Backup Power for Mobile Telecommunications: Market Analysis for Alternatively Fuelled Generators in Brazil, Argentina and Mexico

The opportunity in the markets of Brazil, Argentina and Mexico for high-efficiency, low power (2.5kW and 5kW), alternatively fuelled, extended-run backup power generator products for the mobile telecommunications industry is assessed. Although mobile penetration is very high and mobile data use is growing rapidly, there are few drivers for extended-run back-up power system adoption in these markets. Grid power is reliable in each country. Regulatory attention is focussed elsewhere besides back-up power availability in Brazil and Mexico, and installation of extended-run back-up in Brazil and Mexico is infrequent, limiting the opportunity for alternatively fuelled generator products. Despite its poor macroeconomic climate, Argentina appears to be the most attractive market, driven by government regulation requiring extended-run back-up power at all mobile network sites. Due to its dominance in Mexico, unique strategy in Brazil and major presence in Argentina, América Móvil is the recommended target customer

Apathy and Impulsivity in Frontotemporal Lobar Degeneration

Apathy and Impulsivity in Frontotemporal Lobar Degeneration Ian Coyle-Gilchrist Frontotemporal Lobar Degeneration (FTLD) is pathologically heterogeneous group of degenerative diseases of the brain. While there are distinct and highly recognisable clinical syndromes associated with FTLD there is also a wider and more diverse spectrum of progressive changes in movement, coordination, language and behaviour. Correlation between clinical syndrome and pathology is variable. Furthermore, over the course of an individual’s illness their syndrome may change, or they may present with features of more than one syndrome at a given time. Apathy and Impulsivity are common, distressing and disabling across the entire spectrum of FTLD and may be particularly prominent compared to other neurodegenerative diseases. In this thesis I outline the current classification of syndromes associated with FTLD and how this has undergone expansion, refinement and fragmentation over time. Despite changes in nosology and advances in understanding of pathological heterogeneity, I argue that the clinical syndrome of FTLD is highly recognisable and has been described for centuries. I suggest that a more unifying transdiagnostic approach to FTLD may provide useful insights into an increasingly fragmented spectrum of disease. Using this approach I conducted a large epidemiological study of FTLD and report prevalence, incidence and lifetime risk estimates. From this cohort of recruits I then surveyed patients and their carers and used a range of assessments of cognition and behaviour. I showed that while reports of apathy and impulsivity are common in FTLD, patient and carer based reports do not correlate well with each other or predict performance on a range of behavioural measures of decision making or goal directed cognition. I conclude that in FTLD, apathy and impulsivity are overlapping and multidimensional constructs and that no single testing modality used in isolation represents them completely, hence a multimodal approach to their assessment is required

The management and decision making of secondary headteachers

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Clinical progression of progressive supranuclear palsy: impact of trials bias and phenotype variants.

