Diagnostic utility of FDG-PET in the differential diagnosis between different forms of primary progressive aphasia

PURPOSE: A joint effort of the European Association of Nuclear Medicine (EANM) and the European Academy of Neurology (EAN) aims at clinical guidance for the use of FDG-PET in neurodegenerative diseases. This paper addresses the diagnostic utility of FDG-PET over clinical/neuropsychological assessment in the differentiation of the three forms of primary progressive aphasia (PPA). METHODS: Seven panelists were appointed by the EANM and EAN and a literature search was performed by using harmonized PICO (Population, Intervention, Comparison, Outcome) question keywords. The studies were screened for eligibility, and data extracted to assess their methodological quality. Critical outcomes were accuracy indices in differentiating different PPA clinical forms. Subsequently Delphi rounds were held with the extracted data and quality assessment to reach a consensus based on both literature and expert opinion. RESULTS: Critical outcomes for this PICO were available in four of the examined papers. The level of formal evidence supporting clinical utility of FDG-PET in differentiating among PPA variants was considered as poor. However, the consensual recommendation was defined on Delphi round I, with six out of seven panelists supporting clinical use. CONCLUSIONS: Quantitative evidence demonstrating utility or lack thereof is still missing. Panelists decided consistently to provide interim support for clinical use based on the fact that a typical atrophy or metabolic pattern is needed for PPA according to the diagnostic criteria, and the synaptic failure detected by FDG-PET is an earlier phenomenon than atrophy. Also, a normal FDG-PET points to a non-neurodegenerative cause

Clinical utility of FDG PET in Parkinson's disease and atypical parkinsonism associated with dementia

PURPOSE: There are no comprehensive guidelines for the use of FDG PET in the following three clinical scenarios: (1) diagnostic work-up of patients with idiopathic Parkinson's disease (PD) at risk of future cognitive decline, (2) discriminating idiopathic PD from progressive supranuclear palsy, and (3) identifying the underlying neuropathology in corticobasal syndrome. METHODS: We therefore performed three literature searches and evaluated the selected studies for quality of design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were the sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiving operating characteristic curve, and positive/negative likelihood ratio of FDG PET in detecting the target condition. Using the Delphi method, a panel of seven experts voted for or against the use of FDG PET based on published evidence and expert opinion. RESULTS: Of 91 studies selected from the three literature searches, only four included an adequate quantitative assessment of the performance of FDG PET. The majority of studies lacked robust methodology due to lack of critical outcomes, inadequate gold standard and no head-to-head comparison with an appropriate reference standard. The panel recommended the use of FDG PET for all three clinical scenarios based on nonquantitative evidence of clinical utility. CONCLUSION: Despite widespread use of FDG PET in clinical practice and extensive research, there is still very limited good quality evidence for the use of FDG PET. However, in the opinion of the majority of the panellists, FDG PET is a clinically useful imaging biomarker for idiopathic PD and atypical parkinsonism associated with dementia

CHEMICAL CONTROL OF THE REDBAY AMBROSIA BEETLE, XYLEBORUS GLABRATUS, AND OTHER SCOLYTINAE (COLEOPTERA: CURCULIONIDAE)

