Donepezil and memantine for moderate-to-severe Alzheimer's disease

Background: Clinical trials have shown the benefits of cholinesterase inhibitors for the treatment of mild-to-moderate Alzheimer's disease. It is not known whether treatment benefits continue after the progression to moderate-to-severe disease. Methods: We assigned 295 community-dwelling patients who had been treated with donepezil for at least 3 months and who had moderate or severe Alzheimer's disease (a score of 5 to 13 on the Standardized Mini-Mental State Examination [SMMSE, on which scores range from 0 to 30, with higher scores indicating better cognitive function]) to continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine. Patients received the study treatment for 52 weeks. The coprimary outcomes were scores on the SMMSE and on the Bristol Activities of Daily Living Scale (BADLS, on which scores range from 0 to 60, with higher scores indicating greater impairment). The minimum clinically important differences were 1.4 points on the SMMSE and 3.5 points on the BADLS.
Results: Patients assigned to continue donepezil, as compared with those assigned to discontinue donepezil, had a score on the SMMSE that was higher by an average of 1.9 points (95% confidence interval [CI], 1.3 to 2.5) and a score on the BADLS that was lower (indicating less impairment) by 3.0 points (95% CI, 1.8 to 4.3) (P<0.001 for both comparisons). Patients assigned to receive memantine, as compared with those assigned to receive memantine placebo, had a score on the SMMSE that was an average of 1.2 points higher (95% CI, 0.6 to 1.8; P<0.001) and a score on the BADLS that was 1.5 points lower (95% CI, 0.3 to 2.8; P = 0.02). The efficacy of donepezil and of memantine did not differ significantly in the presence or absence of the other. There were no significant benefits of the combination of donepezil and memantine over donepezil alone.
Conclusions: In patients with moderate or severe Alzheimer's disease, continued treatment with donepezil was associated with cognitive benefits that exceeded the minimum clinically important difference and with significant functional benefits over the course of 12 months. (Funded by the U.K. Medical Research Council and the U.K. Alzheimer's Society; Current Controlled Trials number, ISRCTN49545035).

Adaptive linear combination of heuristic orderings in constructing examination timetables

In this paper, we investigate adaptive linear combinations of graph coloring heuristics with a heuristic modifier to address the examination timetabling problem. We invoke a normalisation strategy for each parameter in order to generalise the specific problem data. Two graph coloring heuristics were used in this study (largest degree and saturation degree). A score for the difficulty of assigning each examination was obtained from an adaptive linear combination of these two heuristics and examinations in the list were ordered based on this value. The examinations with the score value representing the higher difficulty were chosen for scheduling based on two strategies. We tested for single and multiple heuristics with and without a heuristic modifier with different combinations of weight values for each parameter on the Toronto and ITC2007 benchmark data sets. We observed that the combination of multiple heuristics with a heuristic modifier offers an effective way to obtain good solution quality. Experimental results demonstrate that our approach delivers promising results. We conclude that this adaptive linear combination of heuristics is a highly effective method and simple to implement.

A study of the kinetic solvent isotope effect on the destruction of microcystin-LR and geosmin using TiO2 photocatalysis

We have previously reported the effectiveness of TiO₂ photocatalysis in the destruction of species generated by cyanobacteria, specifically geosmin and microcystin-LR. In this paper we report an investigation of factors which influence the rate of the toxin destruction at the catalyst surface. A primary kinetic solvent isotope effect of approximately 1.5 was observed when the destruction was performed in a heavy water solvent. This is in contrast to previous reports of a solvent isotope effect of approximately 3, however, these studies were undertaken with a different photocatalyst material. The solvent isotope effect therefore appears to be dependent on the photocatalyst material used. The results of the study support the theory that the photocatalytic decomposition occurs on the catalyst surface rather than in the bulk of the solution. Furthermore it appears that the rate determining step is not oxygen reduction as previously reported. 

Photocatalytic destruction of geosmin using novel pelleted titanium dioxide

Geosmin is produced by cyanobacteria and actinomycetes in surface waters. It causes undesirable earthy off-flavours in freshwater fish and is a major concern for the drinking water industry. This paper presents the first published study on the use of the novel pelleted Ti0₂ photocatalyst, Hombikat K01/C, for the removal of geosmin from water. Ti0₂ in pelleted form eliminates the requirement for the separation of the catalyst from the water following treatment which is normally the case with the widely used powdered catalysts. A laboratory reactor was designed to limit system loss since the compound adsorbs to a wide range of surfaces. Initial concentration, aeration rate and irradiation were evaluated. It was found that degradation of geosmin followed the Langmuir-Hinshelwood model. Elevated aeration had no effect on the photocatalytic removal of geosmin, but increasing irradiation was found to increase degradation rates. The catalyst proved effective within 10 min under optimum conditions. 

