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The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia.
A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses.
A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance.
Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate.
Incidence rates were assessed for the district of Aarhus, Denmark. From 147 patients operated on mainly with canal wall up mastoidectomies for debuting cholesteatomas, 10-year Kaplan–Meier recidivism rates were calculated and independent prognostic factors for the recidivism were identified by Cox multivariate regression analyses.
Incidence rate was 6.8 per 100 000 per year. The 10-year cumulative recidivism rate was 0.44 (95 per cent confidence interval, 0.37–0.53). Independent prognostic factors for the recidivism were: age below 15 years (hazard ratio = 2.2; p > z = 0.002), cholesteatoma localised to the mastoid (hazard ratio = 1.7; p > z = 0.04), stapes erosion (hazard ratio = 1.9; p > z = 0.02) and incus erosion (hazard ratio = 1.9; p > z = 0.04).
The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.
We analyze a sample of 20 absorption systems intrinsic to long duration GRB host galaxies at z > 2 forwhich the metallicities are known. We compare the relation between the metallicity and cold gas velocity width for thissample to that of the Damped Lyman-alpha systems (DLAs) in the sight-lines of quasars (QSOs), and find completeagreement. We then compare the redshift evolution of the velocity-metallicity relation of our sample to that of QSODLAsand find that also GRB hosts favour a late onset of this evolution, around a redshift of ~2.6. We compute predicted stellar masses for the GRB host galaxies using the prescription determined from QSO-DLAsamples and compare the measured stellar masses for the four hosts where stellar masses have been determinedfrom SED fits. We find excellent agreement and conclude that, on basis of all available data and tests, long durationGRB-DLA hosts and intervening QSO-DLAs are consistent with being drawn from the same underlying population.
Future projections of the evolution of ice caps as well as ice sheets and consequent sea-level rise face several methodological challenges, one being the two-way coupling between ice flow and mass-balance models. Full two-way coupling between mass-balance models – or, in a wider scope, climate models – and ice flow models has rarely been implemented due to substantial technical challenges. Here we examine some coupling effects for the Vestfonna ice cap, Nordaustlandet, Svalbard, by analysing the impacts of different coupling intervals on mass-balance and sea-level rise projections. By comparing coupled to traditionally deployed uncoupled strategies, we prove that neglecting the topographic feedbacks in the coupling leads to underestimations of 10–20% in sea-level rise projections on century timescales in our model. As imposed climate scenarios increasingly change mass balance, uncertainties in the unknown evolution of the fast-flowing outlet glaciers decrease in importance due to their deceleration and reduced mass flux as they thin and retreat from the coast. Parameterizing mass-balance adjustment for changes in topography using lapse rates as a cost-effective alternative to full coupling produces satisfactory results for modest climate change scenarios. We introduce a method to estimate the error of the presented partially coupled model with respect to as yet unperformed two-way fully coupled results.
Norovirus outbreaks occur frequently in Denmark and it can be difficult to establish whether apparently independent outbreaks have the same origin. Here we report on six outbreaks linked to frozen raspberries, investigated separately over a period of 3 months. Norovirus from stools were sequence-typed; including extended sequencing of 1138 bp encompassing the hypervariable P2 region of the capsid gene. Norovirus was detected in 27 stool samples. Genotyping showed genotype GI.Pb_GI.6 (polymerase/capsid) with 100% identical sequences. Samples from five outbreaks were furthermore identical over the variable capsid P2 region. In one outbreak at a hospital canteen, frozen raspberries was associated with illness by cohort investigation (relative risk 6·1, 95% confidence interval 3·2–11). Bags of raspberries suspected to be the source were positive for genogroup I and II noroviruses, one typable virus was genotype GI.6 (capsid). These molecular investigations showed that the apparently independent outbreaks were the result of one contamination event of frozen raspberries. The contaminated raspberries originated from a single producer in Serbia and were originally not considered to belong to the same batch. The outbreaks led to consultations and mutual visits between producers, investigators and authorities. Further, Danish legislation was changed to make heat-treatment of frozen raspberries compulsory in professional catering establishments.
Following recent molecular phylogenetic studies in Old World Gesneriaceae the nomenclatural implications for names in Henckelia are examined. New combinations are made in Codonoboea and Loxocarpus to account for species now excluded from Henckelia. A list is presented in which the current position of all species hitherto assigned to Henckelia is given, including the new combination Henckelia rotundata (Barnett) D.J.Middleton & Mich.Möller. A new combination in Oreocharis is made.
