The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: A prospective observational study

<p>Abstract</p> <p>Background</p> <p>The Mini-Mental State Examination (MMSE) has contributed to detecting cognitive impairment, yet few studies have evaluated its accuracy when used by general practitioners (GP) in an actual public-health setting.</p> <p>Objectives</p> <p>We evaluated the accuracy of MMSE scores obtained by GPs by comparing them to scores obtained by Alzheimer's Evaluation Units (UVA).</p> <p>Methods</p> <p>The study was observational in design and involved 59 voluntary GPs who, after having undergone training, administered the MMSE to patients with symptoms of cognitive disturbances. Individuals who scored ≤ 24 (adjusted by age and educational level) were referred to Alzheimer's Evaluation Units (UVA) for diagnosis (including the MMSE). UVAs were unblinded to the MMSE score of the GP. To measure interrater agreement, the weighted Kappa statistic was calculated. To evaluate factors associated with the magnitude of the difference between paired scores, a linear regression model was applied. To quantify the accuracy in discriminating no cognitive impairment from any cognitive impairment and from Alzheimer's disease (AD), the ROC curves (AUC) were calculated.</p> <p>Results</p> <p>For the 317 patients, the mean score obtained by GPs was significantly lower (15.8 vs. 17.4 for the UVAs; p < 0.01). However, overall concordance was good (Kappa = 0.86). Only the diagnosis made by the UVA was associated with the difference between paired scores: the adjusted mean difference was 3.1 for no cognitive impairment and 3.8 for mild cognitive impairment. The AUC of the scores for GPs was 0.80 (95%CI: 0.75–0.86) for discriminating between no impairment and any impairment and 0.89 (95%CI: 0.84–0.94) for distinguishing patients with AD, though the UVA scores discriminated better.</p> <p>Conclusion</p> <p>In a public-health setting involving patients with symptoms of cognitive disturbances, the MMSE used by the GPs was sufficiently accurate to detect patients with cognitive impairment, particularly those with dementia.</p

Allestimenti temporanei per il recupero: una “pre-azione"

L’abbandono dei borghi antichi e la riduzione del senso di comunità che li caratterizzava, rendono urgente ripensare forme e pratiche che possano riaccendere l’interesse verso i luoghi stessi, il loro patrimonio edificato e la loro possibile riattivazione. Discipline come l’allestimento e l’arte ambientale, che si occupano di creare installazioni sperimentali e temporanee nell’ambiente costruito, risultano essere di grande interesse per il ruolo che potrebbero assumere in questa direzione. La realizzazione di piccole architetture o di installazioni artistiche di breve durata è, per sua natura, un’azione “leggera”, di costo contenuto e reversibile. Rappresenta, per questo, una modalità d’intervento più facilmente perseguibile e realizzabile rispetto ad un consueto processo di ripianificazione e recupero. Si potrebbe definire, in un’unica parola, una “pre-azione”. Una pre-azione che ha come scopo quello di riportare all’attenzione un’urgenza più ampia, che richiede interventi più lunghi e complessi. Il punto che accomuna questo tipo d’interventi è quello di riferirsi fortemente ai luoghi in cui si realizzano, luoghi con una forte identità storica e ambientale, da riscoprire e reinventare. Agire in maniera effimera su di essi, metterli alla prova e reinterpretarli è un modo per mostrarne la preziosità, le qualità intrinseche e le potenzialità. Gli spazi si plasmano e si trasformano, anche se per poco tempo, sotto l’effetto dell’installazione o dell’allestimento “site specific”. Si intravedono nuovi modi d’uso e nuove qualità che un successivo intervento di recupero sarebbe in grado di offrire. Tanto più l’azione è di tipo partecipato, ovvero in grado di coinvolgere un ampio numero di persone sia nel processo creativo che in quello realizzativo, tanto più è efficace. Ed è, soprattutto, in grado di trasferire nello spazio fisico concreto il “senso del luogo”, ovvero la sensazione di accoglienza e condivisione che solo l’azione umana è in grado di produrre. Negli ultimi anni, sia in ambito nazionale che internazionale, le azioni temporanee sul patrimonio storico costruito, degradato o in abbandono, si stanno ampiamente diffondendo. Questo a testimonianza dell’efficacia che la sorpresa che l’azione temporanea produce, è in grado di raggiungere un numero sempre maggiore di persone e di accrescerne la consapevolezza verso i temi di valorizzazione e recupero architettonico e ambientale. L’obiettivo di quest’intervento è quello di illustrare alcune recenti esperienze realizzate in contesti in abbandono, individuarne i tratti comuni, le eventuali criticità e gli esiti, ai fini di delineare dei possibili scenari in cui l’azione temporanea possa essere strumento utile di azione preliminare sul patrimonio costruito

