Bladder function in patients with dystonia undergoing deep brain stimulation

INTRODUCTION Neurogenic bladder dysfunction is well described in Parkinson's disease and has a major impact on quality of live. In contrast, little is known about the extent of urinary symptoms in other movement disorders such as dystonia and about the role of the basal ganglia in bladder control.. PATIENTS AND METHODS A consecutive series of 11 patients with severe dystonia undergoing deep brain stimulation (DBS) of the globus pallidus internus was prospectively enrolled. Bladder function was assessed by the International Prostate Symptom Score and urodynamic investigation (UDI) before DBS surgery and afterwards in the conditions with and without DBS. RESULTS In UDI before DBS surgery, detrusor overactivity was found in 36% (4/11) of dystonia patients. With pallidal DBS ON, maximum flow rate significantly decreased, post-void residual significantly increased and detrusor overactivity disappeared.. CONCLUSIONS Pathological urodynamic changes can be found in a relevant percentage of dystonia patients. Pallidal DBS has a relaxing effect on detrusor function indicating a role of the basal ganglia in lower urinary tract control. Thus, a better understanding on how subcortical networks influence lower urinary tract function might open new therapeutic perspectives..

Is intracranial aneurysm rupture related to solar activity?

Objective: A number of intrinsic and extrinsic risk factors for the rupture of intracranial aneurysms have been identified. Still, the cause precipitating aneurysm rupture remains unknown in many cases. In addition, it has been observed that aneurysm ruptures are clustered in time but the trigger mechanism remains obscure. As solar activity has been associated with cardiovascular mortality and morbidity we decided to study ist association to aneurysm rupture in the Swiss population. Method: Patient data was extracted from the Swiss SOS database, at time of analysis covering 918 patients with angiography-proven aSAH treated at seven Swiss neurovascular centers between 01/01/2009 – 12/31/2011. The number of aneurysm rupture per day, week, month (Daily/Weekly/Monthly Rupture Frequency = RF) was measured and correlated to the absolute amount and the change in various parameters of interest representing continuous measurements of solar activity (radioflux (F10.7 index), solar proton flux, solar flare occurrence, planetary K-index/planetary A-index) using Poisson regression analysis. Results: Of a consecutive series of 918 cases of SAH, precise determination of the date of symptom onset was possible in 816 (88.9%). During the period of interest there were 517 days without recorded aneurysm rupture. There were 398, 139, 27 and 12 days with 1, 2, 3, and 4 ruptures per day. Five or 6 ruptures were only noted on a single day each. Poisson regression analysis demonstrated a significant correlation of F10.7 index and aneurysm rupture (incidence rate ratio (IRR) = 1.006303; standard error (SE) 0.0013201; 95% confidence interval (CI) 1.003719 – 1.008894; p<0.001), according to which every 1-unit increase of the F10.7 index increased the count for an aneurysm to rupture by 0.63%. As the F10.7 index is known to correlate well with the Space Environment Services Center (SESC) sunspot number, we performed additional analyses on SESC sunspot number and sunspot area. Here, a likewise statistically significant relationship of both the SESC sunspot number (IRR 1.003413; SE 0.0007913; 95%CI 1.001864 – 1.004965; p<0.001) and the sunspot area (IRR 1.000419; SE 0.0000866; 95%CI 1.000249 – 1.000589; p<0.001) emerged. All other variables analyzed showed no correlation with RF. Conclusions: Using valid methods, we found higher radioflux, sunspot number and sunspot area to be associated with an increased count of aneurysm rupture. Since we were using rupture frequencies rather than incidences and because we cannot explain the physiological basis of this statistical association, the clinical meaningfulness of this statistical association must be interpreted carefully. Future studies are warranted to rule out a type-1 error.

