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Background: People with Down's syndrome (DS) are at high risk of developing Alzheimer dementia (DS‐AD) due to a triplication of the amyloid precursor protein gene. While several tools to diagnose and screen for DS‐AD, such as the dementia screening questionnaire for individuals with intellectual disabilities (DSQIID), are available in English, validated German versions of such instruments are scarce. Methods: A German version of the DSQIID questionnaire (DSQIID‐G) was completed by caregivers before attending our specialist outpatient department for DS‐AD. All participants were assessed blind to DSQIID‐G scoring using clinical and neuropsychological examinations, including the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). ICD‐10 and amyloid/tau/neurodegeneration (A/T/N) criteria were applied to detect and categorise cognitive decline. Results: Of 86 participants, 43 (50%) showed evidence of cognitive decline. A definite diagnosis of DS‐AD was reached in 17 (19.8%) and mild cognitive impairment in seven (8.3%) participants. Secondary causes of cognitive decline were determined among 13 (15.1%) participants, and in six (7%) cases, the diagnosis remained unclassifiable due to co‐morbidities. Compared with cognitively stable individuals, participants with cognitive decline (n = 43) displayed higher DSQIID‐G total scores [median (range): 3 (0–21) vs. 19 (0–48), P < 0.001]. A total score of >7 provided a sensitivity of 0.94 against a specificity of 0.76, to discriminate DS‐AD and participants without cognitive decline according to ROC analysis. The convergent validity against the CAMDEX‐DS interview score was good (r = 0.74), and split‐half reliability (r = 0.96), internal consistency (Cronbach's α r = 0.96), test–retest reliability (r = 0.88) (n = 25) and interrater reliability (r = 0.81) (n = 31) were excellent. Conclusions: The DSQIID‐G showed excellent psychometric properties, including concurrent and internal validity and reliability. The cut‐off value for screening was lower than in the original English validation study. For a screening instrument like DSQIID‐G, a lower cut‐off is preferable to increase case detection. [ABSTRACT FROM AUTHOR]

We have measured the spectrum of laser photodissociation of OH+ molecular ions to O + H+ and O+ + H fragments for photon energies of 38 100–40 900 cm−1. The OH+ ions were stored as a fast beam (5.50 MeV) in the storage ring TSR for several seconds to achieve rovibrational cooling into the lowest rotations N′′ = 0–11 of the vibrational ground state X3Σ−(v ′′ = 0), close to room temperature (≈300 K). The many resonances in the spectra reveal the energies, widths, and O/O+ branching ratios of 44 predissociating quasibound levels (Feshbach resonances) that lie between the fine-structure states of the O fragment and belong to the last, near-threshold vibrational states v ′ = 9 and 10 of the A3Π electronic state. For the A3Π0,1 substates, isolated levels with v ′ = 11 are observed and attributed to double-well distortions of these curves due to nonadiabatic interactions. Another five isolated levels are assigned to the v ′ = 0 and 1 states of the shallow 15Σ− electronic state, borrowing oscillator strength from nearby A3Π levels. Together, the near-threshold levels deliver a new value D0 = 40 253.8(1.1) cm−1 for the dissociation energy of OH+. Through a two-step photodissociation process, 72 levels from the lower bound states A3Π(v ′ = 7–8) appear as well and are rotationally analyzed. The level energies are used to construct improved A3Π and 15Σ− Born-Oppenheimer potentials. The totality of the spectral data (energies, widths, intensities, and branching ratios) can provide tight constraints for the potentials and nonadiabatic interactions assumed in future coupled-channel calculations of OH+ photodissociation or of the related charge-exchange reaction O + H+ → O+ + H. [ABSTRACT FROM AUTHOR]

