Efficacy and Moderators of Virtual Reality for Cognitive Training in People with Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Background: Mild cognitive impairment (MCI) and dementia result in cognitive decline which can negatively impact everyday functional abilities and quality of life. Virtual reality (VR) interventions could benefit the cognitive abilities of people with MCI and dementia, but evidence is inconclusive. Objective: To investigate the efficacy of VR training on global and domain-specific cognition, activities of daily living and quality of life. To explore the influence of priori moderators (e.g., immersion type, training type) on the effects of VR training. Adverse effects of VR training were also considered. Methods: A systematic literature search was conducted on all major databases for randomized control trial studies. Two separate meta-analyses were performed on studies with people with MCI and dementia. Results: Sixteen studies with people with MCI and four studies with people with dementia were included in each meta-analysis. Results showed moderate to large effects of VR training on global cognition, attention, memory, and construction and motor performance in people with MCI. Immersion and training type were found to be significant moderators of the effect of VR training on global cognition. For people with dementia, results showed moderate to large improvements after VR training on global cognition, memory, and executive function, but a subgroup analysis was not possible. Conclusion: Our findings suggest that VR training is an effective treatment for both people with MCI and dementia. These results contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline

Sagittal and frontal plane evaluation of the whole-spine and clinical outcomes after vertebral fractures

Although it is known that a change in any level of the spine alters biomechanics, there aren’t many studies to evaluate the spine as a whole both in sagittal and frontal planes. This prospective cohort study evaluates the morphology and mobility of the entire spine in patients with vertebral fractures. The treatment group consisted of 43 patients who underwent percutaneous balloon kyphoplasty or percutaneous balloon kyphoplasty plus fixation. The Control Group consisted of 39 healthy subjects. Spinal mouse was used for the assessment of the curvatures and the mobility of the spine. Clinical outcomes were evaluated by Visual-Analogue Scale and Oswestry Disability Index. The measurements were recorded at 15 days, 3, 6 and 12 months postoperatively. Regarding the curvatures and mobility in sagittal plane, a statistically significant increase appeared early at 3 months, for lumbar curve, spinopelvic angulation and overall trunk inclination. In the frontal plane, most of the improvements were recorded after 6 months. Patients with osteoporotic fracture showed statistically significant lower mean value than patients with traumatic fracture. Pain and disability index showed early improvements. This study provides a comprehensive and complete picture of the functionality of the spine in patients treated with percutaneous balloon kyphoplasty

The Mechanism behind Erosive Bursts in Porous Media

Erosion and deposition during flow through porous media can lead to large erosive bursts that manifest as jumps in permeability and pressure loss. Here we reveal that the cause of these bursts is the re-opening of clogged pores when the pressure difference between two opposite sites of the pore surpasses a certain threshold. We perform numerical simulations of flow through porous media and compare our predictions to experimental results, recovering with excellent agreement shape and power-law distribution of pressure loss jumps, and the behavior of the permeability jumps as function of particle concentration. Furthermore, we find that erosive bursts only occur for pressure gradient thresholds within the range of two critical values, independent on how the flow is driven. Our findings provide a better understanding of sudden sand production in oil wells and breakthrough in filtration.Comment: 7 pages, 8 figure

Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort

BACKGROUND: To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older. METHODS: The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N=3,985) aged ≥ 55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined. RESULTS: The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively. CONCLUSION: The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly

Estimating the prevalence of renal insufficiency in seniors requiring long-term care

Estimating the prevalence of renal insufficiency in seniors requiring long-term care.BackgroundRenal function declines with age, but little is known about the extent of renal insufficiency among the institutionalized elderly. The objective of this study was to estimate the prevalence of low glomerular filtration rate (GFR) in a large sample of elderly adults living in long-term care facilities, and to compare two commonly used methods for estimating GFR.MethodsA total of 9931 residents aged 65years and older participated in a retrospective cross-sectional study of 87 long-term care facilities in Ontario. GFR was estimated by the Cockcroft-Gault and Modification of Diet in Renal Disease Study (MDRD) equations. The prevalence of low GFR, using the Cockcroft-Gault equation (<30mL/min), was compared with the MDRD equation (<30mL/min/1.73m2).ResultsA total of 17.0% (95% CI 15.6 to 18.5) of men and 14.4% (95% CI 13.6 to 15.3) of women had a serum creatinine concentration above the laboratory reported upper reference limit of normal. The prevalence of both elevated serum creatinine and low GFR were observed to increase with age (P < 0.0001). The Cockcroft-Gault equation produced a consistently lower estimate of GFR than did the MDRD equation, a discrepancy most pronounced in the oldest residents. Among all men, a low GFR was more prevalent using the Cockcroft-Gault (10.3%, 95% CI 9.2 to 11.5) than MDRD (3.5%, 95% CI 2.8 to 4.2) equation, with a similar difference also seen in women (23.3%, 95% CI 22.4 to 24.3 versus 4.0%, 95% CI 3.6 to 4.5, respectively). Of all residents whose Cockcroft-Gault estimated GFR was under 30mL/min, 14.7% (95% CI 13.2 to 16.3) were found to have GFR greater than 60mL/min/1.73m2 according to the MDRD equation.ConclusionAge-associated renal impairment is common among elderly long-term care residents, but there exists a clear discrepancy between the Cockcroft-Gault and MDRD equations in predicting GFR. Consideration should be given to medication dose adjustment, based on a practical estimate of GFR. However clarification is needed about which method, if either, is most valid among the frail elderly. Complex patient and societal issues surrounding advanced care directives, treatments associated with renal insufficiency, and, if and when to initiate dialysis, require further attention

