13 research outputs found
The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer's Disease
No full textBackground: The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer's disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. Objective: The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Methods: Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Results: Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. Conclusions: The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery
The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer’s Disease
No full textBackground: The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer’s disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. Objective: The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Methods: Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Results: Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. Conclusions: The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery
The association between self-checked visual field impairment and motor vehicle accidents among Japanese taxi drivers
No full textAbstract In this cross-sectional study, we investigated the association between visual field impairment (VFI) and motor vehicle accidents (MVAs) among Japanese taxi drivers. We also evaluated the usefulness of a self-check test, the CLOCK CHART, as a screening tool for VFI. We recruited 1,227 male Japanese taxi drivers from 2018 to 2019. The CLOCK CHART detected defects (CCDD) were recorded as VFI. We collected data on visual field (VF)-related near miss incidents and MVAs over the previous five years using a self-administered questionnaire. A multivariable-adjusted generalized linear model was used to examine the association of the combination between CCDD and VF-related near misses with MVAs. We conducted a follow-up survey among 326 participants with CCDD to determine the proportion of newly diagnosed glaucoma. The proportion of MVAs was 61.9%, with a multivariable-adjusted prevalence ratio (95% confidence interval) of 1.22 (1.05–1.41) for MVAs in the group with both CCDD and VF-related near misses compared to the group without these factors. Further, 14 of these participants were newly diagnosed with glaucoma. A higher prevalence of MVAs was found among taxi drivers with both CCDD and VF-related near misses than for those without these factors. The CLOCK CHART may aid in identifying asymptomatic glaucoma
A nationwide survey of Italian Centers for Cognitive Disorders and Dementia on the provision of care for international migrants
No full textBackground: More than 500,000 dementia cases can be estimated among migrants living in Europe. There is the need to collect "real world" data on the preparedness of healthcare services to support the inclusion of migrants in the public health response to dementia. The present study aimed (i) to estimate the number of migrants referred to Italian memory clinics (Centers for Cognitive Disorders and Dementia [CCDDs]) and (ii) to identify possible barriers and resources for the provision of diversity-sensitive care. Methods: A survey of all Italian CCDDs was conducted between December 2020 and April 2021. An online questionnaire was developed to obtain information on the number of migrants referred to Italian CCDDs in 2019, the challenges encountered in the diagnostic approach, and possible facilitators in the provision of care. Results: Overall, 343 of the 570 contacted CCDDs completed the survey questionnaire (response rate: 60.2%). Nearly 4527 migrants were referred to these services in 2019. Migrants accounted for a median 1.1% (IQR: 0.9%-2.8%) of overall CCDD referrals. More than one-third of respondents reported that the number of migrants referred to their facilities had increased in the last 5 years. The overall quality of the migrants' cognitive assessment was deemed to be very poor or insufficient in most cases. A minority of CCDDs had translated information material on dementia and reported the possibility to contact cultural mediators and interpreters. Conclusions: A relevant number of migrants are being referred to Italian CCDDs that are still not adequately prepared to deliver diversity-sensitive care and support
Interlaminar adhesion assessment of carbon-epoxy laminates under salt water ageing using peel tests
No full textThe aim of this study is to assess the interlaminar adhesion of carbon-epoxy laminates under salt water condition. Carbon-epoxy laminate specimens were immersed in a salt water tank for 60 days. Some specimens were then dried atroom temperature for 280 days, until recovering their initial weight. Specimens were tested using the composite peel test, an adaptation of the floating roller peel tests for composite materials. The results showed a degradation of peel strength in some areas due to the ageing process. The drying process did not affect the test results. A scanning electron microscopic analysis carried out on the fracture surface of the specimens revealed a typical mode I failure microstructure. A mixture of matrix failure and fibre/matrix interfacial failure was observed in non-aged specimens. Finally, a chemical characterization of the fracture surfaces with energy-dispersive spectroscopy confirmed the penetration of salt water in regions near the edge of the specimens. A degradation of the fibre/matrix interface adhesion was observed in affected areas. Floating roller peel tests proved to be a fast and effective method to access the interlaminar adhesion performance of composite laminates.Structural Integrity & Composite
An evaluation of the key skills 2000 curriculum in the further education sector and its effects on students' motivation for learning at foundation level
No full textKey Skills (KS), a component of Curriculum 2000 (C2000) was introduced by government in September 2000 as a range of essential generic, transferable skills that underpin success in education, employment, lifelong learning and personal development. C2000 was introduced into Further Education (FE) colleges to replace the core skills (CS) which had, up to then, been integrated or attached to vocational course structures. KS are different in nature from CS. KS are evidenced, assessed and examined separately from vocational courses and therefore, because of their standalone nature, are attached to the vocational students, not to their courses. This research is an evaluation of the conceptual coherence and practical viability of the KS curriculum (KS2000), as introduced and implemented within the further education sector. The study investigates issues for tutors delivering KS and its effects on their foundation students’ motivation for learning. Eleven case-studies were carried out across one academic year within seven FE colleges in Southern England. The nature, provenance and purpose of KS2000 are explored, and the origin and rationale for KS are examined through an analysis of the concept of the ‘skills’ component on which it is founded. The framework of illuminative evaluation was adopted and ethnographic methods of interviews