Funder: Cambridge Brain BankProgressive supranuclear palsy causes diverse clinical presentations, including classical Richardson's syndrome and several variant phenotypes. Clinical trials of disease-modifying therapies have recently been completed, with more planned for the next 2 years. However, many people with progressive supranuclear palsy do not meet eligibility criteria for these clinical trials. Understanding clinical progression with different phenotypes would improve trial design and enhance the accuracy of risk-benefit and cost-benefit assessments of new treatments for progressive supranuclear palsy. We set out to determine rates of motor and cognitive progression of possible, probable and definite progressive supranuclear palsy, with different phenotypes, from a representative cohort in a regional UK healthcare service. Longitudinal clinical data from people with Richardson's syndrome and variant phenotypes were analysed using linear mixed-modelling, using both the full and modified versions of the Progressive Supranuclear Palsy Rating Scale, Mini-Mental State Examination and the revised Addenbrooke's Cognitive Examination. Subgroup analyses considered patients meeting recent Phase II trial entry criteria and patients with neuropathological confirmation. Two hundred and twenty-seven patients [male = 59%, mean age (±standard deviation), 71.8 (±7.0) years] were followed for a mean 21.6 (±15.6) months. One hundred and seventy-four (77%) had Richardson's syndrome at the outset, 25 had cortical variant presentations (13%, frontal, corticobasal, speech and language variants) and 28 had subcortical variant presentations (14%, parkinsonism, postural instability and gait freezing variants). Across all participants, annual progression in Richardson's syndrome was faster than variant phenotypes on the Mini-Mental State Examination (-1.8 versus -0.9/year, P = 0.005) and revised Addenbrooke's Cognitive Examination (-5.3 versus -3.0/year, P = 0.01) but not the Progressive Supranuclear Palsy Rating Scale (9.0 versus 7.1/year, P = 0.2) nor the modified Progressive Supranuclear Palsy Rating Scale (2.7 versus 2.3/year, P = 0.4). However, for those with more than 1 years' follow-up, a significant difference was observed between Richardson's syndrome and variant phenotypes in Progressive Supranuclear Palsy Rating Scale (8.7 versus 6.3/year, P = 0.04). Survival was longer in variant phenotypes than Richardson's syndrome [7.3 (±3.9) versus 5.6 (±2.0) years, P = 0.02]. Pathologically confirmed cases (n = 49) supported these findings. Patients meeting basic trial-eligibility criteria (n = 129) progressed faster on the Progressive Supranuclear Palsy Rating Scale than trial-not-eligible patients (10.1 versus 6.1/year, P = 0.001). In conclusion, phenotypes other than Richardson's syndrome show slower progression and longer survival. Trial criteria do not select representative progressive supranuclear palsy cases. This has implications for trial design, and application of trial results to clinically more diverse patient populations

Neurophysiological signatures of Alzheimer's disease and frontotemporal lobar degeneration : pathology versus phenotype

The disruption of brain networks is characteristic of neurodegenerative dementias. However, it is controversial whether changes in connectivity reflect only the functional anatomy of disease, with selective vulnerability of brain networks, or the specific neurophysiological consequences of different neuropathologies within brain networks. We proposed that the oscillatory dynamics of cortical circuits reflect the tuning of local neural interactions, such that different pathologies are selective in their impact on the frequency spectrum of oscillations, whereas clinical syndromes reflect the anatomical distribution of pathology and physiological change. To test this hypothesis, we used magnetoencephalography from five patient groups, representing dissociated pathological subtypes and distributions across frontal, parietal and temporal lobes: amnestic Alzheimer's disease, posterior cortical atrophy, and three syndromes associated with frontotemporal lobar degeneration. We measured effective connectivity with graph theory-based measures of local efficiency, using partial directed coherence between sensors. As expected, each disease caused large-scale changes of neurophysiological brain networks, with reductions in local efficiency compared to controls. Critically however, the frequency range of altered connectivity was consistent across clinical syndromes that shared a likely underlying pathology, whilst the localization of changes differed between clinical syndromes. Multivariate pattern analysis of the frequency-specific topographies of local efficiency separated the disorders from each other and from controls (accuracy 62% to 100%, according to the groups' differences in likely pathology and clinical syndrome). The data indicate that magnetoencephalography has the potential to reveal specific changes in neurophysiology resulting from neurodegenerative disease. Our findings confirm that while clinical syndromes have characteristic anatomical patterns of abnormal connectivity that may be identified with other methods like structural brain imaging, the different mechanisms of neurodegeneration also cause characteristic spectral signatures of physiological coupling that are not accessible with structural imaging nor confounded by the neurovascular signalling of functional MRI. We suggest that these spectral characteristics of altered connectivity are the result of differential disruption of neuronal microstructure and synaptic physiology by Alzheimer's disease versus frontotemporal lobar degeneration.Peer reviewe

Relation Between Age and Unplanned Readmissions After Percutaneous Coronary Intervention (Findings from the Nationwide Readmission Database))

Acknowledgements: We are grateful to the Healthcare Cost and Utilization Project (HCUP) and the HCUP Data Partners for providing the data used in the analysis. List of Supports/Grants Information: The study was supported by a grant from the Research and Development Department at the Royal Stoke Hospital. This work is conducted as a part of PhD for CSK which is supported by Biosensors International.Peer reviewedPostprin