A BSTRACT The redbay ambrosia beetle (RAB), Xyleborus glabratus Eichhoff (Coleoptera: Curculionidae: Scolytinae), is an adventive pest of Lauraceae in the southeastern U.S. This wood-boring insect vectors a lethal fungus, Raffaelea lauricola T. C. Harr., Fraedrich & Aghayeva , the causal agent of laurel wilt (LW) disease. The vector-pathogen complex is responsible for extensive mortality of native Persea trees in South Carolina, Georgia, and northern Florida, and now poses an imminent threat to the avocado ( Persea americana Mill.) industry in south Florida. While chemical control of the vector is not viewed as the primary solution, control tactics should be made available to Florida avocado growers. Field and laboratory tests were conducted using avocado bolts, potted avocado trees, and field grown swampbay trees ( Persea palustris (Raf.) Sarg.) treated with contact and systemic insecticides. Zeta-cypermethrin + bifenthrin and lambda-cyhalothrin + thiamethoxam provided the most consistent control of Scolytinae as contact insecticides, while methomyl, malathion, bifenthrin, and endosulfan were more variable in effectiveness. Avocado trees treated with fenpropathrin, cryolite Na Al fluoride, and lambda-cyhalothrin+thiametoxam had similar numbers of beetle entrance holes on treated trees as on the untreated control trees. No statistical differences were observed in disease severity on treated versus non-treated avocados or swampbay. Linear regressions between the number of RAB entrance holes per tree ( x) and LW disease severity ( y a ) and between RAB entrance holes per tree ( x) and recovery of R. lauricola ( y b ) were both significant. Key Words: Redbay ambrosia beetle, avocado, Persea , Xyleborus , Xylosandrus , Hypothenemus , chemical control R ESUMEN El cucarroncito de ambrosia del laurel, Xyleborus glabratus Eichhoff (Coleoptera: Curculionidae), es una plaga exótica de la familia Lauraceae que ha invadido el suroriente de los Estados Unidos. Este insecto barrenador es el vector del hongo, Raffaelea lauricola T.C. Harr., Fraedrich & Aghayeva, agente causal de la enfermedad del secamiento del laurel. El complejo vector-patógeno es responsable de una extensa mortalidad de arboles nativos del genero Persea en Carolina del Sur, Georgia y en el norte de Florida y representa una amenaza inminente para la industria del aguacate ( Persea americana Mill.) de Florida. Aunque el control químico no es la única solución a este problema, se estima que este tipo de opción de tác-ticas se debe ofrecer a los productores de aguacate. Se condujeron experimentos tanto en campo como en laboratorio utilizando troncos de aguacate, arboles de aguacate y arboles del laurel de la ciénaga ( P. palustris (Raf.) Sarg.), los cuales se trataron con insecticidas de contacto y sistémicos. En general, zetaciypermetrina + bifenthrina y lambda-cyalotrina + tiametoxam dieron un control consistente de los Scolytinae como insecticidas de contacto, mientras que metomíl, malatión y bifentrina y endosulfan dieron resultados variables. No hubo diferencias significativas en los orificios de entrada de los cucarroncitos cuando se trataron los arboles de aguacate con fenpropatrina, floruro de cryolita NA Al y lambda-cyalotrina-tiametoxam comparado con los arboles testigo. No se observaron diferencias estadísticas en cuanto a la severidad de la enfermedad entre árboles tratados y aquellos no tratados. Sin embargo, modelos de regresión lineal entre el número de orificios por árbol ( x

El laberinto de la autonomía indígena en el Ecuador: las circunscripciones territoriales indígenas en la Amazonía Central, 2010-2012

¿Cuáles son los avatares y desencuentros presentes en el proceso de constitución de las Circunscripciones Territoriales Indígenas (CTIs) en relación a la vigencia del derecho a la autodeterminación y autogestión territorial de las nacionalidades indígenas en el Ecuador? Para responder a dicha interrogante, el artículo considera el reconocimiento al derecho a la autonomía y autodeterminación de las nacionalidades y pueblos indígenas en Ecuador. Posteriormente, analiza el alcance de los procedimientos establecidos tanto en la Constitución Política como en el Código Orgánico de Ordenamiento Territorial y Descentralización (COOTAD), y su alcance potencial en generar un nuevo tipo de institucionalidad y una nueva organización territorial en el marco de la definición del Estado plurinacional Ecuatoriano. Esta contribución analiza además el proceso derivado de una hoja de ruta acordada entre el Estado y las nacionalidades amazónicas en el periodo comprendido entre 2010 y 2012, y analiza las diferentes acciones desplegadas desde entonces, enfatizando en los avances y contradicciones, tanto a lo interno del movimiento indígena como en su relación con otras instancias estatales centrales y locales. Se examinan los desencuentros y tensiones a lo interno del aparato Estatal y los sectores mestizos, que no se plantean ningún reparo al momento de obstaculizar los avances del proceso. El artículo analiza el desafío de crear las CTIs en el territorio de los Kichwa de las provincias de Napo y Orellana y en los territorios Kichwa y Achuar en la provincia de Pastaza, en la Amazonía central. Finalmente, el texto puntualiza críticamente algunas de las perspectivas y dilemas que dicho proceso plantea al futuro de la relación Estado-nacionalidades indígenas y al proceso de construcción del Estado plurinacional e intercultural en Ecuador

