427 research outputs found
Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records
No full textBackground: Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia. Methods: 447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent class analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C reactive protein (CRP) and Apolipoprotein E (APOE) genotype were assessed via statistical interaction. Results: LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer-related pathophysiology, respectively. Estimated HRs suggest that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95% CI 1.88 to 2.39) and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither CRP nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia. Conclusions: Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia
Chaos in 1D radiative edge Plasmas
No full textBifurcation and chaos in radiative edge plasmas are investigated on the basis of a periodically driven reaction- diffusion equation which results from the time dependent 1d heat conduction equation including a given periodically time- modulated impurity density. The temporal problem shows the transition to chaos through the Feigenbaum route. In Id and time dependent, plasmas Hopf bifurcation and intermittency phenomena exist. The application to a carbon seeded plasma shows the existence of different oscillation regimes
Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model
No full textBackground: Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. Method: This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision tree model compared the costs (in year 2008 international dollars) and outcomes of CTC to a hypothetical 'do-nothing' alternative. The primary outcomes were mortality within one year, and disability adjusted life years (DALYs) after surviving one year. Outcomes and health service costs of CTC were obtained from the CTC programme, local health services and World Health Organization (WHO) estimates of unit costs. Outcomes of doing nothing were estimated from published African cohort studies. Probabilistic and deterministic sensitivity analyses were done. Results: The mean cost of CTC per child was 139–1760 (95% CI 10142) per life saved and 18–88 per DALY gained. Analyses were most sensitive to assumptions about mortality rates with no treatment, weeks of CTC per child and costs of purchasing RUTF. Conclusion: CTC is relatively cost effective compared to other priority health care interventions in developing countries, for a wide range of assumptions
Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool
No full textThis thesis uses experience gained from a large implementation trial in two rural districts of the Western Cape, South Africa, to address the needs of patients with non-communicable diseases (NCDs) and depression, and to identify solutions to those needs. The Primary Care 101 intervention supports and expands nurses' role in integrated care, in particular for NCDs. It comprises a comprehensive clinical management tool implemented in primary care services using educational outreach training. It was evaluated using a pragmatic cluster randomised controlled trial: 38 clinics in the Eden and Overberg districts of the Western Cape were randomised to receive the intervention or to continue with usual care. 4393 Patients were enrolled and four cohorts identified: hypertension, diabetes, chronic respiratory disease and depression. Patients were re-interviewed once, 14 months later. Primary outcomes for the trial were treatment intensification for the hypertension, diabetes and chronic respiratory disease cohorts, and case detection for the depression cohort. Multimorbidity, NCD care and their socioeconomic associations were assessed on the whole trial cohort (combining intervention and control arms) at baseline and follow-up. The results are presented in published papers. Baseline data revealed considerable multimorbidity and unmet treatment needs (Paper 1). Socioeconomic indicators such as education, and modifiable clinic-level factors such as adequate staffing and communitybased chronic medication collection services were associated with blood pressure control (Paper 2) and depression management (Paper 3). The intervention was shown to be feasible and safe but none of the four primary outcomes showed significant improvement (Paper 4). The thesis addresses the public health challenge of providing integrated chronic disease primary care in South Africa by: • Providing original evidence for high levels of NCD multimorbidity and unmet treatment needs. • Identifying modifiable factors that could improve care for these diseases. • Providing new evidence from South Africa to support the bidirectional relationship between poverty and depression. • Reporting evidence of the effectiveness of a novel intervention aimed at improving NCD care. The findings point to the need for improved strategies for NCD care, including equipping primary health care providers to manage the complexities of multimorbidity
Progression of diabetes retinal status within community screening programs and potential implications for screening intervals
