The AMC Linear Disability Score in patients with newly diagnosed Parkinson disease

Objective: The aim of this study was to examine the clinimetric properties of the AMC Linear Disability Score (ALDS), a new generic disability measure based on Item Response Theory, in patients with newly diagnosed Parkinson disease (PD).\ud \ud Methods: A sample of 132 patients with PD was evaluated using the Hoehn and Yahr (H&Y), the Unified PD Rating Scale motor examination, the Schwab and England scale (S&E), the Short Form–36, the PD Quality of Life Questionnaire, and the ALDS.\ud \ud Results: The internal consistency reliability of the ALDS was good ([alpha] = 0.95) with 55 items extending the sufficient item-total correlation criterion (r > 0.20). The ALDS was correlated with other disability measures (r = 0.50 to 0.63) and decreasingly associated with measures reflecting impairments (r = 0.36 to 0.37) and mental health (r = 0.23 to -0.01). With regard to know-group validity, the ALDS indicated that patients with more severe PD (H&Y stage 3) were more disabled than patients with mild (H&Y stage 1) or moderate PD (H&Y stage 2) (p < 0.0001). The ALDS discriminated between more or less severe extrapyramidal symptoms (p = 0.001) and patients with postural instability showed lower ALDS scores compared to patients without postural instability (p = < 0.0001). Compared to the S&E (score 100% = 19%), the ALDS showed less of a ceiling effect (5%).\ud \ud Conclusion: The AMC Linear Disability Score is a flexible, feasible, and clinimetrically promising instrument to assess the level of disability in patients with newly diagnosed Parkinson disease

The effect of sea‐level rise on estuary filling in scaled landscape experiments

When sea-level rise slowed down in the middle Holocene, fluvial and coastal sediments filled the newly created accommodation, whilst others remained largely unfilled because of limited sediment supply. In view of current and future rapid sea-level rise, the question arises how estuarine systems will adapt and whether the land-level rise may keep up. Besides geological data and conceptual models of large-scale and long-term estuary filling, little is known about the filling process during sea-level rise on the decadal-to-centennial time scale that is relevant for society. This study focusses on how sea-level rise affects the morphological and hydrodynamic development of filling estuaries. To this end, scaled laboratory experiments were conducted in a tilting flume facility that creates bidirectional tidal currents and develops entire estuaries. A net importing estuary with sand, mud and vegetation was formed that was subjected to linear sea-level rise. Findings show less of the imported sand was deposited landward following sea-level rise than in an experiment without sea-level rise. The bay-head delta and the flood-tidal delta retained nearly enough sediment to keep up with sea-level rise, whilst the tidal embayment in between drowned except for the highest vegetated bars. Sea-level rise also reduced vegetation survival and sprouting potential, as prolonged inundation increased mortality, negating the potential eco-engineering effect. This resulted in lower vegetation coverage with sea-level rise than under constant sea level. These findings suggest that sea-level rise may cause natural systems to drown even if nearly sufficient sediment is available to fill the newly created accommodation, particularly in areas further away from the fluvial and marine sediment sources. Finally, depending on the sea-level rise rate, the flood-tidal delta may show back-stepping like fluvial deltas, but in the reverse direction towards the sea

The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population

BACKGROUND: Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population. METHODS: This paper uses item response theory to analyse data on 115 of 170 items from a total of 1002 respondents. These were: 551 (55%) residents of supported housing, residential care or nursing homes; 235 (23%) patients with chronic pain; 127 (13%) inpatients on a neurology ward following a stroke; and 89 (9%) patients suffering from Parkinson's disease. RESULTS: Of the 170 items, 115 were judged to be clinically relevant. Of these 115 items, 77 were retained in the item bank following the item response theory analysis. Of the 38 items that were excluded from the item bank, 24 had either been presented to fewer than 200 respondents or had fewer than 10% or more than 90% of responses in the category 'can carry out'. A further 11 items had different measurement properties for younger and older or for male and female respondents. Finally, 3 items were excluded because the item response theory model did not fit the data. CONCLUSION: The Academic Medical Center linear disability score item bank has promising measurement characteristics for the mixed patient population described in this paper. Further studies will be needed to examine the measurement properties of the item bank in other populations

Effects of Sea-Level Rise on Dredging and Dredged Estuary Morphology

Estuaries and deltas worldwide are facing land loss and drowning due to sea-level rise (SLR). Commonly home to ports, their channels are dredged and deepened for navigation. However, little is known about how such sediment management will interact with changing sediment transport patterns due to SLR. Using scale experiments, empirical relations and real world examples from global estuaries and deltas, we identify that dredging and SLR combined enhance bend migration whereas SLR alone leads to decentralizing of channels and drowning of intertidal area. In estuaries where channels are fixed, excess energy due to increasing tidal prism will manifest as bed and bank erosion, placing flood safety measures like dikes at risk. SLR increases dredging volumes in upstream reaches due to the rapid collapse of shoals and river banks along the whole estuary. Channel deepenings are ineffective under SLR conditions due to sediment import induced by increasingly flood-dominant tides. Non-dredged systems which have more regular and level elevations will lose intertidal area more quickly than dredged systems that have disconnected higher intertidal flats and a single deep channel. Mid-size dredged European systems are more likely to drown due to dredging in the present century than from SLR. Effects can be avoided by pursuing sediment management strategies that help restore the morphology disrupted by dredging

