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Neuroimaging biomarkers on routine Computed Tomography (CT) after acute stroke and their association with post-stroke delirium: A cohort study
Get PDFBackground: Delirium affects a quarter of patients after acute stroke and predicts poorer outcomes. The aim of this pragmatic study was to determine whether either qualitative assessment or quantitative assessments of the regional atrophy obtained from routinely performed computed tomography (CT) brain imaging could identify patients most at risk of developing delirium.Methods: We recruited 95 patients with acute stroke (age ≥60) (ischaemic or intracerebral haemorrhage) over one year. Follow-up for delirium and cognition was performed at 1, 3, 5, 7, 14, 21, 28 days, 4 months and 12 months. All participants underwent routine CT brain (Toshiba 64-slice or 128-slice scanner) (within 24 h of stroke onset). White matter lesions and atrophy were rated qualitatively (mild, moderate, severe). Atrophy in multiple specific areas was measured quantitatively.Results: Twenty-six (27 %) developed delirium during the 12 months of follow-up. On univariable analysis, delirium was associated with increasing age, being female, less independent in pre-stroke activities of daily living, pre-existing cognitive impairment, increasing stroke severity, having had a total anterior circulation stroke and global cerebral atrophy on brain CT. Multivariable analysis demonstrated that only global cerebral atrophy, being female and having a more severe stroke predicted delirium. This model accounted for between 38 % and 55 % of the variance in delirium.For quantitative CT analysis, on univariable analysis, delirium was associated with atrophy in several specific brain areas. On multivariable analysis, only NIHSS (for every one point increase OR 1.23, 95 % CI 1.06–1.43; p =0.006)) and cistern ambiens ratio (OR 1.41, 95 % CI 1.48–4.96; p = 0.028) were significantly associated. This model accounted for between 35.1 % and 51.2 % of delirium variance.Conclusion: Clinical variables together with either qualitative atrophy assessment or cistern ambiens ratio on routine CT brain could identify stroke patients most at risk of delirium and to stratify patients in clinical trials of delirium prevention and treatment
Clinical presentation, risk factors and management of pregnancy-associated osteoporosis: a systematic review and meta-analysis
Get PDFSummary: A systematic review and meta-analysis of the presentation, risk factors and treatment response of pregnancy-associated osteoporosis was conducted involving 35 studies and 943 patients. Vertebral fractures, back pain and family history of osteoporosis were common features. Analysis of treatment response was inconclusive due to limited availability of data. Introduction: Pregnancy-associated osteoporosis (PAO) is a rare disorder most often presenting with vertebral fractures during pregnancy or postpartum. Aims: This meta-analysis aimed to evaluate the presenting features of PAO, its risk factors and the effectiveness of various treatments at improving bone mineral density (BMD) and preventing further fractures. Methods: A systematic search of PubMed, EMBASE and Web of Science identified 35 studies comprising 943 cases of PAO. A meta-analysis was conducted to evaluate the effect of treatment on change in BMD at the lumbar spine, femoral neck and total hip. Results: Vertebral fractures and back pain occurred in 89.2% and 90.2% of cases, respectively. The diagnosis was predominantly made postpartum. The most common risk factor was a family history of osteoporosis (40.5%). Calcium and vitamin D supplements (31.8%) and teriparatide (30.8%) were the most commonly used treatments. The meta-analysis of BMD response was inconclusive due to limited availability of data. The BMD change at the lumbar spine was greater with teriparatide compared with calcium/vitamin D and bisphosphonates but this was based on only two studies. There was no difference in BMD response at the femoral neck. Recurrent fractures were reported in 12.9% with no difference between treatment groups. Conclusion: While this review can assist clinicians with the diagnosis and management of PAO, it highlights some key knowledge gaps that may inform conduct of a Delphi process on the diagnosis and management of this disorder, pending conduct of randomised controlled trials.</p
Education and Licensing of Horse Owners: Addressing Poor Horse Welfare in the UK
