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Dementia’s prevalence increases due to population aging, it has become a major public health concern.
To estimate the incidence of dementia and to describe the socio-demographic and clinical profile of patients attended in the psychiatry department of Gabes (Southern of Tunisia).
It was a retrospective descriptive study including all the patients who attended for the first time in the psychiatry department of Gabes, from the 1st January, 2010 to December 31, 2018, and who were diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Socio-demographic and clinical data were assessed. The Mini Mental State Examination (MMSE) was used as a neuropsychological examination.
We included 98 patients. The mean annual hospital incidence of dementia was 2.38%. The mean age was 76.5 ± 9.8 years. Patients were married (68%), illiterate (68%) and jobless (42.9%). A family history of dementia was noted in 39.8% of patients. The common cardiovascular comorbidity was high blood pressure (41.8%). Among our patients, 30 (30.6%) were smokers. The mean age of onset of dementia was 73 ± 11 years. The mean duration of untreated dementia was 3 years [3 months to 11 years]. First symptoms were mainly memory disorders (57.3 %) and behavioral disorders (17.3%) The mean MMSE score was 14 ± 4.8. Alzheimer’s disease was the most frequent etiology of dementia (80 cases, 82.7%).
Our study shows a high incidence of dementia and made it possible to draw up a socio-demographic and clinical profile of dementia patients.
Greenland glaciers exhibit variable seasonal velocity signals that may reflect differences in subglacial hydrology. Here, we conduct a first GrIS-wide glacier classification based on seasonal velocity patterns derived from 2017 Sentinel-1 radar data. Our classification focuses on two distinct seasonal ice velocity patterns, with the first (type-2 from Moon and others, 2014) showing periods of both speedup and slowdown during the melt season, and the second (type-3) instead showing a longer period of slowdown from elevated velocities in the winter and spring. We analyze 221 glaciers in 2017 and show that 48 exhibit type-2 behavior, and 72 exhibit type-3 behavior. We extend the classification to 2018 and 2019 and find that while the glaciers meeting each criterion vary year to year, type-2 is consistently more common in the northern regions and type-3 is more common in the south. Our results highlight the varied impact of meltwater on subglacial drainage systems and glacier flow in Greenland.
The traumatic stress experienced by our black healthcare colleagues is often overlooked. This work contextualizes workplace racism, identifies some interpersonal barriers limiting anti-racist growth, and calls for solidarity.
Roads affect wildlife in a variety of negative ways. Road ecology studies have mostly concentrated on areas in the northern hemisphere despite the potentially greater impact of roads on biodiversity in tropical habitats. Here, we examine 4 years (January 2016–December 2019) of opportunistic observations of mammalian roadkill along a road intersecting Jozani-Chwaka Bay National Park, Unguja, Zanzibar. In particular, we assess the impact of collisions on the population of an endemic primate, the Endangered Zanzibar red colobus Piliocolobus kirkii. Primates accounted for the majority of roadkill in this dataset. Monthly rainfall was not associated with roadkill frequency for mammals generally, nor for the Zanzibar red colobus. No single age–sex class of colobus was found dead more often than expected given their occurrence in the local population. The overall effect of roadkill on colobus populations in habitats fragmented by roads is unknown given the lack of accurate, long-term life history data for this species. Our findings suggest that mortality from collisions with vehicles in some groups of colobus is within the range of mortality rates other primates experience under natural predation. Unlike natural predators, however, vehicles do not kill selectively, so their impact on populations may differ. Although a comparison with historical accounts suggests that the installation of speedbumps along the road near the Park's entrance has led to a significant decrease in colobus roadkill, further actions to mitigate the impact of the road could bring substantial conservation benefits.
Former lakes and wetlands can provide valuable insights to the late Pleistocene environments encountered by the first humans to enter the Levant from Africa. Fluvial incision along Wadi Gharandal in hyperarid southern Jordan has exposed remnants of a small riverine wetland that accumulated as a sedimentary sequence up to ~20 m thick. We conducted a chronometric and sedimentological study of this wetland, including 10 optically stimulated luminescence dates. The wetland sequence accumulated during the period ~125 to 70 ka in response to a positive water balance coupled with a (possibly coseismic) landslide that dammed the outlet. The valley fill was dissected when the dam was incised shortly after ~36 ± 3 ka. Comparison of our ages with regional palaeoclimate indicates that the Gharandal oasis developed during the relatively humid Marine Isotope Stage 5. A minimum age of 74 ± 7 ka for two Levallois flakes collected from stratified sediments suggests that the oasis was visited by humans during the critical 130–90 ka time window of human migration out of Africa. Gharandal joins a growing network of freshwater sites that enabled humans to cross areas of the Levant and Arabia along corridors of human dispersal.
