Statin usage, vascular diagnosis and vascular risk factors in Parkinson's disease

Background and aims: Vascular disease is a common comorbidity in Parkinson’s disease patients. Statins are potentially neuroprotective for Parkinson’s disease through non-vascular mechanisms. We investigated prevailing statin use in a Parkinson’s disease cohort. Methods and results: Data on diagnostic indication for statins, anti-Parkinson therapy, vascular risk factors, and statin prescription, were obtained from electronic medical record review for consecutive Parkinson’s disease patients. The ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network system was used to calculate future cardiovascular risk and identify those warranting statin use. Of 441 patients included, 59.9% were male, with a mean age of 68.9 years (standard deviation 10.3). One hundred and seventy-four (39.5%) patients had at least one diagnostic indication for statin use, of whom 136 (78.2%) were prescribed a statin. In the 267 (60.5%) cases without a diagnostic indication, 54 (20.2%) were excluded owing to age limitations defined in ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network. Of the remaining 213, 62 (29.1%) had an ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network score in the recommended range for statin therapy, of whom 15 (24.1%) were prescribed statins. Conclusion: There is suboptimal implementation of statin therapy in Parkinson’s disease patients. Given the possible neuroprotective effects of statins in Parkinson’s disease in addition to reducing cardiovascular risk, reasons for suboptimal implementation warrant further investigation

Optimal investment in age-structured goodwill

Segmentation is a core strategy in modern marketing and age-specific segmentation, which is based on the age of the consumers, is very common in practice. A characteristic of age-specific segmentation is the change of the segments composition during time, which may be studied only using dynamic advertising models. Here, we assume that a firm wants to promote and sell a single product in an age segmented market and we model the awareness of this product using an infinite dimensional Nerlove- Arrow goodwill as a state variable. Assuming an infinite time horizon, we use some dynamic programming techniques to solve the problem and to characterize both the optimal advertising effort and the optimal goodwill path in the long run. An interesting feature of the optimal advertising effort is an anticipation effect with respect to the segments considered in the target market due to the time evolution of the segmentation.Segmentation; infinite dimensional Nerlove-Arrow goodwill.

Bernoulli numbers and solitons

We present a new formula for the Bernoulli numbers as the following integral $$B_{2m} =\frac{(-1)^{m-1}}{2^{2m+1}} \int_{-\infty}^{+\infty} (\frac{d^{m-1}}{dx^{m-1}} {sech}^2 x)^2dx.$$ This formula is motivated by the results of Fairlie and Veselov, who discovered the relation of Bernoulli polynomials with soliton theory.Comment: 5 page

Doctor of Philosophy in Computing

dissertationThe aim of direct volume rendering is to facilitate exploration and understanding of three-dimensional scalar fields referred to as volume datasets. Improving understanding is done by improving depth perception, whereas facilitating exploration is done by speeding up volume rendering. In this dissertation, improving both depth perception and rendering speed is considered. The impact of depth of field (DoF) on depth perception in direct volume rendering is evaluated by conducting a user study in which the test subjects had to choose which of two features, located at different depths, appeared to be in front in a volume-rendered image. Whereas DoF was expected to improve perception in all cases, the user study revealed that if used on the back feature, DoF reduced depth perception, whereas it produced a marked improvement when used on the front feature. We then worked on improving the speed of volume rendering on distributed memory machines. Distributed volume rendering has three stages: loading, rendering, and compositing. In this dissertation, the focus is on image compositing, more specifically, trying to optimize communication in image compositing algorithms. For that, we have developed the Task Overlapped Direct Send Tree image compositing algorithm, which works on both CPU- and GPU-accelerated supercomputers, which focuses on communication avoidance and overlapping communication with computation; the Dynamically Scheduled Region-Based image compositing algorithm that uses spatial and temporal awareness to efficiently schedule communication among compositing nodes, and a rendering and compositing pipeline that allows both image compositing and rendering to be done on GPUs of GPU-accelerated supercomputers. We tested these on CPU- and GPU-accelerated supercomputers and explain how these improvements allow us to obtain better performance than image compositing algorithms that focus on load-balancing and algorithms that have no spatial and temporal awareness of the rendering and compositing stages

Switch from abobotulinumtoxinA (Dysport®) to incobotulinumtoxinA (Xeomin®) botulinum toxin formulation: A review of 257 cases

