Validation of AD8-Philippines (AD8-P): A brief informant-based questionnaire for dementia screening in the Philippines

Aim: This study was aimed at validating the Filipino version of AD8 (AD8-P). Methods: Community-dwelling Filipino older persons aged ≥60 years, together with their informants, participated in this study. Psychologists independently interviewed the informants with AD8-P and administered the Filipino-validated Mini-Mental State Examination (MMSE-P) and Montreal Cognitive Assessment (MoCA-P) to the older persons. Neurologists and geriatrician conducted physical and neurological examination and Clinical Dementia Rating™ (CDR™) to determine cognitive diagnosis and were blinded with the results of AD8-P. Dementia was diagnosed based on DSM-IV-TR criteria. AD8-P discriminatory ability to screen for dementia was evaluated according to DSM-IV-TR diagnostic criteria for dementia. Results: A total of 366 community-dwelling Filipino older persons aged ≥60 years, 213 with normal cognition and 153 with dementia, and their informants were included in this study. Majority (90%) were at the mildest stage of dementia. Area under the receiver-operating-characteristic curve (AUROC) for AD8-P was 0.94 (95% CI 0.92 to 0.96), demonstrating excellent overall predictive power to screen for dementia. The optimal AD8-P cut-off score with best balance sensitivity (91.5%) and specificity (77.9%) was ≥3. Conclusion: AD8-P demonstrated good psychometric properties to screen for dementia, even at the earliest stage of cognitive decline

Diseño estructural del pavimento más óptimo para la Vía de Evitamiento Norte tramo intersección jr. José Balta con av. 15 de agosto – sazón bajo de la ciudad de Huamachuco - provincia de Sánchez Carrión - La Libertad

La Vía de Evitamiento de la ciudad de Huamachuco presenta un alto nivel de carga vehicular pesada, debido a que su principal función de esta vía es servir como un desvío de tránsito pesado dentro de la ciudad, así mismo sirve de conector con la región de Cajamarca y otros distritos de la Provincia de Sánchez Carrión; esta vía actualmente se encuentra en mal estado y en deterioro. En la presente tesis se realizará el diseño estructural de pavimento más óptimo de 3,255.00 kilómetros del tramo Intersección Jr. José Balta con Av. 15 de Agosto – Sazón Bajo de la ciudad de Huamachuco- Sánchez Carrión- La Libertad, tramo que actualmente no ha sido considerado en ningún expediente técnico para realizar su mejoramiento y que no cuenta con las condiciones necesarias para brindar a los usuarios una buena transitabilidad. Para ello, se propone realizar el diseño estructural de pavimento rígido y pavimento flexible empleando la metodología AASHTO 93, donde se desarrollará el estudio de las diferentes variables que intervienen en esta metodología. Como punto de partida se realizará un estudio de tráfico vial a fin de conocer la demanda de vehículos, posterior a ello, el estudio topográfico para identificar la zona de estudio, el estudio de suelo que determinará la clasificación de suelo y el CBR (dato importante que definirá los espesores de pavimento), el diseño estructural de pavimento rígido y flexible basado en la metodología AASHTO 93, y finalmente se realizará un análisis comparativo de presupuestos de ambos pavimentos. De acuerdo a las diferentes variables consideradas anteriormente, se obtendrá el pavimento más óptimo a emplearse en el tramo de estudio, por ende, al término de la presente tesis se brinda conclusiones y recomendaciones con fines de ser empleadas en futuros estudios similares.The Vía de Evitamiento of the city of Huamachuco has a high level of heavy vehicular load, because its main function is to serve as a diversion of heavy traffic within the city, it also serves as a connector with the Cajamarca region and other districts of the Province of Sánchez Carrión; this road is currently in poor condition and deteriorating. In this thesis, the most optimal pavement structural design of 3,255.00 kilometers of the section Intersección Jr. José Balta with Av. 15 de Agosto - Sazón Bajo of the city of Huamachuco- Sánchez Carrión- La Libertad, a section that has not been currently considered in any technical file for its improvement and that it does not have the necessary conditions to provide users with good walkability. For this, it is proposed to carry out the structural design of rigid pavement and flexible pavement using the AASHTO 93 methodology, where the study of the different variables that intervene in this methodology will be developed. As a starting point, a road traffic study will be carried out in order to know the demand for vehicles, after which, the topographic study to identify the study area, the soil study that will determine the soil classification and the CBR (important data which will define the pavement thicknesses), the rigid and flexible pavement structural design based on the AASHTO 93 methodology, and finally a comparative analysis of the budgets of both pavements will be carried out. According to the different variables considered above, the most optimal pavement to be used in the study section will be obtained, therefore, at the end of this thesis, conclusions and recommendations are provided with the purpose of being used in future similar studiesTesi

