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This concise, yet authoritative, clinical reference guide fulfils the needs of diverse clinicians, pharmacists and allied health professionals prescribing for Parkinson's disease and movement disorders in contemporary clinical practice. With chapters on newly approved drugs and their effects on motor and non-motor symptoms, information is also given on their use in particular populations including the elderly and patients with cognitive impairment. Each chapter includes pharmacological/biochemical rationale for drug use, a general guide to therapeutic use, pharmacokinetics, interaction profile, adverse effects, dosing and use, special population considerations, costs and value for money considerations, clinical vignette, a summary overview, and suggested reading. Ordered alphabetically and perfect for quick reference use, the guide is practical and essential for all prescribers with responsibility for patients with Parkinson's disease, including neurologists, geriatricians, internists, neurosurgeons, psychiatrists, family physicians, pharmacists as well as allied health professionals and resident, fellow, and student trainees in all related medical fields.
To examine feasibility, acceptability, and preliminary effectiveness of a novel group-based telemedicine psychoeducation programme aimed at supporting psychological well-being among adolescents with Fontan-palliated CHD.
Study design:
A 5-week telemedicine psychoeducation group-based programme (WE BEAT) was developed for adolescents (N = 20; 13–18 years) with Fontan-palliated CHD aimed at improving resiliency and psychological well-being. Outcome measures included surveys of resilience (Connor–Davidson Resilience Scale), benefit finding (Benefit/Burden Scale for Children), depression, anxiety, peer relationships, and life satisfaction (National Institutes of Health Patient-Reported Outcomes Measurement Information System scales). Within-subject changes in these outcomes were compared pre- to post-intervention using Cohen’s d effect size. In addition, acceptability in the form of satisfaction measures and qualitative feedback was assessed.
Results:
Among eligible patients reached, 68% expressed interest in study participation. Of those consented, 77% have been scheduled for a group programme to date with 87% programme completion. Twenty adolescents (mean age 16.1 ± SD 1.6 years) participated across five WE BEAT group cohorts (range: 3–6 participants per group). The majority (80%) attended 4–5 sessions in the 5-session programme, and the median programme rating was a 9 out of 10 (10 = most favourable rating). Following WE BEAT participation, resiliency (d = 0.44) and perceptions of purpose in life increased (d = 0.26), while depressive symptoms reduced (d = 0.36). No other changes in assessed outcome measures were noted.
Conclusions:
These findings provide preliminary support that a group-based, telemedicine delivered psychoeducation programme to support psychological well-being among adolescents with CHD is feasible, acceptable, and effective. Future directions include examining intervention effects across diverse centres, populations, and implementation methods.
An attempt was made to develop a novel dairy-based dip-like product from heat-acid-induced milk gel and whey. Based upon preliminary trials, the combination of cream (15–35%), whey (60–70%) and common salt (0.8–1.0%, all three as weight of heat-acid-induced milk gel) was selected for optimization of the dairy dip through factorial design of response surface methodology (RSM). Addition of glycerol monostearate, trisodium citrate and sodium hexametaphosphate each at the rate of 0.3% (as weight of heat-acid-induced milk gel) in the formulation was previously standardized. The optimization was carried out by analysing the textural and sensorial parameters of the dairy-based dip. The sensorial parameters (flavour, body and texture, colour and appearance and overall acceptability) and textural parameters (firmness, stickiness, work of shear and work of adhesion) were significantly (P < 0.05) correlated with the ingredient formulation. RSM analysis suggested the use of cream, whey and common salt at amounts of 27.92, 60.26 and 0.8% of the weight of heat-acid-induced milk gel for preparing dairy-based dip with a desirability of 0.84. The formulated product contained a lower fat but higher protein and lactose content than cheese dip.