CropPol: a dynamic, open and global database on crop pollination

This is the final version. Available from Wiley via the DOI in this record The original dataset (v1.1.0) of the CropPol database can be accessed from the ECOLOGY repository. Main upgrades of these datasets will be versioned and deposited in Zenodo (DOI: 10.5281/zenodo.5546600)Data availability. V.C. Computer programs and data-processing algorithms: The algorithms used in deriving, processing, or transforming data can be accessed in the DataS1.zip file and the Zenodo repository (DOI: 10.5281/zenodo.5546600). V.D. Archiving: The data is archived for long-term storage and access in Zenodo (DOI: 10.5281/zenodo.5546600)Seventy five percent of the world's food crops benefit from insect pollination. Hence, there has been increased interest in how global change drivers impact this critical ecosystem service. Because standardized data on crop pollination are rarely available, we are limited in our capacity to understand the variation in pollination benefits to crop yield, as well as to anticipate changes in this service, develop predictions, and inform management actions. Here, we present CropPol, a dynamic, open and global database on crop pollination. It contains measurements recorded from 202 crop studies, covering 3,394 field observations, 2,552 yield measurements (i.e. berry weight, number of fruits and kg per hectare, among others), and 47,752 insect records from 48 commercial crops distributed around the globe. CropPol comprises 32 of the 87 leading global crops and commodities that are pollinator dependent. Malus domestica is the most represented crop (32 studies), followed by Brassica napus (22 studies), Vaccinium corymbosum (13 studies), and Citrullus lanatus (12 studies). The most abundant pollinator guilds recorded are honey bees (34.22% counts), bumblebees (19.19%), flies other than Syrphidae and Bombyliidae (13.18%), other wild bees (13.13%), beetles (10.97%), Syrphidae (4.87%), and Bombyliidae (0.05%). Locations comprise 34 countries distributed among Europe (76 studies), Northern America (60), Latin America and the Caribbean (29), Asia (20), Oceania (10), and Africa (7). Sampling spans three decades and is concentrated on 2001-05 (21 studies), 2006-10 (40), 2011-15 (88), and 2016-20 (50). This is the most comprehensive open global data set on measurements of crop flower visitors, crop pollinators and pollination to date, and we encourage researchers to add more datasets to this database in the future. This data set is released for non-commercial use only. Credits should be given to this paper (i.e., proper citation), and the products generated with this database should be shared under the same license terms (CC BY-NC-SA). This article is protected by copyright. All rights reserved.OBServ Projec

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Characterization of Industrial Pt-Sn/Al2O3 Catalyst and Transient Product Formations during Propane Dehydrogenation

