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To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD), and healthy comparisons (HCs).
A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.
The United States, France, Japan, and China.
Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.
The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).
We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.
Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent.
Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analysed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission.
Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals.
To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia.
The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures.
Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p < 0.001), and participation in community-living activities (p < 0.001).
These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD.
Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo.
Disturbed sleep and activity are prominent features of bipolar disorder type I (BP-I). However, the relationship of sleep and activity characteristics to brain structure and behavior in euthymic BP-I patients and their non-BP-I relatives is unknown. Additionally, underlying genetic relationships between these traits have not been investigated.
Relationships between sleep and activity phenotypes, assessed using actigraphy, with structural neuroimaging (brain) and cognitive and temperament (behavior) phenotypes were investigated in 558 euthymic individuals from multi-generational pedigrees including at least one member with BP-I. Genetic correlations between actigraphy-brain and actigraphy-behavior associations were assessed, and bivariate linkage analysis was conducted for trait pairs with evidence of shared genetic influences.
More physical activity and longer awake time were significantly associated with increased brain volumes and cortical thickness, better performance on neurocognitive measures of long-term memory and executive function, and less extreme scores on measures of temperament (impulsivity, cyclothymia). These associations did not differ between BP-I patients and their non-BP-I relatives. For nine activity-brain or activity-behavior pairs there was evidence for shared genetic influence (genetic correlations); of these pairs, a suggestive bivariate quantitative trait locus on chromosome 7 for wake duration and verbal working memory was identified.
Our findings indicate that increased physical activity and more adequate sleep are associated with increased brain size, better cognitive function and more stable temperament in BP-I patients and their non-BP-I relatives. Additionally, we found evidence for pleiotropy of several actigraphy-behavior and actigraphy-brain phenotypes, suggesting a shared genetic basis for these traits.
The article analyses the development of the coffee export business of the British company Edward Johnston & Co. in the years 1840-1880. Established in 1842 in the city of Rio de Janeiro, the firm's senior partner was the English merchant Edward Johnston. The departure of partners and the crisis of 1847 made Edward Johnston reorganise the firm in Brazil. In the 1850s, the company established itself as a family business based in Liverpool and then in London in the 1860s. The expansion of the coffee market in the United States made Edward Johnston create a network of firms which consolidated the company as a major exporter of Brazilian coffee by the late 1870s.
The Astroinformatics Program is funded by the Chilean Economy Ministry’s (FIE Grant FIE-2016-V022, CORFO Grant 16IFI6626) with the mission to identify and initiate investments to foster Chilean Digital Economy, using Astronomy data-centric tools (known as astroinformatics). Over 2017 we worked with communities across sectors identifying opportunities to achieve the program mission, the Data Observatory vision emerged from that work and will guide design activities throughout 2018.
Pottery-manufacturing sequences can act as proxies for human migration and interaction. A good example is provided by the ‘spiralled patchwork technology’ (SPT) identified at two key early farming sites in the Ligurian-Provencal Arc in the north-west of the Italian peninsula. SPT is distinct from the ceramic technology used by early farmer communities in south-east Italy that shows technical continuity with the southern Balkans. Macroscopic analysis and micro-computed tomography suggests the presence of two communities of practice, and thus two distinct social groups in the northern Mediterranean: one of southern Balkan tradition, the other (associated with SPT) of as yet unknown origin. The identification of SPT opens up the exciting possibility of tracing the origins and migrations of a second distinct group of early farmers into Southern Europe.
Rapid climatic and socio-economic changes challenge current agricultural R&D capacity. The necessary quantum leap in knowledge generation should build on the innovation capacity of farmers themselves. A novel citizen science methodology, triadic comparisons of technologies or tricot, was implemented in pilot studies in India, East Africa, and Central America. The methodology involves distributing a pool of agricultural technologies in different combinations of three to individual farmers who observe these technologies under farm conditions and compare their performance. Since the combinations of three technologies overlap, statistical methods can piece together the overall performance ranking of the complete pool of technologies. The tricot approach affords wide scaling, as the distribution of trial packages and instruction sessions is relatively easy to execute, farmers do not need to be organized in collaborative groups, and feedback is easy to collect, even by phone. The tricot approach provides interpretable, meaningful results and was widely accepted by farmers. The methodology underwent improvement in data input formats. A number of methodological issues remain: integrating environmental analysis, capturing gender-specific differences, stimulating farmers' motivation, and supporting implementation with an integrated digital platform. Future studies should apply the tricot approach to a wider range of technologies, quantify its potential contribution to climate adaptation, and embed the approach in appropriate institutions and business models, empowering participants and democratizing science.
In this paper we study the asymptotic behaviour near extinction of (sub-)critical continuous-state branching processes. In particular, we establish an analogue of Khintchine's law of the iterated logarithm near extinction time for a continuous-state branching process whose branching mechanism satisfies a given condition.
In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands.
An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated.
In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients).
A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.
In this work we study the interfaces between the Mott insulator LaMnO3 (LMO) and the band insulator SrTiO3 (STO) in epitaxially grown superlattices with different thickness ratios and different transport and magnetic behaviors. Using atomic resolution electron energy-loss spectral imaging, we analyze simultaneously the structural and chemical properties of these interfaces. We find changes in the oxygen octahedral tilts within the LaMnO3 layers when the thickness ratio between the manganite and the titanate layers is varied. Superlattices with thick LMO and ultrathin STO layers present unexpected octahedral tilts in the STO, along with a small amount of oxygen vacancies. On the other hand, thick STO layers exhibit undistorted octahedra while the LMO layers present reduced O octahedral distortions near the interfaces. These findings are discussed in view of the transport and magnetic differences found in previous studies.
This chapter describes a rockfall that occurred at Corno Grande, the highest peak in the Apennines, in Italy on August 22, 2006. A limestone block with an estimated volume of about 30,000 m3 fell from the sub-vertical northeast slope of Corno Grande. Although relatively small, the rockfall covered a large area (ca. 35,000 m2) with debris and generated a giant abrasive dust cloud that affected an area of ca. 110,000 m2 at the base of the slope. The dust cloud extended 3 km from the source slope and reached the village of Casale San Nicola. The A24 motorway was temporarily closed due to limited visibility. The rockfall was recorded by a seismometer array located in the nearby Gran Sasso underground laboratories (LNGS – Laboratori Nazionali del Gran Sasso). We processed the seismic data to assess the evolution of the rockfall in terms of mean velocity, impacts, and energy dissipation. The field surveys and data derived from the seismometer array allowed us to constrain the kinematic evolution of the failure. At least three debris impacts can be seen in the available data; they triggered an air blast and the dust cloud.