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The complexity of movement disorders poses challenges for clinical management and research. Functional imaging with PET or SPECT allows in-vivo assessment of the molecular underpinnings of movement disorders, and biomarkers can aid clinical decision making and understanding of pathophysiology, or determine patient eligibility and endpoints in clinical trials. Imaging targets traditionally include functional processes at the molecular level, typically neurotransmitter systems or brain metabolism, and more recently abnormal protein accumulation, a pathologic hallmark of neurodegenerative diseases. Functional neuroimaging provides complementary information to structural neuroimaging (e.g. anatomic MRI), as molecular/functional changes can present in the absence of, prior to, or alongside structural brain changes. Movement disorder specialists should be aware of the indications, advantages and limitations of molecular functional imaging. An overview is given of functional molecular imaging in movement disorders, covering methodologic background information, typical molecular changes in common movement disorders, and emerging topics with potential for greater future importance.
The UN's urban sustainability goal number eleven (11) is fundamental to the global sustainable development agenda. David Simon explains the anatomy and dynamics of SDG 11, and critically assess how it is being used and understood in different local, regional and national contexts.
Supported by case studies throughout, Simon considers how SDG 11 interacts with other Sustainability Development Goals and how competing indicators, other external constraints, as well as lack of political will can present tough challenges to implementation. He provides a balanced and dispassionate analysis, highlighting problems and limitations alongside positive applications. A key aspect of the unfolding story of the SDGs is how they play out in practice. Although some of the connections and complementarities were designed, others are shown to have emerged by default. Drawing on lessons learnt so far, Simon considers how realistic sustainability goals are for cities and human settlements worldwide, and asks how different will cities be by the end of the SDG's 15-year lifespan in 2030?
Written for students, policy-makers and practitioners, the book provides an authoritative assessment of one of the most important and integrative SDGs.
This paper presents a flexible SiGe monolithic microwave integrated circuit (MMIC) chipset for 120 GHz ultra-wideband frequency-modulated continuous wave radar systems. The highly integrated chipset is implemented with multiple-input and multiple-output radar in mind which leads to transmit and receive MMICs with four integrated channels in each chip. The transmitter achieves an output power of 12.9 dBm with a total power consumption of only 403 mW. The receiver chip incorporates a sub-harmonic approach for suppression of leakage radiation at 120 GHz through a receive channel. Both chips integrate active multiplier chains that are driven by a third reference dual band voltage-controlled oscillator (VCO) MMIC that can deliver an output at center frequencies of 15 or 30 GHz. The reference VCO MMIC demonstrates relative tuning ranges of 32%.
Sport climbing requires a combination of physical and cognitive skills, with working memory (WM) playing a crucial role in performance. This study aimed to investigate the association between WM capacity and climbing ability, while considering potential confounding factors including sex, age, education level, and climbing experience. Additionally, the study compared prefrontal cortex (PFC) hemodynamic responses among different climbing ability groups and sex during WM performance. Twenty-eight climbers participated, with WM assessed using the eCorsi task and PFC hemodynamic responses measured with near infrared spectroscopy (NIRS). Initial linear regression analyses revealed no association between WM and climbing ability. However, significant associations were found after adjustment for covariates. Specifically, sex (p = .014), sex in conjunction with age (p = .026), sex combined with climbing experience (p = .022), and sex along with education level (p = .038) were identified as significant predictors of differences in WM between Expert and Elite climbers. Additionally, notable differences in PFC hemodynamic responses were observed between Expert and Elite climbers, as well as between sexes during the WM task, providing support for differences in WM capacity. This study contributes to understanding the complex relationship between WM capacity and climbing performance, emphasizing the need to account for influencing factors in assessments.
Declining labor force participation of older men throughout the 20th century and recent increases in participation have generated substantial interest in understanding the effect of public pensions on retirement. The National Bureau of Economic Research's International Social Security (ISS) Project, a long-term collaboration among researchers in a dozen developed countries, has explored this and related questions. The project employs a harmonized approach to conduct within-country analyses that are combined for meaningful cross-country comparisons. The key lesson is that the choices of policy makers affect the incentive to work at older ages and these incentives have important effects on retirement behavior.
We examine how media reports influenced trading volumes and order imbalances on the Sydney Stock Exchange (SSX) from 1901 to 1950, focusing on wool market reports as a substitute for broader financial advice in the absence of a specialised investment press. Given wool's status as Australia's primary export and its integration with various sectors, we construct a weekly media sentiment index based on news about wool sales and auctions from the Sydney Morning Herald. Our findings reveal that positive news about the wool market correlates with increased trading volumes and reduced order imbalances on the SSX. This relationship persisted during significant events such as the UK government's wool purchase plans, the 1929 Wall Street Crash, World War II-related trading restrictions, and the short selling ban.