No full textOBJECTIVE: This study aimed to follow the natural progression of retinal changes in patients with diabetes. Such information should inform decisions with regard to the screening intervals for such patients.RESEARCH DESIGN AND METHODS: An observational study was undertaken linking the data from seven diabetes retinal screening programs across the U.K. for retinal grading results between 2005 and 2012. Patients with absent or background retinopathy were followed up for progression to the end points referable retinopathy and treatable retinopathy (proliferative retinopathy).RESULTS: In total 354,549 patients were observed for up to 4 years during which 16,196 patients progressed to referable retinopathy. Of patients with no retinopathy in either eye for two successive screening episodes at least 12 months apart, the conditions of between 0.3% (95% CI 0.3-0.8%) and 1.3% (1.0-1.6%) of patients progressed to referable retinopathy, and rates of treatable eye disease were <0.3% at 2 years. The corresponding progression rates for patients with bilateral background retinopathy in successive screening episodes were 13-29% and up to 4%, respectively, in the different programs.CONCLUSIONS: It may be possible to stratify patients for risk, according to baseline retinal criteria, into groups with low and high risk of their conditions progressing to proliferative retinopathy. Screening intervals for such diverse groups of patients could safely be modified according to their risk.</p
A Perisynaptic Ménage à Trois between Dlg, DLin-7, and Metro Controls Proper Organization of Drosophila Synaptic Junctions
No full textStructural plasticity of synaptic junctions is a prerequisite to achieve and modulate connectivity within nervous systems, e.g., during
learning and memory formation. It demands adequate backup systems that allow remodeling while retaining sufficient stability to
prevent unwanted synaptic disintegration. The strength of submembranous scaffold complexes, which are fundamental to the architecture
of synaptic junctions, likely constitutes a crucial determinant of synaptic stability. Postsynaptic density protein-95 (PSD-95)/
Discs-large (Dlg)-like membrane-associated guanylate kinases (DLG-MAGUKs) are principal scaffold proteins at both vertebrate and
invertebrate synapses. At Drosophila larval glutamatergic neuromuscular junctions (NMJs) DlgA and DlgS97 exert pleiotropic functions,
probably reflecting a few known and a number of yet-unknown binding partners. In this study we have identified Metro, a novel
p55/MPP-like Drosophila MAGUK as a major binding partner of perisynaptic DlgS97 at larval NMJs. Based on homotypic LIN-2,-7 (L27)
domain interactions, Metro stabilizes junctional DlgS97 in a complex with the highly conserved adaptor protein DLin-7. In a remarkably
interdependent manner, Metro and DLin-7 act downstream of DlgS97 to control NMJ expansion and proper establishment of synaptic
boutons. Using quantitative 3D-imaging we further demonstrate that the complex controls the size of postsynaptic glutamate receptor
fields. Our findings accentuate the importance of perisynaptic scaffold complexes for synaptic stabilization and organization.This work was supported by the Deutsche Forschungsgemeinschaft (DFG-Sonderforschungsbereich 854), the
Leibniz Gemeinschaft (WGL-Pakt f ¨ur Forschung und Innovation), and a Max Planck award from the Alexander von
Humboldt Foundation and the Max Planck Society to E.D.G. R.J.K. is supported by the Deutsche Forschungsgemeinschaft
Emmy-Noether Program
Observations of Bºs→ψ(2S)η and Bº(s)→ψ(2S)π+π- decays
No full textFirst observations of the B0s
→ψ(2S)η, B0 →ψ(2S)π
+
π
− and B0s
→ψ(2S)π
+
π
− decays are made
using a dataset corresponding to an integrated luminosity of 1.0 fb−1 collected by the LHCb experiment in
proton–proton collisions at a centre-of-mass energy of
√
s = 7 TeV. The ratios of the branching fractions
of each of the ψ(2S) modes with respect to the corresponding J/ψ decays are
B(B0s
→ψ(2S)η)
÷
B(B0s
→J/ψη)
= 0.83± 0.14 (stat)±0.12 (syst) ±0.02 (B),
;
B(B0→ψ(2S)π
+
π
−
)
÷
B(B0→J/ψπ
+
π
−
)
= 0.56± 0.07 (stat)±0.05 (syst)± 0.01 (B),
;
B(B0s
→ψ(2S)π
+
π
−
)
÷
B(B0s
→J/ψπ
+
π
−
)
= 0.34± 0.04 (stat)±0.03 (syst)± 0.01 (B),
where the third uncertainty corresponds to the uncertainties of the dilepton branching fractions of the J/ψ
and ψ(2S) meson decays
Measurement of the polarization amplitudes and triple product asymmetries in the B0s → Φ Φ decay
No full text<p>Using 1.0 fb−1 of pp collision data collected at a centre-of-mass energy of s√=7 TeV with the LHCb detector, measurements of the polarization amplitudes, strong phase difference and triple product asymmetries in the B0s→ϕϕ decay mode are presented. The measured values are</p>
<p>|A0|2=0.365±0.022(stat)±0.012(syst),|A⊥|2=0.291±0.024(stat)±0.010(syst),cos(δ∥)=−0.844±0.068(stat)±0.029(syst),AU=−0.055±0.036(stat)±0.018(syst),AV=0.010±0.036(stat)±0.018(syst).</p>
O teorema adiabático para sistemas quânticos de muitos corpos
No full textThe original formulation of the Adiabatic Theorem for quantum mechanics was made in
1928 by physicist and mathematician Max Born and physicist Valdimir Fock. Physically, we can
understand this theorem this way: if a quantum system undergoes sufficiently slow perturbations, then, over time, the configuration of the system remains close to the instantaneous fixed point of the perturbation. The main objective of this dissertation is to present the formulation and proof of the adiabatic theorem for extended quantum systems, proven by mathematical physicists Sven Bachmann, Wojciech De Roeck and Martin FraasA formulação original do Teorema Adiabático para a mecânica quântica foi feita em 1928
pelo físico e matemático Max Born e pelo físico Valdimir Fock. Fisicamente, podemos entender
esse teorema da seguinte maneira: se um sistema quântico sofre pertubações suficientemente
lentas, então, ao longo do tempo, a configuração do sistema se mantém próxima do ponto fixo
instantâneo da pertubação. O objetivo principal desta dissertação é apresentar a formulação e
demonstração do teorema adiabático para sistemas quânticos de muitos corpos, provado pelos
físicos matemáticos Sven Bachmann, Wojciech De Roeck e Martin Fraas.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio
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