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Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).
We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale.
The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%).
There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
Imprinting, characterized by unequal expression of the offspring's genes in a parent-of-origin dependent manner, has been functionally implicated in brain development and in psychiatric disorders. In this study, unambiguous distortion in paternal but not maternal transmission of the disease-associated single-nucleotide polymorphism (SNP) rs6556547 (T/G) clearly indicated the presence of parent-of-origin effect (POE) in the GABAA receptor β2 subunit gene (GABRB2). ‘Flipping’ of allelic mRNA expression in heterozygotes of SNP rs2229944 (C/T) and the observed two-tiered distribution of mRNA expression levels in heterozygotes of the disease-associated SNP rs1816071 (G/A) furnished important support for the occurrence of imprinting at GABRB2. Imprinting in effect introduced heterozygotes from different parents-of-origin endowed with dissimilar mRNA expression capabilities. The deficit of upper-tiered expressions accounted for the lowered mRNA expression levels in the schizophrenic heterozygotes. This pointed to the necessity of differentiating between two kinds of heterozygotes of different parental origins in disease association studies on GABRB2. Bisulfite sequencing revealed hypermethylation in the neighborhood of SNP rs1816071, and methylation differences between controls and schizophrenia patients. Notably, allele-specific methylation was observed at the disease-associated SNPs rs6556547 and rs1816071. These findings raised the possibility that CpG methylation status of these sites could have an impact on the expression of GABRB2 and the risk of schizophrenia. Furthermore, the occurrence of imprinting and allele-specific methylation in the schizophrenia candidate gene GABRB2 was compatible with the epigenetic hypothesis for schizophrenia pathophysiology, thereby calling for the need to explore the role of epigenetic factors in mediating susceptibility to schizophrenia.
Patients with schizophrenia show a deficit in emotion recognition through facial expression. Familiarity means the implicit memory of past affective experiences and it involves fast cognitive processes and it is triggered by certain signals.
To assess the emotion recognition in familiar and unfamiliar faces in a sample of schizophrenic patients and healthy controls.
18 outpatients diagnosed with schizophrenia (DSM-IVTR) and 18 healthy volunteers were assessed with the Ekman Test of emotion recognition in unfamiliar faces. In addition each subject was accompanied by 4 familiar people (parents, siblings or friends), which was photographed by expressing the 6 Ekman’s basic emotions.
Schizophrenic patients recognize worse emotions in their relatives than in neutral faces, a greater extent than controls (Mann-Whitney U = 81, p = .01). The patient group showed a mean score on the Ekman test (neutral faces) lower than control group (16 (SD 2.38) versus 17.82 (2.13; U p = 0.03). Regarding familiar faces, the group patients showed a worse performance than the control group (13.22 (3.8) versus 17.18 (2.82); U p = 0.00). In both tests, the highest number of errors was with emotions of anger and fear. The patients group showed a lower level of familiarity and emotional valence to their families (U = 33, p < 0.01).
The sense of familiarity may be a factor involved in face emotion recognition and it may be disturbed in schizophrenia.
Previously the GABA(A) receptor beta-2 subunit gene GABRB2 was found to be associated with schizophrenia (SCZ). for SNPs and haplotypes in GRBRB2, the associations with bipolar disorder (BPD), the functional consequences on GABRB2 expression and their relationship to demographic and clinical characteristics in BPD and SCZ remain to be elucidated.
Case-control analysis was performed for association study of GABRB2 with BPD, and its mRNA expression in postmortem BPD brains was examined using quantitative real-time PCR. Quantitative trait analysis was subsequently employed to assess the covariate effects of demographic and clinical characteristics on genotypic correlation of GABRB2 expression in SCZ and BPD.
Significant association of GABRB2 with BPD and reduction in GABRB2 mRNA expression in BPD brains were observed in the present study. Duration of illness (DOI) was found to be a significant covariate for the correlation of the disease-associated SNPs rs1816071, rs1816072 and rs187269 with GABRB2 expression in both SCZ and BPD. for individuals with homozygous major genotypes of these SNPs, while GABRB2 expression increased with age in the controls, it decreased with DOI and age in SCZ, and with DOI in BPD. with age of onset as covariate, these three SNPs were significantly correlated with antipsychotic dosage in SCZ.
