Agnosia Interferes With Daily Hygiene in Patients With Dementia

Patients with dementia, particularly Alzheimer’s disease, may not recognize that their clothes are dirty. They may see the food stains and discoloration of the clothes and yet because of their agnosia are unable to integrate these observations and deduce that their clothes are dirty and need to be changed. They will, therefore, resist attempts to get them to change clothes, especially if these clothes happen to be their favorite ones. This often causes caregivers to become frustrated, especially, if it represents a change in the patient’s previous habits of only wearing clean clothes. In this case study, we present a 72-year-old woman with moderate Alzheimer’s disease who lives with her daughter, who adamantly refuses to change the clothes she has been wearing for a few days and which are now clearly dirty. We report the interaction, highlight what went wrong in the patient–daughter interaction, and discuss how the catastrophic ending could have been avoided or averted

Macroinvertebrate traits in Arctic streams reveal latitudinal patterns in physiology and habits that are strongly linked to climate

IntroductionArctic freshwater ecosystems are undergoing rapid environmental transformation because of climate change, which is predicted to produce fundamental alterations in river community structure and function.MethodsWe explored how climate change affects benthic invertebrate communities of Arctic streams by examining patterns of their biological traits along latitudinal and climatic gradients in eastern North America (Canada) and northwestern Europe (Sweden, Norway).ResultsDespite differences in taxonomic composition between continents, we identified similarities in the functional trait niche (FTN) of predominant macroinvertebrate taxonomic groups. Trait composition differed by latitude in eastern Canada, with a predominance of cold-tolerant taxa, tubular body shape, and cased and attached habits at the highest latitudes. Differences in trait composition were evident among ecoregions in Europe, with trait dominance at the highest latitudes that was comparable to North America. There was a similar increase in the relative abundance of cold tolerance and tubular body shape and a decrease in obligate shredders and trait richness with decreasing temperatures across both continents.DiscussionThese patterns are indicative of FTNs that include physiological traits and habits that are advantageous for the low temperatures, short ice-free period, and low riparian vegetation cover at the highest latitudes. We predict that climate change will lead to an increase in functional diversity at high latitudes, as organisms with trait modalities that are currently only found at lower latitudes move northward. However, this change in trait composition will be mediated by the effect of spatial connectivity on dispersal ability, with slower change occurring on Arctic islands. These findings can support modelling of future change in Arctic freshwater assemblages in response to ongoing climate change

Spatial and temporal variation in Arctic freshwater chemistry—Reflecting climate-induced landscape alterations and a changing template for biodiversity

Freshwater chemistry across the circumpolar region was characterised using a pan-Arctic data set from 1,032 lake and 482 river stations. Temporal trends were estimated for Early (1970-1985), Middle (1986-2000), and Late (2001-2015) periods. Spatial patterns were assessed using data collected since 2001.Alkalinity, pH, conductivity, sulfate, chloride, sodium, calcium, and magnesium (major ions) were generally higher in the northern-most Arctic regions than in the Near Arctic (southern-most) region. In particular, spatial patterns in pH, alkalinity, calcium, and magnesium appeared to reflect underlying geology, with more alkaline waters in the High Arctic and Sub Arctic, where sedimentary bedrock dominated.Carbon and nutrients displayed latitudinal trends, with lower levels of dissolved organic carbon (DOC), total nitrogen, and (to a lesser extent) total phosphorus (TP) in the High and Low Arctic than at lower latitudes. Significantly higher nutrient levels were observed in systems impacted by permafrost thaw slumps.Bulk temporal trends indicated that TP was higher during the Late period in the High Arctic, whereas it was lower in the Near Arctic. In contrast, DOC and total nitrogen were both lower during the Late period in the High Arctic sites. Major ion concentrations were higher in the Near, Sub, and Low Arctic during the Late period, but the opposite bulk trend was found in the High Arctic.Significant pan-Arctic temporal trends were detected for all variables, with the most prevalent being negative TP trends in the Near and Sub Arctic, and positive trends in the High and Low Arctic (mean trends ranged from +0.57%/year in the High/Low Arctic to -2.2%/year in the Near Arctic), indicating widespread nutrient enrichment at higher latitudes and oligotrophication at lower latitudes.The divergent P trends across regions may be explained by changes in deposition and climate, causing decreased catchment transport of P in the south (e.g. increased soil binding and trapping in terrestrial vegetation) and increased P availability in the north (deepening of the active layer of the permafrost and soil/sediment sloughing). Other changes in concentrations of major ions and DOC were consistent with projected effects of ongoing climate change. Given the ongoing warming across the Arctic, these region-specific changes are likely to have even greater effects on Arctic water quality, biota, ecosystem function and services, and human well-being in the future