The major problem plaguing propane dehydrogenation process is the coke formation on the Pt-Sn/Al2O3 cat-alyst which leads to catalyst deactivation. Due to information paucity, the physicochemical characteristics of the commercially obtained regenerated Pt-Sn/Al2O3 catalyst (operated in moving bed reactor) and coke formation at different temperatures of reaction were discussed. The physicochemical characterization of re-generated catalyst gave a BET surface area of 104.0 m2/g with graphitic carbon content of 8.0% indicative of incomplete carbon gasification during the industrial propylene production. Effect of temperatures on coke formation was identified by studying the product yield via temperature-programmed reaction carried out at 500 oC, 600 oC and 700 oC. It was found that ethylene was precursor to carbon laydown while propylene tends to crack into methane. Post reaction, the spent catalyst possessed relatively lower surface area and pore radius whilst exhibited higher carbon content (31.80% at 700 oC) compared to the regenerated cata-lyst. Significantly, current studies also found that higher reaction temperatures favoured the coke for-mation. Consequently, the propylene yield has decreased with reaction temperature. © 2013 BCREC UNDIP. All rights reserve

Assessment of patient perceptions of technology and the use of machine-based learning in a clinical encounter

Background: Electronic health records (EHR) were implemented to improve patient care, reduce healthcare disparities, engage patients and families, improve care coordination, and maintain privacy and security. Unfortunately, the mandated use of EHR has also resulted in significantly increased clerical and administrative burden, with physicians spending an estimated three-fourths of their daily time interacting with the EHR, which negatively affects within-clinic processes and contributes to burnout. In-room scribes are associated with improvement in all aspects of physician satisfaction and increased productivity, though less is known about the use of other technologies such as Google Glass (GG), Natural Language Processing (NLP) and Machine-Based Learning (MBL) systems. Given the need to decrease administrative burden on clinicians, particularly in the utilization of the EHR, there is a need to explore the intersection between varying degrees of technology in the clinical encounter and their ability to meet the aforementioned goals of the EHR. Aims: The primary aim is to determine predictors of overall perception of care dependent on varying mechanisms used for documentation and medical decision-making in a routine clinical encounter. Secondary aims include comparing the perception of individual vignettes based on demographics of the participants and investigating any differences in perception questions by demographics of the participants. Methods: Video vignettes were shown to 498 OhioHealth Physician Group patients and to ResearchMatch volunteers during a 15-month period following IRB approval. Data included a baseline survey to gather demographic and background characteristics and then a perceptual survey where patients rated the physician in the video on 5 facets using a 1 to 5 Likert scale. The analysis included summarizing data of all continuous and categorical variables as well as overall perceptions analyzed using multivariate linear regression with perception score as the outcome variable. Results: Univariate modeling identified sex, education, and type of technology as three factors that were statistically significantly related to the overall perception score. Males had higher scores than females (p = 0.03) and those with lower education had higher scores (p \u3c 0.001). In addition, the physician documenting outside of the room encounter had statistically significantly higher overall perception scores (mean = 22.2, p \u3c 0.001) and the physician documenting in the room encounter had statistically significantly lower overall perception scores (mean = 15.3, p \u3c 0.001) when compared to the other vignettes. Multivariable modeling identified all three of the univariably significant factors as independent factors related to overall perception score. Specifically, high school education had higher scores than associate/bachelor education (LSM = 21.6 vs. 19.9, p = 0.0002) and higher scores than master/higher education (LSM = 21.6 vs. 19.5, p \u3c 0.0001). No differences between age groups were found on the individual perception scores. Males had higher scores than females on ‘The doctor clearly explained the diagnosis and treatment to the patient’ and ‘The doctor was sincere and trustworthy’. High school education had higher scores than associate/bachelor and master/higher on all five individual perception scores. Conclusion: The study found sex, education, and type of technology were significant indicators for overall perception of varying technologies used for documentation and medical decision-making in a routine clinical encounter. Importantly, the vignette depicting the least interaction with the EHR received the most positive overall perception score, while the vignette depicting the physician utilizing the EHR during the interaction received the least positive overall perception score. This suggests patients most value having the full attention of the physician and feel less strongly about differentiating the logistics of data transcription and medical decision-making, provided they feel engaged during the interaction. Therefore, the authors suggest maximizing face-to-face time in the integration of technology into the clinical encounter, allowing for increased perceptions of personal attention in the patient-physician interaction