Cognitive Rehabilitation for Executive Dysfunction in Parkinson's Disease: Application and Current Directions

Cognitive dysfunction in Parkinson's disease contributes to disability, caregiver strain, and diminished quality of life. Cognitive rehabilitation, a behavioral approach to improve cognitive skills, has potential as a treatment option to improve and maintain cognitive skills and increase quality of life for those with Parkinson's disease-related cognitive dysfunction. Four cognitive rehabilitation programs in individuals with PD are identified from the literature. Characteristics of the programs and outcomes are reviewed and critiqued. Current studies on cognitive rehabilitation in PD demonstrate feasibility and acceptability of a cognitive rehabilitation program for patients with PD, but are limited by their small sample size and data regarding generalization of effects over the long term. Because PD involves progressive heterogeneous physical, neurological, and affective difficulties, future cognitive rehabilitation programs should aim for flexibility and individualization, according to each patient's strengths and deficits

An integrated dyspepsia module for first year Pharmacy students: a flexible and generic template for integrating science with clinical and professional practice

Objective: To design an integrated dyspepsia module for first year pharmacy undergraduates, which combines clinical and professional practice with fundamental sciences, in five different science subject areas, as a prototype for future disease- or system-based integrated modules. Methods: The approaches used in designing this module are described with particular emphases on strategies adopted to integrate science and practice, and the new ways of working adopted by the design team. Students’ views and experiences of the module, and its integration, were explored using questionnaires. Results: A high proportion of students reported positive views and experiences of the module, the integration and its impact (as self-reported) on their learning and practice. The assessment of student performance indicated learning and attainment was at an appropriate level for a first year module. Both the student marks and research results indicate a positive student learning experience. The main activities undertaken whilst designing and developing the module, and the personnel involved are presented, and provide an indication of the staff time and resourcing required in developing this module. Conclusions: The dyspepsia module provides a flexible and effective template for the integration of science and practice in theme-based modules, with students reporting positively about the integration, including their perception of its contribution to improving their learning and understanding. Our experience suggests that new more collaborative ways of working are required when designing integrated modules

An integrated dyspepsia module for first year Pharmacy students: a flexible and generic template for integrating science with clinical and professional practice

Objective: To design an integrated dyspepsia module for first year pharmacy undergraduates, which combines clinical and professional practice with fundamental sciences, in five different science subject areas, as a prototype for future disease- or system-based integrated modules.Methods: The approaches used in designing this module are described with particular emphases on strategies adopted to integrate science and practice, and the new ways of working adopted by the design team. Students’ views and experiences of the module, and its integration, were explored using questionnaires.Results: A high proportion of students reported positive views and experiences of the module, the integration and its impact (as self-reported) on their learning and practice. The assessment of student performance indicated learning and attainment was at an appropriate level for a first year module. Both the student marks and research results indicate a positive student learning experience. The main activities undertaken whilst designing and developing the module, and the personnel involved are presented, and provide an indication of the staff time and resourcing required in developing this module.Conclusions: The dyspepsia module provides a flexible and effective template for the integration of science and practice in theme-based modules, with students reporting positively about the integration, including their perception of its contribution to improving their learning and understanding. Our experience suggests that new more collaborative ways of working are required when designing integrated modules

Evaluation of biological control strategies for polyphagotarsonemus latus (banks) and phyllocoptruta oleivora (ashmead) on valencia orange

