Objectives: To highlight the importance of differential diagnosis in the psychogeriatric context, with an emphasis on Lewy Body Dementia (LBD).

Case Report: A 68-year-old woman with 6 years of education presented with symptoms of hypobulia, social withdrawal, sadness, and anhedonia 10 years ago. Concurrently, she experienced delusions and visual hallucinations, believing that armed neighbors were entering her house to kill her. She began psychiatric treatment at the Geriatric Psychiatry department at UNIFESP, where she was diagnosed with depressive disorder with psychotic symptoms and panic disorder. She was started on sertraline, and due to QT interval prolongation with risperidone and quetiapine, clozapine 100mg was introduced, without extrapyramidal signs and symptoms She experienced remission of visual hallucinations but developed apathy but started to exhibit periods of mental confusion. During follow-up, cognitive impairment was noted, and a diagnosis of dementia was made. She began forgetting to turn off the stove, leaving doors open, and getting lost in unfamiliar places. MRI of the brain (2017) showed diffuse bilateral atrophy, and SPECT (2018) showed diffuse (non-localized) hypoperfusion, as per medical records. The attending team referred her for joint evaluation, suspecting frontotemporal dementia and behavioral variant Alzheimer’s disease due to observed apathy and behavioral changes. She was referred for follow-up at the Behavioral Neurology Clinic at UNIFESP. The patient was evaluated by behavioral, sleep, and extrapyramidal neurology clinics. All concurred on the most probable diagnosis of Lewy body dementia (LBD), characterized initially by well- defined visual hallucinations of deceased relatives interacting with her, significant movement during sleep with vocalization and dream enactment, rigidity, gait instability that worsened with antipsychotic treatment, episodes of inattention, and marked apathy. Cognitive fluctuation was noted by her husband and confirmed by the application of the MMSE in different consultations. Galantamine 24mg was prescribed, leading to initial improvement in cognitive complaints at the start of treatment.

Discussion: Lewy Body Dementia is the second most common neurodegenerative disease causing dementia. It is believed to be vastly underdiagnosed, with a significant disparity between the number of clinically diagnosed cases and those diagnosed via neuropathology at postmortem autopsy. According to a study conducted by Auning E et al., which differentiated the presenting complaints of DLB and AD, the most common complaint reported by DLB patients was memory dysfunction, with a prevalence of 57%, followed by visual hallucinations (44%), depression (34%), problem-solving difficulties (33%), gait disturbances (28%), and tremor and stiffness (25%), all features presented by the patient in this case report.

Conclusions: Specificity and diagnostic accuracy in the clinical setting remain challenges in the diagnosis of DLB. In the clinical setting, DLB is often misdiagnosed.

The ability to manipulate brain function through the communication between the microorganisms in the gastrointestinal tract and the brain along the gut-brain axis has emerged as a potential option to improve cognitive and emotional health. Dietary composition and patterns have demonstrated a robust capacity to modulate the microbiota-gut-brain axis. With their potential to possess pre-, pro-, post-, and synbiotic properties, dietary fibre and fermented foods stand out as potent shapers of the gut microbiota and subsequent signalling to the brain. Despite this potential, few studies have directly examined the mechanisms that might explain the beneficial action of dietary fibre and fermented foods on the microbiota-gut-brain axis, thus limiting insight and treatments for brain dysfunction. Herein, we evaluate the differential effects of dietary fibre and fermented foods from whole food sources on cognitive and emotional functioning. Potential mediating effects of dietary fibre and fermented foods on brain health via the microbiota-gut-brain axis are described. Although more multimodal research that combines psychological assessments and biological sampling to compare each food type is needed, the evidence accumulated to date suggests that dietary fibre, fermented foods, and/or their combination within a psychobiotic diet can be a cost-effective and convenient approach to improve cognitive and emotional functioning across the lifespan.

In this paper the configurations of shock wave–boundary layer interactions (SWBLI) are studied theoretically and experimentally in Mach number 2 and 2.5 flows on test models with various wedge angles ranging from $9^\circ$ to $21^\circ$. The proposed theoretical method couples the free interaction theory (FIT) with the minimum entropy production (MEP) principle to predict the appearance of separation shock, resulting in convex, straight and concave separation shock waves according to different solution combinations, which agree well with current experiments. Additionally, several influences on SWBLI are studied experimentally, in which the parameters related to theoretical solutions are found mostly determining the flow configuration, and SWBLI is much more sensitive to incident shock strength than incoming flow properties. Separation could be suppressed by incident shock when the MEP solution is smaller than the FIT, while it could be intensified when the MEP solution is larger than FIT; by contrast, the effects of separation position and model mounting height could be very weak.

Several preclinical studies have demonstrated neuronal effects of glucocorticoids on the hippocampus (HC), a limbic structure with anterior–posterior anatomical and functional segmentation. We propose a volumetric magnetic resonance imaging analysis of hippocampus head (HH), body (HB) and tail (HT) using Cushing's disease (CD) as model, to investigate whether there is a differential sensitivity to glucocorticoid neuronal damage in these segments. We found a significant difference in the HH bilaterally after 12 months from trans-sphenoidal surgical selective resection of the adrenocorticotropic hormone (ACTH)-secreting pituitary micro-adenomas. This pre–post surgery difference could contribute to better understand the pathopysiology of CD as an in vivo model for stress-related hypercortisolemic neuropsychiatric disorders.

Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms ‘nutraceuticals’, ‘dietary supplements’, ‘herbal drug’ and ‘heart failure’ or ‘left verntricular dysfunction’ were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.

Both blood- and milk-based biomarkers have been analysed for decades in research settings, although often only in one herd, and without focus on the variation in the biomarkers that are specifically related to herd or diet. Biomarkers can be used to detect physiological imbalance and disease risk and may have a role in precision livestock farming (PLF). For use in PLF, it is important to quantify normal variation in specific biomarkers and the source of this variation. The objective of this study was to estimate the between- and within-herd variation in a number of blood metabolites (β-hydroxybutyrate (BHB), non-esterified fatty acids, glucose and serum IGF-1), milk metabolites (free glucose, glucose-6-phosphate, urea, isocitrate, BHB and uric acid), milk enzymes (lactate dehydrogenase and N-acetyl-β-D-glucosaminidase (NAGase)) and composite indicators for metabolic imbalances (Physiological Imbalance-index and energy balance), to help facilitate their adoption within PLF. Blood and milk were sampled from 234 Holstein dairy cows from 6 experimental herds, each in a different European country, and offered a total of 10 different diets. Blood was sampled on 2 occasions at approximately 14 days-in-milk (DIM) and 35 DIM. Milk samples were collected twice weekly (in total 2750 samples) from DIM 1 to 50. Multilevel random regression models were used to estimate the variance components and to calculate the intraclass correlations (ICCs). The ICCs for the milk metabolites, when adjusted for parity and DIM at sampling, demonstrated that between 12% (glucose-6-phosphate) and 46% (urea) of the variation in the metabolites’ levels could be associated with the herd-diet combination. Intraclass Correlations related to the herd-diet combination were generally higher for blood metabolites, from 17% (cholesterol) to approximately 46% (BHB and urea). The high ICCs for urea suggest that this biomarker can be used for monitoring on herd level. The low variance within cow for NAGase indicates that few samples would be needed to describe the status and potentially a general reference value could be used. The low ICC for most of the biomarkers and larger within cow variation emphasises that multiple samples would be needed - most likely on the individual cows - for making the biomarkers useful for monitoring. The majority of biomarkers were influenced by parity and DIM which indicate that these should be accounted for if the biomarker should be used for monitoring.

Unbalanced metabolic status in the weeks after calving predisposes dairy cows to metabolic and infectious diseases. Blood glucose, IGF-I, non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHB) are used as indicators of the metabolic status of cows. This work aims to (1) evaluate the potential of milk mid-IR spectra to predict these blood components individually and (2) to evaluate the possibility of predicting the metabolic status of cows based on the clustering of these blood components. Blood samples were collected from 241 Holstein cows on six experimental farms, at days 14 and 35 after calving. Blood samples were analyzed by reference analysis and metabolic status was defined by k-means clustering (k=3) based on the four blood components. Milk mid-IR analyses were undertaken on different instruments and the spectra were harmonized into a common standardized format. Quantitative models predicting blood components were developed using partial least squares regression and discriminant models aiming to differentiate the metabolic status were developed with partial least squares discriminant analysis. Cross-validations were performed for both quantitative and discriminant models using four subsets randomly constituted. Blood glucose, IGF-I, NEFA and BHB were predicted with respective R2 of calibration of 0.55, 0.69, 0.49 and 0.77, and R2 of cross-validation of 0.44, 0.61, 0.39 and 0.70. Although these models were not able to provide precise quantitative values, they allow for screening of individual milk samples for high or low values. The clustering methodology led to the sharing out of the data set into three groups of cows representing healthy, moderately impacted and imbalanced metabolic status. The discriminant models allow to fairly classify the three groups, with a global percentage of correct classification up to 74%. When discriminating the cows with imbalanced metabolic status from cows with healthy and moderately impacted metabolic status, the models were able to distinguish imbalanced group with a global percentage of correct classification up to 92%. The performances were satisfactory considering the variables are not present in milk, and consequently predicted indirectly. This work showed the potential of milk mid-IR analysis to provide new metabolic status indicators based on individual blood components or a combination of these variables into a global status. Models have been developed within a standardized spectral format, and although robustness should preferably be improved with additional data integrating different geographic regions, diets and breeds, they constitute rapid, cost-effective and large-scale tools for management and breeding of dairy cows.