The objective was to assess the ability of the in situ mobile nylon bag method for predicting small intestinal and total tract starch digestibility. Starch disappearance was measured for 18 samples of different cereals and legumes subjected to different physical and chemical processing methods and compared with coherent in vivo digestibility. Starch disappearance was measured both with and without initial ruminal pre-incubation during 4 h. Bags were retrieved from either the ileal cannula or faeces. Two dry Danish Holstein cows fitted with rumen cannulas were used for rumen pre-incubations and two lactating Danish Holstein cows fitted with duodenal and ileal cannulas were used for intestinal incubations. Rumen pre-incubation had no significant effect on disappearance from bags recovered in faeces. The disappearance of legume starch was lower, both in the rumen and small intestine, compared with starch from barley, wheat, oats, ear maize and maize. Transit times of the mobile bags from duodenum to ileum were not significantly different between feeds. A weak positive correlation was found between in vivo small intestinal and total tract digestibility of starch and disappearance obtained using the mobile bag technique across a broad range of starch sources. Omitting two less conventional starch sources (NaOH wheat and xylose-treated barley) resulted in a high (0.87) correlation between total tract in vivo digestibility and mobile bag disappearance. The use of the mobile bag method for estimation of in vivo starch digestibility will therefore depend on the starch type.
Individuals with body dysmorphic disorder (BDD) may have perceptual distortions for their appearance. Previous studies suggest imbalances in detailed relative to configural/holistic visual processing when viewing faces. No study has investigated the neural correlates of processing non-symptom-related stimuli. The objective of this study was to determine whether individuals with BDD have abnormal patterns of brain activation when viewing non-face/non-body object stimuli.
Fourteen medication-free participants with DSM-IV BDD and 14 healthy controls participated. We performed functional magnetic resonance imaging (fMRI) while participants matched photographs of houses that were unaltered, contained only high spatial frequency (HSF, high detail) information or only low spatial frequency (LSF, low detail) information. The primary outcome was group differences in blood oxygen level-dependent (BOLD) signal changes.
The BDD group showed lower activity in the parahippocampal gyrus, lingual gyrus and precuneus for LSF images. There were greater activations in medial prefrontal regions for HSF images, although no significant differences when compared to a low-level baseline. Greater symptom severity was associated with lower activity in the dorsal occipital cortex and ventrolateral prefrontal cortex for normal spatial frequency (NSF) and HSF images.
Individuals with BDD have abnormal brain activation patterns when viewing objects. Hypoactivity in visual association areas for configural and holistic (low detail) elements and abnormal allocation of prefrontal systems for details are consistent with a model of imbalances in global versus local processing. This may occur not only for appearance but also for general stimuli unrelated to their symptoms.
Milk contains immunomodulatory compounds that may be important to protect the immature intestine in preterm neonates from harmful inflammatory reactions involved in disorders like necrotising enterocolitis (NEC). We hypothesised that bovine colostrum and milk formulas enriched with sialic acids (SL), gangliosides (Gang) or osteopontin (OPN) would improve gastrointestinal function and NEC resistance in preterm neonates. Forty-seven caesarean-delivered preterm pigs were given total parenteral nutrition for 2 d followed by 1·5 d of enteral feeding. In Expt 1, a control formula was compared with an OPN-enriched formula (n 13), while Expt 2 compared a control formula with bovine colostrum or formulas enriched with Gang or SL (n 4–6). OPN enrichment decreased NEC severity relative to control formula (P < 0·01), without any significant effects on NEC incidence, digestive enzyme activities and hexose absorption. Neither SL- nor Gang-enriched formulas improved NEC resistance or digestive functions, while all the intestinal functional parameters were significantly improved in pigs fed bovine colostrum, relative to formula. The effects in vivo were supported in vitro by bacteria- and dose-dependent modulation by colostrum whey of the cytokine response from bacteria-stimulated murine bone marrow-derived dendritic cells (DC). In conclusion, OPN had only moderate NEC-protective effects, while formulas enriched with Gang or SL were ineffective. The observed modulation of DC cytokine response by bovine colostrum whey in vitro may be due to a synergistic action of various milk bioactives, and it may explain its beneficial effects on NEC development and intestinal function in a piglet model of preterm infants.
