Case finding of mild cognitive impairment and dementia and subsequent care; results of a cluster RCT in primary care

Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≤ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3 (138/326) of persons in the intervention, and in 30.5 (98/321) in the control group (estimated difference GEE: 10.8, OR: 1.51, 95-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. Trial Registration Nederlands Trial Register NTR3389 © 2016 van den Dungen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

A SAURON view of galaxies

We have measured the two-dimensional kinematics and line-strength distributions of 72 representative nearby early-type galaxies, out to approximately one effective radius, with our panoramic integral-field spectrograph SAURON. The resulting maps reveal a rich variety in kinematical structures and linestrength distributions, indicating that early-type galaxies are more complex systems than often assumed. We are building detailed dynamical models for these galaxies, to derive their intrinsic shape and dynamical structure, and to determine the mass of the supermassive central black hole. Here we focus on two examples, the compact elliptical M32 and the E3 galaxy NGC4365. These objects represent two extreme cases: M32 has very regular kinematics which can be represented accurately by an axisymmetric model in which all stars rotate around the short axis, while NGC4365 is a triaxial galaxy with a prominent kinematically decoupled core, with an inner core that rotates about an axis that is nearly perpendicular to the rotation axis of the main body of the galaxy. Our dynamical models for these objects demonstrate that two-dimensional observations are essential for deriving the intrinsic orbital structure and dark matter content of galaxies.Comment: 7 pages (3 figures, full resolution Fig. 1 available at http://www.strw.leidenuniv.nl/~verolme/M32.ps). Contributed talk to the Athens Workshop on Galaxies and Chaos, Theory and Observations; Proceedings to appear in "Galaxies and Chaos", eds. G. Contopoulos and N. Vogli

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. / Objective: This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. / Methods: This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0–4, or 5–9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5–9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. / Results: Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. / Conclusions: Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults

Virtual Resection: A New Tool for Preparing for Nephron-Sparing Surgery in Wilms Tumor Patients

Nephron-sparing surgery (NSS) in Wilms tumor (WT) patients is a surgically challenging procedure used in highly selective cases only. Virtual resections can be used for preoperative planning of NSS to estimate the remnant renal volume (RRV) and to virtually mimic radical tumor resection. In this single-center evaluation study, virtual resection for NSS planning and the user experience were evaluated. Virtual resection was performed in nine WT patient cases by two pediatric surgeons and one pediatric urologist. Pre- and postoperative MRI scans were used for 3D visualization. The virtual RRV was acquired after performing virtual resection and a questionnaire was used to assess the ease of use. The actual RRV was derived from the postoperative 3D visualization and compared with the derived virtual RRV. Virtual resection resulted in virtual RRVs that matched nearly perfectly with the actual RRVs. According to the questionnaire, virtual resection appeared to be straightforward and was not considered to be difficult. This study demonstrated the potential of virtual resection as a new planning tool to estimate the RRV after NSS in WT patients. Future research should further evaluate the clinical relevance of virtual resection by relating it to surgical outcome

The Fundamental Plane and the evolution of the M/L ratio of early-type field galaxies up to z~1

We analyse the Fundamental Plane (FP) of 26 strong gravitational lens galaxies with redshifts up to z~1, using tabulated data from Kochanek et al. (2000) and Rusin et al. (2003). The lens galaxies effectively form a mass-selected sample of early-type galaxies in environments of relatively low density. We analyse the FP and its evolution in the restframe Johnson B and Gunn r bands. Assuming that early-type galaxies are a homologous family, the FP then provides a direct measurement of the M/L ratio evolution. If we assume that the M/L ratios of field early-type galaxies evolve as power-laws, we find for the lens galaxies an evolution rate dlog(M/L)/dz of -0.62 +/-0.13 in restframe B, corresponding to a mean stellar formation redshift of =1.8 (-0.5/+1.4). This formation epoch does not differ significantly from that of cluster galaxies =2.0 (-0.2/+0.3), obtained by van Dokkum & Franx (2001) after correction for maximum progenitor bias. However, if we impose the constraint that lens and cluster galaxies that are of the same age have equal M/L ratios and we do not correct for progenitor bias, we find that the stellar populations of the lens galaxies are 10-15 % younger. We find that both the M/L ratios as well as the restframe colors of the lens galaxies show significant scatter. About half of the lens galaxies are consistent with an old cluster-like stellar populations, but the other galaxies are bluer and best fit by single burst models with younger stellar formation redshifts as low as z*~1. Moreover, the scatter in color is correlated with the scatter in M/L ratio. We interpret this as evidence of a significant age spread among the stellar populations of lens galaxies, whereas the ages of the stellar populations of the cluster galaxies are well approximated by a single formation epoch.Comment: 12 pages (5 figures), accepted by MNRAS, abstract abridged; substantial changes from previous version: new data added, color evolution presented (Fig. 4, left), analysis completely in flat cosmology (Omega_M=0.3, Omega_L=0.7

Diagrams for heat kernel expansions

A diagramatic heat kernel expansion technique is presented. The method is especially well suited to the small-derivative expansion of the heat kernel, but it can also be used to reproduce the results obtained by the approach known as covariant perturbation theory. The new technique gives an expansion for the heat kernel at coincident points. It can also be used to obtain the derivative of the heat kernel and this is useful for evaluating the expectation values of the stress-energy tensor.Comment: 17 pages, 4 figures, ReVTe

Improved Design and Use of Shower and Plunge Dipping Equipment for the Eradication of Sheep Body Lice (Bovicola ovis)

ABSTRACT: Considerable evidence was available indicating that wet dipping practices were failing to eradicate lice on sheep and that ineffective wetting was believed to be a major contributory factor. To examine wetting of sheep in plunge and shower dips, a series of experiments were undertaken to investigate both the mechanical and management opportunities which might improve the efficiency and efficacy of wet dipping of sheep for the eradication of the sheep body louse Bovicola ovis. Results indicated that significant improvements could be made to both shower and plunge dipping equipment and practices which would enhance the likelihood of eradication of sheep body lice. On shower dips there was no significant difference between modified nozzle arrangements and the existing Buzacott® single slot arrangement provided the pump pressure was maintained at >390 kPa at a flow rate >18 l/s (nozzle pressure >230 kPa). Pipe diameter had a substantial effect on pressure losses. Wetting of sheep was significantly affected by their position. Wetting of the sheep in a plunge dip was significantly improved by fully immersing the sheep twice during the course of their swim. Swim length was also significant. The work has also identified a number of issues associated with pesticide residues in raw wool, concerns over pesticide concentrations in the dip wash and a number of occupational health and safety issues

Managing digital coordination of design: emerging hybrid practices in an institutionalized project setting

What happens when digital coordination practices are introduced into the institutionalized setting of an engineering project? This question is addressed through an interpretive study that examines how a shared digital model becomes used in the late design stages of a major station refurbishment project. The paper contributes by mobilizing the idea of ‘hybrid practices’ to understand the diverse patterns of activity that emerge to manage digital coordination of design. It articulates how engineering and architecture professions develop different relationships with the shared model; the design team negotiates paper-based practices across organizational boundaries; and diverse practitioners probe the potential and limitations of the digital infrastructure. While different software packages and tools have become linked together into an integrated digital infrastructure, these emerging hybrid practices contrast with the interactions anticipated in practice and policy guidance and presenting new opportunities and challenges for managing project delivery. The study has implications for researchers working in the growing field of empirical work on engineering project organizations as it shows the importance of considering, and suggests new ways to theorise, the introduction of digital coordination practices into these institutionalized settings