The variation of transitional flow features past a micro-ramp is investigated when the Reynolds number is decreased approaching the critical regime. Experiments are conducted in the incompressible flow spanning from supercritical to subcritical roughness-height-based Reynolds number ($Re_{h}=1170$, 730, 460 and 320) with tomographic particle image velocimetry. The effect of $Re_{h}$ on three-dimensional flow behaviour is analysed in a domain encompassing 73 ramp heights in the streamwise direction. Above the critical $Re_{h}$, the primary vortex pair and induced central low-speed region in the mean flow field are active over longer range when decreasing $Re_{h}$. In the instantaneous flow, at $Re_{h}<1000$, the hairpin vortices induced by Kelvin–Helmholtz (K–H) instability progress gradually from close to the micro-ramp into the region where the overall shear layer is destabilized, indicating the correlation between the K–H instability and the onset of transition. The breakdown of K–H vortices as observed at $Re_{h}=1170$, does not occur at lower $Re_{h}$. Decreasing $Re_{h}$, the secondary vortex structures make their first appearance significantly downstream, postponing the formation of sideward disturbances, which destabilize the local shear layer by ejection events. Two major types of eigenmodes with symmetric and asymmetric spatial distribution of velocity fluctuations in the near wake are clearly identified by proper orthogonal decomposition. The symmetric and asymmetric modes correspond to the presence of vortex shedding and a sinuous wiggling motion respectively. It is found that $Re_{h}$ is the key factor determining the importance of the symmetric mode. At $Re_{h}=1170$, the disturbance energy of the symmetric mode decays before the onset of transition, suggesting that it is relatively insignificant in the process. However, decreasing $Re_{h}$ to 730 and 460, the symmetric mode produces continuous growth of high level disturbance energy, leading to transition.

The early stage of three-dimensional laminar-to-turbulent transition behind a micro-ramp is studied in the incompressible regime using tomographic particle image velocimetry. Experiments are conducted at supercritical micro-ramp height $h$ based Reynolds number $Re_{h}=1170$. The measurement domain encompasses 6 ramp widths spanwise and 73 ramp heights streamwise. The mean flow topology reveals the underlying vortex structure of the wake flow with multiple pairs of streamwise counter-rotating vortices visualized by streamwise vorticity. The primary pair generates a vigorous upwash motion in the symmetry plane with a pronounced momentum deficit. A secondary vortex pair is induced closer to the wall. The tertiary and even further vortices maintain a streamwise orientation, but are produced progressively outwards of the secondary pair and follow a wedge-type pattern. The instantaneous flow pattern reveals that the earliest unstable mode of the wake features arc-like Kelvin–Helmholtz (K–H) vortices in the separated shear layer. Under the influence of the K–H vortices, the wake exhibits a high level of fluctuations with a pulsatile mode for the streamwise momentum deficit. The K–H vortices are lifted up due to the upwash induced by the quasi-streamwise vortex pair, while they appear to undergo pairing, distortion and finally breakdown. Immediately downstream, a streamwise interval of relatively low vortical activity separates the end of the K–H region from the formation of new hairpin vortices close to the wall. The latter vortex structures originate from the region of maximum wall shear, induced by the secondary vortex pair causing strong ejection events which transport low-speed flow upwards. The whole pattern features a cascade of hairpin vortices along a turbulent/non-turbulent interface. The wedge-shaped cascade signifies the formation of a turbulent wedge. The turbulent properties of the wake are inspected with the spatial distribution of the velocity fluctuations and turbulence production in the developing boundary layer. Inside the wedge region, the velocity fluctuations approach quasi-spanwise homogeneity, indicating the development towards a turbulent boundary layer. The wedge interface is characterized by a localized higher level of velocity fluctuations and turbulence production, associated to the deflection of the shear layer close to the wall and the onset of coherent hairpin vortices inducing localized large-scale ejections.

The present study was undertaken to examine the effect of cow genetic merit on enteric methane (CH4) emission rate. The study used a data set from 32 respiration calorimeter studies undertaken at this Institute between 1992 and 2010, with all studies involving lactating Holstein-Friesian dairy cows. Cow genetic merit was defined as either profit index (PIN) or profitable lifetime index (PLI), with these two United Kingdom genetic indexes expressing the expected improvement in profit associated with an individual cow, compared with the population average. While PIN is based solely on milk production, PLI includes milk production and a number of other functional traits including health, fertility and longevity. The data set had a large range in PIN (n=736 records, −£30 to +£63) and PLI (n=548 records, −£131 to +£184), days in milk (18 to 354), energy corrected milk yield (16.0 to 45.6 kg/day) and CH4 emission (138 to 598 g/day). The effect of cow genetic merit (PIN or PLI) was evaluated using ANOVA and linear mixed modelling techniques after removing the effects of a number of animal and diet factors. The ANOVA was undertaken by dividing each data set of PIN and PLI into three sub-groups (PIN:<£3, £3 to £15 and >£15, PLI:<£23, £23 to £67 and >£67) with these being categorised as low, medium and high genetic merit. Within the PIN and PLI data sets there was no significant differences among the three sub-groups in terms of CH4 emission per kg feed intake or per kg energy corrected milk yield, or CH4 energy (CH4-E) output as a proportion of energy intake. Linear regression using the whole PIN and PLI data sets also demonstrated that there was no significant relationship between either PIN or PLI, and CH4 emission per kg of feed intake or CH4-E output as a proportion of energy intake. These results indicate that cow genetic merit (PIN or PLI) has little effect on enteric CH4 emissions as a proportion of feed intake. Instead enteric CH4 production may mainly relate to total feed intake and dietary nutrient composition.

This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.