The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing

Introduction The suitability of video conferencing (VC) technology for clinical purposes relevant to geriatric medicine is still being established. This project aimed to determine the validity of the diagnosis of dementia via VC. Methods This was a multisite, noninferiority, prospective cohort study. Patients, aged 50 years and older, referred by their primary care physician for cognitive assessment, were assessed at 4 memory disorder clinics. All patients were assessed independently by 2 specialist physicians. They were allocated one face-to-face (FTF) assessment (Reference standard – usual clinical practice) and an additional assessment (either usual FTF assessment or a VC assessment) on the same day. Each specialist physician had access to the patient chart and the results of a battery of standardized cognitive assessments administered FTF by the clinic nurse. Percentage agreement (P0) and the weighted kappa statistic with linear weight (Kw) were used to assess inter-rater reliability across the 2 study groups on the diagnosis of dementia (cognition normal, impaired, or demented). Results The 205 patients were allocated to group: Videoconference (n = 100) or Standard practice (n = 105); 106 were men. The average age was 76 (SD 9, 51–95) and the average Standardized Mini-Mental State Examination Score was 23.9 (SD 4.7, 9–30). Agreement for the Videoconference group (P0= 0.71; Kw = 0.52; P < .0001) and agreement for the Standard Practice group (P0= 0.70; Kw = 0.50; P < .0001) were both statistically significant (P < .05). The summary kappa statistic of 0.51 (P = .84) indicated that VC was not inferior to FTF assessment. Conclusions Previous studies have shown that preliminary standardized assessment tools can be reliably administered and scored via VC. This study focused on the geriatric assessment component of the interview (interpretation of standardized assessments, taking a history and formulating a diagnosis by medical specialist) and identified high levels of agreement for diagnosing dementia. A model of service incorporating either local or remote administered standardized assessments, and remote specialist assessment, is a reliable process for enabling the diagnosis of dementia for isolated older adults.

Evolution of the extinct Sabretooths and the American cheetah-like cat

The sabretooths (Smilodon and Homotherium) and the American cheetah-like cat (Miracinonyx) were the top predators in Late Pleistocene America, but became extinct about 13 thousand years ago. As the evolutionary history of these taxa remains poorly understood , we analysed their phylogenetic relationship to extant felids. In contrast to previous molecular studies , our results show that the sabretooths diverge early and are not closely related to any living cats. This supports their morphological placement in a separate subfamily (Machairodontinae). Despite its remarkable morphological similarity to the African cheetah (Acinonyx jubatus), Miracinonyx appears to have evolved from a puma-like ancestor, presumably in response to similar ecological pressures.

A preliminary study into the environmental and economic consequences of a sugar factory depithing operation

Bagasse stockpile operations have the potential to lead to adverse environmental and social impacts. Dust releases can cause occupational health and safety concerns for factory workers and dust emissions impact on the surrounding community. Preliminary modelling showed that bagasse depithing would likely reduce the environmental risks, particularly dust emissions, associated with large scale bagasse stockpiling operations. Dust emission properties were measured and used for dispersion modelling with favourable outcomes. Modelling showed a 70% reduction in peak ground level concentrations of PM10 dust (particles with an aerodynamic diameter less than 10 µm) from operations on depithed bagasse stockpiles compared to similar operations on stockpiles of whole bagasse. However, the costs of a depithing operation at a sugar factory were estimated to be approximately $2.1 million in capital expenditure to process 100,000 t/y of bagasse and operating costs were approximately $200,000 p.a. The total capital cost for a 10,000 t/y operation was approximately $1.6 million. The cost of depithing based on a discounted cash flow analysis was $5.50 per tonne of bagasse for the 100,000 t/y scenario. This may make depithing prohibitively expensive in many situations if installed exclusively as a dust control measure.

Mixing and drying mud and ash at Tully Mill

Disposal of mud and ash, particularly in wet weather conditions, is a significant expense for mills. This paper reports on part of a process to pelletise mud and ash, aimed at making mud and ash more attractive to growers across entire mill districts. The full process and the re-constituting and centrifuging rotary vacuum filter mud part of the process were described in two papers to the 2011 conference. The component described in this paper involves aspects of mixing mud and ash with subsequent drying using boiler exit gas. The mud material needs to mix easily with boiler ash and the mixture has to feed easily into and be pneumatically conveyed by a flue gas dryer. The performance of a pilot flue gas dryer for drying mud and ash was evaluated. The mud and ash mixture was found to dry much faster than final bagasse, provided the mud and ash material was broken up into individual particles. A previously developed computer model of bagasse drying was updated to take into account the smaller particle size of the mud and ash mixture. This upgraded model predicted the performance of the pilot flue gas dryer well.

The Quattrocento as a Waltz

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Rain, Ravello

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Enduring Ritual

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Medusa

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The Idea of Mountain

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Letter To Robert Lowell

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Against Ingres

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The Art of disappearing

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