Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, ...physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations.
We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated.
Discontinuation rates varied substantially and ranged between 0% and 49% with a median of 18%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients).
Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention.
PROSPERO (2013:CRD42013003910).
According to some economic analysts, Germany's comeback can be attributed to the control of costs since the mid-1990s. "Germany has gained a significant leap through wage restraint," said Mr Harald ...Jorg. In the long run, high exchange rates are a threat. Germany's strong export performance comes as the euro last week climbed to near-record highs against the dollar, triggering fears that its persistent rise could curb German export growth and derail the eurozone's fragile upturn.
Germany has claimed the title of world's biggest exporter for the first time in 11 years, pulling ahead of the US, raising hopes that wage restraint has boosted the competitiveness of German ...industry. Elga Bartsch, analyst at Morgan Stanley, said Germany had profited from a strong presence in export markets in eastern and central Europe. In the long run, high exchange rates are a threat. Germany's strong export performance comes as the euro last week climbed to near-record highs against the dollar, triggering fears that its persistent rise could curb German export growth and derail the eurozone's fragile upturn.
Approaching rewards and avoiding punishments is a fundamental aspect of behavior, yet individuals differ in the extent of these behavioral tendencies. One popular method to assess differences in ...approach-avoidance tendencies and even modify them, is using behavioral tasks in which spontaneous responses to differently valenced stimuli are assessed (e.g., the visual joystick and the manikin task). Understanding whether these reaction-time-based tasks map onto the same underlying constructs, how they predict interindividual differences in theoretically related constructs and how reliable they are, seems vital to make informed judgements about current findings and future studies. In this preregistered study, 168 participants (81 self-identified men, 87 women) completed emotional face versions of these tasks as well as an alternative, foraging-based paradigm, the approach-avoidance-conflict task, and answered self-report questionnaires regarding anxiety, aggression, depressive symptoms, behavioral inhibition and activation. Importantly, approach-avoidance outcome measures of the two reaction-time-based tasks were unrelated with each other, showed little relation to self-reported interindividual differences and had subpar internal consistencies. In contrast, the approach-avoidance-conflict task was related to behavioral inhibition and aggression, and had good internal consistencies. Our study highlights the need for more research into optimizing behavioral approach-avoidance measures when using task-based approach-avoidance measures to assess interindividual differences.
The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia ...on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.
Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using ...exemplars in Australia and China.
We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% annual discounting, where discounting adjusts future costs to 2020 value.
Low-dose atropine, antimyopia spectacles, antimyopia multifocal soft contact lenses and orthokeratology met our AMM inclusion criteria. Lifetime cost for TMM with 3% discounting was US$7437 (CI US$4953 to US$10 740) in Australia and US$8006 (CI US$3026 to US$13 707) in China. The lowest lifetime cost options with 3% discounting were antimyopia spectacles (US$7280, CI US$5246 to US$9888) in Australia and low-dose atropine (US$4453, CI US$2136 to US$9115) in China.
Financial investment in AMM during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Our methodology can be applied to estimate cost in comparable scenarios.
To investigate utility (a preference-based quality of life QoL measure) associated with uncorrected refractive error (URE).
Cross-sectional study.
A cohort of 341 consecutive patients 40 to 65 years ...of age with refractive error and no ocular disease impairing vision worse than 20/25 (0.1 logarithm of the minimum angle of resolution logMAR units) in the better eye. Without vision correction, 30 had no vision impairment, 65 had only distance vision impairment (DVI), 97 had only near vision impairment (NVI), 112 had moderate amounts of both distance and near vision impairment (DNVI), and 37 had severe impairment (distance or near worse than 20/200 >1.0 logMAR) in the better eye.
All participants underwent a comprehensive eye examination with refraction, aided and unaided visual acuity (VA) at 6 m and 40 cm, and ocular health assessment. Utilities were elicited for a number of scenarios using a standardized, face-to-face time trade-off (TTO) interview method.