Μελέτη και σύγκριση παράκτιας ζώνης Νάξου και Λήμνου (Νότιο και Βόρειο Αιγαίο)

Το Αιγαίο είναι μια περιοχή περίπου 1,8 10 11 m2 με ποσότητα νερού 7,4 1013 m3 (Hopkins,1978), όπου συγκλίνουν τρεις μεγάλου μεγέθους τεκτονικές πλάκες, η Ασιατική, η Ευρωπαϊκή και η Αφρικανική, και αυτή μπορεί να είναι αιτία της πολύ μεγάλης ποικιλομορφίας των ακτών του και του ανάγλυφου του πυθμένα. Γεωγραφικά, χωρίζεται στο Νότιο, το Κεντρικό και το Βόρειο Αιγαίο και αποδεικνύει ότι αυτός ο διαχωρισμός μπορεί να επεκταθεί επίσης και στα υδρογραφικά χαρακτηριστικά των υποθαλάσσιων λεκανών. Έχει μεγάλο πολιτιστικό και ιστορικό πλούτο , πλούσια βιοποικιλότητα και έντονες διαφοροποιήσεις στα διάφορα τμήματα του. Με την παρούσα εργασία, εξετάζεται η παράκτια ζώνη δύο νησιών του Αιγαίου, της Λήμνου και της Νάξου, όπου η μεν ανήκει στο Βόρειο Αιγαίο και η δε στο Νότιο, ως προς τις κλιματολογικές, ωκεανογραφικές και ευρύτερα τις γεωλογικές τους συνθήκες. Για τον σκοπό αυτό, κατασκευάστηκαν οι γεωλογικοί χάρτες των παραπάνω νησιών μέσω του λογισμικού Arcgis, τα δεδομένα των οποίων γεωαναφέρθηκαν σε κοινό προβολικό σύστημα ΕΓΣΑ’87. Επιπλέον μελετήθηκαν οι χάρτες υγροτόπων της WWF, τα σεισμολογικά δεδομένα του Γεωδυναμικού Ινστιτούτου καθώς και τα κλιματολογικά δεδομένα (θερμοκρασίας, υγρασίας και ανέμου) της Εθνικής Μετεωρολογικής Υπηρεσίας. Τέλος, παρατηρήθηκαν οι ακτές μέσω της εφαρμογής Google Earth Pro και της ιστοσελίδας Trip in View και σημειώθηκαν τα φυσικά τους χαρακτηριστικά (κρημνός, πεδιάδα, λιμνοθάλασσα κλπ), η βλάστηση (χαμηλή, μεσαία, υψηλή), οι τουριστικές εγκαταστάσεις (καθόλου, ομπρέλες, οργανωμένες ομπρέλες/ ξαπλώστρες, θαλάσσια σπορ) κ.λπ. Στόχος της εργασίας είναι η σύγκριση Βορείου και Νοτίου Αιγαίου, ως προς τα παραπάνω δεδομένα.Aegean is an area of approximately 1.8 10 11 m2 with its water resources to be 7.4 1013 m3 (Hopkins,1978), where three large tectonic plates, the Asian, European and African, converge, and this may be the reason of the great diversity of its coasts and its seabed morphology. Geographically, it is divided into the South, Central and North Aegean and proves that this division can also be extended to the hydrographic features of the submarine basins. It has great cultural and historical wealth, rich biodiversity and strong differences in its various parts. This study focused on the coastal zone of two Aegean islands, Limnos and Naxos, where the first belongs to the North Aegean and the second to the South, in terms of their climatic, oceanographic and, more broadly, geological conditions. For this purpose, the geological maps of the above islands were constructed with the Arcgis software, the data of which were georeferenced to the EGSA&apos;87 coordinate system. In addition, the WWF’s wetlands maps, the seismological data of the Geodynamic Institute as well as the climatological data (temperature, humidity and wind) of the Hellenic National Meteorological Service were studied. Finally, the coasts were observed through the Google Earth Pro application and the Trip in View website and their physical characteristics (slope, plain, lagoon, etc.), vegetation (low, medium, high), tourist facilities (none, free umbrellas, umbrellas/ sunbeds, water sports) etc. The aim of the paper is to compare the North and South Aegean, in terms of the above data

