Proposed research criteria for prodromal behavioural variant frontotemporal dementia

At present, no research criteria exist for the diagnosis of prodromal behavioural variant frontotemporal dementia (bvFTD), though early detection is of high research importance. Thus, we sought to develop and validate a proposed set of research criteria for prodromal bvFTD, termed \u27mild behavioural and/or cognitive impairment in bvFTD\u27 (MBCI-FTD). Participants included 72 participants deemed to have prodromal bvFTD; this comprised 55 carriers of a pathogenic mutation known to cause frontotemporal lobar degeneration, and 17 individuals with autopsy-confirmed frontotemporal lobar degeneration. All had mild behavioural and/or cognitive changes, as judged by an evaluating clinician. Based on extensive clinical workup, the prodromal bvFTD group was divided into a Development Group (n = 22) and a Validation Group (n = 50). The Development Group was selected to be the subset of the prodromal bvFTD group for whom we had the strongest longitudinal evidence of conversion to bvFTD, and was used to develop the MBCI-FTD criteria. The Validation Group was the remainder of the prodromal bvFTD group and was used as a separate sample on which to validate the criteria. Familial non-carriers were included as healthy controls (n = 165). The frequencies of behavioural and neuropsychiatric features, neuropsychological deficits, and social cognitive dysfunction in the prodromal bvFTD Development Group and healthy controls were assessed. Based on sensitivity and specificity analyses, seven core features were identified: apathy without moderate-severe dysphoria, behavioural disinhibition, irritability/agitation, reduced empathy/sympathy, repetitive behaviours (simple and/or complex), joviality/gregariousness, and appetite changes/hyperorality. Supportive features include a neuropsychological profile of impaired executive function or naming with intact orientation and visuospatial skills, reduced insight for cognitive or behavioural changes, and poor social cognition. Three core features or two core features plus one supportive feature are required for the diagnosis of possible MBCI-FTD; probable MBCI-FTD requires imaging or biomarker evidence, or a pathogenic genetic mutation. The proposed MBCI-FTD criteria correctly classified 95% of the prodromal bvFTD Development Group, and 74% of the prodromal bvFTD Validation Group, with a false positive rate of \u3c10% in healthy controls. Finally, the MBCI-FTD criteria were tested on a cohort of individuals with prodromal Alzheimer\u27s disease, and the false positive rate of diagnosis was 11-16%. Future research will need to refine the sensitivity and specificity of these criteria, and incorporate emerging biomarker evidence

Economic evaluation of implementation science outcomes in low- and middle-income countries: A scoping review

BACKGROUND: Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. METHODS: We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. RESULTS: Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. CONCLUSION: A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs. TRIAL REGISTRATION: The protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ)

Neuropsychological patterns following lesions of the anterior insula in a series of forty neurosurgical patients

In the present study we investigated the effects of lesions affecting mainly the anterior insula in a series of 22 patients with lesions in the left hemisphere (LH), and 18 patients with lesions involving the right hemisphere (RH). The site of the lesion was established by performing an overlap of the probabilistic cytoarchitectonic maps of the posterior insula. Here we report the patients\u2019 neuropsychological profile and an analysis of their pre-surgical symptoms. We found that pre-operatory symptoms significantly differed in patients depending on whether the lesion affected the right or left insula and a strict parallelism between the patterns emerged in the pre-surgery symptoms analysis, and the patients\u2019 cognitive profile. In particular, we found that LH patients showed cognitive deficits. By contrast, the RH patients, with the exception of one case showing an impaired performance at the visuo-spatial planning test were within the normal range in performing all the tests. In addition, a sub-group of patients underwent to the post-surgery follow-up examination

The Star Formation History in The Far Outer Disc of M33

The outer regions of disc galaxies are becoming increasingly recognized as key testing sites for models of disc assembly and evolution. Important issues are the epoch at which the bulk of the stars in these regions formed and how discs grow radially over time. To address these issues, we use Hubble Space Telescope Advanced Camera for Surveys imaging to study the star formation history (SFH) of two fields at 9.1 and 11.6 kpc along M33's northern major axis. These fields lie at ~ 4 and 5 V-band disc scale-lengths and straddle the break in M33's surface brightness profile. The colour-magnitude diagrams (CMDs) reach the ancient main sequence turnoff with a signal-to-noise ratio of ~ 5. From detailed modelling of the CMDs, we find that the majority of stars in both fields combined formed at z < 1. The mean age in the inner field, S1, is ~ 3 +/- 1 Gyr and the mean metallicity is [M/H] ~ -0.5 +/- 0.2 dex. The star formation history of S1 unambiguously reveals how the inside-out growth previously measured for M33's inner disc out to ~ 6 kpc extends out to the disc edge at ~ 9 kpc. In comparison, the outer field, S2, is older (mean age ~ 7 +/- 2 Gyr), more metal-poor (mean [M/H] ~ -0.8 +/- 0.3 dex), and contains ~ 30 times less stellar mass. These results provide the most compelling evidence yet that M33's age gradient reverses at large radii near the disc break and that this reversal is accompanied by a break in stellar mass surface density. We discuss several possible interpretations of this behaviour including radial stellar mixing, warping of the gaseous disc, a change in star formation efficiency, and a transition to another structural component. These results offer one of the most detailed views yet of the peripheral regions of any disc galaxy and provide a much-needed observational constraint on the last major epoch of star formation in the outer disc.Comment: 15 pages, 9 figures, accepted to MNRAS, hi-res version available at http://www.roe.ac.uk/~mkb/astroph/m33hires.pd

Changes in disparity in county-level diagnosed diabetes prevalence and incidence in the United States, between 2004 and 2012

