A Markov Chain Model for Identifying Changes in Daily Activity Patterns of People Living with Dementia

Malnutrition and dehydration are strongly associated with increased cognitive and functional decline in people living with dementia (PLWD), as well as an increased rate of hospitalisations in comparison to their healthy counterparts. Extreme changes in eating and drinking behaviours can often lead to malnutrition and dehydration, accelerating the progression of cognitive and functional decline and resulting in a marked reduction in quality of life. Unfortunately, there are currently no established methods by which to objectively detect such changes. Here, we present the findings of an extensive quantitative analysis conducted on in-home monitoring data collected from 73 households of PLWD using Internet of Things technologies. The Coronavirus 2019 (COVID-19) pandemic has previously been shown to have dramatically altered the behavioural habits, particularly the eating and drinking habits, of PLWD. Using the COVID-19 pandemic as a natural experiment, we conducted linear mixed-effects modelling to examine changes in mean kitchen activity within a subset of 21 households of PLWD that were continuously monitored for 499 days. We report an observable increase in day-time kitchen activity and a significant decrease in night-time kitchen activity (t(147) = -2.90, p < 0.001). We further propose a novel analytical approach to detecting changes in behaviours of PLWD using Markov modelling applied to remote monitoring data as a proxy for behaviours that cannot be directly measured. Together, these results pave the way to introduce improvements into the monitoring of PLWD in naturalistic settings and for shifting from reactive to proactive care.Comment: 12 pages, 7 figures, journa

The Harmony of Numbers. The Use of Musical Intervals Ratios in the Book Architecture

Większość ludzi ma skłonność do porządkowania rzeczywistości wokół siebie, odnajdywania w niej pewnych powtarzających się wzorów. Z tego względu chętnej wybieramy rzeczy ukształtowane według naturalnych proporcji, a nie przypadkowych połączeń liczbowych. Od książki oczekujemy estetycznego wyglądu tym bardziej, że nie jest zwykłym przedmiotem codziennego użytku, ale – jak wyraził się Robert Bringhurst – „odzwierciedleniem stanu ducha i materii”. Jednym z systemów naturalnych proporcji są proporcje interwałów muzycznych odkryte w VI w p.n.e. w starożytnej Grecji. Pierwsi filozofowie chrześcijańscy, przenosząc teorie Pitagorasa i Platona na grunt nauki Kościoła, ujrzeli w muzyce boską zasadę wszechświata, przenikającą i porządkującą przestrzeń fizyczną i duchową. W epoce średniowiecza analogiczne znaczenie otrzymała książka jako symbol harmonijnego dzieła stworzenia, dlatego możemy przypuszczać, że stwierdzone na postawie pomiarów ukształtowanie manuskryptów według proporcji interwałów muzycznych było zabiegiem świadomym i miało na celu włącznie książki w porządek boskiego universum. Proporcje muzyczne znajdują zastosowanie również we współczesnej typografii. Oparty na nich system formatów autorstwa R. Bringhursta stanowi przydatne narzędzie w projektowaniu publikacji, które pozwala nie tylko na wzbudzenie w czytelniku odpowiednich skojarzeń historyczno-kulturowych, ale przede wszystkim gwarantuje wykonanie estetycznej, harmonijnej i funkcjonalnej książki.A large majority of people tend towards organizing the reality around them, which they do by trying to find some repetitive patterns. Therefore we are more inclined to choose what is determined by natural ratios instead of by random combinations of numbers. Our primary expectation from a book is its aesthetic design, the more so because it is not only everyday item but – following Robert Bringhurst –‘a flexible mirror of the mind and the body’.The musical intervals ratios found in the 6th century BC in ancient Greece are the basis of a system that now seems natural. The early Christian philosophers, bringing in the theories of Pythagoras and Plato as background to the Church’s teachings, saw in music God's Rule governing the universe, and so penetrating and ordering it both on a physical and on a spiritual level. In the Middle Ages the book was seen as a symbol of the harmonious work of creation. This is why we can assume that the formation of manuscripts, in accordance with musical intervals ratios observed on the basis of measurements, was intentional and its aim was to enable the book to be a part of the divine order of the universe.Musical ratios can also be applied in modern typography. R. Bringhurst’s format system based on musical ratios is a useful tool in designing publications. It serves not only to arouse suitable historical-cultural associations in the reader’s mind, but above all to guarantee that the book will be aesthetic, harmonious and functional

Correspondence between Kazimierz Sowinski and Poets’ and Painters’ Press over the years 1950–1979

Praca jest edycją krytyczną korespondencji poety i redaktora Kazimierza Sowińskiego z Krystyną i Czesławem Bednarczykami, założycielami Oficyny Poetów i Malarzy – wydawnictwa emigracyjnego działającego w latach 1950–2011 w Londynie. Edycja obejmuje sto pięćdziesiąt siedem listów i kartek pocztowych będących świadectwem niejednokrotnie trudnej, lecz owocnej współpracy Sowińskiego i Bednarczyków, którzy przez niemal trzydzieści lat podejmowali wspólne działania na rzecz polskiej literatury i kultury emigracyjnej. Do ich najważniejszych przedsięwzięć wydawniczych należą pierwsze wydanie typograficzne Vade-mecum Cypriana Kamila Norwida oraz opracowanie i wydanie spuścizny poetyckiej Tadeusza Sułkowskiego.The paper is a critical edition of the correspondence between Kazimierz Sowiński, a poet and editor, and Krystyna and Czeslaw Bednarczyk, founders of the Poets’ and Painters’ Press – a publishing house in exile active in London over the years 1950 and 2011. The edition include 157 letters and postcards witnessing the difficult but fruitful collaboration of Sowiński and the Bednarczyks couple. For nearly 30 years they had been undertaking joint efforts in favor of Polish literature and migrant culture. Their most important publications include the first typographic edition of Cyprian Kamil Norwid's Vade-mecum as well as the compilation and edition of Tadeusz Sulkowski’s poetic heritage

Microbleed detection using automated segmentation (MIDAS): a new method applicable to standard clinical MR images.