The damage caused by P. latus and P. oleivora mites in the orange crop Valencia (Citrus sinensis L.) has an economical detrimental impact due to the external damage of the fruits. To evaluate the effect of biological control agents for these two pests, this work was carried out in a commercial crop in Caicedonia, Valle del Cauca, Colombia. The experimental design consisted of a randomized complete block, in which the following treatments were evaluated: (1) release of Phytoseiidae native species: Neoseiulus anonymus, Neoseiulus californicus, Iphiseiodes zuluagai and Amblyseius herbicolus (500 individuals / tree); (2) release of Chrysoperla carnea larvae (100 larvae/tree); (3) exclusion of beneficial agents (localized application of cypermethrin 2 cm3/l) and (4) farmer control (localized application of abamectin, 1.5 cm3/l). The releases and applications of the treatments were made on marked floral clusters and fruits in the middle third of each tree. Evaluations were made weekly until harvest time. For management of P. latus it was found that the treatments Phytoseiidae release, C. carnea release and abamectin application showed the least damage; exclusion of the beneficial agents demonstrated the importance of the natural control agents on this pest. For management of P. oleivora, C. carnea release and abamectin application showed the least damage. In release treatments of Phytoseiidae native species and the exclusion of beneficial agents, P. oleivora caused significant damage.El daño ocasionado por los ácaros Polyphagotarsonemus latus (Banks) y Phyllocoptruta oleivora (Ashmead) en el cultivo de naranja Valencia (Citrus sinensis L.) es reconocido tanto por el impacto económico como por el dao externo de los frutos. En este trabajo se evaluó el efecto de agentes biológicos para el control de estas plagas en un cultivo comercial de naranja Valencia en el municipio de Caicedonia, Valle del Cauca, Colombia. Se usó un diseo de bloques completos al azar para evaluar los tratamientos siguientes: (1) liberación de especies de Phytoseiidae nativos (Neoseiulus anonymus,Neoseiulus californicus, Iphiseiodes zuluagai y Amblyseius herbicolus en poblaciones de 500 individuos/árbol; (2) liberación de larvas de Chrysoperla carnea (100 larvas/árbol); (3) aplicación localizada de cipermetrina 2 cm3/l como tratamiento de exclusión de agentes benéficos; y (4) testigo consistente en el tratamiento utilizado por los agricultores (aplicación localizada de abamectina, 1.5 cm3/l). Las liberaciones de las especies benéficas y las aplicaciones de los tratamientos se realizaron sobre racimos florales y frutos marcados en el tercio medio de cada árbol. Las evaluaciones de daos se realizaron cada semana hasta la cosecha. Los tratamientos de liberación de Phytoseiidae, liberación de larvas de C. carnea y aplicación de abamectina presentaron el menor dao de P. latus; el tratamiento de exclusión de benéficos demostró la importancia de los agentes controladores naturales sobre la plaga. En el manejo de P. oleivora, los tratamientos de liberación de larvas de C. carnea y aplicación de abamectina presentaron los mejores resultados con el menor dao en frutos. La población de P. oleivora ocasionó daos significativos en el tratamiento de liberación de ácaros Phytoseiidae y exclusión de benéficos

Transit station or destination? Attendance patterns, movements, and abundance estimate of humpback whales off west South Africa from photographic and genotypic matching

