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Frequent and remote cognitive assessment may improve sensitivity to subtle cognitive decline associated with preclinical Alzheimer’s disease (AD). The objective of this study was to evaluate the feasibility and acceptability of repeated remote memory assessment in late middle-aged and older adults.
Participants and Methods:
We recruited participants from a longitudinal aging cohort to complete three medial temporal lobe-based memory paradigms (Object-In-Room Recall [ORR], Mnemonic Discrimination for Objects and Scenes [MDT-OS], Complex Scene Recognition [CSR]) using the neotiv application at repeated intervals over one year. We conducted initial telephone calls to perform screening, consent, and download instructions. Participants were assigned 24 remote sessions on a smartphone or tablet and were alerted via push notification when an assignment was ready to complete. Participants were randomly assigned to: (1) complete memory tests every other week or (2) complete memory tests for multiple days within one week every other month. Each remote session lasts approximately 10 minutes and includes one memory paradigm and brief usability/acceptability questionnaires followed by a delayed retrieval session 90 minutes later. Feasibility metrics examined included participation, retention, compliance, and usability/acceptability.
Results:
Of 150 participants recruited, 113 consented and were enrolled into the study (participation rate = 75%). Current retention rate is 75%, with 85/113 currently active (n=73) or completed (n=12). Of the 85 active or completed participants, the mean age is 68.7 (range = 4882), 64% are women, 70% used a smartphone (30% tablet), 84 are cognitively unimpaired and 1 has mild cognitive impairment. The primary threat to retention was participants consenting into the study but never registering in the app or completing their first scheduled assignment. After enrollment, 130 telephone calls were made by study staff to facilitate registration into the app or to remind participants to complete tasks. 74-80% of participants completed delayed retrieval tasks within 30 minutes of push notification, but average retrieval time was 125137 minutes post-learning trials. Regarding acceptability/usability, 94% agreed the application was easy to use, 56% enjoyed completing the mobile memory tests (36% felt neutral), 40% prefer remote mobile memory tests to standard in-person paper and pencil tests, and 50% understood the test instructions. 87% felt the frequency of tests assigned was “just right” (13% “too often”) and 90% felt the test length was “just right” (7% too short, 3% too long). Participants who completed all 24 sessions to date (n=12) all endorsed being “satisfied” or “very satisfied” with the platform and visit schedule, as well as recommended continued use of this type of cognitive testing.
Conclusions:
Remote memory assessment using smartphones and tablets is feasible and acceptable for cognitively unimpaired late middle-aged and older adults. Follow-up by study staff was needed to ensure adequate retention. Comprehension of instructions and compliance with completing delayed retrieval tasks within the expected timeframe was lower than expected. These feedback will be incorporated into an updated version of the app to improve compliance and retention. Longitudinal data collection is ongoing and results will be updated with a larger sample. Results will be compared across frequency schedule groups.
Fetal and child development are shaped by early life exposures, including maternal health states, nutrition and educational and home environments. We aimed to determine if suboptimal pre-pregnancy maternal body mass index (BMI; underweight, overweight, obese) would associate with poorer cognitive outcomes in children, and whether early life nutritional, educational and home environments modify these relationships. Self-reported data were obtained from mother-infant dyads from the pan-Canadian prospective Maternal-Infant Research on Environmental Chemicals cohort. Relationships between potential risk factors (pre-pregnancy maternal BMI, breastfeeding practices and Home Observation Measurement of the Environment [HOME] score) and child cognitive development at age three (Weschler’s Preschool and Primary Scale of Intelligence, Third Edition scale and its subcategories) were each evaluated using analysis of variance, multivariable regression models and moderating analyses. Amongst the 528 mother−child dyads, increasing maternal pre-pregnancy BMI was negatively associated with scores for child full-scale IQ (β [95% CI]; −2.01 [−3.43, −0.59], p = 0.006), verbal composite (−1.93 [−3.33, −0.53], p = 0.007), and information scale (−0.41 [−0.70, −0.14], p = 0.003) scores. Higher maternal education level or HOME score attenuated the negative association between maternal pre-pregnancy BMI and child cognitive outcome by 30%–41% and 7%–22%, respectively, and accounted for approximately 5%–10% greater variation in male children’s cognitive scores compared to females. Maternal education and higher quality home environment buffer the negative effect of elevated maternal pre-pregnancy BMI on child cognitive outcomes. Findings suggest that relationships between maternal, social and environmental factors must be considered to reveal pathways that shape risk for, and resiliency against, suboptimal cognitive outcomes in early life.
