Predicting Alzheimer's risk: why and how?

Because the pathologic processes that underlie Alzheimer's disease (AD) appear to start 10 to 20 years before symptoms develop, there is currently intense interest in developing techniques to accurately predict which individuals are most likely to become symptomatic. Several AD risk prediction strategies - including identification of biomarkers and neuroimaging techniques and development of risk indices that combine traditional and non-traditional risk factors - are being explored. Most AD risk prediction strategies developed to date have had moderate prognostic accuracy but are limited by two key issues. First, they do not explicitly model mortality along with AD risk and, therefore, do not differentiate individuals who are likely to develop symptomatic AD prior to death from those who are likely to die of other causes. This is critically important so that any preventive treatments can be targeted to maximize the potential benefit and minimize the potential harm. Second, AD risk prediction strategies developed to date have not explored the full range of predictive variables (biomarkers, imaging, and traditional and non-traditional risk factors) over the full preclinical period (10 to 20 years). Sophisticated modeling techniques such as hidden Markov models may enable the development of a more comprehensive AD risk prediction algorithm by combining data from multiple cohorts. As the field moves forward, it will be critically important to develop techniques that simultaneously model the risk of mortality as well as the risk of AD over the full preclinical spectrum and to consider the potential harm as well as the benefit of identifying and treating high-risk older patients

Superfluid state of repulsively interacting three-component fermionic atoms in optical lattices

We investigate the superfluid state of repulsively interacting three-component (color) fermionic atoms in optical lattices. When the anisotropy of the three repulsive interactions is strong, atoms of two of the three colors form Cooper pairs and atoms of the third color remain a Fermi liquid. An effective attractive interaction is induced by density fluctuations of the third-color atoms. This superfluid state is stable against changes in filling close to half filling. We determine the phase diagrams in terms of temperature, filling, and the anisotropy of the repulsive interactions.Comment: 5 pages, 6 figure

Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

Electric Charge in Interaction with Magnetically Charged Black Holes

We examine the angular momentum of an electric charge e placed at rest outside a dilaton black hole with magnetic charge Q. The electromagnetic angular momentum which is stored in the electromagnetic field outside the black hole shows several common features regardless of the dilaton coupling strength, though the dilaton black holes are drastically different in their spacetime structure depending on it. First, the electromagnetic angular momentum depends on the separation distance between the two objects and changes monotonically from eQ to 0 as the charge goes down from infinity to the horizon, if rotational effects of the black hole are discarded. Next, as the black hole approaches extremality, however, the electromagnetic angular momentum tends to be independent of the distance between the two objects. It is then precisely $eQ$ as in the electric charge and monopole system in flat spacetime. We discuss why these effects are exhibited and argue that the above features are to hold in widely generic settings including black hole solutions in theories with more complicated field contents, by addressing the no hair theorem for black holes and the phenomenon of field expulsion exhibited by extremal black holes.Comment: 26 pages, 4 figures ; Typos are corrected and a reference is adde

A tale of seven narrow spikes and a long trough: Constraining the timing of the percolation of HII bubbles at the tail end of reionization with ULAS J1120+0641

High-signal to noise observations of the Ly$\alpha$ forest transmissivity in the z = 7.085 QSO ULAS J1120+0641 show seven narrow transmission spikes followed by a long 240 cMpc/h trough. Here we use radiative transfer simulations of cosmic reionization previously calibrated to match a wider range of Ly$\alpha$ forest data to show that the occurrence of seven transmission spikes in the narrow redshift range z = 5.85 - 6.1 is very sensitive to the exact timing of reionization. Occurrence of the spikes requires the most under dense regions of the IGM to be already fully ionised. The rapid onset of a long trough at z = 6.12 requires a strong decrease of the photo-ionisation rate at z$\sim$6.1 in this line-of-sight, consistent with the end of percolation at this redshift. The narrow range of reionisation histories that we previously found to be consistent with a wider range of Ly$\alpha$ forest data have a reasonable probability of showing seven spikes and the mock absorption spectra provide an excellent match to the spikes and the trough in the observed spectrum of ULAS J1120+0641. Despite the large overall opacity of Ly$\alpha$ at z > 5.8, larger samples of high signal-to-noise observations of rare transmission spikes should therefore provide important further insights into the exact timing of the percolation of HII bubbles at the tail-end of reionizatio

Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia.

