The protocols for the 10/66 dementia research group population-based research programme

BACKGROUND: Latin America, China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia. The 10/66 Dementia Research Group's title refers to the 66% of people with dementia that live in developing countries and the less than one tenth of population-based research carried out in those settings. This paper describes the protocols for the 10/66 population-based and intervention studies that aim to redress this imbalance. METHODS/DESIGN: Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries (India, China, Nigeria, Cuba, Dominican Republic, Brazil, Venezuela, Mexico, Peru and Argentina), with a sample size of between 1000 and 3000 (generally 2000). Each of the studies uses the same core minimum data set with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non communicable disease risk factor questionnaires, disability/functioning, health service utilisation, care arrangements and caregiver strain). Nested within the population based studies is a randomised controlled trial of a caregiver intervention for people with dementia and their families (ISRCTN41039907; ISRCTN41062011; ISRCTN95135433; ISRCTN66355402; ISRCTN93378627; ISRCTN94921815). A follow up of 2.5 to 3.5 years will be conducted in 7 countries (China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Argentina) to assess risk factors for incident dementia, stroke and all cause and cause-specific mortality; verbal autopsy will be used to identify causes of death. DISCUSSION: The 10/66 DRG baseline population-based studies are nearly complete. The incidence phase will be completed in 2009. All investigators are committed to establish an anonymised file sharing archive with monitored public access. Our aim is to create an evidence base to empower advocacy, raise awareness about dementia, and ensure that the health and social care needs of older people are anticipated and met

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche

Conducting 1D site response analyses to capture 2D VS spatial variability effects

One-dimensional site response analyses (1D SRAs) with shear-wave velocity (VS) randomization are commonly performed to estimate median site-specific amplification factors (AFs) under the implicit assumption that this approach yields a realistic response. In this work, an investigation is conducted to determine the appropriate amount of VS randomization (σlnVs) needed to capture a median response that accounts for 2D VS spatial variability effects. Results from 2D SRAs and 1D SRAs with VS randomization show that the median 2D seismic responses are generally higher than 1D responses at the site’s fundamental frequency, and that higher VS variability has a mild impact on the median 2D seismic response amplitude at the fundamental frequency, whereas it significantly reduces the median 1D response. Findings indicate that the 84th percentile AFs based on 1D SRAs conducted with VS randomization using σlnVs = 0.25, approximate well with the more realistic median 2D SRA-based AFs around the fundamental frequency, while the 70th to 60th percentiles might be more appropriate at higher frequencies. The benefit of using percentiles of the 1D SRA-based AFs higher than the median is shown for different site conditions and supported by comparisons against empirical data from four downhole sites

Liquefaction and Cyclic Softening at Balboa Boulevard during the 1994 Northridge Earthquake

The seismic performance of Balboa Boulevard during the 1994 MW 6.7 Northridge earthquake was examined through nonlinear deformation analyses (NDAs) using advanced tools to (1) investigate the failure mechanism leading to ground deformations at this site; (2) evaluate the accuracy of the adopted analysis methods, engineering procedures, and state-of-the-art tools to reasonably estimate horizontal ground displacements; and (3) identify key factors and parameters contributing to earthquake-induced ground deformations at this site. One-dimensional (1D) liquefaction vulnerability indexes (LVIs) and permanent displacements using Newmark sliding block analyses were also estimated and compared against ground deformations observed after the earthquake. The geotechnical characterization of Balboa Boulevard was assessed based on field and laboratory data obtained from two investigation campaigns. Transitional probability geostatistics were used to develop stratigraphic models that capture the heterogeneity and the spatial variability patterns of sand-like and clay-like soils present at this site. The stratigraphic models were implemented in the finite difference software FLAC and the behavior of sand-like and clay-like soils simulated using the PM4Sand and PM4Silt constitutive models, respectively. Sensitivity analyses were performed to address uncertainties associated with the spatial variability of soils, input ground motions, the proportion of sand-like and clay-like soils within the soil deposit, and the strength properties of these materials. Results from NDAs suggest that a compounded effect of both liquefaction of sand-like soils and cyclic softening of clay-like soils led to the excessive ground deformations at Balboa Boulevard. This study sheds light on the importance of using appropriate engineering procedures and numerical modeling protocols in the prediction of deformation patterns, the selection of key input parameters, as well as the applicability of LVIs in complex sites