Background In recent decades, the United States experienced increasing prevalence and incidence of diabetes, accompanied by large disparities in county-level diabetes prevalence and incidence. However, whether these disparities are widening, narrowing, or staying the same has not been studied. We examined changes in disparity among U.S. counties in diagnosed diabetes prevalence and incidence between 2004 and 2012. Methods We used 2004 and 2012 county-level diabetes (type 1 and type 2) prevalence and incidence data, along with demographic, socio-economic, and risk factor data from various sources. To determine whether disparities widened or narrowed over the time period, we used a regression-based β-convergence approach, accounting for spatial autocorrelation. We calculated diabetes prevalence/incidence percentage point (ppt) changes between 2004 and 2012 and modeled these changes as a function of baseline diabetes prevalence/incidence in 2004. Covariates included county-level demographic and, socio-economic data, and known type 2 diabetes risk factors (obesity and leisure-time physical inactivity). Results For each county-level ppt increase in diabetes prevalence in 2004 there was an annual average increase of 0.02 ppt (p<0.001) in diabetes prevalence between 2004 and 2012, indicating a widening of disparities. However, after accounting for covariates, diabetes prevalence decreased by an annual average of 0.04 ppt (p<0.001). In contrast, changes in diabetes incidence decreased by an average of 0.04 ppt (unadjusted) and 0.09 ppt (adjusted) for each ppt increase in diabetes incidence in 2004, indicating a narrowing of county-level disparities. Conclusions County-level disparities in diagnosed diabetes prevalence in the United States widened between 2004 and 2012, while disparities in incidence narrowed. Accounting for demographic and, socio-economic characteristics and risk factors for type 2 diabetes narrowed the disparities, suggesting that these factors are strongly associated with changes in disparities. Public health interventions that target modifiable risk factors, such as obesity and physical inactivity, in high burden counties might further reduce disparities in incidence and, over time, in prevalence

The personal experience of parenting a child with Juvenile Huntington’s Disease: perceptions across Europe

The study reported here presents a detailed description of what it is like to parent a child with juvenile Huntington’s disease in families across four European countries. Its primary aim was to develop and extend findings from a previous UK study. The study recruited parents from four European countries: Holland, Italy, Poland and Sweden,. A secondary aim was to see the extent to which the findings from the UK study were repeated across Europe and the degree of commonality or divergence across the different countries. Fourteen parents who were the primary caregiver took part in a semistructured interview. These were analyzed using an established qualitative methodology, interpretative phenomenological analysis. Five analytic themes were derived from the analysis: the early signs of something wrong; parental understanding of juvenile Huntington’s disease; living with the disease; other people’s knowledge and understanding; and need for support. These are discussed in light of the considerable convergence between the experiences of families in the United Kingdom and elsewhere in Europe

Wales Angelshark Action Plan AUGUST 2020

Sharks, skates and rays are an important part of Wales’ incredible marine environment. The Critically Endangered Angelshark is one of the rarest shark species found in our waters, but has significant scientific and cultural importance to Wales. I’m pleased to present the Wales Angelshark Action Plan, which provides the framework to better understand and safeguard this species in Wales. I look forward to seeing its delivery over the next five years, through partnership working across Wales and beyond, to support our long term aim of ‘clean, healthy, safe, productive and biologically diverse oceans and seas’

Very preterm birth is a risk factor for increased systolic blood pressure at a young adult age

Children born very prematurely who show intrauterine growth retardation (IUGR) are suggested to be at risk of developing high blood pressure as adults. Renal function may already be impaired by young adult age. To study whether very preterm birth affects blood pressure in young adults, we measured 24-h ambulatory blood pressure (Spacelabs™ 90207 device) and renin concentration in 50 very premature individuals (<32 weeks of gestation), either small (SGA) or appropriate (AGA) for gestational age (21 SGA, 29 AGA), and 30 full-term controls who all were aged 20 years at time of measurement. The mean (standard deviation) daytime systolic blood pressure in SGA and AGA prematurely born individuals, respectively, was 122.7 (8.7) and 123.1 (8.5) mmHg. These values were, respectively, 3.6 mmHg [95% confidence interval (CI) −0.9 to 8.0] and 4.2 mmHg (95% CI 0.4−8.0) higher than in controls [119.6 (7.6)]. Daytime diastolic blood pressure and nighttime blood pressure did not differ between groups. We conclude that individuals born very preterm have higher daytime systolic blood pressure and higher risk of hypertension at a young adult age

Upper limits on gravitational wave bursts in LIGO's second science run

We perform a search for gravitational wave bursts using data from the second science run of the LIGO detectors, using a method based on a wavelet time-frequency decomposition. This search is sensitive to bursts of duration much less than a second and with frequency content in the 100–1100 Hz range. It features significant improvements in the instrument sensitivity and in the analysis pipeline with respect to the burst search previously reported by LIGO. Improvements in the search method allow exploring weaker signals, relative to the detector noise floor, while maintaining a low false alarm rate, O(0.1) μHz. The sensitivity in terms of the root-sum-square (rss) strain amplitude lies in the range of hrss∼10-20-10-19  Hz-1/2. No gravitational wave signals were detected in 9.98 days of analyzed data. We interpret the search result in terms of a frequentist upper limit on the rate of detectable gravitational wave bursts at the level of 0.26 events per day at 90% confidence level. We combine this limit with measurements of the detection efficiency for selected waveform morphologies in order to yield rate versus strength exclusion curves as well as to establish order-of-magnitude distance sensitivity to certain modeled astrophysical sources. Both the rate upper limit and its applicability to signal strengths improve our previously reported limits and reflect the most sensitive broad-band search for untriggered and unmodeled gravitational wave bursts to date.B. Abbott...C. Killow...D. Ottaway...et al., LIGO Scientific Collaboratio