Electroencephalographic response to sodium nitrite may predict delayed cerebral ischemia after severe subarachnoid hemorrhage

OBJECTIVES: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed "early brain injury," with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide donor (intravenous sodium nitrite) to explore whether this correlates with the eventual development of delayed cerebral ischemia. DESIGN: Unblinded pilot study testing response to drug intervention. SETTING: Neuroscience ICU, John Radcliffe Hospital, Oxford, United Kingdom. PATIENTS: Fourteen World Federation of Neurosurgeons grades 3, 4, and 5 patients (mean age, 52.8 yr [range, 41-69 yr]; 11 women). INTERVENTIONS: IV sodium nitrite (10 μg/kg/min) for 1 hour. MEASUREMENTS AND MAIN RESULTS: Continuous electroencephalographic recording for 2 hours. The alpha/delta frequency ratio was measured before and during IV sodium nitrite infusion. Seven of 14 patients developed delayed cerebral ischemia. There was a +30% to +118% (range) increase in the alpha/delta frequency ratio in patients who did not develop delayed cerebral ischemia (p < 0.0001) but an overall decrease in the alpha/delta frequency ratio in those patients who did develop delayed cerebral ischemia (range, +11% to -31%) (p = 0.006, multivariate analysis accounting for major confounds). CONCLUSIONS: Administration of sodium nitrite after severe subarachnoid hemorrhage differentially influences quantitative electroencephalographic variables depending on the patient's susceptibility to development of delayed cerebral ischemia. With further validation in a larger sample size, this response may be developed as a tool for risk stratification after aneurysmal subarachnoid hemorrhage.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Development of the Korean Academy of Medical Sciences Guideline for Rating the Impairment in the Brain Injured and Brain Diseased Persons with Motor Dysfunction

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score

Long‐term evolution of the Old Rhine estuary : unraveling effects of changing boundary conditions and inherited landscape.

The long‐term morphodynamic evolution of estuaries depends on a combination of antecedent topography and boundary conditions, including fluvial input, sea‐level change and regional‐landscape interactions. Identifying effects of such boundary conditions on estuary evolution is important to anticipate future changes in specific boundary conditions and for hindcasting with numerical and physical models. A comprehensive synthesis of the evolution of the former Old Rhine estuary is presented here, together with its boundary conditions over its full lifespan from 6,500 to 1,000 cal. yr bp. This system formed during a period of sea‐level high stand, during which the estuary served as the main River Rhine outlet. The estuary went through three stages of evolution: a maturation phase in a wide infilling back‐barrier basin, a stable mature phase and an abandoning phase, both in a laterally confined setting. The Old Rhine River formed by a river avulsion around 6,500 cal. yr bp that connected to a tidal channel within a large back‐barrier basin. Decelerating sea‐level rise caused the back‐barrier basin to silt up around 5,700 cal. yr bp, resulting in shoreline progradation by beach‐barrier formation until ∼2,000 cal. yr bp. Beach‐barrier formation along the coast and natural levee formation along the river triggered peat formation in the coastal plain, laterally constraining the estuary and limiting overbank deposition, which caused most sediment to accumulate offshore. The abandoning phase started around 2,200 cal. yr bp when a series of upstream avulsions led to a substantial reduction in fluvial input. This induced a period of enhanced estuarine overbank clay deposition that continued into near‐complete silting up and estuary closure around 1200 ad. These findings exemplify how tidal systems, formed in wide coastal plains during sea‐level high stand, depend on antecedent conditions, and how they respond to connection and disconnection of a large river over long, millennial timescales

Variants of the Matrix Metalloproteinase-2 but not the Matrix Metalloproteinase-9 genes significantly influence functional outcome after stroke

<p>Abstract</p> <p>Background</p> <p>Multiple lines of evidence suggest that genetic factors contribute to stroke recovery. The matrix metalloproteinases -2 (MMP-2) and -9 (MMP-9) are modulators of extracellular matrix components, with important regulatory functions in the Central Nervous System (CNS). Shortly after stroke, MMP-2 and MMP-9 have mainly damaging effects for brain tissue. However, MMPs also have a beneficial activity in angiogenesis and neurovascular remodelling during the delayed neuroinflammatory response phase, thus possibly contributing to stroke functional recovery.</p> <p>Methods</p> <p>In the present study, the role of <it>MMP-2 </it>and <it>MMP-9 </it>genetic variants in stroke recovery was investigated in 546 stroke patients. Functional outcome was assessed three months after a stroke episode using the modified Rankin Scale (mRS), and patients were classified in two groups: good recovery (mRS ≤ 1) or poor recovery (mRS>1). Haplotype tagging single nucleotide polymorphisms (SNPs) in the <it>MMP-2 </it>(N = 21) and <it>MMP-9 </it>(N = 4) genes were genotyped and tested for association with stroke outcome, adjusting for significant non-genetic clinical variables.</p> <p>Results</p> <p>Six SNPs in the <it>MMP-2 </it>gene were significantly associated with stroke outcome (0.0018<<it>P </it>< 0.0415), two of which survived the Bonferroni correction for multiple testing. In the subset of ischemic stroke patients, association of five of these SNPs remained positive (0.0042<<it>P </it>< 0.0306). No significant associations were found for the <it>MMP-9 </it>gene.</p> <p>Conclusions</p> <p>The results presented strongly indicate that <it>MMP-2 </it>genetic variants are an important mediator of functional outcome after stroke.</p