Temperature and spatial connectivity drive patterns in freshwater macroinvertebrate diversity across the Arctic

Warming in the Arctic is predicted to change freshwater biodiversity through loss of unique taxa and northward range expansion of lower latitude taxa. Detecting such changes requires establishing circumpolar baselines for diversity, and understanding the primary drivers of diversity. We examined benthic macroinvertebrate diversity using a circumpolar dataset of &gt;1,500 Arctic lake and river sites. Rarefied α diversity within catchments was assessed along latitude and temperature gradients. Community composition was assessed through region-scale analysis of β diversity and its components (nestedness and turnover), and analysis of biotic–abiotic relationships. Rarefied α diversity of lakes and rivers declined with increasing latitude, although more strongly across mainland regions than islands. Diversity was strongly related to air temperature, with the lowest diversity in the coldest catchments. Regional dissimilarity was highest when mainland regions were compared with islands, suggesting that connectivity limitations led to the strongest dissimilarity. High contributions of nestedness indicated that island regions contained a subset of the taxa found in mainland regions. High Arctic rivers and lakes were predominately occupied by Chironomidae and Oligochaeta, whereas Ephemeroptera, Plecoptera, and Trichoptera taxa were more abundant at lower latitudes. Community composition was strongly associated with temperature, although geology and precipitation were also important correlates. The strong association with temperature supports the prediction that warming will increase Arctic macroinvertebrate diversity, although low diversity on islands suggests that this increase will be limited by biogeographical constraints. Long-term harmonised monitoring across the circumpolar region is necessary to detect such changes to diversity and inform science-based management.</p

Inhaled recombinant human IL-15 in dogs with naturally occurring pulmonary metastases from osteosarcoma or melanoma: a phase 1 study of clinical activity and correlates of response.

PurposeAlthough recombinant human interleukin-15 (rhIL-15) has generated much excitement as an immunotherapeutic agent for cancer, activity in human clinical trials has been modest to date, in part due to the risks of toxicity with significant dose escalation. Since pulmonary metastases are a major site of distant failure in human and dog cancers, we sought to investigate inhaled rhIL-15 in dogs with naturally occurring lung metastases from osteosarcoma (OSA) or melanoma. We hypothesized a favorable benefit/risk profile given the concentrated delivery to the lungs with decreased systemic exposure.Experimental designWe performed a phase I trial of inhaled rhIL-15 in dogs with gross pulmonary metastases using a traditional 3+3 cohort design. A starting dose of 10 µg twice daily × 14 days was used based on human, non-human primate, and murine studies. Safety, dose-limiting toxicities (DLT), and maximum tolerated dose (MTD) were the primary objectives, while response rates, progression-free and overall survival (OS), and pharmacokinetic and immune correlative analyses were secondary.ResultsFrom October 2018 to December 2020, we enrolled 21 dogs with 18 dogs reaching the 28-day response assessment to be evaluable. At dose level 5 (70 μg), we observed two DLTs, thereby establishing 50 µg twice daily × 14 days as the MTD and recommended phase 2 dose. Among 18 evaluable dogs, we observed one complete response >1 year, one partial response with resolution of multiple target lesions, and five stable disease for an overall clinical benefit rate of 39%. Plasma rhIL-15 quantitation revealed detectable and sustained rhIL-15 concentrations between 1-hour and 6 hour postnebulization. Decreased pretreatment lymphocyte counts were significantly associated with clinical benefit. Cytotoxicity assays of banked peripheral blood mononuclear cells revealed significant increases in peak cytotoxicity against canine melanoma and OSA targets that correlated with OS.ConclusionsIn this first-in-dog clinical trial of inhaled rhIL-15 in dogs with advanced metastatic disease, we observed promising clinical activity when administered as a monotherapy for only 14 days. These data have significant clinical and biological implications for both dogs and humans with refractory lung metastases and support exploration of combinatorial therapies using inhaled rhIL-15

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Macroinvertebrate traits in Arctic streams reveal latitudinal patterns in physiology and habits that are strongly linked to climate