This study presents the design and realization of a dual-port multiple-input–multiple-output (MIMO) filtering antenna system. The device shows good response in the frequency rage 1 (4.1 to 7.125 GHZ) frequency band, which handles most of the cellular mobile communication traffic. First, the single element ultra-wideband (UWB) filtenna is designed by combining a UWB antenna and a band-reject filter (BRF) where the antenna works in the frequency range from 1 to 11 GHz and the BRF is rejecting the frequency range of 3–3.42 GHz with 3.2 GHz as its resonant frequency. Finally, the proposed two-port MIMO filtenna combines two single element UWB filtennas in antiparallel manner which shows impedance bandwidth from 2.59 to 7.1 GHz with a band notch from 3 to 3.42 GHz. The structure is built on cost-efficient FR4 substrate (εr = 4.4, tanδ = 0.02) of dimensions 0.68${{\boldsymbol{\lambda }}_{\boldsymbol{c}}}$×0.27${{\boldsymbol{\lambda }}_{\boldsymbol{c}}}$×0.01${{\boldsymbol{\lambda }}_{\boldsymbol{c}}}$ (mm3), which is compact in size and utilizes a defected ground structure for further miniaturization. The proposed design is simulated using Ansys HFSS software, and after fabrication, it is measured, and the output shows good results for the proposed application. The designed antenna system is suitable for fifth-generation (5G) wideband systems.
To quantify and compare concurrent within-person trends in lifestyle risks, nutrition status, and drivers of food choice among urban migrants in Central Asia.
Design:
We collected panel data on household structure, drivers of food choice, nutrition knowledge, and diverse measures of nutrition status and lifestyle risk from urban migrants at 0, 3, 6, and 9 months using harmonized methodology in two cities. Trends were analyzed using mixed-effects models and qualitatively compared within and between cities.
Setting:
Ulaanbaatar, Mongolia and Almaty, Kazakhstan.
Participants:
200 adults (22-55 years) who migrated to these cities within the past 2 years.
Results:
Adjusting for age and sex, each month since migration was positively associated with fasting triglycerides in Almaty (0.55 mg/dL; 95%CI: 0.13-0.94) and BMI (0.04 kg/m2; 95%CI: 0.01-0.07), body-fat (0.14%; 95%CI: 0.01-0.26), and fasting glucose (0.04 mmol/L; 95%CI: 0.02-0.05) and lipids in Ulaanbaatar (p<0.05). In Almaty, nutrition knowledge (measured using an objective 20-point scale) declined despite improvements in diet quality (measured by Prime Diet Quality Score). Influence of food availability, price, and taste on food choice increased in Almaty (p<0.05). Upon multivariable-adjustment, nutrition knowledge was positively associated with diet quality in Almaty and adherence to “Acculturated” diet patterns in both cities (p<0.05). Different trends in smoking, sleep quality, and generalized anxiety were observed between cities.
Conclusions:
Findings indicate heterogenous shifts in nutrition, lifestyles, and drivers of food choice among urban migrants in Central Asia and provide an evidence base for focused research and advocacy to promote healthy diets and enable nutrition-sensitive food environments.
As I read Zhang and Chen's (2024) perspective paper, I was impressed with the authors' flexibility moving into the medical field and the impact of their research. Moreover, I agreed wholeheartedly with their call to learn by working across fields and with their assessment of how differently management and healthcare scholarship is created, disseminated, and used. Yet I was quite stumped by the editor's request that I suggest some ‘urgent and pressing’ issues that might help management scholars achieve the kind of practical relevance of medical researchers.
For a prime p and a rational elliptic curve $E_{/\mathbb {Q}}$, set $K=\mathbb {Q}(E[p])$ to denote the torsion field generated by $E[p]:=\operatorname {ker}\{E\xrightarrow {p} E\}$. The class group $\operatorname {Cl}_K$ is a module over $\operatorname {Gal}(K/\mathbb {Q})$. Given a fixed odd prime number p, we study the average nonvanishing of certain Galois stable quotients of the mod-p class group $\operatorname {Cl}_K/p\operatorname {Cl}_K$. Here, E varies over all rational elliptic curves, ordered according to height. Our results are conditional, since we assume that the p-primary part of the Tate–Shafarevich group is finite. Furthermore, we assume predictions made by Delaunay for the statistical variation of the p-primary parts of Tate–Shafarevich groups. We also prove results in the case when the elliptic curve $E_{/\mathbb {Q}}$ is fixed and the prime p is allowed to vary.