Funcionamiento del equipo directivo y su incidencia en el liderazgo transformacional en docentes de una Unidad Educativa, Guayaquil - Ecuador, 2017

El presente trabajo de investigación buscó relacionar el Funcionamiento del Equipo Directivo y el Liderazgo Transformacional en los docentes de la Unidad Educativa Réplica “28 de mayo” en Guayaquil – Ecuador en el año 2017. Se planteó bajo una metodología cuantitativa, de nivel descriptivo y tipo correlacional causal. Sé utilizó la técnica de la encuesta con los instrumentos Escala para evaluar el funcionamiento del equipo directivo y el liderazgo transformacional; ambos instrumentos validados por dos expertos, a los que se sometió a pruebas de confiabilidad dando como resultado un coeficiente de 0,955 para la variable Funcionamiento del Equipo Directivo y 0,956 para la variable Liderazgo Transformacional. Ambos instrumentos se aplicaron a 40 docentes de los cuales 33 fueron de género femenino y 7 de género masculino. La variable funcionamiento del equipo directivo se dimensionó en Confianza, Eficiencia y eficacia organizacional, Sentido e Ineficacia y en 21 indicadores en total. La variable liderazgo transformacional se dimensionó en Influencia idealizada, Motivación por inspiración, Estimulación intelectual y Consideración individual y en 21 indicadores en total. Se inició de la hipótesis de que el funcionamiento del equipo directivo se relacionaba directamente con el liderazgo transformacional, lo que finalmente se comprobó con una relación positiva moderada y significativa, con lo que se corrobora las teorías y estudios previos al respecto. Para el procesamiento de la información se utilizó el software SPSS. Los resultados se presentaron mediante tablas y los estadísticos Rho de Spearman. El presente trabajo de investigación concluye demostrando que el funcionamiento del equipo directivo incide significativamente en el liderazgo transformacional en docentes de una Unidad Educativa Réplica “28 de Mayo”, Guayaquil – Ecuador, 2017

A High Docosahexaenoic Acid Diet Alters the Lung Inflammatory Response to Acute Dust Exposure

Agricultural workers are at risk for the development of acute and chronic lung diseases due to their exposure to organic agricultural dusts. A diet intervention using the omega-3 fatty acid docosahexaenoic acid (DHA) has been shown to be an effective therapeutic approach for alleviating a dust-induced inflammatory response. We thus hypothesized a high-DHA diet would alter the dust-induced inflammatory response through the increased production of specialized pro-resolving mediators (SPMs). Mice were pre-treated with a DHA-rich diet 4 weeks before being intranasally challenged with a single dose of an extract made from dust collected from a concentrated swine feeding operation (HDE). This omega-3-fatty-acid-rich diet led to reduced arachidonic acid levels in the blood, enhanced macrophage recruitment, and increased the production of the DHA-derived SPM Resolvin D1 (RvD1) in the lung following HDE exposure. An assessment of transcript-level changes in the immune response demonstrated significant differences in immune pathway activation and alterations of numerous macrophage-associated genes among HDE-challenged mice fed a high DHA diet. Our data indicate that consuming a DHA-rich diet leads to the enhanced production of SPMs during an acute inflammatory challenge to dust, supporting a role for dietary DHA supplementation as a potential therapeutic strategy for reducing dust-induced lung inflammation