A reformulation of the Social Brain Theory of schizophrenia is proposed that contends that schizophrenia is a novel human phenomenon that arose following the establishment of large permanent human settlements and the abandonment of the hunter-gatherer way of life. It is contended that the blurring of the demarcation between ingroup and outgroup membership and living in close proximity to strangers is a stressor that leads to perturbation in the development of the social brain in vulnerable individuals leading to the syndrome of schizophrenia. Contrary to previous authors who have considered schizophrenia to be an inherently human condition that has existed throughout human history we suggest that schizophrenia is a relatively recent phenomenon and that the vulnerability to it remained hidden amongst hunter-gatherers. Hence, we contend that schizophrenia is the result of a mismatch between the post-Neolithic human social environment and the design of the social brain. The importance of the distinction between ingroup and outgroup membershipin human evolutionary history lies at the heart of inter-group conflict, violence and xenophobia. This formulation explains a range of epidemiological findings on schizophrenia related to the risk of migration and urbanisation. The present hypothesis can therefore, account for a range of disparate findings regarding schizophrenia that have thus far defied explanation by other extant theories. However, as this formulation claims to have identified the ultimate causation of schizophrenia the hypothesis does not specify the proximate mechanisms that lead to it. We conclude with a number of testable and refutable predictions.
This chapter reviews the most researched psychotherapeutic interventions for individuals with cognitive impairment (CI) and common symptoms targeted by these interventions. Elements of assessment and psychotherapy modifications to consider when working with individuals with dementia are also discussed. Assessment components might include clarification of medical symptom overlap, collateral information, assessment instruments developed for individuals with cognitive difficulties, and incorporating consultation with other specialties. In general, clinicians should consider using simplified skills, increasing the number and frequency of sessions, shortening sessions, reducing group size, and providing more guidance during skill instruction and practice when working with individuals with cognitive impairments. Despite their promise and recommendations for their use, nonpharmacological therapies for individuals with dementia have a small research base and warrant continued development and evaluation.
Introduction: Email and text messaging holds the potential to not only contact patients after emergency department (ED) care for clinically important communications such as appointment reminders, but also to solicit feedback for quality improvement and/or participation in research. A necessary first step though is the collection of electronic contact information, but little is known about current practice in Ontario EDs. In this study, we sought to characterize current collection, consent and use of patient email and texting to communicate with ED patients at academic and community hospitals across Ontario. Methods: We developed a questionnaire, with a blend of multiple choice and open-ended questions, targeted at ED registration administrators. The questions focused on if and how EDs collect, store and consent for patient emails, how and what they utilize those emails for and if they text patients. The questionnaire was administered both online and by phone. Participants were recruited through snowball sampling, including facilitated dissemination of the questionnaire via an existing listserv of the Patient Registration Network of Ontario (PRNO). Results: Twenty-two respondents (41% response rate) completed the questionnaire. Seven of the 22 institutions were academic health centres (32%). Nine institutions (41%) collected patient email addresses in the ED and none collected or used text message technology. In all 9, registration staff were tasked with asking, consenting, collecting and storing patient details within their hospital admissions, discharge and transfer system (ADT). For sites with email address collection, respondents estimated 40-60% of ED patients shared an email address. Seven of 9 institutions had a verbal consent process, while 2 used implied consent. Only 2 institutions used email to send patients post-discharge feedback questionnaires and four used email to facilitate access to patient portals. Four institutions were looking at using text messages to direct patients at triage, sometime in the future. Conclusion: Engagement in optimized care and feedback requires communication which is quickly shifting to electronic format. Collection of electronic contact information continues to be slow and uneven in Ontario. There is an immediate need for clearer guidance to accelerate collection, storage, consent and use of email and text messaging technology.