These results have thus revealed correlations of GABRB2 SNPs and expression not only with the occurrence of SCZ and BPD, but also with the clinical characteristics of patients, therefore providing support for a shared etiological role played by the gene in both diseases.
Long-acting injectable (LAI) antipsychotics have been used as an alternative to oral antipsychotic formulations.
to evaluate the impact of switching to a LAI second-generation antipsychotic (SGA) in terms of changes in patient's psychopathology, subjective experience of drug and quality of life.
18 adult outpatients diagnosed with Schizoaffective disorder (by means of the SCID-I/P) and attending the Psychiatric Unit of the University of Florence were recruited. All patients were under a stabilized therapy with a single oral SGA (either olanzapine or paliperidone) and were switched to its corresponding LAI formulation (olanzapine pamoate or paliperidone palmitate). Patients were assessed by means of the following questionnaires: MADRS, YMRS, PANSS, DAI-10, SWN and SF-36 at enrolment (T0) and after 6 months (T1).
A significant reduction was found between T0 and T1 (p<.05) in PANSS total, negative and general psychopathology mean scores, as well as in mean MADRS and YMRS total scores. No difference was found for positive PANSS mean scores. We observed a significant increase of mean DAI-10 and SWN total scores between T0 and T1 (p<.05). A reduction of side effects like sedation and blunted affect between T0 and T1 (p<.05) was confirmed by significant increases in mean SF-36 subscales scores, such as: general health (p<.01) change in health (p<.01) and social integration (p<.05).
Treatment with LAI SGAs seems to be a valid alternative in patients with Schizoaffective disorder. Our preliminary data suggest an improvement in patient's subjective experience of pharmacological therapy and health-related quality of life, together with a similar efficacy on psychopathology.
The aim of the study was to identify inpatients due to autolytic behavior in the acute psychiatric hospitalization of Dr. R. Lafora Hospital. It is an observational, descriptive and retrospective study. We collected information about patients aged 18 to 64 who were hospitalized during the month of January of 2015 in the acute psychiatric hospitalization by Selene software. The results were analyzed by SPSS software; 53.3% of patients diagnosed with schizophrenia spectrum and other psychotic disorders were hospitalized for acute exacerbation of paranoid schizophrenia; 57.1% of personality disorders for suicide attempts, 28.6% autolytic ideation; 28.6% of bipolar disorders due to mania, 28.6% depression, 28.6% mixed clinical and 14.29% suicide attempts; 60% of alcohol use disorders for autolytic ideation, 20% intoxication; 100% of substance-related and addictive disorders due to autolytic ideation; 100% of feeding and eating disorders for autolytic ideation; 50% of obsessive-compulsive and related disorders due to autolytic ideation; 100% of adjustment disorders with depressed mood due to drug over-eating; 100% of adjustment disorders with mixed anxiety and depressed mood for mixed clinic; 16.7% of depressive disorders due to dysthymia, 16.7% due to major depressive episode, 16.7% for moderate depressive episode, 16.7% for mild depressive episode with mixed nature, 16.7% for drug over-eating, 16.7% for autolytic ideation. It would be important to focus on patients with a diagnosis of adjustment disorders, personality disorders, alcohol use disorders, obsessive-compulsive and related disorders and bipolar disorders, providing community care and avoiding the risks associated psychiatric hospitalization.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The vortex-induced vibration of a spring-mounted, damped, rigid circular cylinder, immersed in a Newtonian viscous flow and capable of moving in the direction orthogonal to the unperturbed flow is investigated for Reynolds numbers
in the vicinity of the onset of unsteadiness (
$15\leqslant Re\leqslant 60$
) using the incompressible linearised Navier–Stokes equations. In a first step, we solve the linear problem considering an imposed harmonic motion of the cylinder. Results are interpreted in terms of the mechanical impedance, i.e. the ratio between the vertical force coefficient and the cylinder velocity, which is represented as function of the Reynolds number and the driving frequency. Considering the energy transfer between the cylinder and the fluid, we show that impedance results provide a simple criterion allowing the prediction of the onset of instability of the coupled fluid-elastic structure case. A global stability analysis of the fully coupled fluid/cylinder system is then performed. The instability thresholds obtained by this second approach are found to be in perfect agreement with the predictions of the impedance-based criterion. A theoretical argument, based on asymptotic developments, is then provided to give a prediction of eigenvalues of the coupled problem, as well as to characterise the region of instability beyond the threshold as function of the reduced velocity
, the dimensionless mass
and the Reynolds number. The influence of the damping parameter
on the instability region is also explored.
