The Epidemiology of Cognitive Function In a Community Based Population. The EPIC-Norfolk Study

Although age is the strongest known risk factor, not all people who reach old age develop dementia before they die. Recommendations on potentially modifiable risk factors for the prevention of dementia are based on evidence that is, at best, moderate in strength. There are major calls to strengthen the evidence on potentially modifiable risk factors of dementia. The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) is a prospective population study of 25 639 men and women aged 40–79 years first recruited in 1993-1997, who attended a health examination. Subsequent follow-ups have involved self-report of health and lifestyle and further health examinations. Cognitive measures (7 tests assessing a range of domains) were introduced as part of a third health examination between 2006 and 2011 (including data from a pilot phase 2004–2006) and are available on 8585 individuals. Almost complete follow-up for disease outcomes, including dementia and mortality, has been established via linkage to health records. Education was strongly associated with cognitive function for all abilities tested. Cross-sectional and prospective analyses showed those who were physically inactive during work, were less likely to have poor cognition (bottom tenth percentile of a composite cognition score); Odds Ratio (OR) = 0.68 (95% Confidence Interval or CI 0.54, 0.86 P=0.001). In contrast, inactivity during leisure time was associated with increased risk of poor performance in the cross-sectional analyses, although this association was not observed in the prospective analyses. Poor cognition was independently associated with higher risk of all-cause mortality and predictive of incident dementia. Associations were observed for the composite score (global cognition) as well as specific cognitive abilities. Poor cognition in four or more tests was associated with ten-fold increased risk of developing dementia compared with those who did not perform poorly in any test OR=10.82 (95% CI 6.85, 17.10 P<0.001). Addition of each cognitive measure strengthened prediction models of dementia further, Area under the curve (AUC) = 0.85 (95% CI 0.82, 0.87 P<0.001), with the single test for episodic memory having the strongest influence. Routinely collected health records are increasingly encouraged and used for epidemiological research for dementia outcome ascertainment. The linkage of the cohort to diverse routine records enabled comparison of these data sources. I provide evidence for the need of a more consensus-based approach to the methods of data collection, coding and interpretation of health data across all sources examined (hospital inpatient, mortality and mental health services datasets). In summary, the findings from this dissertation suggest the relationships between lifestyle factors, poor cognition and dementia are complex. For stronger evidence, future studies need to account for characteristics of the sample population and for the test used to measure cognition. Furthermore, there is a need for a more nuanced approach to the way the exposure of interest as well as dementia outcomes are measured and to adequately address the issue of potential confounding

Skype, code and shouting: a digitally mediated drama between Egypt and Scotland

Springtime (Tron Theatre, Glasgow, 19 May 2012) was a computationally mediated theatrical performance involving Arab and Glaswegian-Arab actors and musicians. The project was produced by Ankur Theatre Productions, Scotland’s foremost black and ethnic minority theatre company. Springtime was directed by the dramaturge Shabina Aslam. Against the backdrop of the “Arab Spring” and its aftermath, the play explored issues of authenticity and identity as mediated through multiple technologies. This paper explores the impact and significance of the production and evaluates the use of Skype, social media and custom-made software in the writing, rehearsal and final performance stages of the play

Papillon- Lefèvre Syndrome: report of a case and its management

Papillon-Lefèvre Syndrome (PLS) is a rare autosomal recessive disorder first described by two French physicians, Papillon and Lefèvre in 1924. The disorder is characterized by diffuse palmoplantar keratoderma and precocious aggressively progressing periodontitis, leading to the premature loss of deciduous and permanent teeth at a very young age. The cutaneous lesions are usually manifested simultaneously with the intra-oral presentations and include keratotic plaques on the palms and soles varying from mild psoriasiform scaly skin to overt hyperkeratosis. The etiopathogenesis of the syndrome is relatively obscure and immunologic, genetic or possible bacterial etiologies have been proposed. Due to the vast degree of periodontal breakdown involved at such an early age, the dental surgeon is often the first to diagnose the syndrome. This paper presents a clinical presentation a 15 year old male diagnosed with Papillon- Lefèvre Syndrome

Multimodal Based Audio-Visual Speech Recognition for Hard-of-Hearing: State of the Art Techniques and Challenges

