Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery

Background: Mobility impairment is common in older adults and negatively influences the quality of life. Mobility level may change rapidly following surgery or hospitalization in the elderly. The timed up and go (TUG) is a simple, frequently used clinical test for functional mobility; however, TUG requires supervision from a trained clinician, resulting in infrequent assessments. Additionally, assessment by TUG in clinic settings may not be completely representative of the individual's mobility in their home environment. Objective: In this paper, we introduce a method to estimate TUG from activities detected in free-living, enabling continuous remote mobility monitoring without expert supervision. The method is used to monitor changes in mobility following total hip arthroplasty (THA). Methods: Community-living elderly (n = 239, 65-91 years) performed a standardized TUG in a laboratory and wore a wearable pendant device that recorded accelerometer and barometric sensor data for at least three days. Activities of daily living (ADLs), including walks and sit-to-stand transitions, and their related mobility features were extracted and used to develop a regularized linear model for remote TUG test estimation. Changes in the remote TUG were evaluated in orthopaedic patients (n = 15, 55-75 years), during 12-weeks period following THA. Main results: In leave-one-out-cross-validation (LOOCV), a strong correlation (p = 0.70) was observed between the new remote TUG and standardized TUG times. Test-retest reliability of 3-days estimates was high (ICC = 0.94). Compared to week 2 post-THA, remote TUG was significantly improved at week 6 (11.7 +/- 3.9 s versus 8.0 +/- 1.8 s,p &lt;0.001), with no further change at 12-weeks (8.1 +/- 3.9s, p = 0.37). Significance: Remote TUG can be estimated in older adults using 3-days of ADLs data recorded using a wearable pendant. Remote TUG has discriminatory potential for identifying frail elderly and may provide a convenient way to monitor changes in mobility in unsupervised settings.</p

Rivastigmine for gait stability in patients with Parkinson's disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial

Background Falls are a frequent and serious complication of Parkinson's disease and are related partly to an underlying cholinergic deficit that contributes to gait and cognitive dysfunction in these patients. Gait dysfunction can lead to an increased variability of gait from one step to another, raising the likelihood of falls. In the ReSPonD trial we aimed to assess whether ameliorating this cholinergic deficit with the acetylcholinesterase inhibitor rivastigmine would reduce gait variability. Methods We did this randomised, double-blind, placebo-controlled, phase 2 trial at the North Bristol NHS Trust Hospital, Bristol, UK, in patients with Parkinson's disease recruited from community and hospital settings in the UK. We included patients who had fallen at least once in the year before enrolment, were able to walk 18 m without an aid, had no previous exposure to an acetylcholinesterase inhibitor, and did not have dementia. Our clinical trials unit randomly assigned (1:1) patients to oral rivastigmine or placebo capsules (both taken twice a day) using a computer-generated randomisation sequence and web-based allocation. Rivastigmine was uptitrated from 3 mg per day to the target dose of 12 mg per day over 12 weeks. Both the trial team and patients were masked to treatment allocation. Masking was achieved with matched placebo capsules and a dummy uptitration schedule. The primary endpoint was difference in step time variability between the two groups at 32 weeks, adjusted for baseline age, cognition, step time variability, and number of falls in the previous year. We measured step time variability with a triaxial accelerometer during an 18 m walking task in three conditions: normal walking, simple dual task with phonemic verbal fluency (walking while naming words beginning with a single letter), and complex dual task switching with phonemic verbal fluency (walking while naming words, alternating between two letters of the alphabet). Analysis was by modified intention to treat; we excluded from the primary analysis patients who withdrew, died, or did not attend the 32 week assessment. This trial is registered with ISRCTN, number 19880883. Findings Between Oct 4, 2012 and March 28, 2013, we enrolled 130 patients and randomly assigned 65 to the rivastigmine group and 65 to the placebo group. At week 32, compared with patients assigned to placebo (59 assessed), those assigned to rivastigmine (55 assessed) had improved step time variability for normal walking (ratio of geometric means 0·72, 95% CI 0·58–0·88; p=0·002) and the simple dual task (0·79; 0·62–0·99; p=0·045). Improvements in step time variability for the complex dual task did not differ between groups (0·81, 0·60–1·09; p=0·17). Gastrointestinal side-effects were more common in the rivastigmine group than in the placebo group (p<0·0001); 20 (31%) patients in the rivastigmine group versus three (5%) in the placebo group had nausea and 15 (17%) versus three (5%) had vomiting