The main goal of this work was to evaluate the in vitro biological activity of two ferrocenyl chalcones (FcC-1 and FcC-2) against Haemonchus contortus (third-stage larvae (L3)) and Nacobbus aberrans (second-stage juveniles (J2)). Both compounds were synthesized and characterized by usual spectroscopic methods and their molecular structures were confirmed by single-crystal X-ray diffractometry. Nematode strains were examined in terms of percentage mortality of H. contortus (L3) by the action of FcC-1, which showed an effectivity of 100% at a concentration of 342 μM in 24 h, with EC50 = 20.33 μM and EC90 = 162.76 μM, whereas FcC-2 had an effectivity of 72% at a concentration of 342 μM in 24 h, with EC50 = 167.39 μM and EC90 = 316.21 μM. The effect of FcC-1 against nematode phytoparasite N. aberrans showed a better percentage of 95% at a concentration of 342 μM, with EC50 = 7.18 μM and EC90 = 79.25 μM, whereas the effect of FcC-2 was 87% at 342 μM, with EC50 = 168 μM and EC90 = 319.56 μM at 36 h. After treatment, the scanning electron micrographs revealed deformities in the dorsal flank and posterior part close to the tail of H. contortus L3. They showed moderate in vitro nematicidal activity against H. contortus L3 and N. aberrans J2.
This study proposed the application of a novel immersed boundary method (IBM) for the treatment of irregular geometries using Cartesian computational grids for high speed compressible gas flows modelled using the unsteady Euler equations. Furthermore, the method is accelerated through the use of multiple Graphics Processing Units – specifically using Nvidia’s CUDA together with MPI - due to the computationally intensive nature associated with the numerical solution to multi-dimensional continuity equations. Due to the high degree of locality required for efficient multiple GPU computation, the Split Harten-Lax-van-Leer (SHLL) scheme is employed for vector splitting of fluxes across cell interfaces. NVIDIA visual profiler shows that our proposed method having a computational speed of 98.6 GFLOPS and 61% efficiency based on the Roofline analysis that provides the theoretical computing speed of reaching 160 GLOPS with an average 2.225 operations/byte. To demonstrate the validity of the method, results from several benchmark problems covering both subsonic and supersonic flow regimes are presented. Performance testing using 96 GPU devices demonstrates a speed up of 89 times that of a single GPU (i.e. 92% efficiency) for a benchmark problem employing 48 million cells. Discussions regarding communication overhead and parallel efficiency for varying problem sizes are also presented.
Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
This paper studies the transition to three-dimensional flow in the wake of a cylinder immersed in a free stream, where the cylinder is externally forced to continuously rotate about its axis and to linearly oscillate in the streamwise direction. Floquet stability analysis is used to assess the stability of the nominal two-dimensional flows at a Reynolds number
and rotation rate
to three-dimensional perturbations, as a function of the amplitude and frequency of the linear oscillations. Two modes of instability are found, distinguished by their spatial structure, temporal behaviour and apparent mechanism. The first mode has a shorter wavelength in the spanwise direction and appears to be linked to a centrifugal instability in the layer of fluid near the rotating body. The second mode has a longer wavelength and is linked to an instability of the vortex cores in the wake that is subharmonic, leading to a period doubling. Either mode can be stable while the other is unstable, depending primarily on the frequency of the oscillation of the cylinder. This indicates that either mode can control the transition to a three-dimensional flow. The results are compared to the fully three-dimensional simulation results of a rotating cylinder elastically mounted and free to oscillate in the streamwise direction from Bourguet & Lo Jacono (J. Fluid Mech., vol. 781, 2015, pp. 127–165), and appear to be able to explain the surprising switching of the observed spanwise wavelength in that flow as a change in the dominant mode, and therefore mechanism, of instability.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
Retrospective observational cohort study.