Get PDFHorse welfare concerns have been a subject of increasing discussion for decades. The issue of compromised horse welfare in the UK and across the globe is complex as welfare concerns are varied, wide-ranging and nuanced. Several solutions to combat compromised horse welfare have been suggested by existing research; however, each of these has its limitations. In this study, existing literature regarding horse welfare, education and licensing as potential solutions were analysed. Distress behaviour was the most-cited welfare concern in the literature, narrowly followed by health issues and behavioural issues. The citations for causes of poor welfare were dominated by management and training practices. The analysis found that the highest cited barrier to good welfare was a lack of knowledge, followed by a lack of understanding by horse owners. Further field research into horse welfare causes was most commonly suggested as the best step to address welfare concerns, and increased awareness of welfare issues was suggested as the best solution to prevent welfare issues. In terms of education, the most-cited positive outcomes were increased knowledge, awareness or understanding. However, the most prominent limitation of education was an unclear effect on behaviour as well as other notable factors, such as availability. The most-cited licensing success was used as a consumer tool to aid decision making; however, licensing was limited by enforcement. Taking the relevant literature as a whole, there is no single evident solution that can solve the horse welfare problem; however, there are areas identified that merit closer consideration.</p
Home-based end-of-life care for people with dementia:A systematic review of quantitative and qualitative evidence
Get PDFBackground: Integrating home-based end-of-life care for people with dementia will become increasingly important as the population ages. Therefore, it is timely and necessary to evaluate the evidence of home-based end-of-life care for people living with dementia. Aim: This review aims to identify the characteristics of home-based end-of-life care interventions for people living with dementia and review the existing evidence on implementation outcomes. Design: Systematic Review and Narrative Synthesis. The Mixed Methods Appraisal Tool was used to assess study quality. Data sources: A comprehensive search was conducted across five databases (PubMed, Web of Science, MEDLINE CINAHL and Scopus) from June to August 2023, and the citations to the included studies were tracked through citation tracking in Google Scholar to identify potentially relevant studies. Results: Of the 2022 articles retrieved, 12 were included in this review. The included studies were geographically diverse, with four from the United States, three from Singapore, two from the United Kingdom, and one each from the Netherlands, Belgium, and Israel. Additionally, due to the difference of focus and nature of the studies, only seven of these studies provided information on home-based end-of-life care interventions for people living with dementia. The interventions identified in this review align closely with the essential components of optimal palliative care for dementia outlined in the European Association for Palliative Care white paper. However, the evidence supporting these home-based end-of-life care interventions for people living with dementia is constrained by the number of studies and methodological limitations. Nevertheless, this systematic review still identifies some evidence supporting home-based end-of-life care for people living with dementia, including reduced healthcare utilization and costs, as well as help people living with dementia realize their wish to die at home. Conclusions: Whilst current evidence highlights benefits of home-based end-of-life care for people living with dementia, the relatively limited number, methodology of studies, the heterogeneity of study focus and outcome measures hinder the formation of definitive conclusions. Therefore, further research is needed to develop and evaluate home end-of-life care services for people living with dementia
Family welfare during the deployment of Ghana armed forces in peacekeeping missions:Exploring the role of “military surrogacy”
Get PDFThis research focuses on the place of soldiers’ families and family life while on deployment, using the case of Ghana’s regular deployments to international peacekeeping missions. We advance the concept of a “military surrogate” to explain the ways in which military hierarchy temporarily take on family roles when a soldier is deployed. This involves intervening in issues related to military spouses, troublesome children, and resolving financial matters. We argue that filling the role as a “surrogate” family member is used by the command both as a way to support deployed soldiers but also as a way to shape behaviors. This phenomenon demonstrates ways that discipline and conformity to military norms work through families and the openings that are left during deployments. We also highlight the ways this process shapes peer bonding, often building peer-to-peer relationships as an attempt to prevent involvement by senior command in their family affairs