Trichinella nativa infection (trichinellosis) is highly prevalent in Arctic wildlife, but the human burden of trichinellosis in present-day Greenland is unknown. The study aimed to determine Trichinella seroprevalence in an eastern Greenlandic hunting community and to evaluate risk factors for seropositivity. Overall, 998 inhabitants aged ⩾10 years in the Ammassalik municipality were tested for Trichinella-specific IgG antibodies. Background information was obtained from questionnaires. Seropositivity was 1·4% in persons aged <40 years and increased to >12% in those aged ⩾60 years. Older age, occupation as hunter or fisherman, and consumption of polar bear meat significantly increased the risk of Trichinella seropositivity. The seropositivity age pattern probably reflects changes in dietary preferences, but could also reflect mandatory meat inspection since 1966. However, preventive measures against Trichinella infection should be strengthened in Greenland.
To compare three methods of haemostasis used for ‘cold steel’ tonsillectomy, in terms of pain scores and morbidity.
Method and material:
Prospective, randomised, single-blinded, controlled clinical study. Three haemostasis methods were compared: compression of the tonsillar fossae with gauze packs; bipolar diathermy; and local anaesthesia then pack compression. The outcome measures were pain scores (derived from a visual analogue scale), peri-operative bleeding, and post-operative episodes of blood-stained saliva, consultation rate, tonsillar bed healing and days before return to regular diet. One hundred and five patients were included.
Peri-operative bleeding was significantly reduced in the local anaesthesia group compared with the other two groups. Delayed post-operative tonsillar bed healing was noted in the diathermy group. No other significant differences were found between the three haemostasis groups, for any other outcome measures. The presence of blood-stained saliva was associated with higher pain scores.
Diathermy and compression were associated with similar post-tonsillectomy morbidity.
Here we report on the present status of our project on statistical modelling of charge dynamics within irradiated samples. Boltzmann statistical approach to model the radiation damage in samples irradiated by FEL photons is tested in a study case of a spherically symmetric xenon cluster. Qualitative agreement between the model predictions and the experimental data is found. The results obtained demonstrate the potential of the statistical method for describing the non-equilibrium dynamics of samples exposed to FEL radiation.
It is unclear whether postprandial blood glucose or insulin exerts a regulatory function in short-term appetite regulation in humans. The aim of this study was to investigate, by use of meta-analysis, the role of blood glucose and insulin in short-term appetite sensation and energy intake (EI) in normal weight and overweight participants. Data from seven test meal studies were used, including 136 healthy participants (ALL) (92 normal weight (NW) and 44 overweight or obese (OW)). All meals were served as breakfasts after an overnight fast, and appetite sensations and blood samples were obtained frequently in the postprandial period. Finally, an ad libitum lunch was served. Data were analysed by fixed effects study level (SL) meta-regression analysis and individual participant data (IPD) regression analysis, using STATA software. In SL analysis, postprandial insulin response was associated with decreased hunger in ALL, NW and OW (P < 0·019), and with increased satiety in NW (P = 0·004) and lower subsequent EI in OW (P = 0·022). Multivariate IPD analysis showed similar associations, but only in NW for hunger, satiety and EI (P < 0·028), and in ALL for EI (P = 0·016). The only association involving blood glucose was the multivariate IPD analysis showing an inverse association between blood glucose and EI in ALL (P = 0·032). Our results suggest that insulin, but not glucose, is associated with short-term appetite regulation in healthy participants, but the relationship is disrupted in the overweight and obese. We conclude that the postprandial insulin response may be an important satiety signal, and that central nervous system insulin resistance in overweight might explain the blunted effect on appetite.
In principle, dark galaxies in the dwarf-galaxy mass range may be detectable through additional, small-scale image splitting of quasars that are already known to be multiply-imaged on arcsecond scales. Here, we derive the image separations expected for dark galaxies with density profiles favoured by recent N-body simulations. The results are compared to the angular resolution of existing and planned telescopes at X-ray, optical, near-infrared and radio wavelengths.