There is a place for radical cystectomy and urinary diversion, including orthotopic bladder substitution, in patients aged 75 and older: Results of a retrospective observational analysis from a high-volume center

INTRODUCTION The incidence of cancer increases with age and owing to the changing demographics we are increasingly confronted with treating bladder cancer in old patients. We report our results in patients>75 years of age who underwent open radical cystectomy (RC) and urinary diversion. MATERIAL AND METHODS From January 2000 to March 2013, a consecutive series of 224 old patients with complete follow-up who underwent RC and urinary diversion (ileal orthotopic bladder substitute [OBS], ileal conduit [IC], and ureterocutaneostomy [UCST]) were included in this retrospective single-center study. End points were the 90-day complication rates (Clavien-Dindo classification), 90-day mortality rates, overall and cancer-specific survival rates, and continence rates (OBS). RESULTS Median age was 79.2 years (range: 75.1-91.6); 35 of the 224 patients (17%) received an OBS, 178 of the 224 patients (78%) an IC, and 11 of the 224 patients (5%) an UCST. The 90-day complication rate was 54.3% in the OBS (major: Clavien grade 3-5: 22.9%, minor: Clavien Grade 1-2: 31.4%), 56.7% in the IC (major: 27%, minor: 29.8%), and 63.6% in the UCST group (major: 36.4%, minor: 27.3%); P = 0.001. The 90-day mortality was 0% in the OBS group, 13% in the IC group, and 10% in the UCST group (P = 0.077). The Glasgow prognostic score was an independent predictor of all survival parameters assessed, including 90-day mortality. Median follow-up was 22 months. Overall and cancer-specific survivals were 90 and 98, 47 and 91, and 11 and 12 months for OBS, IC, and UCST, respectively. In OBS patients, daytime continence was considered as dry in 66% and humid in 20% of patients. Nighttime continence was dry in 46% and humid 26% of patients. CONCLUSION With careful patient selection, oncological and functional outcome after RC can be good in old patients. Old age as the sole criterion should not preclude the indication for RC or the option of OBS. In old patients undergoing OBS, satisfactory continence results can be achieved.

Anterior fixation of unstable pelvic ring fractures using the modified Stoppa approach: mid-term results are independent on patients' age

PURPOSE Open surgical management of unstable pelvic ring injuries has been discussed controversially compared to percutaneous techniques in terms of surgical site morbidity especially in older patients. Thus, we assessed the impact of age on the outcome following fixation of unstable pelvic ring injuries through the modified Stoppa approach. METHODS Out of a consecutive series of 92 patients eligible for the study, 63 patients (mean age 50 years, range 19-78) were evaluated [accuracy of reduction, complications, failures, Majeed-Score, Oswestry Disability Questionnaire (ODI), Mainz Pain Staging System (MPSS)] at a mean follow-up of 3.3 years (range 1.0-7.9). Logistic multivariate regression analysis was performed to assess the outcome in relation to increasing patient age and/or Injury Severity Score (ISS). RESULTS Out of 63 patients, in 36 an "anatomic" reduction was achieved. Ten postoperative complications occurred in eight patients. In five patients, failure of fixation was noted at the anterior and/or posterior pelvic ring. In 49 patients, an "excellent" or "good" Majeed-Score was obtained; the mean ODI was 14 % (range 0-76 %); 50 patients reported either no or only minor chronic pelvic pain (MPSS). Only an increasing ISS conferred an increased likelihood of the occurrence of a non-anatomical reduction, a "poor" or "fair" Majeed-Score, or an ODI >20 %. CONCLUSIONS Increasing age did not impact the analysed parameters. Open reduction and internal fixation of the anterior pelvic ring through a modified Stoppa approach in unstable pelvic ring injuries did not result in an unfavourable outcome with increasing age of patients.

La rehabilitación de construcciones militares para uso hotelero: la red de Paradores de Turismo, (1928-2012)