Based on hierarchies of filter lengths, the large eddy decomposition and the related subgrid stresses are recognized to represent generalized central moments for the study and modelling of the different modes composing turbulence. In particular, the subgrid stresses and the subgrid dissipation are shown to be alternative observables for quantitatively assessing the scale-dependent properties of momentum flux (subgrid stresses) and the energy exchange between the large and small scales (subgrid dissipation). In this work we present a theoretical framework for the study of the subgrid stress and dissipation. Starting from an alternative decomposition of the turbulent stresses, a new formalism for their approximation and understanding is proposed which is based on a tensorial turbulent viscosity. The derived formalism highlights that every decomposition of the turbulent stresses is naturally approximated by a general form of turbulent viscosity tensor based on velocity increments which is then recognized to be a peculiar property of small-scale stresses in turbulence. The analysis in a turbulent channel shows the rich physics of the small-scale stresses which is unveiled by the tensorial formalism and usually missed in scalar approaches. To further exploit the formalism, we also show how it can be used to derive new modelling approaches. The proposed models are based on the second- and third-order inertial properties of the grid element. The basic idea is that the structure of the integration volume for filtering (either implicit or explicit) impacts the anisotropy and inhomogeneity of the filtered-out motions and, hence, this information could be leveraged to improve the prediction of the main unknown features of small-scale turbulence. The formalism provides also a rigorous definition of characteristic lengths for the turbulent stresses, which can be computed in every type of computational elements, thus overcoming the rather elusive definition of filter length commonly employed in more classical models. A preliminary analysis in a turbulent channel shows reasonable results. In order to solve numerical stability issues, a tensorial dynamic procedure for the evolution of the model constants is also developed. The generality of the procedure is such that it can be employed also in more conventional closures.
The purpose of this study is the verification of intensity modulated radiation therapy (IMRT) head neck treatment planning with one-dimensional and two-dimensional (2D) dosimeters using imaging and radiation oncology core (IROC) Houston head & neck (H&N) phantom.
The image of the H&N phantom was obtained by computed tomography scan which was then transferred to Pinnacle@3 treatment planning system (TPS) for treatment planning. The contouring of the target volumes and critical organ were done manually and dose constraints were set for each organ according to IROC prescription. The plan was optimised by adoptive convolution algorithm to meet the IROC criteria and collapse cone convolution algorithm calculated the delivered doses for treatment. Varian Clinac 2110 was used to deliver the treatment plan to the phantom, the process of irradiation and measurement were repeated three times for reproducibility and reliability. The treatment plan was verified by measuring the doses from thermoluminescent dosimeters (TLDs) and GafChromic external beam therapy 2 films. The agreement between the planned and delivered doses were checked by calculating the percentage dose differences, analysing their isodose line profiles and 2D gamma maps.
The average percent dose difference of 1·8% was obtained between computed doses by TPS and measured doses from TLDs, however these differences were found to be higher for organ at risk. The film dose profile was well in agreement with the planned dose distribution with distance to agreement of 1·5 mm. The gamma analysis of the computed and recorded doses passed the criteria of 3%/3 mm with passing percentages of >96%, which shows successful authentication of delivered doses for IMRT.
IMRT pre-treatment validation can be done with IROC anthropomorphic phantoms, which is essential for the delivery of modulated radiotherapies. It was concluded that films and TLDs can be used as quality assurance tools for IMRT.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
Direct numerical simulations of turbulent suspension flows are carried out with the force-coupling method in plane Couette and pressure-driven channel configurations. Dilute to moderately concentrated suspensions of neutrally buoyant finite-size spherical particles are considered when the Reynolds number is slightly above the laminar–turbulent transition. Tests performed with synthetic streaks, in both turbulent channel and Couette flows, show clearly that particles trigger the instability in channel flow whereas the plane Couette flow becomes laminar. Moreover, we have shown that particles have a pronounced impact on pressure-driven flow through a detailed temporal and spatial analysis whereas they have no significant impact on the plane Couette flow configuration. The substantial difference between the two flow configurations is related to the spatial preferential distribution of particles in the large-scale rolls (inactive motion) in Couette flow, whereas they are accumulated in the ejection (active motion) regions in pressure-driven flow. Through investigation of particle modification in two distinct flow configurations, we were able to show the specific response of turbulent structures and the modulation of the fundamental mechanisms composing the regeneration cycle in the buffer layer of the near-wall turbulence. Especially for pressure-driven flow, the particles enhance the lift-up and let it act continuously whereas the particles do not significantly alter the streak breakdown process. The reinforcement of the streamwise vortices is attributed to the vorticity stretching term by the wavy streaks. The smaller and more numerous wavy streaks enhance the vorticity stretching and consequently strengthen the circulation of large-scale streamwise vortices in suspension flow.