Osteoporosis in Canadian adult cystic fibrosis patients: A descriptive study

BACKGROUND: Cystic fibrosis is the most common fatal autosomal recessive genetic disease in the Caucasian population. Osteoporosis is increasingly being recognised as an important complication in people with cystic fibrosis. METHODS: A descriptive study of adult cystic fibrosis patients receiving care at a Canadian tertiary care hospital was conducted to evaluate the prevalence of osteoporosis, the prevalence of non-vertebral fractures, and the change in bone mineral density during the course of a year. Data on bone mineral density were obtained for 40 adult cystic fibrosis patients by reviewing dual x-ray absorptiometry scans taken at baseline (when annual scans became standard clinical practice) and one year prior to baseline. Data on prevalent fractures were obtained by reviewing all available patient charts. Clinical and laboratory data were collected from an existing clinic database. RESULTS: Over half of the 40 patients had reduced T- and Z-scores at baseline. For the 27 patients who had data available one year prior to baseline, total hip and lumbar spine bone mineral density had decreased by 3.04% and 0.86% after one year while total body bone mineral density had not changed significantly. Four prior non-vertebral fractures were reported in three patients (1,146 patient-years). CONCLUSION: This study confirms that osteoporosis is a significant problem in adult cystic fibrosis patients, and constitutes the first published evidence of cystic fibrosis bone disease in Canadians

Estimating osteoporotic fracture risk following a wrist fracture: a tale of two systems

© 2015, The Author(s). Summary: The WHO fracture risk assessment (FRAX) and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools can both be used to determine an individual’s 10-year risk of osteoporotic fracture. However, these tools differ in their risk calculation. For participants fracture, FRAX provides a lower fracture risk estimate than CAROC resulting in fewer decisions to initiate therapy.Purpose: The purpose of the current report is to compare fracture risk prediction rates using the CAROC and the FRAX® tools.Methods: Individuals ≥50 years with a distal radius fracture resulting from a fall from standing height or less were recruited from a single orthopedic clinic. Participants underwent a DXA scan of their lumbar spine and hip. Femoral neck (FN) bone mineral density (BMD) and fracture risk factors were used to determine each participant’s 10-year fracture risk using both fracture risk assessment tools. Participants were categorized as low (\u3c10 \u3e%), moderate (10–20 %), or high (\u3e20 %) risk. Stratified by age (\u3c65 \u3eyears, \u3e65 years), the proportion of participants in each category was compared between the tools.Results: Analyses included 60 participants (mean age 65.7 ± 9.6 years). In those (n = 26), the proportion of individuals at low, moderate, and high risk differed between the FRAX and CAROC tools (p \u3c 0.0001). FRAX categorized 69 % as low (CAROC 0 %) and 3 % as high (CAROC 12 %) risk. For individuals \u3e65 years, almost all were at least at moderate risk (FRAX 79 %, CAROC 53 %), but fewer were at high risk using FRAX (18 vs. 47 %, p \u3c 0.0003).Conclusion: For participants 65 years were at moderate or high risk under both FRAX and CAROC and should at least be considered for pharmacotherapy

A Decentralized Recommender System for Effective Web Credibility Assessment

An overwhelming and growing amount of data is available online. The problem of untrustworthy online information is augmented by its high economic potential and its dynamic nature, e.g. transient domain names, dynamic content, etc. In this paper, we address the problem of assessing the credibility of web pages by a decentralized social recommender system. Specifically, we concurrently employ i) item-based collaborative filtering (CF) based on specific web page features, ii) user-based CF based on friend ratings and iii) the ranking of the page in search results. These factors are appropriately combined into a single assessment based on adaptive weights that depend on their effectiveness for different topics and different fractions of malicious ratings. Simulation experiments with real traces of web page credibility evaluations suggest that our hybrid approach outperforms both its constituent components and classical content-based classification approaches