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Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke.
We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery.
We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone.
Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%.
The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.
The sustainability of indigenous customary hunting and fishing in remote areas can be influenced by human factors operating at global as well as regional and local scales because of the hybrid nature and sectoral interactions of the local economic environment. The internationally significant population of dugongs (Dugong dugon or seacow) in Torres Strait between Australia and Papua New Guinea supports an important indigenous fishery. The economic, socio-cultural and environmental factors that influenced hunting activity in 1998 and 1999 by the members of the community of Mabuiag Island were investigated to inform the sustainable management of the fishery. The landed catch during the eight months March to October of 145 dugongs in 1998 and 170 dugongs in 1999 potentially provided the community with an average of 290 g of dugong meat per person per day. Fifty-seven per cent of adult males on the island participated in dugong hunting, but more than half the catch in each year was caught by only two hunters. The probability of at least one person from the community going dugong hunting in 1998 and 1999 was 0.59 ± 0.02 per day. This probability was influenced by local environmental factors, including the abundance of dugongs in the traditional hunting grounds (affected by wind speed, year, season and lunar day) and the size of the commercial crayfish catch (which is influenced by the global market price, as well as local conditions). Although dugong hunting remains a very important part of the islanders’ contemporary culture and customary economy, the capacity to hunt dugongs is facilitated by the ease with which some hunters move between the state, commercial and customary sectors of their local economy. The complexities of the economic, social and cultural environments need to be considered in planning for the sustainable harvesting of threatened species by remote indigenous communities.
A significant proportion of the world's remaining dugongs (Dugong dugon) occur off northern Australia where they face various anthropogenic impacts. Here, we investigate the viability of two dugong meta-populations under varying regimes of indigenous hunting. We construct population viability analyses (PVAs) using the computer package VORTEX and published estimates of population sizes and hunting rates. In Torres Strait between Cape York and New Guinea, our models predict severe and imminent reductions in dugong numbers. Our ‘optimistic’ and ‘pessimistic’ models suggest median times for quasi-extinction of 123 and 42 years, respectively. Extinction probabilities are also high for eastern Cape York Peninsula. We demonstrate the inadequacy of reserves when harvest rates in neighbouring areas are high, identify the maximum harvest rates for meta-population stability and emphasise the urgent need for indigenous community involvement in management to establish sustainable rates of dugong harvest in these regions.
The globally significant dugong population of Torres Strait supports an important indigenous fishery for meat and oil. The fishery is protected by the Torres Strait Treaty between Australia and Papua New Guinea. A time series of aerial survey estimates from 1987–2001 confirms that there is considerable temporal variability in the size of the dugong population in the region and adds to a growing body of evidence from other aerial surveys and satellite tracking that dugongs undertake large-scale movements associated with temporal and spatial changes in the distribution of their seagrass food. The magnitude of these effects on both the size of the population and the catch cannot be disaggregated from the effects of population depletion from over-harvesting. The Potential Biological Removal method was used in conjunction with the aerial survey data to estimate sustainable anthropogenic mortality from all causes for a range of empirically-derived estimates of dugong life-history parameters. These estimates of a sustainable harvest are so far below the current harvest that it must be unsustainable. Governments should heed the Islanders' requests for assistance in implementing co-management of the fishery as a matter of urgency.
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