The authors report on ancient DNA data from two human skeletons buried within the chancel of the 1608–1616 church at the North American colonial settlement of Jamestown, Virginia. Available archaeological, osteological and documentary evidence suggest that these individuals are Sir Ferdinando Wenman and Captain William West, kinsmen of the colony's first Governor, Thomas West, Third Baron De La Warr. Genomic analyses of the skeletons identify unexpected maternal relatedness as both carried the mitochondrial haplogroup H10e. In this unusual case, aDNA prompted further historical research that led to the discovery of illegitimacy in the West family, an aspect of identity omitted, likely intentionally, from genealogical records.
This Element addresses a burning question – how can archaeologists best identify and interpret cultural burning, the controlled use of fire by people to shape and curate their physical and social landscapes? This Element describes what cultural burning is and presents current methods by which it can be identified in historical and archaeological records, applying internationally relevant methods to Australian landscapes. It clarifies how the transdisciplinary study of cultural burning by Quaternary scientists, historians, archaeologists and Indigenous community members is informing interpretations of cultural practices, ecological change, land use and the making of place. This title is also available as Open Access on Cambridge Core.
As technological improvements advance, the use of remote monitoring is among the new diagnostic tools that have become a growing part of medical care delivery. But reliance on technologies also challenges the traditional liability schemes that exist to deter negligent physician behavior and compensate injured patients. Liability can arise at each point in a remote monitoring system, from when information is gathered by a device, to when it is processed by an algorithm, and, finally, used by a physician. This chapter explores how different types of liability might arise for device manufacturers and physicians at each of these stages, outlining the main legal rules and complicating factors.
In the Basilicata region, located in southern Italy and known for hosting among the first occurrences of the Acheulean culture in southwestern Europe, the Lower Paleolithic site of Loreto at Venosa is located less than a kilometer from the emblematic site of Notarchirico and less than 25 km from Cimitero di Atella. The Loreto site has not been studied as thoroughly as the two other sites and, although geological investigations have been carried out in the Venosa basin, no direct numerical dating has ever been published for the three archaeological levels brought to light during the excavation campaigns. We present a multi-method geochronological approach combining ESR/U-series, ESR, and 40Ar/39Ar permitting to refine the age of the most ancient archaeological level (A) of the Loreto site. These data allow us to propose an MIS 13 age for this level, in accordance with previous hypotheses based on geological and paleontological data. We also propose a technical review of the lithic tools preserved in the collection of the National Archaeological Museum of Venosa to integrate Loreto in the evolution scheme of the European Acheulean techno-complex emergence and diffusion.
A quaternary ammonium and alcohol-based disinfectant with reported continuous activity demonstrated reduced microbial buildup on surfaces over time compared to routine disinfectants without continuous activity in in vitro and hospital studies. We compared these disinfectants in ambulatory settings and found no difference in bioburden on high-touch surfaces over time.
INDUCT (Interdisciplinary Network for Dementia Using Current Technology), and DISTINCT (Dementia Inter-sectorial strategy for training and innovation network for current technology) are two Marie Sklodowska-Curie funded International Training Networks that aimed to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia.
Methods:
In INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support everyday life; technology to promote meaningful activities; and healthcare technology. In DISTINCT (2019-2023) 15 Early Stage Researchers worked on technology to promote Social health in three domains: fulfilling ones potential and obligations in society, managing one’s own life, and participation in social and other meaningful activities.
Both networks adopted three transversal objectives: 1) To determine practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; 3) To trace facilitators and barriers for implementation of technology in dementia care.
Results:
The main recommendations resulting from all research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which was recently updated (Dec 2022 and June 2023) and will be presented at the congress. The recommendations are meant for different target groups, i.e. people in different stages of dementia, their (in)formal carers, policy makers, designers and researchers, who can easily find the recommendations relevant to them in the Best Practice Guidance by means of a digital selection tool.
Conclusions:
The INDUCT/DISTINCT Best Practice Guidance informs on how to improve the development, usage, impact and implementation of technology for people with dementia in various technology areas. This Best Practice Guidance is the result of intensive collaborative partnership of INDUCT and DISTINCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the projects.
There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.
Method
Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.
Results
The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.
Conclusion
All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.
Most previous studies of the kaolin deposits in the southeastern United States have focused on their mineralogy and petrology to understand better the depositional and diagenetic environments of the kaolins. Many studies suggest, however, that much of the information held within the minerals was changed during extensive post-depositional groundwater and microbial alteration. Organic δ13C and biomarker analyses were used, therefore, to provide further information on the nature of the original sediments, the depositional environment(s), and the amount of diagenetic alteration that has occurred in Georgia kaolin deposits.
Two different types of kaolin can be discerned, based on their total organic carbon contents: organic-lean kaolin and lignitic kaolin. The bulk organic δ13C in the Georgia kaolins ranges from ~−26 to −19% (VPDB, Vienna Pee Dee Belemnite standard), with a noticeable enrichment in 13C with decrease in organic carbon concentration. The lean kaolins are by far the more dominant types, with an organic-matter composition primarily of C16–C22n-alkanes, C16 and C18 fatty acids, and unresolved complex mixtures. Lignitic kaolin has a distinctly different organic matter (OM) composition. The lignitic material is primarily C15–C33n-alkanes with a greater abundance of C23–C31n-alkanes and lesser amounts of resinous and microbial constituents along with the oxidized forms of the saturated lipid fractions.