Fundamento de la tesis: Al comienzo del siglo XX, el interés por el turismo unido a la necesidad de restaurar un abundante patrimonio histórico, posibilitó en España que los poderes públicos se embarcaran en una singular experiencia: la creación de una infraestructura hotelera a partir de la rehabilitación de edificios históricos. La preservación, mantenimiento e incluso rentabilidad de una gran parte del patrimonio español se haría efectiva a través de la innovadora fórmula patrimonio‐turismo, cuya máxima expresión se materializó en la Red de Paradores desde su fundación en la segunda década del siglo pasado hasta nuestros días. Sorprendentemente, este tema no ha sido todavía investigado en su vertiente arquitectónica pese a que España ha sido pionera y modelo en la cuestión de la hotelería pública. Este trabajo aborda el estudio del caso más significativo de todos los edificios de la red, en tanto que el patrimonio que ha servido de base a los fines hoteleros del Estado ha contado con un total de seis tipos arquitectónicos a lo largo de su historia, dentro de los cuales la arquitectura militar despunta con su mayoritaria presencia dentro del contexto de los edificios históricos de la red. El carácter arquetípico de los castillos y fortalezas, arraigado en el inconsciente colectivo, les hizo especialmente atractivos como alojamiento turístico al permitir evocar la remota época medieval, pese a ser el tipo arquitectónico más comprometido para la rehabilitación hotelera. El estudio de las intervenciones operadas en estos inmuebles se revela de forma clara como escaparate de los distintos criterios de intervención patrimonial que se han sucedido en el siglo XX, hasta enlazar con la perspectiva interdisciplinar actual. La tesis abarca en, primer lugar, diferentes aspectos generales relativos al promotor hotelero, la hotelería pública de ámbito nacional e internacional, y la caracterización de los inmuebles de la red estatal española, desde el punto de vista hotelero y arquitectónico, entendida esta última en sus tres escalas de influencia: la arquitectónica, la urbana o paisajística, y la del interiorismo. Se analiza en segundo término la arquitectura militar dentro del contexto de la Red de Paradores, desde la consideración de su transformación hotelera, para lo cual ha sido necesario realizar una clasificación propia, que abarca tanto edificios que respondieron a una estructura de cuartel, como castillos‐palacio, o fortalezas que habían servido a los fines de una orden religiosa militar, además de considerarse las intervenciones en recintos históricos de carácter militar, donde se hacía obligatorio construir de nueva planta. En tercer y último lugar, se analiza a lo largo de las distintas etapas del organismo turístico las rehabilitaciones realizadas en estas construcciones militares, a la vez que se tienen en cuenta las intervenciones en los restantes edificios históricos, para evitar la descontextualización. Este recorrido comienza con la promoción de los dos primeros paradores a cargo del Comisario Regio, el marqués de la Vega‐Inclán, que sirvieron para sentar las bases de los conceptos e ideas que habrían de desarrollarse en las siguientes décadas. Posteriormente, se desarrolló y tomó forma la red con el Patronato Nacional del Turismo, en la que las primeras intervenciones en tipos militares se tradujeron en reformas interiores de locales. La etapa clave de la red, y en particular de la arquitectura militar, tuvo lugar con el Ministerio de Información y Turismo, marcada por la “repristinación” de monumentos, tras un período preparatorio con la Dirección General del Turismo en el que lo militar había quedado de telón de fondo de otros tipos arquitectónicos. Tras el auge del Ministerio llegó el período de decadencia en el que los castillos y fortalezas desaparecieron de los intereses de las Secretarias de Turismo, hasta llegar a las inauguraciones de los novedosos establecimientos del siglo XXI y el resurgimiento del tipo militar con el parador de Lorca. Metodología empleada: Este trabajo de investigación se ha servido fundamentalmente de documentación inédita, procedente de diversos archivos, además de una muy extensa toma de datos in situ. Dentro del patrimonio analizado, los inmuebles que responden al tipo arquitectónico militar se han dividido en tres grandes grupos: inmuebles rehabilitados que entraron en funcionamiento en la red, inmuebles en proceso de transformación hotelera, e inmuebles que fueron adquiridos con fines hoteleros pero que no llegaron a rehabilitarse. Para cada uno de ellos ha sido necesario determinar en qué estado llegaron a manos de la Administración Turística, cuál fue el mecanismo a través del cual se adquirieron, en qué consistió su primera rehabilitación hotelera, y cuáles fueron las ampliaciones o reformas más significativas que se realizaron posteriormente. Estos datos se han sintetizado en fichas y se han extraído conclusiones al comparar cada unidad con el conjunto. Simultáneamente se introdujeron dos factores externos: la historia del turismo que permitió hacer una ordenación cronológica de los inmuebles según etapas, y la historia de la teoría y práctica de la intervención patrimonial en España que permitió comparar los criterios patrimoniales de la Administración competente respecto de las intervenciones de la Administración Turística, cuyo