Search

Objective:The Apolipoprotein (APOE) ε4 allele increases the risk for mild cognitive impairment (MCI) and dementia, but not all carriers develop MCI/dementia. The purpose of this exploratory study was to determine if early and subtle preclinical signs of cognitive dysfunction and medial temporal lobe atrophy are observed in cognitively intact ε4 carriers who subsequently develop MCI.Methods:Twenty-nine healthy, cognitively intact ε4 carriers (ε3/ε4 heterozygotes; ages 65–85) underwent neuropsychological testing and MRI-based measurements of medial temporal volumes over a 5-year follow-up interval; data were converted toz-scores based on a non-carrier group consisting of 17 ε3/ε3 homozygotes.Results:At follow-up, 11 ε4 carriers (38%) converted to a diagnosis of MCI. At study entry, the MCI converters had significantly lower scores on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT) Trials 1–5, and RAVLT Immediate Recall compared to non-converters. MCI converters also had smaller MRI volumes in the left subiculum than non-converters. Follow-up logistic regressions revealed that left subiculum volumes and RAVLT Trials 1–5 scores were significant predictors of MCI conversion.Conclusions:Results from this exploratory study suggest that ε4 carriers who convert to MCI exhibit subtle cognitive and volumetric differences years prior to diagnosis.

OBJECTIVE The apolipoprotein E (APOE) e4 allele is the most important genetic risk factor for late-onset Alzheimer's disease. Many e4 carriers, however, never develop Alzheimer's disease. The purpose of this study is to characterize the variability in phenotypic expression of the e4 allele, as measured by the longitudinal trajectory of cognitive test scores and MRI brain volumes, in cognitively intact elders. METHOD Healthy older adults, ages 65-85, participated in a 5-year longitudinal study that included structural MRI and cognitive testing administered at baseline and at 1.5 and 5 years postenrollment. Participants included 22 e4 noncarriers, 15 e4 carriers who experienced a decline in cognition over the 5-year interval, and 11 e4 carriers who remained cognitively stable. RESULTS No baseline cognitive or volumetric group differences were observed. Compared to noncarriers, declining e4 carriers had significantly greater rates of atrophy in left (p = .001, Cohen's d = .691) and right (p = .003, d = .622) cortical gray matter, left (p = .003, d = .625) and right (p = .020, d = .492) hippocampi, and greater expansion of the right inferior lateral ventricle (p < .001, d = .751) over 5 years. CONCLUSIONS This study illustrates the variability in phenotypic expression of the e4 allele related to neurodegeneration. Specifically, only those individuals who exhibited longitudinal declines in cognitive function experienced concomitant changes in brain volume. Future research is needed to better understand the biological and lifestyle factors that may influence the expression of the e4 allele. (PsycINFO Database Record

© 2017 International Council of Nurses Aim: To explore the primary healthcare needs and health service use of homeless men in inner Sydney. Background: People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and affordable primary healthcare services could improve the health of homeless persons and potentially decrease costs to the healthcare system. Methods: A multimethod design using a cross-sectional survey (n = 40) and administrative data (n = 2 707 daily summaries) collected from a nurse-led primary healthcare clinic for homeless men in Sydney. Findings: Survey respondents were aged 27-76 years. Health problems reflected multimorbidity, with mental health issues present in almost all respondents. The majority had attended the clinic more than 20 times in the past year and said the services, treatments and referrals helped them avoid the emergency department. Administrative data indicated that medication administration was the most frequent service provided. Referrals to other health services doubled over the 7-year period. Discussion: Multiple morbidities, particularly mental health issues, are associated with homelessness. A proactive approach by nurses including preventative services appeared to overcome barriers to health service use. Conclusion: This nurse-led primary healthcare clinic highlights the importance of providing services to homeless men with multiple comorbidities. Respect and trust in addition to easy access to health services appear to be important facilitators of health service use. Implications for Nursing, and Implications for Health Policy: A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.

Inconsistencies abound in the current forensic literature regarding the definition, and as a result, the significance of female genital injury after sexual intercourse. These definitions are based on variables related to the anatomic locations that are examined, the actual physical findings types, and the methods used to detect the findings.To derive and perform initial clinimetric analyses on a simple instrument that defines, and based on severity, quantifies external genital injury after sexual intercourse. The scale utilizes standard injury definitions and a standardized examination method.After empirical investigation, it was determined that the application of the tool would require the use of magnification and toluidine blue in order to have the sensitivity to detect the majority of injuries that occur after sexual intercourse. Separate matrices were constructed based on anatomic locations and injury types from data collected from sexual assault genital injury examination forms. Principal Components Analyses were applied. A clinical model was constructed from the resultant variables, utilizing operational definitions and forming a template for the instrument.A twelve-factor instrument measuring five variables along five "types" of severity and two "classes" of severity ensued. The resultant instrument was tested for internal consistency and differential validity. Very good internal consistency was attained (Cronbach's Coefficient α = 0.8). In a pilot study, the scale was able to distinguish a cohort of sexual assault patients from one of consensual intercourse subjects based on type and class of injury (p0.0001).The findings presented demonstrate that while employing a standardized examination method, the Genital Injury Severity Scale has utility in defining and measuring external genital injury after sexual intercourse.