Introduction: Arctic freshwater ecosystems are undergoing rapid environmental transformation because of climate change, which is predicted to produce fundamental alterations in river community structure and function.Methods: We explored how climate change affects benthic invertebrate communities of Arctic streams by examining patterns of their biological traits along latitudinal and climatic gradients in eastern North America (Canada) and northwestern Europe (Sweden, Norway).Results: Despite differences in taxonomic composition between continents, we identified similarities in the functional trait niche (FTN) of predominant macroinvertebrate taxonomic groups. Trait composition differed by latitude in eastern Canada, with a predominance of cold-tolerant taxa, tubular body shape, and cased and attached habits at the highest latitudes. Differences in trait composition were evident among ecoregions in Europe, with trait dominance at the highest latitudes that was comparable to North America. There was a similar increase in the relative abundance of cold tolerance and tubular body shape and a decrease in obligate shredders and trait richness with decreasing temperatures across both continents.Discussion: These patterns are indicative of FTNs that include physiological traits and habits that are advantageous for the low temperatures, short ice-free period, and low riparian vegetation cover at the highest latitudes. We predict that climate change will lead to an increase in functional diversity at high latitudes, as organisms with trait modalities that are currently only found at lower latitudes move northward. However, this change in trait composition will be mediated by the effect of spatial connectivity on dispersal ability, with slower change occurring on Arctic islands. These findings can support modelling of future change in Arctic freshwater assemblages in response to ongoing climate change

Table_1_Macroinvertebrate traits in Arctic streams reveal latitudinal patterns in physiology and habits that are strongly linked to climate.xlsx

IntroductionArctic freshwater ecosystems are undergoing rapid environmental transformation because of climate change, which is predicted to produce fundamental alterations in river community structure and function.MethodsWe explored how climate change affects benthic invertebrate communities of Arctic streams by examining patterns of their biological traits along latitudinal and climatic gradients in eastern North America (Canada) and northwestern Europe (Sweden, Norway).ResultsDespite differences in taxonomic composition between continents, we identified similarities in the functional trait niche (FTN) of predominant macroinvertebrate taxonomic groups. Trait composition differed by latitude in eastern Canada, with a predominance of cold-tolerant taxa, tubular body shape, and cased and attached habits at the highest latitudes. Differences in trait composition were evident among ecoregions in Europe, with trait dominance at the highest latitudes that was comparable to North America. There was a similar increase in the relative abundance of cold tolerance and tubular body shape and a decrease in obligate shredders and trait richness with decreasing temperatures across both continents.DiscussionThese patterns are indicative of FTNs that include physiological traits and habits that are advantageous for the low temperatures, short ice-free period, and low riparian vegetation cover at the highest latitudes. We predict that climate change will lead to an increase in functional diversity at high latitudes, as organisms with trait modalities that are currently only found at lower latitudes move northward. However, this change in trait composition will be mediated by the effect of spatial connectivity on dispersal ability, with slower change occurring on Arctic islands. These findings can support modelling of future change in Arctic freshwater assemblages in response to ongoing climate change.</p

Image_1_Macroinvertebrate traits in Arctic streams reveal latitudinal patterns in physiology and habits that are strongly linked to climate.pdf

IntroductionArctic freshwater ecosystems are undergoing rapid environmental transformation because of climate change, which is predicted to produce fundamental alterations in river community structure and function.MethodsWe explored how climate change affects benthic invertebrate communities of Arctic streams by examining patterns of their biological traits along latitudinal and climatic gradients in eastern North America (Canada) and northwestern Europe (Sweden, Norway).ResultsDespite differences in taxonomic composition between continents, we identified similarities in the functional trait niche (FTN) of predominant macroinvertebrate taxonomic groups. Trait composition differed by latitude in eastern Canada, with a predominance of cold-tolerant taxa, tubular body shape, and cased and attached habits at the highest latitudes. Differences in trait composition were evident among ecoregions in Europe, with trait dominance at the highest latitudes that was comparable to North America. There was a similar increase in the relative abundance of cold tolerance and tubular body shape and a decrease in obligate shredders and trait richness with decreasing temperatures across both continents.DiscussionThese patterns are indicative of FTNs that include physiological traits and habits that are advantageous for the low temperatures, short ice-free period, and low riparian vegetation cover at the highest latitudes. We predict that climate change will lead to an increase in functional diversity at high latitudes, as organisms with trait modalities that are currently only found at lower latitudes move northward. However, this change in trait composition will be mediated by the effect of spatial connectivity on dispersal ability, with slower change occurring on Arctic islands. These findings can support modelling of future change in Arctic freshwater assemblages in response to ongoing climate change.</p