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Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains.
Method:
Older adults with major depressive disorder (N = 228, ages 65–91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning.
Results:
Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity.
Conclusions:
Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.
Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.
Participants and Measurements:
Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.
Results:
Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.
Conclusions:
Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Let $F_{\pi }$ be a finite Galois-algebra extension of a number field F, with group G. Suppose that $F_{\pi }/F$ is weakly ramified and that the square root $A_\pi $ of the inverse different $\mathfrak {D}_{\pi }^{-1}$ is defined. (This latter condition holds if, for example, $|G|$ is odd.) Erez has conjectured that the class $(A_\pi )$ of $A_\pi $ in the locally free class group $\operatorname {\mathrm {Cl}}(\mathbf {Z} G)$ of $\mathbf {Z} G$ is equal to the Cassou–Noguès–Fröhlich root number class $W(F_{\pi }/F)$ associated with $F_\pi /F$. This conjecture has been verified in many cases. We establish a precise formula for $(A_\pi )$ in terms of $W(F_{\pi }/F)$ in all cases where $A_\pi $ is defined and $F_\pi /F$ is tame, and are thereby able to deduce that, in general, $(A_\pi )$ is not equal to $W(F_\pi /F)$.
We explore whether ageist stereotypes in job ads are detectable using machine-learning methods measuring the linguistic similarity of job-ad language to ageist stereotypes identified by industrial psychologists. We then conduct an experiment to evaluate whether this language is perceived as biased against older workers searching for jobs. We find that job-ad language classified by the machine-learning algorithm as closely related to ageist stereotypes is perceived by experimental subjects as biased against older job seekers. These methods could potentially help enforce anti-discrimination laws by using job ads to predict or identify employers more likely to be engaging in age discrimination.
There has been growing interest in the vertical integration of physicians and hospitals during the past decade, as evidenced by multiple literature reviews and research investigations.1 Historically, physicians operated small firms that provided “physicians’ services” to patients who sometimes used facilities provided by separate hospital firms at which many physicians would have “privileges.” This interest in combining the two types of organizations culminated in a December 2020 issue of Health Services Research devoted to the topic that expressed surprise (and disappointment) that integration is not “a miracle cure”.2 Just months earlier, two of the major proponents of vertical integration published a study in the August issue of Health Affairs that came to a similar, “startling” conclusion: the financial integration of physicians and hospitals (e.g., via employment) had no impact on their clinical integration (and perhaps none on quality).
Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the proven with regard to how care is rendered, how patients can be in control, how providers should be paid, and how disparities can be reduced – and they also identify the issues for which evidence is currently missing. It provides an antidote to frustration and a clear-eyed guide for forward progress, helping health care and insurance innovators make better decisions on deciding whether to go ahead now based on current evidence, to seek and wait for additional evidence, or to move on to different ideas. It will be useful to practitioners in hospital systems, medical groups, and insurance organizations and can also be used in executive and MBA teaching.
Article V of the U.S. Constitution, which establishes the formal amendment procedure, sets perhaps the highest bar to reform of any national constitution, discouraging amendment. But despite these challenges, members of Congress have proposed nearly twelve thousand constitutional amendments, with most introduced after the New Deal, raising questions about why members engage in such seemingly futile efforts. We argue that the rise of judicial power following the New Deal substantially decreased the importance of Article V as a tool for constitutional reform. But, by largely abandoning this purpose, members of Congress have repurposed Article V as a mechanism for constitutional position-taking, even though—indeed, perhaps precisely because—their efforts at formal constitutional revision have little chance for success. Through a mixed-methods approach, we first document the shifting purpose of Article V at an aggregate level by coding all 11,969 proposed constitutional amendments throughout American history. We then substantiate the shifting purpose of Article V through a series of in-depth case studies focused on polygamy, women's suffrage, Equal Rights Amendments, and Federal Marriage Amendments. Taken together, this evidence helps us understand Article V as a repurposed institution and suggests that textually static constitutional provisions nonetheless may be open to reinvention at the behavioral level in subtle but important ways.
We develop methods for constructing explicit generators, modulo torsion, of the $K_3$-groups of imaginary quadratic number fields. These methods are based on either tessellations of hyperbolic $3$-space or on direct calculations in suitable pre-Bloch groups and lead to the very first proven examples of explicit generators, modulo torsion, of any infinite $K_3$-group of a number field. As part of this approach, we make several improvements to the theory of Bloch groups for $ K_3 $ of any field, predict the precise power of $2$ that should occur in the Lichtenbaum conjecture at $ -1 $ and prove that this prediction is valid for all abelian number fields.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
Aims
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
Method
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
Results
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Conclusions
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
Previous work suggests low intakes of fruit and vegetables (FV) across the world, poor knowledge of the details of FV recommendations, and associations between the two. This work aimed to develop an interactive mobile phone application (app) to facilitate adherence to the UK 5-a-day FV recommendations, and reports on the findings and feedback from the first test of the prototype.
Materials and Methods
Requirements for the app were first gained from previous research and potential end-users via four public engagement workshops, and prioritised using the MoSCoW method. A prototype app was then designed and developed using an agile approach. The prototype app was then tested in a randomized controlled pilot trial for impacts on FV knowledge and FV intake. Ninety-four adult volunteers were randomized to either receive (N = 50) or not receive the app (N = 44) for two or four weeks, and FV knowledge, self-report FV intakes, and FV behaviour (complimentary drink choice), were assessed at study start and study end. App use and feedback were also investigated.
Results
Low knowledge of the FV recommendations centred around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving knowledge in a practical manner, that would be available both at time of consumption and outside of these times. Findings revealed improved FV behaviour in volunteers who received the app for two weeks at study end: 16 app users chose a fruit drink, compared to 4 app users who chose a non-fruit drink, where 4 control volunteers also chose a fruit drink and 6 control volunteers chose a non-fruit drink. App users also suggested increased FV intakes, but changes were small, and possibly masked in questionnaire measures. Improvements in FV knowledge (of approx. 10%) were also found, but with no differences between groups. App usage was low and feedback suggested a desire for reminder notifications and a wish to return to the input for a previous day due to forgetting. Increased awareness of low FV intakes was also offered as feedback.
Discussion
Our prototype app was well received and of potential benefit. A final version of the app was subsequently developed incorporating the findings and feedback from the pilot test. Improvements in the final version of the app include a message to increase awareness of low intakes and an option to add notifications to increase use. Testing of the final app is now needed.
We investigate the Galois structures of $p$-adic cohomology groups of general $p$-adic representations over finite extensions of number fields. We show, in particular, that as the field extensions vary over natural families the Galois modules formed by these cohomology groups always decompose as the direct sum of a projective module and a complementary module of bounded $p$-rank. We use this result to derive new (upper and lower) bounds on the changes in ranks of Selmer groups over extensions of number fields and descriptions of the explicit Galois structures of natural arithmetic modules.
Experiments were conducted to compare barnyardgrass control and rice injury and yield with emulsifiable concentrate and dry flowable formulations of propanil as single or repeat applications with crop oil concentrate, methylated seed oil, a blend of organosilicone surfactant and methylated seed oil or conventional nonionic surfactant, and organosilicone surfactant. Two applications of propanil were more effective in controlling barnyardgrass than a single application. The emulsifiable concentrate formulation of propanil controlled barnyardgrass more effectively than the dry flowable formulation in some but not all experiments. Differences in barnyardgrass control with propanil as influenced by adjuvants were minor and inconsistent. The most consistent barnyardgrass control and the highest rice yields were obtained with repeat applications of the emulsifiable concentrate formulation of propanil.