Multimodal Integration (MI) is the study of merging the knowledge acquired by the nervous system using sensory modalities such as speech, vision, touch, and gesture. The applications of MI expand over the areas of Audio-Visual Speech Recognition (AVSR), Sign Language Recognition (SLR), Emotion Recognition (ER), Bio Metrics Applications (BMA), Affect Recognition (AR), Multimedia Retrieval (MR), etc. The fusion of modalities such as hand gestures- facial, lip- hand position, etc., are mainly used sensory modalities for the development of hearing-impaired multimodal systems. This paper encapsulates an overview of multimodal systems available within literature towards hearing impaired studies. This paper also discusses some of the studies related to hearing-impaired acoustic analysis. It is observed that very less algorithms have been developed for hearing impaired AVSR as compared to normal hearing. Thus, the study of audio-visual based speech recognition systems for the hearing impaired is highly demanded for the people who are trying to communicate with natively speaking languages.  This paper also highlights the state-of-the-art techniques in AVSR and the challenges faced by the researchers for the development of AVSR systems

Contextualizing Teacher Education Emphases for Classroom Diversity

Nominal attention has been dedicated to standards of best practice that local teachers should demonstrate in teaching culturally and linguistically diverse (CLD) students. The CREDE standards address the gap and emphasize five transnational, universals of best practice for CLD students/families. However, recent research indicates that teachers practices indicative of the most important of these, contextualization, are among the least robust of those observed. Necessarily, future research is needed to unpack these findings. In the interim, we argue that teachers’ critical reflection on their own socialization is essential to the fundamental understandings necessary for standards-based practices with these students and families

Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort.

OBJECTIVE: To quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort. DESIGN: A prospective population-based study of men and women. SETTING: Norfolk, UK. PARTICIPANTS: 11,228 men and 13,786 women aged 40-79 years in 1993-1997 followed between 1999 and 2009. MAIN OUTCOMES MEASURES: Number of hospital admissions and total bed days for individuals over a 10-year follow-up period identified using record linkage; five categories for admissions (from zero to highest ≥ 7) and hospital bed days (from zero to highest ≥ 20 nights). RESULTS: Over a period of 10 years, 18,179 (72.7%) study participants had at least one admission to hospital, 13.8% with 7 or more admissions and 19.9% with 20 or more nights in hospital. In logistic regression models with outcome ≥ 7 admissions, low education level OR 1.14 (1.05 to 1.24), age OR per 10-year increase 1.75 (1.67 to 1.82), male sex OR 1.32 (1.22 to 1.42), manual social class 1.22 (1.13 to 1.32), current cigarette smoker OR 1.53 (1.37 to 1.71) and body mass index >30 kg/m² OR 1.41 (1.28 to 1.56) all independently predicted the outcome with p30 kg/m², estimated percentages of the cohort in the categories of admission numbers and hospital bed days in stratified age bands with twofold to threefold differences in future hospital use between those with high-risk and low-risk scores. CONCLUSIONS: The future probability of cumulative hospital admissions and bed days appears independently related to a range of simple demographic and behavioural indicators. The strongest of these is increasing age with high body mass index and smoking having similar magnitudes for predicting risk of future hospital usage.The design and conduct of the EPIC-Norfolk study and collection and management of the data was supported by programme grants from the Medical Research Council UK (G9502233, G0401527) and Cancer Research UK (C864/A8257, C864/A2883).This is the final version of the article. It first appeared from the BMJ Group via http://dx.doi.org/10.1136/bmjopen-2015-00946

Abnormal Tc99m sulesomab in Klippel-Trenaunay syndrome

Tc-99m sulesomab is indicated in bone and joint infection, but reading of scans can be affected by pre-existing conditions. This case report describes a case of Klippel-Trenaunay syndrome (KTS) which results in vascular malformations of one or more limbs. Tc-99m sulesomab imaging demonstrated persistent blood pool activity up to 20 hours post injection. However, despite this, septic arthritis could be identified with confidence in the same limb. Nuclear Med Rev 2010; 13, 2: 84&#8211;8

Congenital bilateral choanal atresi

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full-term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal endoscopic repair to relieve the life threatening nasal obstruction at the tenth day of life