Investigation of key parameters and issues in simulating centrifuge model tests of a sheet-pile wall retaining a liquefiable soil deposit

Numerical simulations of centrifuge experiments examining a sheet-pile wall with a liquefiable backfill are conducted and results are compared against the experimental responses to evaluate the numerical tools’ ability to accurately predict the seismic performance of this geosystem. The platform FLAC and the constitutive model PM4Sand are used for the simulations, and focus is placed on the sheet-pile wall displacements. The influence of relative density (DR) on the system's response is evaluated, together with the influence of other parameters such as the soil's permeability and numerical model construction method. The consideration of both mass-based and CPT-based DR estimates allows for a better prediction of the overall range of permanent sheet-pile wall displacements. Other parameters have a moderate to important effect on the estimated pre-shaking displacements but only a minor to moderate effect on the end-of-shaking wall displacements

Musculoskeletal MRI of Nontraumatic Emergencies

A wide range of nontraumatic musculoskeletal conditions may require emergent or urgent management to avoid adverse clinical outcomes. These entities include bone and soft tissue infections, tissue necrosis, impending pathologic fracture or fungating tumor, and pseudoaneurysms. In this review, the magnetic resonance imaging appearance of these various entities is presented and discussed with the aim of improving radiologist and clinician recognition of the importance of key imaging findings in each case

Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature

This review compiles the current literature on the bleeding risks in common musculoskeletal interventional procedures and attempts to provide guidance for practicing radiologists in making decisions regarding the periprocedural management of patients on antithrombotic therapy. The practitioner must weigh the risk of bleeding if therapy is continued against the possibility a thromboembolic occurring if anticoagulation therapy is withheld or reversed. Unfortunately, there is little empirical data to guide evidence-based decisions for many musculoskeletal interventions. However, a review of the literature shows that for low-risk procedures, such as arthrograms/arthrocenteses or muscle/tendon sheath injections, bleeding risks are sufficiently small that anticoagulants and antiplatelet therapies need not be withheld. Additionally, relatively higher-risk procedures, such as needle biopsies of bone and soft tissue, may be safely performed without holding antithrombotic therapy, provided pre-procedural INR is within therapeutic range. Thus, while a patient's particular clinical circumstances should dictate optimal individualized management, anticoagulation alone is not a general contraindication to most interventional musculoskeletal radiology procedures

Small soft tissue masses indeterminate at imaging: histological diagnoses at a tertiary orthopedic oncology clinic

To review histologic diagnoses of soft-tissue masses (STMs) ≤ 2 cm with indeterminate imaging features encountered in musculoskeletal oncology clinic at a tertiary referral center. This was an IRB-approved retrospective review of patients with STMs ≤ 2 cm, referred to our tertiary care orthopedic oncology clinic over 4.75 consecutive years. Maximum diameter was based on imaging measurement by a fellowship-trained musculoskeletal radiologist. Simple lipomas, synovial cysts, metastases, and cases without histologic confirmation were excluded. Patient demographics, tumor imaging features (location, depth, size, and tumor:muscle enhancement and T2 signal ratios), and histology were recorded and compared. Mean maximum diameter for 42 trunk/extremity STMs was 1.5 cm (range, 0.7 to 2 cm). Mean age was 48 years (range, 18-83 years). Nine (21%) of the masses were malignant, while 33 (79%) were non-malignant. Thirty-nine (93%) of masses were superficial; 7/39 (18%) of these superficial tumors were malignant. Malignancy was not associated with underlying vessels, tendon, or fascia (p = 0.19). The non-malignant vs. malignant tumor:muscle enhancement ratio was 2.15 vs. 2.32 (p = 0.58) and enhancement coefficient of variation was 0.14 vs. 0.10 (p = 0.29). Most common malignant histologic subtypes were synovial sarcoma (n = 3), fibroblastic/myofibroblastic sarcoma (n = 2), leiomyosarcoma (n = 2), myxofibrosarcoma (n = 1), and angiomatoid fibrous histiocytoma (n = 1). The majority (67%) of non-malignant lesions were: leiomyoma (n = 6), angiomyoma (n = 5), schwannoma (n = 4), benign fibrous histiocytoma (n = 4), and hemangioma (n = 3). At a tertiary musculoskeletal oncology referral clinic, primary STMs ≤ 2 cm with indeterminate imaging features should be managed cautiously despite their small size and/or superficial location