Humpback whales found off west South Africa (WSA) are known to display an atypical migration that may include temporary residency and feeding during spring and summer. At a regional scale there is uncertainty about how these whales relate to the greater West African Breeding Stock B as a whole, with evidence both for and against its division into two sub-stocks. A database containing sighting information of humpback whales intercepted by boat in the WSA region from 1983 to 2008 was compiled. It included a total of 1,820 identification images of ventral tail flukes and lateral views of dorsal fins. After systematic within- and between-year matching of images of usable quality, it yielded 154 different individuals identified by tail flukes (TF), 230 by left dorsal fins (LDF), and 237 by right dorsal fins (RDF). Microsatellite (MS) matching of 216 skin biopsies yielded 156 individuals. By linking all possible sightings of the same individuals using all available identification features, the periodicity and seasonality of 281 individual whales were examined. Sixty whales were resighted on different days of which 44 were between different calendar years. The most resightings for one individual was 11 times, seen in six different years, while the longest interval between first and last sightings was about 18 years. A resighting rate of 15.6% of whales at intervals of a year or more indicates long-term fidelity to the region. Shorter intervals of 1 – 6 months between sequential sightings in the same year may suggest temporary residency. The TF image collection from WSA was compared to TF collections from four other regions, namely Gabon, Cabinda (Angola), Namibia and the Antarctic Humpback Whale Catalogue (AHWC). Three matches were detected were between WSA (in late spring or summer) and Gabon (in winter), confirming direct movement between these regions. The capture-recapture data of four different identification features (TF, RDF, LDF and MS) from six successive subsets of data from periods with the highest collection effort (2001 – 2007), were used to calculate the number of whales that utilise the region, using both closed and open-population models. Since dorsal fins have never been used to estimate abundance for humpback whales, the different identification features were evaluated for potential biases. This revealed 9 – 14% incidence of missed matches (false negatives) when using dorsal fins that will result in an overestimate, while variation in individual fluke-up behaviour may lower estimates due to heterogeneity of individual capture probability, by as much as 57-69%. Taking into consideration the small dataset and low number of recaptures, the most consistent and precise results were obtained from a fully time-dependent version of the Jolly-Seber open-population model, with annual survival fixed at 0.96, using the MS dataset. This suggests that the WSA feeding assemblage during the months of spring and summer of the study period numbered about 500. The relationship of these whales to those (perhaps strictly migratory) that may occur here in other seasons of the year, and their links to possible migratory routes and other feeding or breeding areas remain uncertain.National Research Foundation (NRF), South Africa, under Grant Number 2047517. Earthwatch Institute (funding), The Mazda Wildlife Fund (through the provision of a field vehicle), SASOL (through the donation of two four-stroke engines), PADI Project AWARE (UK) (funding), the South African Navy (access to the shore-based look-out), the Military Academy, University of Stellenbosch (accommodation) and Iziko South African Museum (office space and support). JB gratefully received financial support in the form of bursaries from the NRF, the Society for Marine Mammalogy, University of Pretoria, and the Wildlife Society of South Africa (Charles Astley Maberley Memorial bursary). The Namibian Dolphin Project is supported by NACOMA (Namibian Coastal Conservation and Management Project), the Nedbank Go Green Fund, Mohammed bin Zayed Species Conservation Fund, the British Ecological Society, the Rufford Small Grants Foundation and the Namibia Nature Foundation. JB and TJQC received funding from the International Whaling Commission (IWC) to conduct between-region matching.http://www.tandfonline.com/loi/tams20nf201

BRCA2 polymorphic stop codon K3326X and the risk of breast, prostate, and ovarian cancers

Background: The K3326X variant in BRCA2 (BRCA2*c.9976A>T; p.Lys3326*; rs11571833) has been found to be associated with small increased risks of breast cancer. However, it is not clear to what extent linkage disequilibrium with fully pathogenic mutations might account for this association. There is scant information about the effect of K3326X in other hormone-related cancers. Methods: Using weighted logistic regression, we analyzed data from the large iCOGS study including 76 637 cancer case patients and 83 796 control patients to estimate odds ratios (ORw) and 95% confidence intervals (CIs) for K3326X variant carriers in relation to breast, ovarian, and prostate cancer risks, with weights defined as probability of not having a pathogenic BRCA2 variant. Using Cox proportional hazards modeling, we also examined the associations of K3326X with breast and ovarian cancer risks among 7183 BRCA1 variant carriers. All statistical tests were two-sided. Results: The K3326X variant was associated with breast (ORw = 1.28, 95% CI = 1.17 to 1.40, P = 5.9x10- 6) and invasive ovarian cancer (ORw = 1.26, 95% CI = 1.10 to 1.43, P = 3.8x10-3). These associations were stronger for serous ovarian cancer and for estrogen receptor–negative breast cancer (ORw = 1.46, 95% CI = 1.2 to 1.70, P = 3.4x10-5 and ORw = 1.50, 95% CI = 1.28 to 1.76, P = 4.1x10-5, respectively). For BRCA1 mutation carriers, there was a statistically significant inverse association of the K3326X variant with risk of ovarian cancer (HR = 0.43, 95% CI = 0.22 to 0.84, P = .013) but no association with breast cancer. No association with prostate cancer was observed. Conclusions: Our study provides evidence that the K3326X variant is associated with risk of developing breast and ovarian cancers independent of other pathogenic variants in BRCA2. Further studies are needed to determine the biological mechanism of action responsible for these associations