In this chapter we use conversation analysis to analyse the use of tag questions by co-participants of people with dementia. Tag questions can function as a ‘current speaker selects next’ technique. They also prefer, and hence put interactional pressure on, the next speaker to produce a response that aligns with the tag-formatted turn. We examine three classes of co-participant-produced tag-formatted actions and analyse how their use is recipient-designed for people with dementia. Tag-formatted assertions and assessments present information that the person with dementia has already been told or might be expected to know, while simultaneously acknowledging that this information is, or should be, within the recipient’s epistemic domain. By eliciting agreement, they co-opt the person with dementia into the co-construction of this topical talk. Tag-formatted challenges are produced in response to an inappropriate turn by the person with dementia and, as well as challenging/complaining about that turn, act to elicit from the person with dementia an acknowledgement of its inappropriacy. We then show how tag questions are used to induce verbal acquiescence to a suggested activity. We discuss how these tag questions encroach into the person with dementia’s territories of knowledge, power and interactional competence, highlighting asymmetries between the person with dementia and the co-participant in these domains.
Chapter 2 delves into the intricate interactional dynamics of administering cognitive assessments, with a focus on the Addenbrooke’s Cognitive Examination-III (ACE-III). The chapter critically examines the standardisation challenges faced by clinicians in specialised memory assessment services, highlighting the nuanced reasons for non-standardized practices. While cognitive assessments play a pivotal role in diagnosing cognitive impairments, the study questions the assumed standardization of the testing process. Drawing on Conversation Analysis (CA), the authors analyse 40 video-recordings of the ACE-III being administered in clinical practice to reveal variations from standardized procedures. The chapter expands on earlier findings to show how clinicians employ recipient-design strategies during the assessment. It introduces new analyses of practitioner utterances in the third turn, suggesting deviations could be associated with practitioners’ working diagnoses. The chapter contends that non-standard administration is a nuanced response to the interactional and social challenges inherent in cognitive assessments. It argues that clinicians navigate a delicate balance between adhering to standardized procedures and tailoring interactions to individual patient needs, highlighting the complex interplay between clinical demands and recipient design. Ultimately, the chapter emphasizes the importance of understanding the social nature of cognitive assessments and provides insights into the valuable reasons for non-standardized practices in clinical settings.
Nutrition is the critical nongenetic factor that has a major influence on the health status of an organism. The nutritional status of the mother during gestation and lactation plays a vital role in defining the offspring’s health. Undernutrition during these critical periods may induce chronic metabolic disorders like obesity and cardiovascular diseases in mothers as well as in offspring. The present study aims to evaluate the impact of undernutrition during gestational and lactational periods on the plasma metabolic profile of dams. Additionally, we investigated the potential synergistic mitigating effects of astaxanthin and docosahexaenoic acid (DHA) on dysregulated plasma metabolic profiles. Evaluation of plasma lipid profile revealed that undernourishment resulted in elevated levels of total cholesterol, triglycerides, low density and very low-density lipoproteins in dams. Liquid chromatography-tandem mass spectrometry (LC–MS/MS) based untargeted metabolomics illustrated that pathways related to lipid metabolism, such as cholesterol metabolism, steroid biosynthesis and metabolism of amine-derived hormones, were dysregulated by undernourishment. Additionally, pathway enrichment analysis predicted that there is a high incidence of development of desmosterolosis, hypercholesterolaemia, lysosomal acid lipase deficiency and Smith–Lemli–Opitz syndrome in the offspring, reflecting predisposition in mothers. However, synergistic supplementation of astaxanthin and DHA ameliorated these adverse effects by regulating a separate set of metabolic pathways associated with lipid metabolism. They included branched chain amino acid degradation such as valine, leucine and isoleucine, metabolism of alpha-linolenic acid, lipoic acid, lysine degradation, biosynthesis, elongation and degradation of fatty acids.