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
Diatoms microalgae represent a natural source of highly porous biosilica shells (frustules) with promising applications in a wide range of technological fields. Functionalization of diatoms’ frustules with tailored luminescent molecules can be envisaged as a convenient, scalable biotechnological route to new light emitting silica nanostructured materials. Here we report a straightforward protocol for the in vivo modification of Thalassiosira weissflogii diatoms’ frustules with a red emitting organic dye based on thienyl, benzothiadiazolyl and phenyl units. The metabolic insertion of the dye molecules into the diatoms shells, combined with an acidic-oxidative isolation protocol of the resulting dye stained biosilica, represents a novel strategy to develop highly porous luminescent biosilica nanostructures with promising applications in photonics.
A numerical study of the flow-induced vibration of two elastically mounted cylinders in tandem and staggered arrangements at Reynolds number
is presented. The cylinder centres are set at a streamwise distance of 1.5 cylinder diameters, placing the rear cylinder in the near-wake region of the front cylinder for the tandem arrangement. The cross-stream or lateral offset is varied between 0 and 5 cylinder diameters. The two cylinders are identical, with the same elastic mounting, and constrained to oscillate only in the cross-flow direction. The variation of flow behaviours is examined for static cylinders and for elastic mountings of a range of spring stiffnesses, or reduced velocity. At least seven major modes of flow response are identified, delineated by whether the oscillation is effectively symmetric, and the strength of the influence of the flow through the gap between the two cylinders. Submodes of these are also identified based on whether or not the flow remains periodic. More subtle temporal behaviours, such as period doubling, quasi-periodicity and chaos, are also identified and mapped. Across all of these regimes, the amplitudes of vibration and the magnitude of the fluid forces are quantified. The modes identified span the parameter space between two important limiting cases: two static bodies at varying lateral offset; and two elastically mounted bodies in a tandem configuration at varying spring stiffnesses. Some similarity in the response of extremely stiff or static bodies and extremely slack bodies is shown. This is explained by the fact that the slack bodies are free to move to an equilibrium position and stop, effectively becoming a static system. However, the most complex behaviour appears between these limits, when the bodies are in reasonably close proximity, and the natural structural frequency is close to the vortex shedding frequency of a single cylinder. This appears to be driven by the interplay between a series of time scales, including the vortex formation time, the advection time across the gap between the cylinders and the oscillation period of both bodies. This points out an important difference between this multi-body system and the classic single-cylinder vortex-induced vibration: two bodies in close proximity will not oscillate in a synchronised, periodic manner when their natural structural frequencies are close to the nominal vortex shedding frequency of a single cylinder.
Childhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.
To test whether people with first-episode psychosis who had experienced childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.
The sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d.=9.7).
Severe sexual abuse was significantly associated with a diagnosis of affective psychosis (χ2=4.9, P=0.04) and with higher rates of lifetime use of cannabis (68% v. 41%; P = 0.02) and heroin (20% v. 5%; P=0.02). Severe physical abuse was associated with increased lifetime use of heroin (15% v. 5%; P = 0.03) and cocaine (32% v. 17%; P = 0.05).
Patients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use.
To explore cross-sectional adherence to cancer prevention recommendations by adults enrolled in a prospective cohort in Alberta, Canada.
Questionnaire data were used to construct a composite cancer prevention adherence score for each participant, based on selected personal recommendations published by the World Cancer Research Fund/American Institute for Cancer Research (2007). Data were self-reported on health and lifestyle, past-year physical activity and past-year FFQ. The scores accounted for physical activity, dietary supplement use, body size, and intakes of alcohol, fruit, vegetables and red meat. Tobacco exposure was also included. Scores ranged from 0 (least adherent) to 7 (most adherent).