contacto se haría obligatorio a partir del Decreto, de 22 de abril de 1949, que dejaba bajo la tutela del Estado a todos los castillos y fortalezas. Aportación de la tesis: Con carácter general, la tesis centra una ordenación y sistematización completa del patrimonio inmobiliario de la red, desde el punto de vista de los tipos hoteleros y arquitectónicos, además de poner por primera vez en conexión distintos modelos de hotelería pública, para constituirse en el sustrato de futuras investigaciones. El estudio realizado se ha hecho extensivo a las distintas escalas que inciden de forma interconectada en la implantación de un parador: la arquitectónica, la urbana y la del interiorismo, hasta ahora referenciado desde la exclusiva visión arquitectónica. Se han definido las etapas de la historia de la red, no ya sólo a partir del hilo conductor de la cadena sucesiva de organismos turísticos, sino que por primera vez se hace en razón de la evolución que sufren las intervenciones patrimoniales a lo largo del tiempo, a la vez que se entra en conexión con la teoría y praxis de la restauración monumental. Con carácter particular, la arquitectura militar dentro del contexto de los paradores se destaca en el período del Ministerio, en el que se experimentaron todas las posibilidades que presentaba su rehabilitación. En este sentido se ha puesto de manifiesto en este trabajo un tipo híbrido de parador, a caballo entre la rehabilitación y la edificación de nueva planta, las dos formas básicas de establecimiento creadas en la Comisaría Regia, al que se ha denominado edificación de nueva planta en recinto histórico militar. Esta nueva caracterización se ha valorado como la forma más eficiente de implantar paradores, cuyas pautas arquitectónicas abarcaron un abanico de posibilidades: imitación de modelos arquitectónicos históricos con utilización de elementos patrimoniales prestados que dieran el valor de la historia, utilización de un lenguaje moderno, o la inspiración en la arquitectura vernácula. La amalgama de elementos, estilos e intervenciones sucesivas de ampliación fue la característica común tanto para la implantación de un parador en un edificio como en un recinto amurallado. La arquitectura militar transformada en establecimiento hotelero evidencia la vocación escenográfica de las intervenciones patrimoniales, secundada por el interiorismo, además de su aportación a la arquitectura hotelera en lo referente al confort, organización y funcionamiento de sus instalaciones. La tesis ahonda en los diversos aspectos de la rehabilitación hotelera apuntados de forma parcial por algunos autores, y pone de manifiesto la “ambientación medieval” operada en la arquitectura militar, que llegó a tener su máxima expresión con el criterio de la “unidad de estilo” del Ministerio de Información y Turismo. La rehabilitación hotelera dentro del contexto de la Red de Paradores, queda caracterizada en la tesis en relación a intervenciones en construcciones militares, cuya sistematización puede ser extrapolable a otros tipos arquitectónicos o cadenas hoteleras de titularidad pública, a partir del estudio que se ha avanzado en este trabajo. Thesis basis: At the beginning of the 20th century the interest in tourism added to the plentiful heritage in Spain enabled the authorities to embark on a singular experience: the creation of a hotel infrastructure from the restoration of historic buildings. Preservation, maintenance, and even profitability of a large part of the Spanish heritage would be effective through the innovative formula heritage-tourism. Its greatest expression materialized in the Paradores Network since its foundation in last century’s second decade to the present day. Surprisingly, this subject has not yet been investigated in its architectural aspect, even though Spain has been a pioneer and a model in the matter of public hotel business. This project tackles the study of the most significative case of all the network’s buildings, since the heritage which has served throughout history as a base for the State hotel purposes has altogether six architectural types, among which military architecture stands out with its majority presence in the context of the historical buildings of the network. The archetypal character of castles and fortresses, ingrained in the collective subconscious, made them specially attractive for tourist accommodation, as it allowed the evocation of far medieval times, despite being the most awkward architectural type for hotel restoration. The study of the interventions in these buildings clearly reveals itself as a showcase of the different criteria of heritage intervention along the 20th century, connecting to the present interdisciplinary perspective. Firstly, the thesis covers different general aspects regarding the hotel developer, the domestic and international public hotel business, and the description of the Spanish state network buildings from a hotel business and an architectural point of view, the latter from its three influence scales: architectural, urban or landscape, and interior design. Secondly, the transformation of the military architecture in the Paradores Network into hotels is analyzed. For that purpose it was necessary to create a specific classification, which included barrack-structured buildings, castle-palaces, or fortresses which served