Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study

Background: Few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. Method: The postcodes of the 2424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. Results: Higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. Conclusion: Features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies

Mantle flow and lithosphere-asthenosphere coupling beneath the southwestern edge of the North American craton: constraints from shear-wave splitting measurements

High-quality broadband seismic data recorded by the USArray and other stations in the southwestern United States provide a unique opportunity to test different models of anisotropy-forming mechanisms in the vicinity of a cratonic edge. Systematic spatial variations of anisotropic characteristics are revealed by 3027 pairs of splitting parameters measured at 547 broadband seismic stations. The western and southern edges of the North American craton show edge-parallel fast directions with larger-than-normal splitting times, and the continental interior is characterized by smaller splitting times spatially consistent fast directions that are mostly parallel to the absolute plate motion direction of North America. Except for a small area in the vicinity of the Llano Uplift in central Texas, no systematic azimuthal variations of the splitting parameters are observed, suggesting that a single layer of anisotropy with horizontal axis of symmetry can adequately explain the observations. Estimation of the depth of the source of the observed anisotropy using spatial coherency of the splitting parameters indicates that the observed anisotropy mostly originate from the upper asthenosphere, through simple shear between the partially coupled lithosphere and asthenosphere --Abstract, page iv

Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study

Background: Few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. Method: The postcodes of the 2424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. Results: Higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. Conclusion: Features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies

A longitudinal study of muscle rehabilitation in the lower leg after cast removal using Magnetic Resonance Imaging and strength assessment

Acknowledgements We thank the A&E nurses and plaster technicians for identifying suitable patients, the MRI radiographers for performing the scanning, Dr Scott Semple for invaluable help in some of the pilot studies and Mr E. C. Stevenson for constructing the footrest used in the scanner. We are very grateful to the dedicated patients themselves who gave considerable amounts of time to come in for scanning, exercise and assessment during the course of this study.Peer reviewedPublisher PD

Psychological Capital as Mediator between Adaptive Perfectionism and Academic Procrastination

Research on perfectionism and separately on procrastination is extensive and both are related in general to negative consequences. However, there has been little research on different forms of perfectionism (maladaptive vs adaptive) and the relationships with procrastination. One study (Seo, 2008) has suggested that self-efficacy mediates between adaptive perfectionism and procrastination in academic settings and leads to more productive outcomes. Identifying further such positive productive factors may prove useful in helping individuals deal with their perfectionism and-or their procrastination tendencies. Positive psychological capital (PsyCap) may be one such other mediator, as PsyCap involves not only self-efficacy but also resilience, hope and optimism—attributes that have been associated separately each in their own right with positive behaviour and not with normal academic procrastination Most studies of PsyCap have occurred in organisational settings and may also be considered to be important attributes in the academic setting. Psychological capital as a positive mediator between adaptive perfectionism and procrastination in an academic setting was therefore examined in the current study, with results supporting the mediation effect. The implication is that those students with perfectionistic attributes can be helped to control some of the negative outcomes (such as procrastination) by developing skills in psychological capital. How this might work is discussed. Further detailed studies are needed including replication and identification of other mediators

Prevalence of dementia in East Asia: a synthetic review of time trends.

OBJECTIVE: This study aims to synthesise evidence on time trends of dementia prevalence in East Asian countries including Japan, China, South Korea and Taiwan and assess the impact of the societal changes on future prevalence. METHOD: Relevant reviews and recent nationwide studies in East Asia were identified to investigate changes in prevalence of dementia over time taking into account the potential impact of methodological factors and study designs. RESULTS: The robust evidence that has been interpreted to suggest a substantial increasing trend over time is less compelling once fundamental differences in study methods and populations across individual surveys are considered. In Japan, longitudinal studies in small areas suggest the potential increase of prevalence after 2000. Increasing trends in China, South Korea and Taiwan over the last 20-30 years are based on the literature review without adjustment for methodological differences. Economic development and huge societal changes alongside the rise of non-communicable disease in East Asia could lead to increasing prevalence of dementia in the future once those cohorts with high risk of dementia reached their older age. CONCLUSION: Current evidence is not sufficient to suggest increasing trends of dementia prevalence in East Asia. Longitudinal studies with representative samples and stable methodology are needed to provide fundamental information of the epidemiology of dementia and identify important risk factors in East Asian societies.There is no specific funding contributing to this study. Yu-Tzu Wu received a PhD scholarship from the Cambridge Trust, University of Cambridge. Fiona E. Matthews was supported by the Medical Research Council [grant number U105292687].This is the final published version. It first appeared at http://onlinelibrary.wiley.com/doi/10.1002/gps.4297/abstract

Dementia: time trends and policy responses.