The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.
Aims
To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.
Method
The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).
Results
Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).
Conclusions
Management of mental health may play a role in HIV and STI prevention.
Issues stemming from differences and similarities in cultural identities affect residents and workforces in care homes in Scotland, as they do across the United Kingdom. Theoretical guidance and policy drivers emphasise the importance of considering cultural diversity when planning or enacting person-centred care processes, regardless of where health or social care takes place. Nevertheless, there is a recognised worldwide dearth of research concerning the intersections of culture, dementia and long-term care. This being so, a recent research study found that inadequate understandings of issues stemming from cultural diversity could be seen to constrain person-centred care in some Scottish care homes. In addition, the study uncovered little-recognised socio-cultural phenomena which were observed to positively enhance person-centre care. This article will focus on that, and will lay out findings from the study which lead to the following broad assertion: there is a broad lack of understanding of the power, and potential utility, of shared identity and community as a bulwark against the erosion of personhood which is often associated with dementia. This article describes these findings in some detail, thereby providing fresh insights into how shared cultural identity, and the sense of community it may bring, bears upon the interactions between workers and residents with dementia in Scottish care homes. It then suggests how the school of ‘person-centred care’ may be developed through further research into these phenomena.
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
Methods
A retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
Results
A range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
Conclusions
Neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments. Prehosp Disaster Med. 2016;31(6):675–679.
The fragmented ecosystems along the Niagara Escarpment World Biosphere Reserve provide important habitats for biota including lichens. Nonetheless, the Reserve is disturbed by dense human populations and associated air pollution. Here we investigated patterns of lichen diversity within urban and rural sites at three different locations (Niagara, Hamilton, and Owen Sound) along the Niagara Escarpment in Ontario, Canada. Our results indicate that both lichen species richness and community composition are negatively correlated with increasing human population density and air pollution. However, our quantitative analysis of community composition using canonical correspondence analysis (CCA) indicates that human population density and air pollution is more independent than might be assumed. The CCA analysis suggests that the strongest environmental gradient (CCA1) associated with lichen community composition includes regional pollution load and climatic variables; the second gradient (CCA2) is associated with local pollution load and human population density factors. These results increase the knowledge of lichen biodiversity for the Niagara Escarpment and urban and rural fragmented ecosystems as well as along gradients of human population density and air pollution; they suggest a differential influence of regional and local pollution loads and population density factors. This study provides baseline knowledge for further research and conservation initiatives along the Niagara Escarpment World Biosphere Reserve.
Determining the internal layout of archaeological structures and their uses has always been challenging, particularly in timber-framed or earthen-walled buildings where doorways and divisions are difficult to trace. In temperate conditions, soil-formation processes may hold the key to understanding how buildings were used. The abandoned Roman town of Silchester, UK, provides a case study for testing a new approach that combines experimental archaeology and micromorphology. The results show that this technique can provide clarity to previously uncertain features of urban architecture.
Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).
There was no statistically significant difference noted in family satisfaction as determined by FSICU–24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.
Significance of results:
This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.
Vulcanian eruptions are named for the 1888–90 eruptions of Vulcano, Aeolian Islands, Italy (Mercalli, 1907), and are defined here as short-lived, discrete explosions resulting from sudden decompression of a volcanic conduit caused by disruption of a sealing plug or dome. Resulting eruptions characteristically last only seconds to minutes and may produce buoyant columns, pyroclastic density currents, or both. They may occur as single events or in a sequence of discrete explosions. The short duration and unsteady vent conditions of vulcanian eruptions make them distinct from sustained plinian or subplinian eruptions. Pre-eruption pressures can reach 10 MPa, vent velocities may approach 400 m s−1, eruption plumes typically rise to < 10 km, but in some cases may reach nearly 20 km, and the amount of magma erupted is typically < 1011 kg. This chapter reviews mechanisms associated with vulcanian eruptions and discusses several relevant conceptual and quantitative models. Topics include plug formation and disruption, magma fragmentation, calculation of vent flux, the production and propagation of shock waves, the dynamics of pyroclastic jets and plumes ascending from unsteady sources, and ballistic analysis. This chapter also addresses important questions regarding controls on the scale and duration of such short-lived explosions, as well as transitions in eruptive style.