Biomarker data suggest that the lignitic material is primarily terrestrially derived from conifers with minor input from microbial lipids. The OM in both types of kaolin shows strong signs of microbial decomposition that yield the organically lean kaolins. The oxidation of the detrital organic matter would subsequently yield organic acids that would have exerted significant influence on the mineralogy and metal mobility.
In Australia, 18F-fluorodeoxyglucose positron emission tomography with low-dose computed tomography (FDG-PET/CT) is currently only funded for cancer staging-related indications. A recent multicenter randomized trial demonstrated that FDG-PET/CT, compared with standard of care computed tomography (CT) imaging, improved antimicrobial management and the outcomes of patients with persistent and recurrent neutropenic fever. There is potential value in expanding the use of FDG-PET/CT as a diagnostic tool for this high-risk population. We conducted an economic evaluation from a healthcare perspective alongside the randomized trial and compared FDG-PET/CT with standard CT up to 6 months after the scans.
Methods
Case report forms were used to collect resource utilization data and length of hospitalization. Effectiveness was measured as the number of patients with antimicrobial rationalization and quality-adjusted life-years (QALYs) derived from patient-reported trial-based health-related quality of life. Generalized linear models (GLM) were used to analyze costs and outcomes. Incremental cost-effectiveness ratios (ICERs) for each of the outcomes were calculated and interpreted as the cost per patient with antimicrobial rationalization and cost per QALY gained. To account for sampling, we performed bootstrapping with 1,000 replications using the recycled predictions method.
Results
The adjusted healthcare costs were lower in the FDG-PET/CT group (mean AUD49,563, 95% confidence interval [CI]: 36,867, 65,133; equivalent to USD34,268, 95% CI: 25,490, 45,033) compared with the standard CT group (mean AUD57,574, 95% CI: 44,837, 73,347; equivalent to USD39,807, 95% CI: 31,000, 50,712). The magnitude of differences in QALYs between the two groups was small (0.001; 95% CI: -0.001, -0.001). When simulated 1,000 times, our analysis showed that across both outcomes FDG-PET/CT was the dominant strategy as it was cheaper and had better outcomes than standard CT in 74 percent of simulations.
Conclusions
FDG-PET/CT is cost effective when compared with standard CT for investigating persistent or recurrent neutropenic fever in high-risk patients. Aligning economic evaluations with clinical studies is key to an integrated evidence generation approach for supporting funding for FDG-PET/CT in this patient group.
The International Federation of Medical and Biological Engineering created a multidisciplinary working group to discuss assessments of artificial intelligence and machine learning (AI/ML) applications in health care. Engineers, clinicians, and economists identified evidence generation as a critical topic. Heart failure (HF) was selected to investigate the available evidence on the clinical effectiveness and safety of AI/ML applications. Attention was paid to transparency of AI/ML methods and their data sources.
Methods
A scoping review was conducted on AI/ML algorithms developed for the management of HF. A search for systematic reviews, scoping reviews, and meta-analyses published from 1976 to October 2022 was conducted in Embase, MEDLINE, and Scopus.
Results
Of 456 relevant publications, 21 papers were included in the final analysis. Most papers (10 systematic reviews, five meta-analyses, and six non-systematic or scoping reviews) included studies conducted in North America. No study was conducted in Africa. The healthcare setting was not clearly stated in approximately half of the studies. A lack of agreement was noticed regarding the quality assessment tools used among the reviews. The most common data source for AI/ML algorithms was electronic health records, but in some cases data sources were not reported. While deep learning emerged as the most common adopted methodology, covariates were not always included in the algorithm development. The review demonstrated that comparative assessment of algorithms requires further investigation, given the high variability in the comparator used (e.g., clinical gold standard, other AI/ML algorithms, or other statistical methods). The main investigated endpoints were the incidence of HF and the number of hospital admissions.
Conclusions
When assessing innovative health technologies such as AI/ML applications in health care, evidence is among the main challenges. Our scoping review, focusing on algorithms developed to manage HF, showed that the biggest challenges relate to the quality of the studies, the adoption of a comparative approach, and transparency of methods.
On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; 75% were women, and the mean age was 85.1 years (± 9). Most patients were unable to walk. A total of 30 basic life support (BLS) ambulances, 3 advanced cardiac life support (ACLS) teams on fast cars, 2 buses, and 1 coordination team were deployed. A scoop and run approach was adopted with patients being transported to 15 health care facilities. The event was terminated at 5:43 am. Though the local mass casualty incident (MCI) response plan was correctly applied, the evacuation of the building was difficult due to the age and comorbidities of the patients. START failed to correctly identify patients categorized as minor. Communication problems arose on site that led to the late evacuation of critical patients.