the purposes of military-religious orders. The interventions in those military historical places where new building became compulsory were also taken into consideration. Thirdly and lastly, the thesis analyses the restorations in these military constructions through the different stages of the tourist organization. In order to avoid decontextualization, interventions in other historical buildings were also considered. This route begins with the promotion of the two first Paradores by the Royal Commissioner, the marquis of Vega-Inclán, which paved the way for the concepts and ideas that were developed in the following decades. Subsequently, the network was developed and took shape with the National Tourism Board. The first interventions on military types were inside refurbishments. The Network’s key period, and in particular of its military architecture, took place with the Ministry of Information and Tourism, a time marked by the “restoration to its original state” of monuments. This stage arrived after a preparatory period with the State Tourist Office, when the military type was left as a backdrop for other architectural types. After the Ministry’s boom arrived a decline, in which castles and fortresses disappeared from the Tourist Department’s interests up to the opening of the 21st century new establishments and the resurgence of the military type with Lorca’s Parador. Methodology: The present research project has mainly used unpublished documentation from several archives and has done an extensive in situ data-gathering. Within the heritage analyzed, military buildings have been divided into three main groups: restored buildings that began to operate in the network, those in process of hotel transformation, and those acquired for hotel purposes, but which did not become restored. In each case, it has been necessary to determine the condition in which they arrived to the Tourist Administration, the procedure by which they were acquired, what their first hotel restoration consisted of, and which their subsequent most significative enlargements and alterations were. These facts have been synthesized in cards, and conclusions were drawn by comparing each unit with the whole. Simultaneously, two external factors were introduced: the history of tourism, that allowed establishing a chronological order according to different periods, and the history of Spanish heritage intervention’s theory and practice, that permitted to compare the heritage criteria from the competent Administration with those of the Tourist Administration’s interventions. Both Administrations came compulsorily into contact after the Decree of 22nd April 1949, by which all castles and fortresses became under the protection of the State. Thesis contribution: In general, the thesis focuses on a complete order and systematization of the network’s heritage buildings from the hotel and architectural types points of view, besides connecting for the first time different public hotel business models, becoming the substratum for future investigations. The study has included the different scales that impact interconnected on the establishment of a Parador: architectural, urban and interior design, only referenced to date from an architectural point of view. The Network’s history stages have been defined according to not only a consecutive series of tourist organizations, but also, and for the first time, to the evolution of heritage interventions over time, thus connecting with the theory and praxis of monumental restoration. In particular, within the Paradores, military architecture stands out in the Ministry’s period, in which all kind of restoration possibilities were explored. In this sense, the present project puts forth a hybrid type of Parador between restoration and new building, the two basic ways of establishment created in the Royal Commission, termed new building in military historic enclosure. This new characterization has been evaluated as the most efficient for establishing Paradores, whose architectonic guidelines include a wide range of possibilities: the imitation of historical architectonic models with use of borrowed heritage components that provide historical value, the use of modern language, or the inspiration in vernacular architecture. The amalgam of elements, styles and consecutive enlargement interventions was the common feature of the establishment of a Parador, both in a building or in a walled enclosure. The military architecture transformed into a hotel establishment gives proof of the scenographic vocation of heritage interventions, supported by interior design, as well as of its contribution to hotel architecture, related to its comfort, organization and the functioning of its facilities. The thesis delves into the diverse aspects of hotel restoration, partially pointed out by several authors, and puts forth the creation of a “medieval atmosphere” in military architecture, which came to its highest expression with the “unitary style” criteria of the Ministry of Information and Tourism. Hotel restoration within the context of the Paradores’ Network is defined in this thesis in relation to interventions in military constructions, whose systemization can be extrapolative to other architectural types or public hotel chains, based on the study which has been put forward in this project.