Superhydrophobic (SHPo) surfaces can capture a thin layer of air called a plastron under water to reduce skin friction. Although a ~30 % drag reduction has been recently reported with longitudinal micro-trench SHPo surfaces under a boat and in a towing tank, the results lacked the consistency to establish a clear trend. Designed based on Yu et al. (J. Fluid Mech, vol. 962, 2023, A9), this work develops and tests a series of high-performance SHPo surface coupons that can sustain a pinned plastron underneath a passenger motorboat revamped to reach 14 knots. Importantly, plastrons in a pinned state, not just their existence, are confirmed during flow experiments for the first time. All the drag-reduction data measured on different longitudinal micro-trenches are found to collapse if plotted against slip length in wall units. In comparison, aligned posts and transverse trenches show less and little drag reduction, respectively, confirming the adverse effect of the spanwise slip in turbulent flows. This report not only verifies SHPo surfaces can provide a consistent drag reduction at high speeds in open sea but also shows that one may predict the amount of drag reduction in turbulent flows using the physical slip length obtained for Stokes flows.
Control of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa spread in healthcare settings begins with timely and accurate laboratory testing practices. Survey results show most Veterans Affairs facilities are performing recommended tests to identify these organisms. Most facilities report sufficient resources to perform testing, though medium-complexity facilities report some perceived barriers.
Migratory animals likely play an important role in the geographic spread of parasites. In fact, a common assumption is that parasites are potentially transmitted by migratory animals at temporary stopover sites along migratory routes, yet very few studies have assessed whether transmission at stopover sites can or does occur. We investigated the potential for a group of vector-transmitted parasites, the avian haemosporidians, to be transmitted during migratory stopover periods at Rushton Woods Preserve in Pennsylvania, USA. Using an analysis of 1454 sampled avian hosts, we found that while a core group of abundant haemosporidians was shared between local breeding birds and passing migrants, the parasite community of migratory birds at Rushton was distinct from that of local breeding birds and showed similarity to a previously sampled boreal forest haemosporidian community. Haemosporidians that were unique to passing migratory birds were associated with sampling sites in North America with cooler summer temperatures than haemosporidians that are transmitted at Rushton, suggesting that the transmission of these parasites may be restricted to high-latitude regions outside of our temperate stopover site. We also found that the abundance of mosquitoes in our study region is offset from that of migratory bird abundance during avian migratory periods, with the peak period of bird migration occurring during periods of low mosquito activity. Collectively, these findings suggest that although abundant haemosporidians are possibly transmitted between local and passing migratory birds, a combination of biotic and abiotic factors may constrain haemosporidian transmission during avian stopover at our study site.
To assess the potential contribution of large-scale food fortification (LSFF) towards meeting dietary micronutrient requirements in Tanzania.
Design:
We used household food consumption data from the National Panel Survey 2014–15 to estimate fortifiable food vehicle coverage and consumption (standardised using the adult female equivalent approach) and the prevalence at risk of inadequate apparent intake of five micronutrients included in Tanzania’s fortification legislation. We modelled four LSFF scenarios: no fortification, status quo (i.e. compliance with current fortification contents) and full fortification with and without maize flour fortification.
Setting:
Tanzania.
Participants:
A nationally representative sample of 3290 Tanzanian households.
Results:
The coverage of edible oils and maize and wheat flours (including products of wheat flour and oil such as bread and cakes) was high, with 91 percent, 88 percent and 53 percent of households consuming these commodities, respectively. We estimated that vitamin A-fortified oil could reduce the prevalence of inadequate apparent intake of vitamin A (retinol activity equivalent) from 92 percent without LSFF to 80 percent with LSFF at current fortification levels. Low industry LSFF compliance of flour fortification limits the contribution of other micronutrients, but a hypothetical full fortification scenario shows that LSFF of cereal flours could substantially reduce the prevalence at risk of inadequate intakes of iron, zinc, folate and vitamin B12.
Conclusions:
The current Tanzania LSFF programme likely contributes to reducing vitamin A inadequacy. Policies that support increased compliance could improve the supply of multiple nutrients, but the prominence of small-scale maize mills restricts this theoretical benefit.