Dark galaxies may in principle be detectable through strong-lensing image splitting of quasars on small angular scales (milliarcseconds or below). Here, we estimate the overall probabilities for such detections under the assumption that the quasars can be treated as point sources. Due to the very low probabilities derived, we conclude that it is currently not feasable to use this strategy to put the CDM predictions for the dark galaxy population to the test.
Boar taint is an off-flavour of pork caused primarily by a microbial breakdown product, skatole and a testicular steroid, androstenone. As skatole is produced in the large intestine from tryptophan, it is possible that some ‘bioactive’ ingredients could modify protein fermentation and, in the process, diminish boar taint. The aim of this study was to examine the effect of inulin-rich chicory roots (Cichorium intybus L.) on boar taint. In the first of three trials individually penned, entire males and females were given an organic concentrate in which 0·25 of the daily energy intake was replaced with crude chicory roots for 9 or 4 weeks prior to slaughter. In the second trial, entire male pigs were given diets that included, either crude chicory roots, dried chicory roots, or inulin (extracted from chicory roots) for 6 weeks pre-slaughter. In the third trial, intact male pigs were given the dried chicory diet for either 2 or 1 week before slaughter. In all trials the chicory diets were offered on a scale at 0·95 of the Danish recommendation for energy intake, and pig performance was compared with a control group given the organic concentrate at 0·95 of recommended energy intake plus silage ad libitum. In trial 1 an additional control group was offered the organic concentrate at a daily energy intake level of 1·0 of Danish recommendations. The pigs in trials 1, 2, and 3 were slaughtered at an average live weight of 118, 124, and 110 kg, respectively, in order to ensure that they had achieved sexual maturity. Overall, skatole concentrations in blood plasma and backfat at slaughter were reduced to almost zero levels by including crude or dried chicory or inulin in the diet. This occurred irrespective of sex and length of feeding period (1 to 9 weeks). In trial 3 a significant effect on blood plasma concentration was observed after 3 days of feeding a diet containing dried chicory. The only significant reduction in plasma androstenone levels was detected in pigs given the crude chicory for a 9 week duration in trial 1. The production and proportion of lean was generally not affected by the addition of either form of chicory to the diets in trials 1 and 2. Therefore, dried chicory may be the most suitable form for commercial use because it: had no initial adverse effects on food intake, consistently reduced skatole without reducing performance, was easy to handle throughout the entire year and is relatively inexpensive.
This paper reviews methods for hedging and valuation of insurance claims with an inherent financial risk, with special emphasis on quadratic hedging approaches and indifference pricing principles and their applications in insurance. It thus addresses aspects of the interplay between finance and insurance, an area which has gained considerable attention during the past years, in practice as well as in theory. Products combining insurance risk and financial risk have gained considerable market shares. Special attention is paid to unit-linked life insurance contracts, and it is demonstrated how these contracts can be valued and hedged by using traditional methods as well as more recent methods from incomplete financial markets such as risk-minimisation, mean-variance hedging, super-replication and indifference pricing with mean-variance utility functions.
Background and objective: This study was performed to identify risk factors for complications and in-hospital mortality associated with pneumonectomy.
Methods: The influence of fluid balance during anaesthesia was evaluated, taking into account the patient's age, gender and body mass index, smoking habits, history of pulmonary or cardiac disorders, the site of pneumonectomy and duration of anaesthesia. One-hundred-and-seven patients undergoing elective pneumonectomy were included in the study.
Results: A total of 31 patients (29%) suffered from one or more postoperative complications, seven (22.4%) of these had severe dysrhythmias, six (19.6%) had pulmonary complications and three (9.3%) had cardiovascular complications. The overall mortality rate was 10.3%.
Conclusions: Based on logistic regression analysis, our data indicate the following risk factors for postoperative complications: positive fluid balance exceeding 4000 mL during anaesthesia (pulmonary complications and mortality), body mass index < 17 or > 25 kg m−2 (severe dysrhythmias), or history of chronic heart disease (pulmonary complications). Thirteen patients (12.4%) suffered from a fluid balance 4000 ml during anaesthesia. Regression analysis indicated that fluid balance exceeding 4000 mL was associated with a higher risk of postoperative complications than blood loss exceeding 1000 mL and to be the strongest risk factor for postoperative pulmonary complications and in-hospital mortality. Further trials estimating the effect of restrictive fluid regimens and the use of vasopressors for blood pressure control during anaesthesia must be carried out.