An unusually large positive salinity anomaly was observed across the eastern Gulf of Maine in winter 2017–2018. Buoy measurements in Jordan Basin found this anomaly extended down to at least 100 m, the deepest mixing observed in the past 19 years. Similarly, this is the strongest positive regional salt anomaly ever observed in sea surface salinity (SSS) satellite observations. To determine the source waters driving this event and to diagnose the relative importance of forcing processes, passive tracer adjoint sensitivity experiments are performed using a data assimilating version of the Regional Ocean Modeling System. The model suggests that northeastward Scotian Shelf wind anomalies is one factor in the dramatic decrease in freshwater transport to Jordan Basin, which leads to an early winter upper water column salinity surplus. This salinity change weakens the normally haline‐controlled vertical stratification across the eastern Gulf. Modeled upper ocean density and vertical diffusivity from 2007 to 2021 both show a maximum in January 2018. Winter 2017–2018 is the only period where the enhanced winter mixing extends below 100 m. Thus, anomalous vertical entrainment of saltier subsurface Gulf water is the major factor driving the extreme positive satellite‐observed SSS anomaly across the eastern Gulf including Jordan Basin. Other factors, including a modest increase in wind‐forced slope water transport, and positive fall 2017 salinity anomalies on the Scotian Shelf and Slope Sea, appear to play lesser roles in the observed salinification. The adjoint sensitivity analysis demonstrates its utility for back tracing transport pathways for periods of several months. Plain Language Summary: An unusually large positive salinity anomaly observed in the Gulf of Maine (GoM) in winter 2017–2018 is studied using both model‐derived and observational data from satellites and buoys. The study shows that wind anomalies cause a dramatic decrease in freshwater transport from the Scotian Shelf to the GoM, which leads to an upper water column salinity surplus that in turn leads to enhanced winter mixing. Key Points: Multi‐year regional assimilative model simulates winter 2017–2018 abnormal salinification of the eastern Gulf of Maine (eGoM)Model adjoint sensitivity analysis suggests a dramatic reduction of both Scotian Shelf inflow and haline stability during this eventAbnormally deep 2017–2018 winter overturning due to lack of surface freshwater is responsible for the uplift of salty water in the eGoM [ABSTRACT FROM AUTHOR]

This article sets out to investigate alcohol and substance use (ASU) among adolescents living with HIV (ALWH) in the sub-Saharan African setting of Uganda. A cross-sectional analysis of the records of 479 adolescents (aged between 12and 17 years) attending the study, "Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (the CHAKA study)" was undertaken. ASU was assessed through both youth self-report and caregiver report using the Diagnostic and Statistical Manual of Mental Disorders-5 referenced instruments, the Youth Inventory-4R and the Child and Adolescent Symptom Inventory-5 (CASI-5). Rates and association with potential risk and outcome factors were investigated using logistic regression models. The rate of ASU was 29/484 (5.9%) with the most frequently reported ASU being alcohol 22/484 (4.3%) and marijuana 10/484 (2.1%). Functional impairment secondary to ASU was reported by 10/484 (2.1%) of the youth. ASU was significantly associated with urban residence, caregiver psychological distress and the psychiatric diagnosis of post-traumatic stress disorder. On associations with negative outcomes, ASU was significantly associated with only "ever had sex". Health care for ALWH in sub-Saharan Africa should include ASU prevention and management strategies. [ABSTRACT FROM AUTHOR]

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We present a detailed experimental and theoretical study of the charging of silicon nitride and silicon oxide thin films following focused ion beam irradiation. The samples were irradiated using 30 keV Ga+ ions at different ion doses and their consequent work function changes were measured by Kelvin probe force microcopy. The surface potential of both samples increased following the ion irradiation up to a critical ion dose, and then moderately decreased. The dependence of the sample surface potential on the irradiated ion dose is analyzed by taking into account all the main factors affecting charging in dielectric thin films: electron-hole generation by the incident fast ions, secondary ion-electron emission, sputtering of surface atoms, electron-hole recombination, electron recombination with the incident stopped ions, hole leakage current to the Si substrate, and various charge trapping processes. It was found that the much larger surface potential induced in Si3N4 in comparison to SiO2 is associated with the different resistance to the Ga+ ion bombardment. Under equal ion irradiation dose, a larger concentration of shallow traps is created in SiO2 than in Si3N4. This leads to an increased hole capture in shallow traps versus deep traps, and a consequent decrease in the surface potential. [ABSTRACT FROM AUTHOR]

