Parkinson’s disease dyskinesias possibly relate to greater dopamine transporter losses in the putamen over time

The pathophysiology of levodopa-induced dyskinesias in Parkinson’s disease is incompletely understood. This study was designed to investigate in Parkinson’s patients, whether time-related changes in striatal dopamine transporter availability are associated to the appearance of dyskinesias. 15 Parkinson’s patients had dopamine transporter-specific SPECT imaging with 123I-FP-CIT twice: at baseline (when they were drug naïve) and at follow-up (6.31±2.29 years from baseline), and were followed up clinically every six months. At the end of the study, patients were divided in two groups according to whether they had developed dyskinesias or not. Semi-quantification of 123I-FP-CIT data was performed using the occipital cortex as the reference region. Specific binding ratios were calculated for the putamen and the caudate. During the clinical follow-up, all Parkinson’s patients were treated pharmaceutically. 8 patients developed dyskinesias, while 7 remained nondyskinetic. At baseline, the two groups had similar 123I-FP-CIT specific binding ratio values for the putamen and the caudate (p>0.05). Also, between-group differences in age, disease duration, and Hoehn & Yahr scores were not statistically significant. Over-time, the putaminal 123I-FP-CIT specific binding ratio values in the dyskinetic group decreased significantly (p<0.01). The nondyskinetic patients had smaller reductions (p<0.05) during the same period of time. At follow-up, the dyskinetic patients had significantly higher Hoehn & Yahr scores (p<0.01) and were taking higher levodopa equivalent doses (p<0.001), as compared to the nondyskinetic patients. The development of Parkinson’s dyskinesias is related to a faster progression rate, as reflected by marked putaminal dopamine transporter decreases

Improving Communicative Competence in Global Aphasia

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Measuring Communication Competence in Global Aphasia

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Students as co-producers in a multidisciplinary software engineering project: addressing cultural distance and cross-cohort handover

This article reports on an undergraduate software engineering project in which, over a period of two years, four student teams from different cohorts developed a note-taking app for four academic clients at the students’ own university. We investigated how projects involving internal clients can give students the benefits of engaging in real software development while also giving them experience of a student-staff collaboration that has its own benefits for students, academics, and the university more broadly. As the university involved is a Sino-Foreign university located in China, where most students are Chinese and most teaching staff are not, this ‘student as co-producer’ approach interacts with another feature of the project: cultural distance. Based on analysis of notes, reports, interviews, and focus groups, we recommend that students should be provided with communicative strategies for dealing with academics as clients; universities should develop policies on ownership of student-staff collaborations; and projects should include a formalised handover process. This article can serve as guidance for educators considering a ‘students as co-producers’ approach for software development projects

Hierarchical cluster analysis of polychlorinated dioxins and furans in Michigan, USA, soils: Evaluation of industrial and background congener profiles

As part of the University of Michigan Dioxin Exposure Study, soil samples were collected from 766 residential properties near the Tittabawassee River between Midland and Saginaw; near the Dow Chemical Facility in Midland; and, for comparison, in the other areas of Midland and Saginaw Counties and in Jackson and Calhoun Counties, all located in the state of Michigan, USA. A total of 2,081 soil samples were analyzed for 17 polychlorinated dibenzo- p -dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). In order to better understand the distribution and sources of the PCDD/F congeners in the study area, hierarchical cluster analysis (HCA) was used to statistically group samples with similar congener patterns. The analysis yielded a total of 13 clusters, including: 3 clusters among the soils impacted by contamination present in the Tittabawassee River sediments, a cluster comprised mainly of samples collected within the depositional area of the Dow incinerator complex, a small cluster of samples with elevated 2,3,7,8-tetrachlorinated dibenzo- p -dioxin (TCDD), and several clusters exhibiting background patterns. The clusters related to the Tittabawassee River floodplain contamination all contained elevated PCDF levels and were differentiated from one another primarily by their relative concentrations of higher-chlorinated PCDDs, a difference likely related to both extent and timing of impacts from Tittabawassee sediments. The background clusters appear to be related to combustion processes and are differentiated, in part, by their relative fractions of TCDD. Thus, HCA was useful for identifying congener profile characteristics in both contaminated and background soil samples. Environ. Toxicol. Chem. 2010;29:64–72. © 2009 SETACPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64530/1/24_ftp.pd

Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease:A prospective, observational study

BACKGROUND: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.AIM: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.METHODS: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality.RESULTS: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI]).CONCLUSIONS: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions.</p

Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease:A prospective, observational study

BACKGROUND: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.AIM: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.METHODS: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality.RESULTS: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI]).CONCLUSIONS: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions.</p

Hypersensitivity pneumonitis: an overlooked cause of cough and dyspnea.

Hypersensitivity pneumonitis (HP) is an immune-mediated pulmonary disorder involving inflammation of the lung interstitium, terminal bronchioles, and alveoli caused by the immune response to the inhalation of an offending environmental airborne agent. It can manifest as exertional dyspnea, fatigue, weight loss, and progressive respiratory failure if left untreated. Because of its protean features, it can be misdiagnosed as other common obstructive lung conditions such as asthma. If triggers are not avoided, it can progress to irreversible pulmonary fibrosis. In this article, we present the case of a 51-year-old male who presented to our hospital with recurrent bouts of dyspnea and cough, initially diagnosed as an asthma exacerbation. He received a final diagnosis of HP after investigation of his workplace revealed airborne spores and surface molds from multiple fungal species, serology revealed eosinophilia, and computed tomography showed bronchiectasis. Avoidance of occupational exposure resulted in significant improvement of his respiratory symptoms after two months