This work introduces a novel compact ultra-wideband (UWB) antenna designed for wearable applications, employing a bioinspired structure and machine learning (ML) techniques to achieve exceptional performance in the 3.10–10.42 GHz range. The antenna is fabricated by positioning conductive fabric on a polydimethylsiloxane polymer of 1 mm thickness to augment high flexibility and durability. Additionally, it pioneers integrating a complete ground plane to mitigate back radiation toward the human body, presenting a compact (35.5 × 30.5 × 1 mm3) UWB antenna design compliant with IEEE 802.15.6 standards. The design methodology includes using bandwidth enhancement techniques such as chamfering edges, slots, and adding stubs in the feed, along with applying ML to optimize the antenna’s dimensions for desired return loss characteristics. The proposed antenna demonstrates exceptional resilience to human body loading and physical deformation. The simulation and measurement results have good agreement. The K-nearest neighbour method beat the other ML algorithms maximum accuracy of 99.62% to predict the S11. According to the author’s best knowledge, this is the first compact UWB antenna with full ground specified by IEEE.802.15.6 with ML reported.
Creating a sustainable residency research program is necessary to develop a sustainable research pipeline, as highlighted by the recent Society for Academic Emergency Medicine 2024 Consensus Conference. We sought to describe the implementation of a novel, immersive research program for first-year emergency medicine residents. We describe the curriculum development, rationale, implementation process, and lessons learned from the implementation of a year-long research curriculum for first-year residents. We further evaluated resident perception of confidence in research methodology, interest in research, and the importance of their research experience through a 32-item survey. In two cohorts, 25 first-year residents completed the program. All residents met their scholarly project requirements by the end of their first year. Two conference abstracts and one peer-reviewed publication were accepted for publication, and one is currently under review. Survey responses indicated that there was an increase in residents’ perceived confidence in research methodology, but this was limited by the small sample size. In summary, this novel resident research curriculum demonstrated a standardized, reproducible, and sustainable approach to provide residents with an immersive research program.
This research proposes an inexpensive technique for wireless image transfer for security and surveillance applications. The technique uses a 5.8 GHz transmitter and receiver module, along with external antennas in the real-time image transfer within a radius of 100 m. The transferred images are stored in a laptop using a Python code-based graphical user interface application. Different antennas, dipole, circular split-ring resonators, hexagonal split-ring resonators, and metamaterial antennas are utilized for comparison. The Blind/Referenceless Image Spatial Quality Evaluator method is used to assess the picture quality of transferred images to quantify image transfer performance when no ground truth or reference photos are supplied. According to the presented results, images transferred using metamaterial antennas have higher quality than those transferred with other types of antennas. For security considerations, such a system can communicate and store the images in real time.
To evaluate the impact of changes in the size and characteristics of the hospitalized patient population during the COVID-19 pandemic on the incidence of hospital-associated Clostridioides difficile infection (HA-CDI).
Design:
Interrupted time-series analysis.
Setting:
A 576-bed academic medical center in Portland, Oregon.
Methods:
We established March 23, 2020 as our pandemic onset and included 24 pre-pandemic and 24 pandemic-era 30-day intervals. We built an autoregressive segmented regression model to evaluate immediate and gradual changes in HA-CDI rate during the pandemic while controlling for changes in known CDI risk factors.
Results:
We observed 4.5 HA-CDI cases per 10,000 patient-days in the two years prior to the pandemic and 4.7 cases per 10,000 patient-days in the first two years of the pandemic. According to our adjusted segmented regression model, there were neither significant changes in HA-CDI rate at the onset of the pandemic (level-change coefficient = 0.70, P-value = 0.57) nor overtime during the pandemic (slope-change coefficient = 0.003, P-value = 0.97). We observed significant increases in frequency and intensity of antibiotic use, time at risk, comorbidities, and patient age before and after the pandemic onset. Frequency of C. difficile testing did not significantly change during the pandemic (P= 0.72).
Conclusions:
Despite large increases in several CDI risk factors, we did not observe the expected corresponding changes in HA-CDI rate during the first two years of the COVID-19 pandemic. We hypothesize that infection prevention measures responding to COVID-19 played a role in CDI prevention.