA values of these regions.
Current subthreshold depressive symptoms in early HD are associated with microstructural changes – without concomitant brain volume loss – in brain regions known to be involved in major depressive disorder, but not those typically associated with HD pathology.
Soil organic carbon (C) plays a critical role in supporting the productive capacity of soils and their ability to provide a wide range of ecologically important functions including the storage of atmospherically derived carbon dioxide (CO2). The present paper collates available information on Scottish soil C stocks and C losses and reviews the potential pressures on terrestrial C, which may threaten future C stocks. Past, present and possible future land use, land management practices and land use changes (LUCs) including forestry, agriculture, nitrogen (N) additions, elevated CO2 and climate change for Scotland are discussed and evaluated in relation to the anthropogenic pressures on soil C.
The review deduces that current available data show little suggestion of significant changes in C stocks of Scottish soils, although this may be due to a lack of long-term trend data. However, it can be concluded that there are many pressures, such as climate change, intensity of land use practices, scale of LUC, soil erosion and pollution, which may pose significant threats to the future of Scottish soil C if these factors are not taken into consideration in future land management decisions. In particular, this is due to the land area covered by vulnerable peats and highly organic soils in Scotland compared with other areas in the UK. It is therefore imperative that soil C stocks for different land use, management practices and LUCs are monitored in more detail to provide further insight into the potential changes in sequestered C and subsequent greenhouse gas emissions, as advised by the United Nations Framework Convention on Climate Change (UNFCCC).
The present study explored parents’ requirements for healthy eating support prior to the development of a tailored intervention.
A cross-sectional study of parents attending children's centres.
Children's centres in Cornwall (rural south-west England) and Islington (urban London borough).
A total of 261 parents (94·2 % female) of pre-school children (aged 2–5 years) completed a questionnaire on factors influencing food choice, and preferences for and views on healthy eating support.
Parents reported that health, taste, freshness and quality were the most important factors influencing their food choices for their pre-school children. The importance of individual factors varied according to level of educational attainment. Over a third (38 %) of parents said they wanted more advice on healthy eating for children. Less educated parents showed the greatest interest in learning more about several aspects: what a ‘healthy diet’ means, how to prepare and cook healthy food, how to understand food labels, budgeting for food, examples of healthy food and snacks for children, appropriate portion sizes for children and ways to encourage children to eat well.
There was demand for healthy eating support among parents of pre-school children, especially those who are less educated, in one rural and one urban area of England.
Intercropping systems that include legumes can provide symbiotically fixed nitrogen (N) and potentially increase yield through improved resource use efficiency. The aims of the present study were: (a) to evaluate the effects of different legumes (species and varieties) and barley on grain yield, dry matter production and N uptake of the intercrop treatments compared with the associated cereal sole crop; (b) to assess the effects on the yields of the next grain crop and (c) to determine the accumulation of N in shoots of the crops in a low-input rotation. An experiment was established near Edinburgh, UK, consisting of 12 hydrologically isolated plots. Treatments were a spring barley (Hordeum vulgare cvar Westminster) sole crop and intercrops of barley/white clover (Trifolium repens cvar Alice) and barley/pea (Pisum sativum cvar Zero4 or cvar Nitouche) in 2006. All the plots were sown with spring oats (Avena sativa cvar Firth) in 2007 and perennial ryegrass in 2008. No fertilizers, herbicides or pesticides were used at any stage of the experiment. Above-ground biomass (barley, clover, pea, oat and ryegrass) and grain yields (barley, pea and oat) were measured at key stages during the growing seasons of 2006, 2007 and 2008; land equivalent ratio (LER) was measured only in 2006. At harvest, the total above-ground biomass of barley intercropped with clover (4·56 t biomass/ha) and barley intercropped with pea cvar Zero4 (4·49 t biomass/ha) were significantly different from the barley sole crop (3·05 t biomass/ha; P<0·05). The grain yield of the barley (2006) intercropped with clover (3·36 t grain/ha) was significantly greater than that in the other treatments (P<0·01). The accumulation of N in barley was low in 2006, but significantly higher (P<0·05) in the oat grown the following year on the same plots. The present study demonstrates for the first time that intercrops can affect the grain yield and N uptake of the following crop (spring oats) in a rotation. Differences were also linked to the contrasting legume species and cultivars present in the previous year's intercrop. Legume choice is essential to optimize the plant productivity in intercropping designs. Cultivars chosen for intercropping purposes must take into account the effects upon the growth of the partner crop/s as well as to the following crop, including environmental factors.