Alternative genetic pathways in colorectal carcinogenesis

The comparative typing of matched tumor and blood DNAs at dinucleotide repeat (microsatellite) loci has revealed in tumor DNA the presence of alleles that are not observed in normal DNA. The occurrence of these additional alleles is possibly due to replication errors (RERs). Although this observation has led to the recognition of a subtype of colorectal cancer with a high incidence of RERs (caused by a deficiency in DNA mismatch repair), a thorough analysis of the RER frequency in a consecutive series of colorectal cancers had not been reported. It is shown here that the extensive typing of 88 colorectal tumors reveals a bimodal distribution for the frequency of RER at microsatellite loci. Within the major mode (75 tumors, RER− subtype), the probability that a locus exhibited instability did not differ significantly among loci and tumors, being 0.02. The subsequent development of a statistical test for an operational discrimination between the RER− and RER+ subtypes indicated that the probability of misclassification did not exceed 0.001 in this series. The frequency of K-ras mutation was found to be equivalent in the two subtypes. However, in the RER+ tumors, the p53 gene mutation was less frequently detected, the adenomatous polyposis coli (APC) mutation was rare, and the biallelic inactivation of either of these genes was not observed. Furthermore, the concomitant occurrence of APC and tumor growth factor β receptor type II gene alterations was found only once. These data suggest that the repertoires of genes that are frequently altered in RER+ and RER− tumors may be more different than previously thought.

Semanario judicial de la Federación /

Description based on: 6. época, v. 4, 1. parte (oct. de 1957).

Journal of the Royal Society of Antiquaries of Ireland.

Series and volume enumeration dropped and consecutive volume enumeration used, 1947-

Bulletin.

No. 500-599? have been removed from its Bulletin series to be used for miscellaneous pamphlets and brochures in its Publication series.

Beyond verbal fluency: Investigating the long-term effects of bilateral subthalamic (STN) deep brain stimulation (DBS) on language in two cases

Cognitive functioning has been described as largely impervious to chronic STN-DBS administered over 12-month periods. In relation to the domain of language, however, the effects of STN-DBS are yet to be thoroughly delineated. Verbal fluency tasks represent an almost exclusively applied index of linguistic proficiency relative to neuropsychological research within this population. Comprehensive investigations of the impact of STN-DBS on language function, however, have never been undertaken. The more precise elucidation of the role of the STN in the mediation of language processes, by way of assessments which probe language comprehension and production mechanisms, served as the primary focus of this research. Longitudinal analysis also afforded consideration of the way in which cognitive-linguistic circuits respond to STN-DBS over time. Bilateral STN-DBS primarily effected clinically reliable fluctuations (i.e., both improvements and declines) in performance in both subjects on tasks demanding cognitive-linguistic flexibility in the formulation and comprehension of complex language. Of particular note, both subjects demonstrated a cumulative increase in the proportion of reliable post-operative improvements achieved over time. The findings of this research lend support to models of subcortical participation in language which endorse a role for the STN, and suggest that bilateral STN-DBS may serve to enhance the proficiency of basal ganglia-thalamocortical linguistic circuits over time.

Costs of managing urinary and faecal incontinence in a sub-acute care facility: A "bottom-up" approach

Aims: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. Materials and Methods: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or subacute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. Results: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. Conclusions: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carets. (C) 2004 Wiley-Liss, Inc.