A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at stage 2 reconstruction

ObjectiveWe compare the hemodynamics and perioperative course of shunt type in hypoplastic left heart syndrome at the time of stage 2 reconstruction and longer-term survival.MethodsWe retrospectively reviewed the echocardiograms, catheterizations, and hospital records of all patients who had a stage 1 reconstruction between January 2002 and May 2005 and performed a cross-sectional analysis of hospital survivors.ResultsOne hundred seventy-six patients with hypoplastic left heart syndrome and variants underwent a stage 1 reconstruction with either a right ventricle–pulmonary artery conduit (n = 62) or a modified Blalock–Taussig shunt (n = 114). The median duration of follow-up is 29.1 months (range, 0-57 months). By means of Kaplan–Meier analysis, there is no difference in survival at 3 years (right ventricle–pulmonary artery conduit: 73% [95% confidence limit, 59%–83%] vs modified Blalock–Taussig shunt: 69% [95% confidence limit, 59%–77%]; P = .6). One hundred twenty-four patients have undergone stage 2 reconstruction (78 modified Blalock–Taussig shunts and 46 right ventricle–pulmonary artery conduits). At the time of the stage 2 reconstruction, patients with right ventricle–pulmonary artery conduits were younger (153 days [range, 108–340 days]; modified Blalock–Taussig shunt, 176 days [range, 80–318 days]; P = .03), had lower systemic oxygen saturation (73% [range, 58%–85%] vs 77% [range, 57%–89%], P < .01), and had higher preoperative hemoglobin levels (15.8 g/dL [range, 13–21 g/dL] vs 14.8 g/dL [range, 12–19 g/dL], P < .01) compared with those of the modified Blalock–Taussig shunt group. By means of echocardiographic evaluation, there was a higher incidence of qualitative ventricular dysfunction in patients with right ventricle–pulmonary artery conduits (14/46 [31%] vs 9/73 [12%], P = .02). However, no difference was observed in common atrial pressure or the arteriovenous oxygen difference.ConclusionInterim analyses suggest no advantage of one shunt type over another. This report raises concern of late ventricular dysfunction and outcome in patients with a right ventricle–pulmonary artery conduit

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID-19 pandemic, now and in the future

We have provided an overview on the profound impact of COVID-19 upon older people with Alzheimer's disease and other dementias and the challenges encountered in our management of dementia in different health-care settings, including hospital, outpatient, care homes, and the community during the COVID-19 pandemic. We have also proposed a conceptual framework and practical suggestions for health-care providers in tackling these challenges, which can also apply to the care of older people in general, with or without other neurological diseases, such as stroke or parkinsonism. We believe this review will provide strategic directions and set standards for health-care leaders in dementia, including governmental bodies around the world in coordinating emergency response plans for protecting and caring for older people with dementia amid the COIVD-19 outbreak, which is likely to continue at varying severity in different regions around the world in the medium term

Cancer risk and survival in path _ MMR carriers by gene and gender up to 75 years of age: a report from the prospective Lynch Syndrome database

Background Most patients with path_MMR gene variants (Lynch syndrome (LS)) now survive both their first and subsequent cancers, resulting in a growing number of older patients with LS for whom limited information exists with respect to cancer risk and survival. Objective and design This observational, international, multicentre study aimed to determine prospectively observed incidences of cancers and survival in path_MMR carriers up to 75 years of age. Results 3119 patients were followed for a total of 24 475 years. Cumulative incidences at 75 years (risks) for colorectal cancer were 46%, 43% and 15% in path_MLH1, path_MSH2 and path_MSH6 carriers; for endometrial cancer 43%, 57% and 46%; for ovarian cancer 10%, 17% and 13%; for upper gastrointestinal (gastric, duodenal, bile duct or pancreatic) cancers 21%, 10% and 7%; for urinary tract cancers 8%, 25% and 11%; for prostate cancer 17%, 32% and 18%; and for brain tumours 1%, 5% and 1%, respectively. Ovarian cancer occurred mainly premenopausally. By contrast, upper gastrointestinal, urinary tract and prostate cancers occurred predominantly at older ages. Overall 5-year survival for prostate cancer was 100%, urinary bladder 93%, ureter 85%, duodenum 67%, stomach 61%, bile duct 29%, brain 22% and pancreas 0%. Path_PMS2 carriers had lower risk for cancer. Conclusion Carriers of different path_MMR variants exhibit distinct patterns of cancer risk and survival as they age. Risk estimates for counselling and planning of surveillance and treatment should be tailored to each patient's age, gender and path_MMR variant. We have updated our open-access website www.lscarisk.org to facilitate this