Introduction The Genital Injury Severity Scale (GISS) is a clinimetrically-tested tool in use for quantifying and qualifying external genital injury after sexual intercourse. Purpose To evaluate inter- and intra-rater agreement of the GISS amongst examiner/raters in an urban, ethnically diverse, emergency department based sexual assault center. Methods The study was conducted in three phases. Six examiners with various years of experience rated their own cases and each others' cases greater than one year after the initial exam. They rated the photographs and documentation of each case at least one year apart. Another six raters utilized a combination of the photos and documentation simultaneously from the same cases. The evaluation method was the completion of the GISS for each phase. Results Based on the experience level of the rater, the differences in overall agreement were not significant. Strength of agreement was highest with the combination of photos and documentation with W ranging from 0.60501 (substantial) to 0.91056 (almost perfect). The GISS variables with the highest level of agreement were tissue break type and toluidine blue uptake type, both with photo evaluation alone and combination of documentation and photos (W = 0.72051 and 0.74599, respectively). Conclusion The Genital Injury Severity Scale is a reliable tool to quantify and qualify the severity of external genital injury when used to evaluate a combination of photos and documentation utilizing midlevel providers trained as sexual assault forensic examiners with various years of experience.

Neuropathological changes associated with Alzheimer's disease (AD) precede symptom onset by more than a decade. Possession of an apolipoprotein E (APOE) ɛ4 allele is the strongest genetic risk factor for late onset AD. Cross-sectional studies of cognitively intact elders have noted smaller hippocampal/medial temporal volumes in ɛ4 carriers (ɛ4+) compared to ɛ4 non-carriers (ɛ4-). Few studies, however, have examined long-term, longitudinal, anatomical brain changes comparing healthy ɛ4+ and ɛ4- individuals. The current five-year study examined global and regional volumes of cortical and subcortical grey and white matter and ventricular size in 42 ɛ4+ and 30 ɛ4- individuals. Cognitively intact participants, ages 65-85 at study entry, underwent repeat anatomical MRI scans on three occasions: baseline, 1.5, and 4.75 years. Results indicated no between-group volumetric differences at baseline. Over the follow-up interval, the ɛ4+ group experienced a greater rate of volume loss in total grey matter, bilateral hippocampi, right hippocampal subfields, bilateral lingual gyri, bilateral parahippocampal gyri, and right lateral orbitofrontal cortex compared to the ɛ4- group. Greater loss in grey matter volumes in ɛ4+ participants were accompanied by greater increases in lateral, third, and fourth ventricular volumes. Rate of change in white matter volumes did not differentiate the groups. The current results indicate that longitudinal measurements of brain atrophy can serve as a sensitive biomarker for identifying neuropathological changes in persons at genetic risk for AD and potentially, for assessing the efficacy of treatments designed to slow or prevent disease progression during the preclinical stage of AD.

To identify the mathematics and science content knowledge and understandings associated with the Third International Mathematics and Science Study (TIMSS) empirically derived benchmarks of performance for the 4th and 8th grades – the 90th, 75th, 50th, and 25th international percentiles of performance – the TIMSS 1995 International Study Center conducted an in-depth analysis of achievement on the TIMSS 4th- and 8th-grade mathematics and science tests. Sets of items that students reaching each international benchmark could answer correctly were identified. Two 10-member panels of subject-matter specialists were convened to scrutinize the sets of items and describe student proficiency at each level. By articulating performance at the TIMSS international benchmarks, “world class” achievement has been defined. Together, the benchmark descriptions and the percentages of students in each country reaching each international benchmark show the strengths and weaknesses of 4th and 8th graders in the TIMSS countries.

Methods of examining the sexual assault patient are not standardized and a definition of what constitutes significant genital injury after sexual assault (SA) remains controversial. This pilot study tests the empirical validity (initial differential validity) of a genital injury severity scale (GISS) under development by the authors with the hypothesis that women who report SA have more severe external genital injuries than those who engage in consensual intercourse (CI). In this observational, prospective study, an initially developed GISS is applied and the exam results of 59 CI volunteers and 185 SA patients are compared. All examinations were performed by experienced sexual assault forensic examiners (SAFE) using toluidine blue (TB) and colposcopy. The Independent Samples Median Test indicates a significant difference in median genital injury type between CI and SA subjects (p < 0.0001). There is a significant difference in the prevalence of Class A (less severe) and Class B injuries (more severe) between the SA and the CI groups (SA: Class A 60%/Class B 40%; CI: Class A 90%/Class B 10% (p= 0.0001)). This initial validation study shows effectiveness in using magnification and TB, combined with a standardized injury severity scale, in describing external genital injury in women after sexual intercourse.