Oligodeoxynucleotides (ODNs) containing cytosine-phosphate-guanosine sequence (CpG) is considered as an immune stimulator when it is fed to animals. These synthetic molecules mount different immune responses in the animals including mice, chickens, ducks, dogs and horses. CpG ODNs induce specific antigenic immunity against co-administered vaccines and are well tolerated in healthy individuals and are capable of stimulating toll-like receptors (TLRs) such as TLR-9 to activate innate immunity. The CpG ODNs can be used as an adjuvant in different vaccines synthesised specifically for poultry diseases caused by viruses and bacteria. In chickens, CpG ODNs stimulate TLRs involved in humoral immunity. CpG ODNs have been used as mucosal vaccine adjuvants against several pathogens, including avian influenza and Newcastle disease. The CpG ODNs function to protect the chickens from Newcastle disease by producing plasma dendric cells (pDCs) which ultimately produce interferons (INFs). The inoculation of CpG ODNs along with the cationic microparticles and DNA vaccine for infectious bursal disease virus result in the influx of T cells and a reduction of antigen load. When CpG ODNs are used against avian leucosis, they result in significantly higher antibody titres. In many other vaccines e.g., infectious laryngotracheitis, infectious bronchitis, herpes, viral enteritis, Marek's disease virus, E. coli and Salmonella spp. including CpG ODNs exhibit immunostimulatory effects. In conclusion, CpG ODNs may be used as effective adjuvants in viral, bacterial and parasitic vaccines in poultry.
Avian influenza virus (AIV) type A subtype H9N2 usually causes mild asymptomatic infections, and is mostly undetected and is, therefore, under-reported. This has allowed the virus to rapidly evolve via mutations and reassortments in its genome with other avian influenza subtypes especially H1N1, H5N1 and H7N3 thereby introducing new variant strains and producing severe disease. It has been reported that the AIV H9N2 donated its internal genes for the devastating 1997 Hong Kong outbreak and furthermore, it may be the cause of the next influenza pandemic. There are many factors such as its wide host range, ability to cross the species barrier, ecological diversity, antiviral resistance and zoonotic importance that make it an excellent candidate for the next influenza pandemic. These and other factors like ineffective vaccination, negative immunological pressures, lack of surveillance, which contribute to its continuous persistence and evolutionary dynamics are discussed in this paper. It is important to take the necessary measures to control and prevent its unchecked circulation to prevent the future outbreaks.
We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia.
We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted.
We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively.
We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38–46)
Serpins are a broadly distributed family of proteases found in various organisms that play an important role in regulating the immune response. Here, we identified a serpin-1 gene from Antheraea pernyi that encodes a 279 amino acid protein with a molecular weight of 30.8 kDa. We expressed the recombinant Ap-serpin-1 protein in Escherichia coli and used the purified protein to prepare rabbit anti-Ap-serpin-1 polyclonal antibodies. We calculated the enzyme-linked immunosorbent assay titer of the antibody as 1:128000. Quantitative real-time polymerase chain reaction analysis revealed that Ap-serpin-1 was expressed in all examined tissues, including hemolymph, malpighian tubules, midgut, silk gland, integument and the fat body; the highest Ap-serpin-1 expression levels was detected in the fat body. We next investigated the expression patterns of Ap-serpin-1 in both fat body and hemolymph samples, following treatment with E. coli, Beauveria bassiana, Micrococcus luteus and nuclear polyhedrosis virus (NPV). We reported that NPV and M. luteus significantly enhanced Ap-serpin-1 expression in the fat body. While, in the hemolymph samples, treatment with B. bassiana and M. luteus was shown to upregulate Ap-serpin-1 expression at 24 h induction. Altogether, our results suggest that Ap-serpin-1 is involved in the innate immunity of A. pernyi.
The Jeans instability is examined in quantum dusty magnetoplasmas due to low-frequency magnetosonic perturbations. The fluid model consisting of the momentum balance equation for quantum plasmas, Poisson’s equation for the gravitational potential and Maxwell’s equations for electromagnetic magnetosonic perturbations is solved. The numerical analysis elaborates the significant contribution of magnetic field, electron number density and variable dust mass to the Jeans instability.