Interventions for neurocognitive dysfunction

Purpose of review: To evaluate current barriers to HIV cure strategies and interventions for neurocognitive dysfunction with a particular focus on recent advancements over the last three years. Recent findings: Optimal anti-retroviral therapy (ART) poses challenges to minimise neurotoxicity, whilst ensuring blood brain barrier penetration and minimising the risk of cerebrovascular disease. CSF biomarkers, BCL11B and neurofilament light chain may be implicated with a neuroinflammatory cascade leading to cognitive impairment. Diagnostic imaging with diffusion tensor imaging as well as resting-state fMRI show promise in future diagnosis and monitoring of HAND. Summary: The introduction of ART has resulted in a dramatic decline in HIV-associated dementia. Despite this reduction, milder forms of HIV-associated neurocognitive disorder (HAND) are still prevalent and are clinically significant. The central nervous system (CNS) has been recognised as a probable reservoir and sanctuary for HIV, representing a significant barrier to management interventions

Gastrointestinal dysfunction in Parkinson\u27s disease

Background: Gastrointestinal (GI) dysfunction is prevalent in Parkinson’s disease (PD). Symptoms are evident throughout the disease course, affect the length of the GI tract and impact on patient quality of life and management. We clarify real-life differences in the frequency and severity of GI symptoms in a cohort of PD and healthy control (HC) subjects. Methods: 103 PD patients were compared to 81 HC subjects. Outcome measures collected from validated questionnaires included constipation severity, upper and lower GI symptoms and physical activity. Results: PD patients were three-times more likely to experience constipation than HC subjects, (78.6% vs 28.4%), exhibited a fourfold increase in constipation severity and formed harder stools. PD patients also reported increased symptoms of indigestion, nausea, excessive fullness and bloating, compared to the HCs. A higher mean Leeds Dyspepsia Questionnaire score for PD patients (8.3 (standard deviation (SD) 7.7) vs 4.6 (SD 6.1), p=0.001)) indicated increased symptom severity. Chronic pain was more frequently reported and correlated with constipation and upper GI dysfunction, being more prevalent and severe in women. Physical activity was notably decreased in the PD cohort (1823.6 (±1693.6) vs 2942.4 (±2620.9) metabolic equivalent-minutes/week, p=0.001) and correlated with constipation severity. PD therapies were associated with increased fullness and bloating and harder stools. Conclusions: PD patients report more prevalent and severe GI dysfunction, although our cohort comprised of many later stage participants. Earlier recognition of GI dysfunction in PD provides the opportunity to direct treatment for chronic pain and constipation, promote physical activity and rationalise PD therapies for optimal patient care

Depression in Parkinson\u27s disease: Perspectives from an Australian cohort

Introduction: Depression is often an under-recognised feature of Parkinson\u27s disease (PD). It is detrimental to physical and interpersonal functioning, negatively impacting a patient\u27s clinical management, quality of life and well-being. We aimed to identify clinical predictors and management implications of depression in Australian PD patients. Methods: 103 PD and 81 Healthy Control (HC) subjects were evaluated using the Beck Depression Inventory (BDI) and other validated PD motor and non-motor symptom (NMS) tools. Results: Nearly twice as many PD patients were depressed, (38.9% vs 20.1%, p = 0.009), with a corresponding increase in depression severity on the BDI (11.9; standard deviation (SD) 8.8 vs 5.2; SD 5.5, p\u3c0.001), and an odds ratio of 2.4 (95% confidence interval 1.2 - 4.7). Employment appeared to be a relative protective factor for depression, whilst patients requiring support services seemed to be more vulnerable to depression. Rapid Eye Movement Sleep Behaviour Disorder, dyskinesias, impulse control disorder, higher daily levodopa equivalent dose, increased motor severity, as well as catechol-O-methyltransferase inhibitor and amantadine use, all showed associations with depression (p\u3c0.05). Chronic pain, decreased physical activity, constipation and upper gastrointestinal dysfunction presented with an apparent increase in risk for developing depression and increased depression severity. Other NMS were also found to be associated with PD-related depression. Limitations: Potential selection bias of self-reporting data collection from specialist PD clinics in a single metropolitan area. Conclusion: Our findings provide novel insight into the prevalence of depression in PD, possible contributory factors and future treatment strategies targeting depression in PD