In recent years, dementia has been considered a public health priority and become a topic of major political interest. Recent reviews and studies have reported with varying degrees of alarm an impending and existing "dementia epidemic" with increasing predicted trends in prevalence and enormous numbers of people with dementia particularly in low- and middle-income countries (LMICs). However, robust evidence from dementia research in high-income countries suggests stable or decreased prevalence over the last decades. Current evidence is not sufficient to suggest increasing trends of prevalence in LMICs once variation in methodological factors and study populations are taken into account. Changes in diagnostic methods over the last decades substantially influence the identification of dementia cases with systematic difference between the resulting individual prevalence studies. Potential geographical variations at the country level might indicate potential risk factors at population levels or systematic difference in clinical application of dementia diagnosis. Although it is important and necessary to use information from dementia research for evidence-based policymaking, over-interpretation of results without carefully considering underlying factors could exaggerate the findings and influence policy planning in ways which do not serve current and future population best. Planning of dementia policy needs to take full cognisance of the provenance of the data being used and be integrated with policies which optimise health across the lifecourse.Yu-Tzu Wu received a PhD scholarship from the Cambridge Trust, University of Cambridge. Fiona E. Matthews was supported by the Medical Research Council [grant number U105292687].This is the accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.maturitas.2014.06.02

Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): An international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset with usual stroke unit care

Rationale: A key objective of A Very Early Rehabilitation Trial is to determine if the intervention, very early mobilisation following stroke, is cost-effective. Resource use data were collected to enable an economic evaluation to be undertaken and a plan for the main economic analyses was written prior to the completion of follow up data collection. Aim and hypothesis To report methods used to collect resource use data, pre-specify the main economic evaluation analyses and report other intended exploratory analyses of resource use data. Sample size estimates: Recruitment to the trial has been completed. A total of 2,104 participants from 56 stroke units across three geographic regions participated in the trial. Methods and design: Resource use data were collected prospectively alongside the trial using standardised tools. The primary economic evaluation method is a cost-effectiveness analysis to compare resource use over 12 months with health outcomes of the intervention measured against a usual care comparator. A cost-utility analysis is also intended. Study outcome: The primary outcome in the cost-effectiveness analysis will be favourable outcome (modified Rankin Scale score 0-2) at 12 months. Cost-utility analysis will use health-related quality of life, reported as quality-adjusted life years gained over a 12 month period, as measured by the modified Rankin Scale and the Assessment of Quality of Life. Discussion: Outcomes of the economic evaluation analysis will inform the cost-effectiveness of very early mobilisation following stroke when compared to usual care. The exploratory analysis will report patterns of resource use in the first year following stroke

End User Query Performance: The Interaction of User Characteristics and Information Request Ambiguity

This paper investigates the effects of personality characteristics on individuals’ abilities to resolve ambiguity in an information retrieval environment. In particular, this research examines the effects on query performance of the interaction of personality characteristics (as measured using the NEO PI-R) with information requests that contained extraneous, syntactic, or both extraneous and syntactic ambiguities. The results indicate that ambiguity affected performance. The results also show that various personality dimensions significantly affect end-users’ abilities to compose accurate queries. Neuroticism, agreeableness, openness to experience, and conscientiousness affected the number of errors made in the query formulations. Conscientiousness affected the length of time taken to compose the queries and neuroticism affected the confidence end users had in the accuracy of their queries. In addition, the results indicated that, while the personality dimensions affected performance, there was no interaction between the personality dimensions and ambiguity