Etica pubblica e contrasto alla corruzione: i Codici di comportamento in sede decentrata

L'articolo considera le innovazioni normative intervenute con riferimento agli strumenti di contrasto della corruzione, e in particolare esamina la natura dei codici di comportamento delle Pubbliche Amministrazioni

A PAAS-Based framework for automated performance analysis of service-oriented systems

Service-oriented systems are often at the core of mission- or business-critical systems, and thus advanced quantitative analysis techniques are needed to assess, from the early development stages, whether or not the system accomplishes the stakeholder requirements and constraints. In this respect, in order to take advantage of the distributed nature of the considered systems, the use of distributed simulation (DS) appears the most natural and effective simulation approach. Nevertheless, the integration of traditional system development processes with DS approaches can be cost-And time-demanding. This paper presents SOAsim, a highly automated framework that allows system designers to generate the executable DS code from the model-based specification of the system under study, by use of automated model transformations. Moreover, in order to reduce the costs of setting-up dedicated DS platforms, SOAsim also automates the DS deployment and execution over a cloud-based infrastructure, according to a Platform-As-A-Service (PaaS) paradigm.Service-oriented systems are often at the core of mission- or business-critical systems, and thus advanced quantitative analysis techniques are needed to assess, from the early development stages, whether or not the system accomplishes the stakeholder requirements and constraints. In this respect, in order to take advantage of the distributed nature of the considered systems, the use of distributed simulation (DS) appears the most natural and effective simulation approach. Nevertheless, the integration of traditional system development processes with DS approaches can be cost-And time-demanding. This paper presents SOAsim, a highly automated framework that allows system designers to generate the executable DS code from the model-based specification of the system under study, by use of automated model transformations. Moreover, in order to reduce the costs of setting-up dedicated DS platforms, SOAsim also automates the DS deployment and execution over a cloud-based infrastructure, according to a Platform-As-A-Service (PaaS) paradigm

Automated Development of Web-based Modeling Services for MSaaS Platforms

MSaaS (M&S as a Service) is gaining momentum as an effective approach to bring the benefits of service-oriented architectures and cloud computing into the M&S field, so as to enhance interoperability, composability, reusability and reduce the cost of M&S efforts. Such significant advantages can be further enhanced by introducing automated model transformations that support the various phases of a M&S effort, from simulation model building down to model implementation, deployment and execution. In previous contributions we have already addressed the use of automated model transformations that can be effectively adopted to provide simulation services for MSaaS platforms. This paper instead focuses on the automated development of modeling services for MSaaS, i.e., those services that allow platform users to easily build models in their own modeling language by use of a web-based user interface. Specifically, this work proposes an approach to automatically generate web-based visual editors from a metamodel that defines a given modeling language. Once generated, such editors can be made available on demand through a complete MSaaS platform, which also includes simulation services. The paper first describes the architecture of a MSaaS platform that includes modeling services, then illustrates the method for the automated development of web-based modeling services and, finally, gives a complete example application of the proposed method

Etica pubblica e contrasto alla corruzione: i Codici di comportamento in sede decentrata

L'articolo considera le innovazioni normative intervenute con riferimento agli strumenti di contrasto della corruzione, e in particolare esamina la natura dei codici di comportamento delle Pubbliche Amministrazioni

Business process modeling and simulation: state of the art and MSaaS opportunities

The analysis and continuous improvement of business processes (BPs) has a strategic relevance for those enterprises that strongly rely on the performance of their operational processes to deliver services and/or goods to customers. The adoption of Modeling & Simulation (M&S) approaches is widely recognized as a valuable solution for analyzing and improving BPs, even though it is not yet fully exploited, due to the required know-how, effort and cost. In this context, M&S as a Service (MSaaS) is a promising paradigm that contributes to effectively ease the introduction of M&S approaches in the BP lifecyle, by saving the investments required to build and maintain the needed hardware and software infrastructure. This paper first illustrates a survey that analyzes the state-of-The-Art regarding the adoption of M&S approaches in the BP domain and then, starting from a set of identified open issues, proposes a next generation MSaaS architecture which aims at enabling a time-And cost-effective M&S-based analysis of BPs. © 2017 Society for Modeling & Simulation International (SCS)