Discovery of s-process enhanced stars in the LAMOST survey

Here we present the discovery of 895 s-process-rich candidates from 454 180 giant stars observed by the Large Sky Area Multi-Object Fibre Spectroscopic Telescope (LAMOST) using a data-driven approach. This sample constitutes the largest number of s-process enhanced stars ever discovered. Our sample includes 187 s-process-rich candidates that are enhanced in both barium and strontium, 49 stars with significant barium enhancement only and 659 stars that show only a strontium enhancement. Most of the stars in our sample are in the range of effective temperature and log g typical of red giant branch (RGB) populations, which is consistent with our observational selection bias towards finding RGB stars. We estimate that only a small fraction (∼0.5 per cent) of binary configurations are favourable for s-process enriched stars. The majority of our s-process-rich candidates (95 per cent) show strong carbon enhancements, whereas only five candidates (<3  per cent) show evidence of sodium enhancement. Our kinematic analysis reveals that 97 per cent of our sample are disc stars, with the other 3 per cent showing velocities consistent with the Galactic halo. The scaleheight of the disc is estimated to be z_h = 0.634±0.063kpc⁠, comparable with values in the literature. A comparison with yields from asymptotic giant branch (AGB) models suggests that the main neutron source responsible for the Ba and Sr enhancements is the ¹³C(α,n)¹⁶O reaction. We conclude that s-process-rich candidates may have received their overabundances via mass transfer from a previous AGB companion with an initial mass in the range 1−3M_⊙

On the discovery of K-enhanced and possibly Mg-depleted stars throughout the Milky Way

Stars with unusual elemental abundances offer clues about rare astrophysical events or nucleosynthetic pathways. Stars with significantly depleted magnesium and enhanced potassium ([Mg/Fe] 1) have to date only been found in the massive globular cluster NGC 2419 and, to a lesser extent, NGC 2808. The origin of this abundance signature remains unknown, as does the reason for its apparent exclusivity to these two globular clusters. Here we present 112 field stars, identified from 454 180 LAMOST giants, that show significantly enhanced [K/Fe] and possibly depleted [Mg/Fe] abundance ratios. Our sample spans a wide range of metallicities (−1.5 < [Fe/H] < 0.3), yet none show abundance ratios of [K/Fe] or [Mg/Fe] that are as extreme as those observed in NGC 2419. If confirmed, the identified sample of stars represents evidence that the nucleosynthetic process producing the anomalous abundances ratios of [K/Fe] and [Mg/Fe] probably occurs at a wide range of metallicities. This would suggest that pollution scenarios that are limited to early epochs (such as Population III supernovae) are an unlikely explanation, although they cannot be ruled out entirely. This sample is expected to help guide modelling attempts to explain the origin of the Mg–K abundance signature

Identifying refuges for Borneo's elusive Hose's civet

Human-induced environmental changes, particularly climate change, pose a threat to many tropical montane species, making the identification of optimal future habitat a conservation priority. Here we used maximum entropy (Maxent) and boosted regression trees to predict suitable habitat of the threatened Bornean highland endemic Hose's civet (Diplogale hosei), that is currently available, and for future time periods (2050s and 2080s), considering future land cover and climate change predictions. Next, we identified areas that were consistently suitable under current and future model predictions as forest refuges. Our analysis predicted that Hose's civet is restricted mainly to the highlands of Borneo to an area less than 20,000 km2 (about 2% of the entire island of Borneo). Changes in land cover have little impact on predicted suitable area for the species. However, we predicted habitat loss due to climate change to approximate 86% by 2080, except under a “green economy scenario” which showed stable or increasing suitable habitat. Refuges were small, about 11% of 2010 habitat, and mostly restricted to lower montane forest. About 28–35% of refuges lie within the current protected area network though much is designated as commercial forests within the proposed Heart of Borneo (HoB). For the conservation of Hose's civet and likely other Bornean highland endemics, we recommend increased wildlife and forest law enforcement in identified protected refuges and sustainable timber harvesting practices in surrounding commercial forests, both within the HoB and the extensions we identified. Results of our green model showed that efforts to reduce greenhouse gas emissions will likely contribute immensely to the long-term conservation of highland species such as Hose's civet