Vibrational relaxation and isomerization of internally excited deuterated formyl and isoformyl cations has been investigated on the time scale of 2 ms to 12 s using the nearly interaction-free environment of an ion storage ring. De-excitation of the v[sub 2] bending modes of DCO[sup +] and DOC[sup +] due to spontaneous radiative transitions was observed as a function of the storage time by measuring their foil-induced Coulomb explosion using three-dimensional coincident fragment imaging. No isomerization of low-lying vibrational levels of DOC[sup +] ions was observed on the time scales considered. By comparing the Coulomb explosion data to molecular bond angle distributions obtained from vibrational wave function calculations, the time evolution of the mean v[sub 2] population is deduced for both isomers. The stored DOC[sup +] ions are found to thermalize with the 300 K black-body radiation, while relaxation of the DCO[sup +] bending vibrations was found to require considerably longer times, in agreement with a predicted very small transition moment of the v[sub 2]=1 level. © 2002 American Institute of Physics. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: To assess a multimodal physician‐to‐physician communication initiative that is low in cost and impact to daily workflow to reduce blood product wastage. Background: Blood product stewardship is an important issue in all hospital systems. Previous studies have proposed low‐cost interventions to reduce blood product wastage, but few have evaluated improvements in communication between the blood bank and providers. We undertook a prospective quality improvement project focusing on improving communication to reduce blood product wastage. Methods: We conducted a prospective quality improvement project over the first quarter of 2017, identifying patients with issued but unused blood products. Each service overseeing the care of patients identified on the unit status report was contacted through two possible methods: (i) phone or (ii) proprietary Health Insurance Portability and Accountability Act of 1996 compliant digital messaging application. Collected variables included reserved blood product type and participant time spent. Outcomes included the rate of blood product release and changes in wastage compared with historical data tracked by the blood bank. Results: Eight hundred and forty products were reserved during the study period, of which 436 (52%) were released. Average participant times ranged from 2 ± 1 min to 15 ± 4 min with no significant differences in time spent between participants (P = 0·194). Compared with the average product wastage 10 months prior to project initiation, there were significant reductions in the average wastage for platelets (5·3 ± 2·5 units vs 2·5 ± 1·5 units, P = 0·05), RBCs (6·1 ± 3·7 units vs 0 ± 0 units, P = 0·01) and overall wastage (58·3 ± 14·9 units vs 40 ± 15·7 units, P = 0·05). Conclusion: Efforts focusing on improving provider‐to‐provider communication can reduce blood product wastage. [ABSTRACT FROM AUTHOR]

We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV. [ABSTRACT FROM AUTHOR]

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Unemployment among the almost 5 million working-age adults with cognitive disabilities in the USA is a costly problem in both tax dollars and quality of life. Job coaching is an effective tool to overcome this, but the cost of job coaching services sums with every new employee or change of employment roles. There is a need for a cost-effective, automated alternative to job coaching that incurs a one-time cost and can be reused for multiple employees or roles. An effective automated job coach must be aware of its location and the location of destinations within the job site. This project presents a design and prototype of a cart-mounted indoor positioning and navigation system with necessary original software using Ultra High Frequency Radio Frequency Identification (UHF RFID). The system presented in this project for use within a warehouse setting is one component of an automated job coach to assist in the job of order filler. The system demonstrated accuracy to within 0.3 m under the correct conditions with strong potential to serve as the basis for an effective indoor navigation system to assist warehouse workers with disabilities. Implications for rehabilitationAn automated job coach could improve employability of and job retention for people with cognitive disabilities.An indoor navigation system using ultra high frequency radio frequency identification was proposed with an average positioning accuracy of 0.3 m.The proposed system, in combination with a non-linear context-aware prompting system, could be used as an automated job coach for warehouse order fillers with cognitive disabilities. [ABSTRACT FROM PUBLISHER]

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Copyright of Der Nervenarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Colonoscopy is the leading preventative procedure for colorectal cancer. The traditional tool used for this procedure is an endoscope, which can cause patient discomfort, pain and fear of the procedure. There has been a movement to develop a robotic capsule colonoscope (RCC) in an attempt to mitigate these drawbacks and increase procedure popularity. An RCC is a capsule robot that propels itself through the colon as opposed to being pushed, like a traditional endoscope. In this study, an overview of an in vivo RCC is given, followed by the introduction of a mobility method for an RCC using micropatterned polydimethylsiloxane (PDMS). The design of a three degree-of-freedom automated traction measurement (ATM) platform for quantitative evaluation of the mobility method is presented. An empirical model for traction force as a function of slip ratio, robot speed, and weight for micropatterned PDMS on synthetic tissue is developed using data collected from the ATM platform. The model is then used to predict traction force at different slip ratios, speeds, and weights, and is verified experimentally. The average normalized root-mean-square error (NRMSE) between the empirical model and the data used to develop the model is 1.1% (min 0.0024%, max 4.2%). The average NRMSE between the traction force predicted by the model and the data used to verify the prediction is 1.8% (min 0.020%, max 8.6%). Understanding how model parameters influence tread performance will improve future RCC mobility systems and aid in the development of analytical models, leading to more optimal designs. [ABSTRACT FROM PUBLISHER]

Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented. [ABSTRACT FROM AUTHOR]

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In an open surgery, identification of precise margins for curative tissue resection is performed by manual palpation. This is not the case for minimally invasive and robotic procedures, where tactile feedback is either distorted or not available. In this paper, we introduce the concept of intraoperative wireless tissue palpation. The wireless palpation probe (WPP) is a cylindrical device (15 mm in diameter, 60 mm in length) that can be deployed through a trocar incision and directly controlled by the surgeon to create a volumetric stiffness distribution map of the region of interest. This map can then be used to guide the tissue resection to minimize healthy tissue loss. The wireless operation prevents the need for a dedicated port and reduces the chance of instrument clashing in the operating field. The WPP is able to measure in real time the indentation pressure with a sensitivity of 34 Pa, the indentation depth with an accuracy of 0.68 mm, and the probe position with a maximum error of 11.3 mm in a tridimensional workspace. The WPP was assessed on the benchtop in detecting the local stiffness of two different silicone tissue simulators (elastic modulus ranging from 45 to 220 kPa), showing a maximum relative error below 5%. Then, in vivo trials were aimed to identify an agar-gel lump injected into a porcine liver and to assess the device usability within the frame of a laparoscopic procedure. The stiffness map created intraoperatively by the WPP was compared with a map generated ex vivo by a standard uniaxial material tester, showing less than 8% local stiffness error at the site of the lump. [ABSTRACT FROM PUBLISHER]

Background: The state-of-the-art technology for gastrointestinal (GI) tract exploration is a capsule endoscope (CE). Capsule endoscopes are pill-sized devices that provide visual feedback of the GI tract as they move passively through the patient. These passive devices could benefit from a mobility system enabling maneuverability and controllability. Potential benefits of a tethered robotic capsule endoscope (tRCE) include faster travel speeds, reaction force generation for biopsy, and decreased capsule retention.Methods: In this work, a tethered CE is developed with an active locomotion system for mobility within a collapsed lumen. Micro-patterned polydimethylsiloxane (PDMS) treads are implemented onto a custom capsule housing as a mobility method. The tRCE housing contains a direct current (DC) motor and gear train to drive the treads, a video camera for visual feedback, and two light sources (infrared and visible) for illumination.Results: The device was placed within the insufflated abdomen of a live anesthetized pig to evaluate mobility performance on a planar tissue surface, as well as within the cecum to evaluate mobility performance in a collapsed lumen. The tRCE was capable of forward and reverse mobility for both planar and collapsed lumen tissue environments. Also, using an onboard visual system, the tRCE was capable of demonstrating visual feedback within an insufflated, anesthetized porcine abdomen.Conclusion: Proof-of-concept in vivo tRCE mobility using micro-patterned PDMS treads was shown. This suggests that a similar method could be implemented in future smaller, faster, and untethered RCEs. [ABSTRACT FROM AUTHOR]