and observations employed. Progressive focussing, used in conjunction with a grounded theory approach of treating the literature as part of the collection of data, gave some capacity for theory-building. The thesis found that all college staffs, both KS and vocational, whilst agreeing that KS were remedial in nature, held different opinions as to what KS were and of what value the KS2000 was to the foundation students. KS tutors believed they provided students with a basis for opportunities to acquire important ‘skills’ for their future, but most vocational staff did not and were even opposed to their being delivered in the context of FE. KS managers agreed that KS should not have to be provided by the FE sector. Members from all groups of participants reported having large numbers of school-leavers entering their colleges with poor levels of basic maths and English. Supplying adequate tutoring and support for such students was demanding for management and stressful for many KS tutors. The students were socialised into accepting that their future employment depended on KS and a majority were positive in their belief that they could achieve them. However, in spite of government funding to provide KS2000, great effort from all staffs to implement the curriculum and students’ apparent motivation and self-belief, many students were observed behaving badly in class and KS qualification rates generally remained poo
Improving patient experience and healthcare quality in primary care for patients with complex chronic disease: Adopting qualitative methods into a user-centred design approach to develop the electronic Patient Reported Outcomes (ePRO) tool
No full textABSTRACTBackground: Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD.Objective: This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool. Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers.Methods: Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool.Results: Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis—Possible, Implementable, (to be) Challenged, (to be) Killed—guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5). Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes.Conclusions: Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers.<br/
Cognitive bias modification for social anxiety: protocol for a living systematic review of human studies and meta-analysis
No full textBackgroundSocial anxiety is a heightened fear and discomfort in social situations. Cases of elevated distress and impaired functioning can lead to a clinical diagnosis of social anxiety disorder. Altering cognitive biases associated with social anxiety has been suggested as potentially beneficial; however, little is known about the comparative effectiveness of such interventions. The aim of this living systematic review is to examine the efficacy of cognitive bias modification for reducing social anxiety.MethodsWe will search multiple electronic databases for randomised controlled trials evaluating the efficacy of cognitive bias modification for people diagnosed with social anxiety and people exposed to a social stressor. The primary outcome will be change in social anxiety related symptoms; secondary outcomes will be changes in social functioning and quality of life and adverse events. Study selection, data extraction and risk of bias assessment will be done by at least two reviewers using pre-defined tools. We will synthesise data from people with social anxiety diagnosis and those subjected to a simulated social stressor separately using random effects meta-analyses. Heterogeneity will be evaluated by investigating characteristics of included studies and we will conduct a network meta-analysis in order to compare the efficacy of subtypes of cognitive bias modification for social anxiety disorder. We will appraise the strength of the evidence for each outcome by reviewing the overall association, internal and external validity, and reporting biases. Where data allows, we will triangulate the evidence from both sources with a multidisciplinary group of experts. We will also descriptively report factors reported to mediate cognitive bias modification, The review will begin in living mode and the database search will be rerun every three months to identify potential new evidence. We will co-produce this review with members of a global lived experience advisory board. This protocol was registered on 15.10.2024 (CRD42024601380).
Objectively analyzed air-sea heat fluxes for the global ice-free oceans (1981-2005)
No full textAuthor Posting. © American Meteorological Society, 2007. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Bulletin of the American Meteorological Society 88 (2007): 527-539, doi:10.1175/bams-88-4-527.A 25-yr (1981–2005) time series of daily latent and sensible heat fluxes over the global ice-free oceans has been produced by synthesizing surface meteorology obtained from satellite remote sensing and atmospheric model reanalyses outputs. The project, named Objectively Analyzed Air–Sea Fluxes (OAFlux), was developed from an initial study of the Atlantic Ocean that demonstrated that such data synthesis improves daily flux estimates over the basin scale. This paper introduces the 25-yr heat flux analysis and documents variability of the global ocean heat flux fields on seasonal, interannual, decadal, and longer time scales suggested by the new dataset.
The study showed that, among all the climate signals investigated, the most striking is a long-term increase in latent heat flux that dominates the data record. The globally averaged latent heat flux increased by roughly 9 W m−2 between the low in 1981 and the peak in 2002, which amounted to about a 10% increase in the mean value over the 25-yr period. Positive linear trends appeared on a global scale, and were most significant over the tropical Indian and western Pacific warm pool and the boundary current regions. The increase in latent heat flux was in concert with the rise of sea surface temperature, suggesting a response of the atmosphere to oceanic forcing.The authors gratefully
acknowledge support from NOAA through the Cooperative
Institute for Climate and Oceanic Research (CICOR) at the
Woods Hole Oceanographic Institution (WHOI). Supporting
NOAA grants are from the Office of Climate Observations
(OCO) and Climate Change Data and Detection (CCDD)
Evidencias de descomposición en multiferróicos RE2(MoO4)3 antes de PIA
No full textIn this work we present the study of rare earth molybdates RE=(Eu, Tb and
Ho) with formula RE2(MoO4)3. Under ambient conditions, Eu- and Tb-containing
compounds can be found in the phases α and β0
, while holmium-containing can be
found in the phase γ and β0 under these conditions. In the study of the β0
-Tb2(MoO4)3
compression by the CCDD group, the hypothesis of a transition to a new phase, called
the phase δ, was considered. Subsequently, in the study of Y2(MoO4)3 synthesised
unconventional conditions, non-stoichiometric oxide and molybdate phases with dif fractograms very similar to those of the phase δ were obtained.