Alberta’s Tomorrow Project; a research platform based on a prospective cohort.
Adult men and women (n 24 988) aged 35–69 years recruited by random digit dialling and enrolled in Alberta’s Tomorrow Project between 2001 and 2009.
Of the cohort, 14 % achieved adherence scores ≥5 and 60 % had scores ≤3. Overall adherence scores were higher in women (mean (sd): 3·4 (1·1)) than in men (3·0 (1·2)). The extent of overall adherence was also associated with level of education, employment status, annual household income, personal history of chronic disease, family history of chronic disease and age.
Reported adherence to selected personal recommendations for cancer prevention was low in this cohort of adults. In the short to medium term, these results suggest that more work is required to identify behaviours to target with cancer prevention strategies at a population level. Future work will explore the associations between adherence scores and cancer risk in this cohort.
Diatoms represent a natural source of mesoporous silica whose applications range from biomedical to photonic fields. Porous hierarchically organized micro structures, the biosilica shells called frustules, can be obtained by removal of the organic biological matter from the unicellular living algae. Diatoms frustules have been investigated as scaffold for bone tissue growth taking advantage of their nanostructured surface and of the possibility to chemically modify the biosilica. Here we report on an easy way to calcium-doped biosilica supports for bone tissue regeneration by in vivo feeding the algae. FTIR and EDX analyses confirmed the incorporation of calcium into the mesopouros biosilica. Cell viability studies showed an ameliorative effect on the Saos-2 cells spreading compared with the cells grown on non-doped biosilica supports.
Expert judgement is frequently used within general insurance. It tends to be a method of last resort and used where data is sparse, non-existent or non-applicable to the problem under consideration. Whilst such judgements can significantly influence the end results, their quality is highly variable. The use of the term “expert judgement” itself can lend a generous impression of credibility to what may be a little more than a guess. Despite the increased emphasis placed on the importance of robust expert judgements in regulation, actuarial research to date has focussed on the more technical or data-driven methods, with less emphasis on how to use and incorporate softer information or how best to elicit judgements from others in a way that reduces cognitive biases. This paper highlights the research that the Getting Better Judgement Working Party has conducted in this area. Specifically, it covers the variable quality of expert judgement, both within and outside the regulatory context, and presents methods that may be applied to improve its formation. The aim of this paper is to arm the insurance practitioner with tools to distinguish between low-quality and high-quality judgements and improve the robustness of judgements accordingly, particularly for highly material circumstances.
This study aimed to determine the prevalence of vestibular dysfunction in the Singaporean elderly and its association with presbyacusis, age and other associated risk factors.
A cross-sectional study was undertaken in a tertiary otorhinolaryngology department and the community. Healthy adults aged 40 years and above who participated in the institution's community presbyacusis screening programme were invited to participate. The main outcome measures including pure tone audiometry and vestibular assessment were obtained using a modified Clinical Test of Sensory Interaction on Balance.
The prevalence of vestibular dysfunction and presbyacusis in the study population of 216 participants was 30.1 per cent (95 per cent confidence interval, 24.0 to 36.2 per cent) and 55.6 per cent (95 per cent confidence interval, 49.0 to 62.2 per cent), respectively. The median age was 60 years (range, 40–86 years). The adjusted odds ratio for vestibular dysfunction increased by 6.2 per cent with every year of life (p < 0.05), and by 3.14 times in the presence of presbyacusis (p < 0.05). After adjusting for age and presbyacusis, diabetes (n = 30), hypertension (n = 85), hypercholesteraemia (n = 75), cardiac disease (n = 14), stroke (n = 7) and smoking (n = 55) were associated with an increased odds ratio for vestibular dysfunction which did not reach statistical significance (p > 0.05).
Vestibular dysfunction is independently associated with ageing and presbyacusis. Further research into the benefits of additional screening for vestibular dysfunction in elderly presbyacusis patients is warranted.