In this study, an experimental platform is developed to quantitatively measure the performance of robotic wheel treads in a dynamic environment. The platform imposes a dynamic driving condition for a single robot wheel, where the wheel is rotated on a translating substrate, thereby inducing slip. The normal force of the wheel can be adjusted mechanically, while the rotational velocity of the wheel and the translational velocity of the substrate can be controlled using an open-loop control system. Wheel slip and translational speed can be varied autonomously while wheel traction force is measured using a load cell. The testing platform is characterized by testing one micropatterned polydimethylsiloxane (PDMS) tread on three substrates (dry synthetic tissue, hydrated synthetic tissue, and excised porcine small bowel tissue), at three normal forces (0.10, 0.20, and 0.30 N), 13 slip ratios (−0.30 to 0.30 in increments of 0.05), and three translational speeds (2, 3, and 6 mm/s). Additionally, two wheels (micropatterned and smooth PDMS) are tested on beef liver at the same three normal forces and translational speeds for a tread comparison. An analysis of variance revealed that the platform can detect statistically significant differences between means when observing normal forces, translational speeds, slip ratios, treads, and substrates. The variance due to within (platform error, P = 1) and between trials (human error, P = 0.152) is minimal when compared to the normal force (P = 0.036), translational speed ( P = 0.059), slip ratio (P = 0), tread (P = 0.004), and substrate variances ( P = 0). In conclusion, this precision testing platform can be used to determine wheel tread performance differences on the three substrates and for each of the studied parameters. Future use of the platform could lead to an optimized micropattern-based mobility system, under given operating conditions, for implementation on a robotic capsule endoscope. [ABSTRACT FROM PUBLISHER]

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Objective: Despite expanding access to antiretroviral therapy (ART) in Sub-Saharan Africa, there are few data on patients' perceptions about starting ART to explore issues affecting decisions to start ART in eligible individuals during the ART roll out.Methods: We studied patterns of ART uptake for 957 participants in a trial of cryptococcal disease prevention and performed a qualitative cross-sectional study about issues affecting decisions to start ART in this cohort. In-depth interviews (IDIs) were conducted with 48 participants who started ART after variable time on the trial.Results: Time to starting ART from trial enrolment decreased during the ART roll out (Median 83 days to 68 days). Multiple factors causing delay to ART were reported; awaiting home visit by service provider (P=0.025), domestic issues (P=0.028), moving from area (P≤0.001) and fear of side effects (P=0.013) were statistically significant. In the IDIs, fear of side effects was the strongest factor for delay and observation of health improvement in others on ART was the strongest inducement to start. Information from patients already taking ART was the most valued source of information.Conclusions: This study provided novel information about factors encouraging people to start ART early; positive beliefs about ART were the most important. Whilst side effects of ART must not be downplayed, programmes should provide information in a balanced way to prevent unnecessary fear of starting ART. Those already receiving ART were found to be good advocates and should be utilised by ART programmes to educate others. [ABSTRACT FROM AUTHOR]

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This paper presents whole-rock geochemical and mineral chemical data for chromitite layers of the Middle Group of the eastern Bushveld complex. It reports on compositional variations of chromite from the chromitite layers, and special attention is paid to the platinum-group element (PGE) content and mineralisation within the chromitite layers. The discussion is focused on possible mechanisms by which the association of PGE enrichment within the chromitite layers can be modelled. The MG chromitites from bottom (MG0) to top (MG4C) are characterised by progressive melt evolution, showing decreasing Mg# and Cr/(Cr+Fe) ratio and increasing Cr/(Cr+Al) ratio, TiO2 and V concentrations. An increase in the Mg# together with a drop in the Cr/Cr+Al) and an increasing Cr/(Cr+Fe) ratio at the base of the MG4A chromitite strongly suggests the addition of hot and primitive magma. High Cu concentrations in the chromitite layers with coincident low S values suggest the application of Naldrett et al.36 Fe-loss model during cooling. With the help of the La/Cu and Cu/S ratios it could be shown that Cu is concentrated neither in base metal sulphides nor in trapped silicate melt and thus the model is not applicable. Laser ablation inductively coupled plasma mass spectrometry studies of single chromite grains also have not revealed Cu to be in solid solution and thus another Cu concentrating phase must be found. The PGE patterns of the MG chromitite layers are very similar to the one of the UG2 suggesting that they derived from the same magma and the same style of mineralisation did apply. It furthermore implies the presence of one parental magma only for the entire Critical Zone. Due to low S contents in the MG chromitite layers, it seems unlikely that the PGE have been concentrated by base metal sulphides only. About a sixth of the platinum-group mineral observed is associated with As, Bi and Te, and therefore PGE concentration by the cluster model is favoured. Enrichment of the high-temperature PGE over the lower-temperature PGE in the lowermost MG chromitite layers and the MG4A is probably due to the presence of high temperatures of the chromitite forming melt, and thus temperature could play a role in the fractionation of the two PGE groups. [ABSTRACT FROM AUTHOR]