Vibration Isolation Technology (VIT) ATD Project

A fundamental advantage for performing material processing and fluid physics experiments in an orbital environment is the reduction in gravity driven phenomena. However, experience with manned spacecraft such as the Space Transportation System (STS) has demonstrated a dynamic acceleration environment far from being characterized as a 'microgravity' platform. Vibrations and transient disturbances from crew motions, thruster firings, rotating machinery etc. can have detrimental effects on many proposed microgravity science experiments. These same disturbances are also to be expected on the future space station. The Microgravity Science and Applications Division (MSAD) of the Office of Life and Microgravity Sciences and Applications (OLMSA), NASA Headquarters recognized the need for addressing this fundamental issue. As a result an Advanced Technology Development (ATD) project was initiated in the area of Vibration Isolation Technology (VIT) to develop methodologies for meeting future microgravity science needs. The objective of the Vibration Isolation Technology ATD project was to provide technology for the isolation of microgravity science experiments by developing methods to maintain a predictable, well defined, well characterized, and reproducible low-gravity environment, consistent with the needs of the microgravity science community. Included implicitly in this objective was the goal of advising the science community and hardware developers of the fundamental need to address the importance of maintaining, and how to maintain, a microgravity environment. This document will summarize the accomplishments of the VIT ATD which is now completed. There were three specific thrusts involved in the ATD effort. An analytical effort was performed at the Marshall Space Flight Center to define the sensitivity of selected experiments to residual and dynamic accelerations. This effort was redirected about half way through the ATD focusing specifically on the sensitivity of protein crystals to a realistic orbital environment. The other two thrusts of the ATD were performed at the Lewis Research Center. The first was to develop technology in the area of reactionless mechanisms and robotics to support the eventual development of robotics for servicing microgravity science experiments. This activity was completed in 1990. The second was to develop vibration isolation and damping technology providing protection for sensitive science experiments. In conjunction with the this activity, two workshops were held. The results of these were summarized and are included in this report

Parkinson\u27s disease and the gastrointestinal microbiome

Recently, there has been a surge in awareness of the gastrointestinal microbiome (GM) and its role in health and disease. Of particular note is an association between the GM and Parkinson’s disease (PD) and the realisation that the GM can act via a complex bidirectional communication between the gut and the brain. Compelling evidence suggests that a shift in GM composition may play an important role in the pathogenesis of PD by facilitating the characteristic ascending neurodegenerative spread of α-synuclein aggregates from the enteric nervous system to the brain. Here, we review evidence linking GM changes with PD, highlighting mechanisms supportive of pathological α-synuclein spread and intestinal inflammation in PD. We summarise existing patterns and correlations seen in clinical studies of the GM in PD, together with the impacts of non-motor symptoms, medications, lifestyle, diet and ageing on the GM. Roles of GM modulating therapies including probiotics and faecal microbiota transplantation are discussed. Encouragingly, alterations in the GM have repeatedly been observed in PD, supporting a biological link and highlighting it as a potential therapeutic target

Validity and usefulness of members reports of implementation progress in a quality improvement initiative: findings from the Team Check-up Tool (TCT)

<p>Abstract</p> <p>Background</p> <p>Team-based interventions are effective for improving safety and quality of healthcare. However, contextual factors, such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. Yet, the science for measuring context is immature. The goal of this study is to validate measures from a short instrument tailored to track dynamic context and progress for a team-based quality improvement (QI) intervention.</p> <p>Methods</p> <p>Design: Secondary cross-sectional and longitudinal analysis of data from a clustered randomized controlled trial (RCT) of a team-based quality improvement intervention to reduce central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs).</p> <p>Setting: Forty-six ICUs located within 35 faith-based, not-for-profit community hospitals across 12 states in the U.S.</p> <p>Population: Team members participating in an ICU-based QI intervention.</p> <p>Measures: The primary measure is the Team Check-up Tool (TCT), an original instrument that assesses context and progress of a team-based QI intervention. The TCT is administered monthly. Validation measures include CLABSI rate, Team Functioning Survey (TFS) and Practice Environment Scale (PES) from the Nursing Work Index.</p> <p>Analysis: Temporal stability, responsiveness and validity of the TCT.</p> <p>Results</p> <p>We found evidence supporting the temporal stability, construct validity, and responsiveness of TCT measures of intervention activities, perceived group-level behaviors, and barriers to team progress.</p> <p>Conclusions</p> <p>The TCT demonstrates good measurement reliability, validity, and responsiveness. By having more validated measures on implementation context, researchers can more readily conduct rigorous studies to identify contextual variables linked to key intervention and patient outcomes and strengthen the evidence base on successful spread of efficacious team-based interventions. QI teams participating in an intervention should also find data from a validated tool useful for identifying opportunities to improve their own implementation.</p