A constructive approach for examination timetabling based on adaptive decomposition and ordering

In this study, we investigate an adaptive decomposition and ordering strategy that automatically divides examinations into difficult and easy sets for constructing an examination timetable. The examinations in the difficult set are considered to be hard to place and hence are listed before the ones in the easy set in the construction process. Moreover, the examinations within each set are ordered using different strategies based on graph colouring heuristics. Initially, the examinations are placed into the easy set. During the construction process, examinations that cannot be scheduled are identified as the ones causing infeasibility and are moved forward in the difficult set to ensure earlier assignment in subsequent attempts. On the other hand, the examinations that can be scheduled remain in the easy set.

Within the easy set, a new subset called the boundary set is introduced to accommodate shuffling strategies to change the given ordering of examinations. The proposed approach, which incorporates different ordering and shuffling strategies, is explored on the Carter benchmark problems. The empirical results show that the performance of our algorithm is broadly comparable to existing constructive approaches.

Serum- and HDL3-serum amyloid A and HDL3-LCAT activity are influenced by increased CVD-burden

BACKGROUND: High density lipoproteins (HDL) protect against cardiovascular disease (CVD). However, increased serum amyloid-A (SAA) related inflammation may negate this property. This study investigated if SAA was related to CVD-burden.

METHODS: Subjects referred to the rapid chest pain clinic (n = 240) had atherosclerotic burden assessed by cardiac computerised tomography angiography. Subjects were classified as: no-CVD (n = 106), non-obstructive-CVD, stenosis<50% (n = 58) or moderate/significant-CVD, stenosis ≥50% (n = 76). HDL was subfractionated into HDL2 and HDL3 by rapid-ultracentrifugation. SAA-concentration was measured by ELISA and lecithin cholesterol acyltransferase (LCAT) activity measured by a fluorimetric assay.

RESULTS: We illustrated that serum-SAA and HDL3-SAA-concentration were higher and HDL3-LCAT-activity lower in the moderate/significant-CVD-group, compared to the no-CVD and non-obstructive-CVD-groups (percent differences: serum-SAA, +33% & +30%: HDL3-SAA, +65% and +39%: HDL3-LCAT, -6% & -3%; p < 0.05 for all comparisons). We also identified a positive correlation between serum-SAA and HDL3-SAA (r = 0.698; p < 0.001) and a negative correlation between HDL3-SAA and HDL3-LCAT-activity (r = -0.295; p = 0.003), while CVD-burden positively correlated with serum-SAA (r = 0.150; p < 0.05) and HDL3-SAA (r = 0.252; p < 0.001) and negatively correlated with HDL3-LCAT-activity (r = -0.182; p = 0.006). Additionally, multivariate regression analysis adjusted for age, gender, CRP and serum-SAA illustrated that HDL3-SAA was significantly associated with modifying CVD-risk of moderate/significant CVD-risk (p < 0.05).

CONCLUSION: This study has demonstrated increased SAA-related inflammation in subjects with moderate/significant CVD-burden, which appeared to impact on the antiatherogenic potential of HDL. We suggest that SAA may be a useful biomarker to illustrate increased CVD-burden, although this requires further investigation.

Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial)

Background: Traffic light labelling of foods—a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods—has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions.

Methods/design: The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial.

Discussion: The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial.

Memorial with the resolutions adopted at the anti-tariff meeting held at Abbeville Court-House, South Carolina, on Monday, the 3d of September, 1827

This document contains the resolutions adopted at the anti-tariff meeting held at the Abbeville courthouse following taxes imposed by the federal government, which members of the state believed to be unconstitutional.

A realidade em exercício: um percurso entre filosofia e fotografia

Tese apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em Filosofia, especialidade de Estética

Silêncio, potência e gesto : um corpo na dança

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Le prince Carol [de Roumanie] en Egypte, le prince passe en revue la garde du sultan au Caire [avec lord Allenby, en mars 1920] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58833