A systematic review on the prevalence of, and risk factors for, eating disorders in systemic lupus erythematosus
Get PDFSystematic Lupus Erythematosus (SLE) is a chronic autoimmune disease with significant physical and psychological challenges. Case studies have highlighted examples of eating disorders (ED) developing in patients with SLE, but little is known about rates of co-morbidity or reasons for this. This systematic review investigated the prevalence of, and risk factors for, EDs in individuals with SLE. Exploring 21 studies with 3,214 participants, most of which were cross-sectional with small sample sizes, findings indicated a similar prevalence of EDs in SLE populations as in the general population. However, individuals with SLE exhibited increased body image concerns, linked to higher disease activity, disease damage, and depressive symptoms. No studies explored risk factors for other ED symptoms (e.g., restriction, binge eating). This review emphasizes the need for further research to better understand the relationship between SLE and EDs, providing a basis for improved clinical practices and interventions for this population
Gulags, crime, and elite violence:Origins and consequences of the Russian mafia
Get PDFThis paper studies the origins and consequences of the Russian mafia (vory-v-zakone). Using a unique web scraped dataset containing detailed biographies of more than 5,000 mafia leaders, I first show that the Russian mafia originated in the Soviet Gulag, and could be found near the camps’ initial locations throughout the 1990s Russia. Then, using an instrumental variable approach that exploits the proximity of the Russian mafia to the camps, I show that Russian communities with mafia presence in the 1990s experienced a dramatic rise in crime driven by elite violence which erupted shortly after the collapse of the Soviet Union in 1991. The surge in violence was indiscriminate with respect to the victim type. Furthermore, the effect of mafia presence on elite violence was smaller in places where either all or none of the vory were ethnic Russians, suggesting some degree of ethnic conflict within the criminal organization itself
Implications of fungal biofilms in microbial keratitis
Get PDFFungal keratitis—an infection of the cornea caused by yeast or filamentous fungi—is a leading cause of visual impairment, blindness and eye-loss worldwide. Infection progression most commonly follows epithelial cell damage, leading to spore adhesion to the ocular surface, germination, hyphal growth and finally biofilm formation within the corneal stroma. Abiotic fungal biofilms may also be introduced to the eye directly via contaminated contact lenses. Interestingly, not all keratitis-causing fungi form biofilm (when grown in vitro), and it is not essential for severe disease manifestation. However, biofilm-forming fungi modulate the immune response, and confer greater resistance to drug and environmental stresses, such as antifungals and UV irradiation. Herein, we report fungal keratitis pathogenesis from a pre-clinical and clinical perspective, with and without contact lens propagation. We further present current and emerging treatment strategies in the context of biofilm eradication, using approaches such as novel drug delivery systems, immunomodulation and light-mediated therapies
Numerical stability of the symplectic LL<sup>T </sup>factorization
Get PDFIn this paper we give the detailed error analysis of two algorithms W1 and W2 for computing the symplectic factorization of a symmetric positive definite and symplectic matrix A∈R2n×2n in the form A=LLT, where L∈R2n×2n is a symplectic block lower triangular matrix. We prove that Algorithm W2 is numerically stable for a broader class of symmetric positive definite matrices A∈R2n×2n. It means that Algorithm W2 is producing the computed factors L~ in floating-point arithmetic with machine precision u such that ‖A-L~L~T‖2=O(n2u‖A‖2). On the other hand, Algorithm W1 is unstable, in general, for symmetric positive definite and symplectic matrix A. In this paper we also give corresponding bounds for Algorithm W1 that are weaker. We show that the factorization error depends on the conditioning of the principal submatrix A11∈Rn×n, located in the upper-left block of A. Bounds for the loss of symplecticity of the lower block triangular matrices L for both Algorithms W1 and W2 that hold in exact arithmetic for a broader class of symmetric positive definite matrices A (but not necessarily symplectic) are also given. The tests performed in MATLAB illustrate that our error bounds for considered algorithms are reasonably sharp.</p
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