Cerebral microbleeds, visible on gradient-recalled echo (GRE) T2* MRI, have generated increasing interest as an imaging marker of small vessel diseases, with relevance for intracerebral bleeding risk or brain dysfunction.Manual rating methods have limited reliability and are time-consuming. We developed a new method for microbleed detection using automated segmentation (MIDAS) and compared it with a validated visual rating system. In thirty consecutive stroke service patients, standard GRE T2* images were acquired and manually rated for microbleeds by a trained observer. After spatially normalizing each patient's GRE T2* images into a standard stereotaxic space, the automated microbleed detection algorithm (MIDAS) identified cerebral microbleeds by explicitly incorporating an "extra" tissue class for abnormal voxels within a unified segmentation-normalization model. The agreement between manual and automated methods was assessed using the intraclass correlation coefficient (ICC) and Kappa statistic. We found that MIDAS had generally moderate to good agreement with the manual reference method for the presence of lobar microbleeds (Kappa = 0.43, improved to 0.65 after manual exclusion of obvious artefacts). Agreement for the number of microbleeds was very good for lobar regions: (ICC = 0.71, improved to ICC = 0.87). MIDAS successfully detected all patients with multiple (≥2) lobar microbleeds.MIDAS can identify microbleeds on standard MR datasets, and with an additional rapid editing step shows good agreement with a validated visual rating system. MIDAS may be useful in screening for multiple lobar microbleeds

Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scalesResearch in context

Summary: Background: Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity. Methods: This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary’s Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George’s Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients’ performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary’s Hospital TBI clinic in London (UK). Findings: The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p < 0.001 and r = 0.81, p = 0.02). Sensitivity to cognitive deficits after TBI was evident in the TBI clinic setting under supervised and unsupervised conditions (F (15,555) = 3.99; p < 0.001). Interpretation: Online cognitive assessment of TBI patients is feasible, sensitive, and efficient. When combined with normative sociodemographic models and autogenerated reports, it has the potential to transform cognitive assessment in the healthcare setting. Funding: This work was funded by a National Institute for Health Research (NIHR) Invention for Innovation (i4i) grant awarded to DJS and AH (II-LB-0715-20006)

Lichens and lichenicolous fungi of Magurski National Park (Poland, Western Carpathians)

The paper lists 337 species from Magurski National Park (MNP): 314 lichens, 18 lichenicolous fungi, four saprotrophic fungi and one lichenicolous myxomycete; 112 of them are new for MNP, 75 are reported for the first time for the Beskid Niski Mts, and two are new for Poland. Selected species are accompanied by taxonomic notes and remarks on their distribution in Poland and other Carpathian ranges. First records of Intralichen lichenicola, Burgoa angulosa and Verrucaria policensis and a second record of Epigloea urosperma are given for the whole Carpathian range, and Fuscidea arboricola was recorded for the first time in the Western Carpathians. Halecania viridescens and Mycomicrothelia confusa are new for the Polish Carpathians. The records of Absconditella pauxilla, Collema crispum, Licea parasitica and Rinodina griseosoralifera in MNP are their second known localities for the range. 93 species, mainly rare or threatened in Poland, were reported from MNP in the 20th century but were not refound

Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study

Introduction The prevalence of traumatic brain injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interact with age-related conditions such as multimorbidity. Despite this, TBI research in older adults is sparse. Minder, an in-home monitoring system developed by the UK Dementia Research Institute Centre for Care Research and Technology, uses infrared sensors and a bed mat to passively collect sleep and activity data. Similar systems have been used to monitor the health of older adults living with dementia. We will assess the feasibility of using this system to study changes in the health status of older adults in the early period post-TBI.Methods and analysis The study will recruit 15 inpatients (&gt;60 years) with a moderate-severe TBI, who will have their daily activity and sleep patterns monitored using passive and wearable sensors over 6 months. Participants will report on their health during weekly calls, which will be used to validate sensor data. Physical, functional and cognitive assessments will be conducted across the duration of the study. Activity levels and sleep patterns derived from sensor data will be calculated and visualised using activity maps. Within-participant analysis will be performed to determine if participants are deviating from their own routines. We will apply machine learning approaches to activity and sleep data to assess whether the changes in these data can predict clinical events. Qualitative analysis of interviews conducted with participants, carers and clinical staff will assess acceptability and utility of the system.Ethics and dissemination Ethical approval for this study has been granted by the London-Camberwell St Giles Research Ethics Committee (REC) (REC number: 17/LO/2066). Results will be submitted for publication in peer-reviewed journals, presented at conferences and inform the design of a larger trial assessing recovery after TBI