Blood amyloid-β oligomerization associated with neurodegeneration of Alzheimers disease

Introduction Oligomeric amyloid-ß is a major toxic species associated with Alzheimers disease pathogenesis. Methods used to measure oligomeric amyloid-β in the blood have increased in number in recent years. The Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) is a specific method to measure oligomerization tendencies in the blood. The objective of this study was to determine the association between amyloid-ß oligomerization in the plasma and structural changes of the brain. Methods We studied 162 subjects composed of 92 community-based normal healthy subjects, 17 with subjective cognitive decline, 14 with mild cognitive impairment and 39 with Alzheimers disease dementia. All subjects underwent MDS-OAβ and three-dimensional T1 magnetic resonance imaging. To determine the structural changes of the brain that are statistically correlated with MDS-OAβ level, we used voxel-based morphometry with corrections for age and total intracranial volume covariates. Results We found brain volume reduction in the bilateral temporal, amygdala, parahippocampal and lower parietal lobe and left cingulate and precuneus regions (family-wise error, p < 0.05). Reduction was also found in white matter in proximity to the left temporal and bilateral lower parietal lobes and posterior corpus callosum (family-wise error, p < 0.05). Brain volume increment was not observed in any regions within grey or white matter. Discussion Findings suggest that substantial correlation exists between amyloid ß oligomerization in the blood and brain volume reduction in the form of Alzheimers disease despite of uncertainty in the casual relationship.This work was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C1251)

Cancer risk and survival in path_MMR carriers by gene and gender up to 75 years of age: a report from the Prospective Lynch Syndrome Database

Background Most patients with path_MMR gene variants (Lynch syndrome (LS)) now survive both their first and subsequent cancers, resulting in a growing number of older patients with LS for whom limited information exists with respect to cancer risk and survival. Objective and design  This observational, international, multicentre study aimed to determine prospectively observed incidences of cancers and survival in path_MMR carriers up to 75 years of age. Results 3119 patients were followed for a total of 24 475 years. Cumulative incidences at 75 years (risks) for colorectal cancer were 46%, 43% and 15% in path_MLH1, path_MSH2 and path_MSH6 carriers; for endometrial cancer 43%, 57% and 46%; for ovarian cancer 10%, 17% and 13%; for upper gastrointestinal (gastric, duodenal, bile duct or pancreatic) cancers 21%, 10% and 7%; for urinary tract cancers 8%, 25% and 11%; for prostate cancer 17%, 32% and 18%; and for brain tumours 1%, 5% and 1%, respectively. Ovarian cancer occurred mainly premenopausally. By contrast, upper gastrointestinal, urinary tract and prostate cancers occurred predominantly at older ages. Overall 5-year survival for prostate cancer was 100%, urinary bladder 93%, ureter 85%, duodenum 67%, stomach 61%, bile duct 29%, brain 22% and pancreas 0%. Path_PMS2 carriers had lower risk for cancer. Conclusion  Carriers of different path_MMR variants exhibit distinct patterns of cancer risk and survival as they age. Risk estimates for counselling and planning of surveillance and treatment should be tailored to each patient's age, gender and path_MMR variant. We have updated our open-access website www.lscarisk. org to facilitate this