The impact of residential respite care on the behavior of older people

Background: The aim of this study was to examine the impact of residential respite care on disruptive behavior displayed by older people, particularly those with dementia. Methods: A quasi-experimental, repeated-measures, single-group design was used. The participants were a consecutive series of 100 older people with a mean age of 81.8 years (range 66-96 years) who had been booked for a respite admission to one of several residential aged care facilities in a provincial Australian city. A diagnosis of dementia was reported for 29% of the sample. Disruptive behaviors were rated before and after the period of respite by home caregivers (N = 100) and during the period of respite by nurses (N= 25) using the Dementia Behavior Disturbance Scale (DBDS). Results: Age, male gender and the presence of dementia were all significantly related to the frequency of reported disruptive behaviors. Residential respite care was associated with a significant reduction in the frequency of reported disruptive behaviors in older people (Wald chi(2) = 28.28, P < 0.0001). However, this improvement in behavior did not persist into the post-respite period. The deteriorating behavioral trajectory that was evident prior to respite care continued following the period of respite care. Conclusions: Residential respite care was associated with a temporary diminution in the frequency of reported disruptive behaviors in older people. This finding should be reassuring both for family carets considering placing a relative in residential respite care and for health workers considering whether to recommend such a course of action.

Factors determining disease duration in Alzheimer's disease:a postmortem study of 103 cases using the Kaplan-Meier estimator and Cox regression

Factors associated with duration of dementia in a consecutive series of 103 Alzheimer's disease (AD) cases were studied using the Kaplan-Meier estimator and Cox regression analysis (proportional hazard model). Mean disease duration was 7.1 years (range: 6 weeks-30 years, standard deviation = 5.18); 25% of cases died within four years, 50% within 6.9 years, and 75% within 10 years. Familial AD cases (FAD) had a longer duration than sporadic cases (SAD), especially cases linked to presenilin (PSEN) genes. No significant differences in duration were associated with age, sex, or apolipoprotein E (Apo E) genotype. Duration was reduced in cases with arterial hypertension. Cox regression analysis suggested longer duration was associated with an earlier disease onset and increased senile plaque (SP) and neurofibrillary tangle (NFT) pathology in the orbital gyrus (OrG), CA1 sector of the hippocampus, and nucleus basalis of Meynert (NBM). The data suggest shorter disease duration in SAD and in cases with hypertensive comorbidity. In addition, degree of neuropathology did not influence survival, but spread of SP/NFT pathology into the frontal lobe, hippocampus, and basal forebrain was associated with longer disease duration. © 2014 R. A. Armstrong.

Childhood obesity treatment: integrating mobile health technology into a paediatric obesity service

Background: The management of childhood obesity is challenging. Aims: Thesis, i) reviews the evidence for lifestyle treatment of obesity, ii) explores cardiometabolic burden in childhood obesity, iii) explores whether changes in body composition predicts change in insulin sensitivity (IS), iv) develops and evaluates a lifestyle obesity intervention; v) develops a mobile health application for obesity treatment and vi) tests the application in a clinical trial. Methods: In Study 1, systematic reviews and meta-analyses of the 12‐month effects of lifestyle and mHealth interventions were conducted. In Study 2, the prevalence of cardiometabolic burden was estimated in a consecutive series of 267 children. In Study 3, body composition was estimated with bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA) and linear regression analyses were used to estimate the extent to which each methods predicted change in IS. Study 4 describes the development of the Temple Street W82GO Healthy Lifestyle intervention for clinical obesity in children and a controlled study of treatment effect in 276 children is reported. Study 5 describes the development and testing of the Reactivate Mobile Obesity Application. Study 6 outlines the development and preliminary report from a clinical effectiveness trial of Reactivate. Results: In Study 1, meta--‐analyses BMI SDS changed by -0.16 (-0.24,‐0.07, p<0.01) and -0.03 (-0.13, 0.06, p=0.48). In study 2, cardiometabolic comorbidities were common (e.g. hypertension in 49%) and prevalence increased as obesity level increased. In Study 3, BC changes significantly predicted changes in IS. In Study 4, BMI SDS was significantly reduced in W82GO compared to controls (p<0.001). In Study 5, the Reactivate application had good usability indices and preliminary 6‐month process report data from Study 6, revealed a promising effect for Reactivate. Conclusions: W82GO and Reactivate are promising forms of treatment.

Project Pró-Natal: population-based study of perinatal and infant mortality in Natal, Northeast Brazil

RAMOS, Ana Maria de Oliveira et al. Project Pró-Natal: population-based study of perinatal and infant mortality in Natal, Northeast Brazil. Pediatric and Developmental Pathology, v.3, n.1, p.29-35, 2000