OBJECTIVE: To explore the dose equivalence ratio and treatment costs for abobotulinumtoxinA and incobotulinumtoxinA for patients with focal dystonias. DESIGN: Patient chart review. SUBJECTS/PATIENTS: Adult patients with blepharospasm (n = 19), cervical dystonia (n = 122), hemifacial spasm (n = 91) or segmental/generalized dystonia (n = 19) at a neurology outpatient clinic. METHODS: Patients were switched from established abobotulinumtoxinA therapy to incobotulinumtoxinA at a ~4:1 unit ratio. Dose requirements, injection intervals, treatment efficacy, and adverse events were evaluated for a period of ≥ 1 year. RESULTS: Patients were switched from abobotulinumtoxinA to incobotulinumtoxinA with a mean dose ratio of 4.07 (standard deviation (SD) 0.50). After switching, incobotulinumtoxinA dose requirements remained stable; the mean (SD) dose ratio at the end of the review period (52-219 weeks after switching) was 3.89 (SD 0.58). Injection intervals also remained stable after switching. Adverse events were injection site pain (n = 45) and bruising (n = 4). Five patients (2.0%) discontinued incobotulinumtoxinA treatment: 4 stopped receiving injections, and 1 reverted to abobotulinumtoxinA. Switching to incobotulinumtoxinA reduced the mean toxin expenditure to 76.7% of the cost of abobotulinumtoxinA. CONCLUSION: For patients with conditions commonly treated in dystonia clinics, switching from abobotulinumtoxinA to incobotulinumtoxinA, given at equivalent doses (~4:1 unit ratio) at similar intervals, was effective, well tolerated and achieved cost savings

Therapy concordance and drug adherence in Parkinson's disease

Chapter 1 gives an overview of the relevance of studying therapy adherence in Parkinson’s disease. Chapter 2 examines drug induced neurological syndromes and considers the validity of patients’ concerns about taking prescribed medications. Chapter 3 compares different methods of assessing therapy adherence. Chapter 4 studies factors associated with sub-optimal medicine usage in 54 patients. Chapter 5 reports a study of patient perceived involvement with management decisions and an assessment of satisfaction with the movement disorder service in 107 patients. Chapter 6 explores patients’ beliefs about antiparkinson medication in 129 patients. Chapter 7 examines the effect on Parkinson’s patients of emerging data about drug side effects, specifically fibrosis due to ergot-based dopamine agonists. Chapter 8 reports on an educational intervention designed to improve Parkinson drug timing compliance. In summary, this thesis provides important new information about medicine taking in Parkinson’s disease. A fifth of PD patients take less than 80% of prescribed antiparkinson medication. Electronic monitoring is the only reliable method of accurately detecting sub-optimal medication usage. Patients who take less than 80% of prescribed medicines are more likely to be younger, have concomitant depression, be prescribed more tablets per day and have poorer quality of life. Patients are more satisfied if they are involved in management decisions and have increased intention to comply with prescribed medication if there is better communication. Poorer quality of life is associated with less intention to comply with prescribed medication. Timing of medication intake is generally irregular but can be improved by informing patients of the continuous dopaminergic theory and providing specific drug timings. Once daily drugs are taken more consistently than drugs with more frequent doses

INTRODUCTION : THE EU-NETWORK CRAYNET- IMPACTS ON FUNDAMENTAL QUESTIONS

The European network CRAYNET “European crayfish as keystone species-linking science, management and economics with sustainable environmental quality” emphasises knowledge-based management strategies. The CRAYNET meetings concentrate on certain topics: monitoring in conservation and management of natives; interaction between natives and aliens; control of aliens; habitat restoration; reintroduction and restocking; legislation; education. The Irish meeting (Kilkenny, 2003) “The endangered native crayfish Austropotamobius pallipes: bioindicator and heritage species” initiated debates about (1) what is a bioindicator, a flagship species or a heritage species?; (2) the problem of species complexes and the need to clarify and resolve taxonomy before management; and (3) what is meant by biodiversity in the context of European crayfish? The Norwegian meeting (Halden, 2003) “European native, crayfish with a special focus on Astacus astacus: linking socioeconomics and conservation ” involved roundtables about (1) threats to indigenous population of crayfish at a landscape level; (2) exploitation, conservation, legislation; (3) reintroduction of indigenous crayfish, habitat restoration and monitoring; and (4) the urgent need for joint research about pathology. The present meeting (Innsbruck, 2004) “European native crayfish in relation to land-use and habitat deterioration with a special focus on Austropotamobius torrentim” aims to identify the species protection programs, to examine if legislation is working well in protecting vulnerable species, the state of advances about conservation genetics and how to make progress in education of the public. A permanent connection between the 12 core members provides opportunities to check the needed lines of research, to prepare recommendations, and to gather information for an atlas on the distribution of crayfish species in Europe as well as to prepare leaflets for the public

How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations : a multilevel study

Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants’ responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients’ expressions of emotional distress and consultants’ responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant reduce space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1–20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants’ responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.PostprintPeer reviewe