Telepsychology: public speaking fear treatment on the internet

El objetivo es presentar un sistema de telepsicología para el tratamiento del miedo a hablar en público. El sistema utiliza procedimientos de auto-ayuda y está compuesto por: a) Un protocolo de evaluación que rastrea información clínicamente relevante; b) Un protocolo de tratamiento basado en procedimientos cognitivo-comportamentales que cuenta con una serie de vídeos de audiencias reales que permiten a la persona afrontar las situaciones temidas. Está organizado en bloques separados a los que se accede a medida que se supera cada fase previa. c) Un protocolo de control que rastrea el progreso durante todo el proceso y controla que la persona no se salta partes del tratamiento (algo común en procedimientos de autoayuda). Este sistema es el primero en todo el mundo totalmente autoaplicado que utiliza internet como soporte. Este estudio constituye la tesis de licenciatura de la solicitante (obteniendo la máxima calificación, sobresaliente por unanimidad), siendo la directora la Dra. Baños de la Universidad de Valencia. La solicitante diseñó el sistema, escribió la mayor parte de los protocolos, controló cada fase del proceso y redactó el manuscrito final

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

River bank burrowing by invasive crayfish: Spatial distribution, biophysical controls and biogeomorphic significance

Invasive species generate significant global environmental and economic costs and represent a particularly potent threat to freshwater systems. The biogeomorphic impacts of invasive aquatic and riparian species on river processes and landforms remain largely unquantified, but have the potential to generate significant sediment management issues within invaded catchments. Several species of invasive (non-native) crayfish are known to burrow into river banks and visual evidence of river bank damage is generating public concern and media attention. Despite this, there is a paucity of understanding of burrow distribution, biophysical controls and the potential significance of this problem beyond a small number of local studies at heavily impacted sites. This paper presents the first multi-catchment analysis of this phenomenon, combining existing data on biophysical river properties and invasive crayfish observations with purpose-designed field surveys across 103 river reaches to derive key trends. Crayfish burrows were observed on the majority of reaches, but burrowing tended to be patchy in spatial distribution, concentrated in a small proportion (< 10%) of the length of rivers surveyed. Burrow distribution was better explained by local bank biophysical properties than by reach-scale properties, and burrowed banks were more likely to be characterised by cohesive bank material, steeper bank profiles with large areas of bare bank face, often on outer bend locations. Burrow excavation alone has delivered a considerable amount of sediment to invaded river systems in the surveyed sites (3 t km− 1 impacted bank) and this represents a minimum contribution and certainly an underestimate of the absolute yield (submerged burrows were not recorded). Furthermore, burrowing was associated with bank profiles that were either actively eroding or exposed to fluvial action and/or mass failure processes, providing the first quantitative evidence that invasive crayfish may cause or accelerate river bank instability and erosion in invaded catchments beyond the scale of individual burro

TECNOB: study design of a randomized controlled trial of a multidisciplinary telecare intervention for obese patients with type-2 diabetes

Obesity is one of the most important medical and public health problems of our time: it increases the risk of many health complications such as hypertension, coronary heart disease and type 2 diabetes, needs long-lasting treatment for effective results and involves high public and private costs. Therefore, it is imperative that enduring and low-cost clinical programs for obesity and related co-morbidities are developed and evaluated. METHODS/DESIGN: TECNOB (TEChnology for OBesity) is a comprehensive two-phase stepped down program enhanced by telemedicine for the long-term treatment of obese people with type 2 diabetes seeking intervention for weight loss. Its core features are the hospital-based intensive treatment (1-month), that consists of diet therapy, physical training and psychological counseling, and the continuity of care at home using new information and communication technologies (ICT) such as internet and mobile phones. The effectiveness of the TECNOB program compared with usual care (hospital-based treatment only) will be evaluated in a randomized controlled trial (RCT) with a 12-month follow-up. The primary outcome is weight in kilograms. Secondary outcome measures are energy expenditure measured using an electronic armband, glycated hemoglobin, binge eating, self-efficacy in eating and weight control, body satisfaction, healthy habit formation, disordered eating-related behaviors and cognitions, psychopathological symptoms and weight-related quality of life. Furthermore, the study will explore what behavioral and psychological variables are predictive of treatment success among those we have considered. DISCUSSION: The TECNOB study aims to inform the evidence-based knowledge of how telemedicine may enhance the effectiveness of clinical interventions for weight loss and related type-2 diabetes, and which type of obese patients may benefit the most from such interventions. Broadly, the study aims also to have a effect on the theoretical model behind the traditional health care service, in favor of a change towards a new "health care everywhere" approach