This opened the door to another possible hypothesis about the β0 → δ transition,
that it was a decomposition induced by high pressure. For its verification, the synt hesis of the named compounds was carried out, modifying the solid state synthesis,
applying a pressure of 0.66 GPa for compacting powder samples and increasing or
decreasing the synthesis temperature, which was different for each case.
We carry out a study of the crystalline structures of the most relevant phases
involved: chelite-α, β-β0 and γ. Additionally, symmetry relationships provide clarity
in understanding the phase transitions.
A routine diffractogram was performed for each compound synthesised by using
the X-ray diffractometer available at SIDIX (X-ray Facilitiy of the La Laguna Univer sity). Diffraction data collected under pressure were provided by the CCDD (group
with which the supervisors of this work are researching). Note that, in addition to
the β0
-Tb2(MoO4)3 data, β0
-phase of Ho and Eu molybdates data were also available.
Using the ICSD database we simulated the different phases that would be expec ted to be found, and with which a visual identification of the phases was performed.
Applying the Le Bail refinement method, the intensities of the full profile were refined
as a verification of the existence of the expected phases.
The synthesis of europium molybdate was carried out at 500oC, 550oC and
600oC. After the analysis and refinements, different mixtures of phases with struc tural types Sm2O3, MoO3, Eu4Mo7O27, Eu2Mo4O15 and the phase α-Eu2(MoO4)3
were detected. Furthermore, by analysing the pure β0
-Eu2(MoO4)3 phase under pres sure, it was observed that around 2.23 GPa a phase transition occurs, interpreted
as a decomposition into the β0
, Eu2O3 and Eu2Mo4O15 phases, while at 5 GPa an
amorphisation undergoes.
Holmium oxide, β0
-Ho2(MoO4)3, nonstoichiometric Y2Mo4O15 phases were iden tified for the holmium molybdated synthetised at 600oC. Under pressure, as in the
case of the europium molybdate, a phase transition occurs around 2.3 GPa in which
the β0
-phase, the europium oxide and the Y2Mo4O15 phase are involved and the
non-reversible amorphous phase starts at around 5 GPa.
In these cases as well as the one studied by the CCDD group on Tb molybdate,
when the decompression is carried out, the initial β0
-RE2(MoO4)3 phase is not com pletely recovered, so the phase transition is not reversible, which leads us to think
that it is a decomposition induced by pressure.
In addition to the experimental work and the analysis and discussion of the
results, we would like to highlight the literature review carried out, which is a very
important part of this dissertation. On the one hand, the research was contextualised,
its interest was explained and an exhaustive description of the crystal structures of the
materials studied was made. It was also necessary to: 1) review and introduce some
crystallographic terms that were later used in the description of these structures. 2)
Describe the experimental techniques used, reviewing their physical foundations. 3)
Explain the tools used in the analysis of the data. Therefore, the work was structured
as follows:
Chapter 1. Introduction. This is divided into three sections: the state of the art,
the motivations and how the work was organised.
Chapter 2. Crystallographic basis for the description of polymorphs with for mula RE2(MoO4)3. In the first section we explain concepts about crystal structures
and symmetry relations: direct lattice and symmetry, point and space groups and
group-subgroup relations. In the second section we describe the crystal structures
of the RE2(MoO4)3 family of compounds: the α, β0, γ and other non-stoichiometric
phases.
Chapter 3. Experimental preparation and diffraction. Here we explain how com pounds are prepared by solid state synthesis, giving details of the material, the equip ment, the stoichiometric calculations and the solid state reaction. The second section
is devoted to X-ray diffraction by powder samples. Diffraction concepts are introdu ced, the operation of powder diffractometers is explained and measurement conditions
at the SIDIX and DIAMOND synchrotron are given.
Chapter 4. Analysis of results and conclusions. The first section explains the
procedure followed for the identification of the phases, using databases, CIF files and
simulating the possible phases. The second section explains the refinement by the
Le Bail method. In the third section, the diffractograms measured in SIDIX (pha se identification and refinement) are analysed and discussed. In the fourth section,
the diffractograms measured in DIAMOND (phase identification and refinement) are
analysed and discussed. In the fifth section the conclusions are developed and in the
sixth section the possible continuation of this TFG is proposed