This paper presents a simplified methodology for calculating the risk benefit associated with potential performance improvements for the dry pressurized water reactor (PWR) containment. The analysis is based on the June 1989 draft NUREG-1150 results for the Zion commercial nuclear reactor. Simplified containment event trees and the large accident progression event trees from draft NUREG-1150 are used to evaluate the effects of potential improvements on the response of the Zion containment to dominant severe accident sequences. Source terms are generated parametrically using the ZISOR code and offsite consequences are calculated with the MELCOR Accident Consequence Code System (MACCS). These results give point estimates of the risk reduction associated with each containment improvement identified by Brookhaven National Laboratory in their draft Issues Characterization Report.

This paper summarizes the results of previous analyses of containment venting at US light water reactors. The focus of the paper is on the risk aspects of containment venting as a severe accident mitigation strategy; therefore, past risk analyses of venting are critically reviewed and conclusions are drawn where possible concerning the risk and efficacy of this strategy. Because the accident mitigation issues vary from one reactor and containment type to another, the paper examines five containment types separately.

Background. Acute chest syndrome (ACS) is the leading cause of hospitalization, morbidity, and mortality in patients with sickle cell disease. Radiographic and clinical findings in ACS resemble pneumonia; however, etiologies other than infectious pathogens have been implicated, including pulmonary fat embolism (PFE) and infarction of segments of the pulmonary vasculature. The National Acute Chest Syndrome Study Group was designed to identify the etiologic agents and clinical outcomes associated with this syndrome. Methods. Data were analyzed from the prospective study of 671 episodes of ACS in 538 patients with sickle cell anemia. ACS was defined as a new pulmonary infiltrate involving at least 1 complete segment of the lung, excluding atelectasis. In addition, the patients had to have chest pain, fever >38.5C, tachypnea, wheezing, or cough. Samples of blood and deep sputum were analyzed for evidence of bacteria, viruses, and PFE. Mycoplasma pneumoniae infection was determined by analysis of paired serologies. Detailed information on patient characteristics, presenting signs and symptoms, treatment, and clinical outcome were collected. Results. Fifty-one (9%) of 598 episodes of ACS had serologic evidence of M pneumoniae infection. Twelve percent of the 112 episodes of ACS occurring in patients younger than 5 years were associated with M pneumoniae infection. At the time of diagnosis, 98% of all patients with M pneumoniae infection had fever, 78% had a cough, and 51% were tachypneic. More than 50% developed multilobar infiltrates and effusions, 82% were transfused, and 6% required assisted ventilation. The average hospital stay was 10 days. Evidence of PFE with M pneumoniae infection was seen in 5 (20%) of 25 patients with adequate deep respiratory samples for the PFE assay. M pneumoniae and Chlamydia pneumoniae was found in 16% of patients with diagnostic studies for C pneumoniae. Mycoplasma hominis was cultured in 10 (2%) of 555 episodes of ACS and occurred more frequently in older patients, but the presenting symptoms and clinical course was similar to those with M pneumoniae. Conclusions. M pneumoniae is commonly associated with the ACS in patients with sickle cell anemia and occurs in very young children. M hominis should be considered in the differential diagnosis of ACS. Aggressive treatment with broad-spectrum antibiotics, including 1 from the macrolide class, is recommended for all patients as well as bronchodilator therapy, early transfusion, and respiratory support when clinically indicated.

PURPOSE Few studies address the association of Chlamydia pneumoniae infection with pulmonary disease and outcome in patients with underlying pathology such as sickle cell disease (SCD). SCD patients are susceptible to the pulmonary disorder known as acute chest syndrome (ACS), where the etiology remains ill defined. The purpose of this study was to analyze the clinical course and outcome of C. pneumoniae-associated ACS among SCD patients as part of the National Acute Chest Syndrome Study.This was a longitudinal study of SCD patients presenting with ACS to multiple U.S. medical centers. Two hundred ninety-six SCD patients who developed ACS were tested by PCR for C. pneumoniae and by standard techniques for other respiratory pathogens. These infections were evaluated for association with ACS, clinical course, and complications.Forty-one (14%) patients with first episodes of ACS were PCR positive for C. pneumoniae. Compared with other infections, C. pneumoniae-infected patients were older, were more likely to present with chest pain, and had higher hemoglobin levels at diagnosis. Both groups had similar rates of respiratory failure and prolonged hospitalization. Of the 89 patients with single-pathogen infections, 27 (30%) were due to C. pneumoniae, 21% to Mycoplasma pneumoniae, 10% to RSV, 4% to Staphylococcus aureus, and 3% to Streptococcus pneumoniae.C. pneumoniae was the most prevalent pathogen in this study of ACS and was responsible for significant morbidity. Additional research is required to develop effective treatment guidelines for ACS.