On the discovery of K-enhanced and possibly Mg-depleted stars throughout the Milky Way

Stars with unusual elemental abundances offer clues about rare astrophysical events or nucleosynthetic pathways. Stars with significantly depleted magnesium and enhanced potassium ([Mg/Fe] 1) have to date only been found in the massive globular cluster NGC 2419 and, to a lesser extent, NGC 2808. The origin of this abundance signature remains unknown, as does the reason for its apparent exclusivity to these two globular clusters. Here we present 112 field stars, identified from 454 180 LAMOST giants, that show significantly enhanced [K/Fe] and possibly depleted [Mg/Fe] abundance ratios. Our sample spans a wide range of metallicities (−1.5 < [Fe/H] < 0.3), yet none show abundance ratios of [K/Fe] or [Mg/Fe] that are as extreme as those observed in NGC 2419. If confirmed, the identified sample of stars represents evidence that the nucleosynthetic process producing the anomalous abundances ratios of [K/Fe] and [Mg/Fe] probably occurs at a wide range of metallicities. This would suggest that pollution scenarios that are limited to early epochs (such as Population III supernovae) are an unlikely explanation, although they cannot be ruled out entirely. This sample is expected to help guide modelling attempts to explain the origin of the Mg–K abundance signature

Predicted distribution of the marbled cat Pardofelis marmorata (Mammalia: Carnivora: Felidae) on Borneo

Little is known about the ecology of the rare marbled cat Pardofelis marmorata on Borneo. In addition, the little information that is available on the species often comes from incidental sightings. Here we use the MaxEnt algorithm to produce a habitat suitability map for this species based on a compilation of existing data. We collected 105 marbled cat occurrence records for Borneo, of which 27 (Balanced Model) or 69 (Spatial Filtering Model) were used to estimate potential habitat suitability. The resulting relative habitat suitability map showed key conservation areas in Borneo. According to these results it appears that the most suitable habitats for marbled cat are lowland forests, but these forests are most threatened by deforestation and other anthropogenic activities.It is imperative to develop appropriate conservation strategies for the marbled cat on Borneo, including long-term research and monitoring, reduction of human disturbances in lowland forests, increased data-sharing and research networking, and stakeholder involvement for conservation planning and activities

Hyperpolarized 13C-Pyruvate Metabolism as a Surrogate for Tumor Grade and Poor Outcome in Renal Cell Carcinoma-A Proof of Principle Study.

Differentiating aggressive clear cell renal cell carcinoma (ccRCC) from indolent lesions is challenging using conventional imaging. This work prospectively compared the metabolic imaging phenotype of renal tumors using carbon-13 MRI following injection of hyperpolarized [1-13C]pyruvate (HP-13C-MRI) and validated these findings with histopathology. Nine patients with treatment-naïve renal tumors (6 ccRCCs, 1 liposarcoma, 1 pheochromocytoma, 1 oncocytoma) underwent pre-operative HP-13C-MRI and conventional proton (1H) MRI. Multi-regional tissue samples were collected using patient-specific 3D-printed tumor molds for spatial registration between imaging and molecular analysis. The apparent exchange rate constant (kPL) between 13C-pyruvate and 13C-lactate was calculated. Immunohistochemistry for the pyruvate transporter (MCT1) from 44 multi-regional samples, as well as associations between MCT1 expression and outcome in the TCGA-KIRC dataset, were investigated. Increasing kPL in ccRCC was correlated with increasing overall tumor grade (ρ = 0.92, p = 0.009) and MCT1 expression (r = 0.89, p = 0.016), with similar results acquired from the multi-regional analysis. Conventional 1H-MRI parameters did not discriminate tumor grades. The correlation between MCT1 and ccRCC grade was confirmed within a TCGA dataset (p < 0.001), where MCT1 expression was a predictor of overall and disease-free survival. In conclusion, metabolic imaging using HP-13C-MRI differentiates tumor aggressiveness in ccRCC and correlates with the expression of MCT1, a predictor of survival. HP-13C-MRI may non-invasively characterize metabolic phenotypes within renal cancer