Human movement constitutes a fundamental part of the archaeological process, and of any interpretation of a site's usage; yet there has to date been little or no consideration of how movement observed (in contemporary situations) and inferred (in archaeological reconstruction) can be documented. This paper reports on the Motion in Place Platform project, which seeks to use motion capture hardware and data to test human responses to Virtual Reality (VR) environments and their real-world equivalents using round houses of the Southern British Iron Age which have been both modelled in 3D and reconstructed in the present day as a case study. This allows us to frame questions about the assumptions which are implicitly hardwired into VR presentations of archaeology and cultural heritage in new ways. In the future, this will lead to new insights into how VR models can be constructed, used and transmitted.
Experimental archaeology is often cited as an important asset in the study of human interaction with material culture, especially in remote periods of history where there are few other sources of data on the human interventions which constitute the archaeological record. This has found many expressions in the discourse of archaeological theory, including the so-called chaîne opératoire, or ‘operational sequence’ theory (see e.g. Bar-Yosef and Van Peer 2009). However, due to an understandable desire to adhere to empirical evidence, means of inferring the human movement behind those interventions are rarely considered in the computational reconstruction of archaeological environments. The most obvious reason for this is that buildings, features and artefacts can be understood and reconstructed (whether digitally or not) from empirical archaeological remains, whereas there is little or no direct evidence for how people might have looked and moved through the spaces they created. Approaches which seek to go beyond this are methodologically fraught, resulting in a limitation of the scope of 3D reconstruction, both as a tool for archaeological research and as means of presenting cultural heritage to the public. The impact on the user's experience of those reconstructions is also limited. In a review of 3D visualization in archaeology, Gillings states: ‘[I]t is worth noting that one of the most striking things about archaeological Virtualmodels is the lack of people in them.
In order to determine whether Aratinga erythrogenys and Brotogeris pyrrhopterus can formally classified as globally threatened species, their distribution, population sizes and ecological requirements are reviewed, together with national and international trade data from the last decade. The study concludes that, on current data, it is not possible to classify the two species formally, but there are strong indications that, at least locally, the populations of the two species are in decline. The causal factors appear to be a combination of high trade levels and habitat loss. It is essential that trade moratoria are implemented, pending the outcome of further research into the species' population sizes, ecology and breeding success, and further work to determine the extent of trade. Interim recommendations are given and it is proposed that future exploitation of the species should continue only when it has been determined that it has a sustainable basis.
A popular email is currently being widely circulated:
Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways, chocolate in one hand, wine in the other, body thoroughly used up, totally worn out and screaming ‘WOO-HOO what a ride!’
What is appealing about this message is its explicit lay challenge to exhortations towards active and healthy ageing: looking after yourself is all fine and good, but what is more important is to indulge and have fun. Of course, few of us live our later lives in terms of this either/or choice. Most of us would like to think that we work at both. Neither is our journey to the grave unaccompanied, but is influenced by those we travel with or meet along the way. Nevertheless, policy echoes both the individualistic focus and the implied dichotomy (Kemp and Denton, 2003), only this time without the fun. The opposite of ‘active’ and ‘healthy’ ageing in later life is seen as a negative dependency.
This chapter develops further our exploration of the notion of active ageing, questioning the limited understanding of this central concept in current policy and research on ageing (ESRC, no date: 2). Elsewhere (Clarke and Warren, 2007), we argue that older people experience active ageing in a diversity of ways, both shared and unique, that are not necessarily captured in existing research, showing how active ageing is important to looking ahead beyond retirement, as well as being understood in terms of people's pasts. This chapter focuses on understanding active ageing as a relational experience. It is based on Clarke's series of biographical interviews with older people, central to which is the belief that to understand ageing we have to examine older people's experiences in the much broader context of their lives (Clarke, 2001). Here we demonstrate that, whether we go for ‘attractive and well preserved’ or ‘worn out and screaming’, choices we make about activity in later life are influenced, and sometimes constrained, by a sense of freedom. But they also place value on participation in wider society.