ObjectivesEarly recognition of dementia would allow patients and their families to receive care earlier in the disease process, potentially improving care management and patient outcomes, yet nearly half of patients with dementia are undiagnosed. Our aim was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia (EHR Risk of Alzheimer's and Dementia Assessment Rule [eRADAR]).DesignRetrospective cohort study.SettingKaiser Permanente Washington (KPWA), an integrated healthcare delivery system.ParticipantsA total of 16 665 visits among 4330 participants in the Adult Changes in Thought (ACT) study, who undergo a comprehensive process to detect and diagnose dementia every 2 years and have linked KPWA EHR data, divided into development (70%) and validation (30%) samples.MeasurementsEHR predictors included demographics, medical diagnoses, vital signs, healthcare utilization, and medications within the previous 2 years. Unrecognized dementia was defined as detection in ACT before documentation in the KPWA EHR (ie, lack of dementia or memory loss diagnosis codes or dementia medication fills).ResultsOverall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 498 (49%) were unrecognized in the KPWA EHR. The final 31-predictor model included markers of dementia-related symptoms (eg, psychosis diagnoses, antidepressant fills), healthcare utilization pattern (eg, emergency department visits), and dementia risk factors (eg, cerebrovascular disease, diabetes). Discrimination was good in the development (C statistic = .78; 95% confidence interval [CI] = .76-.81) and validation (C statistic = .81; 95% CI = .78-.84) samples, and calibration was good based on plots of predicted vs observed risk. If patients with scores in the top 5% were flagged for additional evaluation, we estimate that 1 in 6 would have dementia.ConclusionThe eRADAR tool uses existing EHR data to detect patients with good accuracy who may have unrecognized dementia. J Am Geriatr Soc 68:103-111, 2019

Large Ly α opacity fluctuations and low CMB τ in models of late reionization with large islands of neutral hydrogen extending to z < 5.5

High-redshift QSO spectra show large spatial fluctuations in the Ly-alpha opacity of the intergalactic medium on surprisingly large scales at z>~5.5. We present a radiative transfer simulation of cosmic reionization driven by galaxies that reproduces this large scatter and the rapid evolution of the Ly-alpha opacity distribution at 5<z<6. The simulation also reproduces the low Thomson scattering optical depth reported by the latest CMB measurement and is consistent with the observed short near-zones and strong red damping wings in the highest-redshift QSOs. It also matches the rapid disappearance of observed Ly-alpha emission by galaxies at z>~6. Reionization is complete at z=5.3 in our model, and 50% of the volume of the Universe is ionized at z=7. Agreement with the Ly-alpha forest data in such a late reionization model requires a rapid evolution of the ionizing emissivity of galaxies that peaks at z~6.8. The late end of reionization results in a large scatter in the photoionisation rate and the neutral hydrogen fraction at redshifts as low as z<~5.5 with large residual neutral 'islands' that can produce very long Gunn-Peterson troughs resembling those seen in the data

ABSOLUTE CONTINUITY AND HYPONORMAL OPERATORS

ABSTRACT. Let T be a completely hyponormal operator, wit

Planting the Seed : Perceived Benefits of and Strategies for Discussing Long-Term Prognosis with Older Adults

OBJECTIVES: To characterize the goals and approaches of clinicians with experience discussing long-term prognostic information with older adults. DESIGN: We used a semistructured interview guide containing 2 domains of perceived benefits and strategies to explore why and how clinicians choose to discuss long-term prognosis, defined as life expectancy on the scale of years, with patients. SETTING: Clinicians from home-based primary care practices, community-based clinics, and academic medical centers across San Francisco. PARTICIPANTS: Fourteen physicians, including 11 geriatricians and 1 geriatric nurse practitioner, with a mean age of 40 and a mean 9 years in practice. MEASUREMENTS: Clinician responses were analyzed qualitatively using the constant comparisons approach. RESULTS: Perceived benefits of discussing long-term prognosis included establishing realistic expectations for patients, encouraging conversations about future planning, and promoting shared decision-making through understanding of patient goals of care. Communication strategies included adapting discussions to individual patient preferences and engaging in multiple conversations over time. Clinicians preferred to communicate prognosis in words and with a visual aid, although most did not know of a suitable visual aid. CONCLUSION: Engaging in customized longitudinal discussions of long-term prognosis aids clinicians in anchoring conversations about future planning and preparing patients for the end of life

Critical properties of S=1/2 Heisenberg ladders in magnetic fields

The critical properties of the $S=1/2$ Heisenberg two-leg ladders are investigated in a magnetic field. Combining the exact diagonalization method and the finite-size-scaling analysis based on conformal field theory, we calculate the critical exponents of spin correlation functions numerically. For a strong interchain coupling, magnetization dependence of the critical exponents shows characteristic behavior depending on the sign of the interchain coupling. We also calculate the critical exponents for the $S=1/2$ Heisenberg two-leg ladder with a diagonal interaction, which is thought as a model Hamiltonian of the organic spin ladder compound ${Cu}_2({1,4-diazacycloheptane})_2{Cl}_4$. Numerical results are compared with experimental results of temperature dependence of the NMR relaxation rate $1/T_1$.Comment: REVTeX, 10 pages, 8 figures, accepted for Phys. Rev.