The main outcome measure was TTO utility for the participant's own uncorrected vision state. Utilities ranged from 0 to 1, where 0 = death and 1 = perfect vision, and were scaled to account for comorbidities so that 1 = perfect health (adjusted utility).
Unaided VA was 0.50 ± 0.24 logMAR at distance in the DVI group, 0.43 ± 0.17 logMAR at near in the NVI group, and 0.72 ± 0.36 and 0.56 ± 0.29 at distance and near, respectively, in the DNVI group. Adjusted utilities for the 3 groups were 0.82 ± 0.16 in the DVI group, 0.81±0.17 in the NVI group, and 0.68 ± 0.25 in the DNVI group. The DVI and NVI group utilities (adjusted and unadjusted) did not differ significantly (P = 0.73 and P = 0.77, respectively). The DNVI utility was significantly worse than that of the DVI and NVI groups (adjusted and unadjusted, P<0.01).
The URE is associated with measurable reductions in utility (and therefore QoL). Reductions are similar regardless of whether near or distance vision is impaired, but worse when both are impaired. The results underscore the significance of the effect of URE on QoL, particularly with respect to uncorrected presbyopia, which has been a relatively neglected area in research and policy. The utility figures in this study can be used as inputs for cost-effectiveness studies relating to URE to assist resource allocation decisions.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Rationale
Balancing approach of positive and avoidance of negative stimuli is essential when faced with approach-avoidance conflicts, e.g., situations with both positive and negative outcomes. This ...balance is disturbed in several mental disorders, e.g., excessive avoidance in anxiety disorders, and heightened approach in substance use disorders. Since stress is assumed to impact these disorders’ etiology and maintenance, it seems crucial to understand how stress influences behavior in approach-avoidance conflicts. Indeed, some studies suggested altered approach-avoidance behavior under acute stress, but the mechanism underlying these effects is unknown.
Objectives
Investigate how the pharmacological manipulation of major stress mediators (cortisol and noradrenaline) influences task-based approach-avoidance conflict behavior in healthy individuals.
Methods
Ninety-six participants (48 women, 48 men) received either 20mg hydrocortisone, 20mg yohimbine, both, or placebo before performing a task targeting foraging under predation in a fully crossed double-blind between-subject design. Moreover, we investigated effects of gender and endogenous testosterone and estradiol levels on approach-avoidance behavior.
Results
While biological stress markers (cortisol concentration, alpha amylase activity) indicated successful pharmacological manipulation, behavior in approach-avoidance conflicts was not affected as expected. Although yohimbine administration affected risky foraging latency under predation, we found no main effect of hydrocortisone or their interaction on behavior. In contrast, we found gender differences for almost all behavioral outcome measures, which might be explained by differences in endogenous testosterone levels.
Conclusions
The investigated major stress mediators were not sufficient to imitate previously shown stress effects on approach-avoidance conflict behavior. We discuss potential reasons for our findings and implications for future research.
Large scale oil palm monocultures are continuously replacing Indonesia's tropical rainforests. The impact of intensive nitrogen (N) fertilization and herbicide application on biogeochemical processes ...in these monocultures remains unknown. Thus, we aim to understand NPK and herbicide effects on soil carbon (C) cycle. We hypothesize that (1) increased microbial activity due to N fertilization leads to faster soil organic matter (SOM) decomposition and to increased CO2 emissions from soil. Despite this, we expect (2) that herbicide application increases soil organic carbon (SOC) sequestration, as it counteracts the fertilizer's effects by hampering soil microbial activity, by deactivating the same synthesizing pathway as in plants, leading to decreased microbial respiration. We investigated the effects of fertilization (conventional and reduced NPK) and weed control (herbicide or mechanical weeding) on SOC decomposition in the rows between the palms (interrows) and around the palm stems (weeding circles). 14C labelled glucose was added to soil to analyze the response of microbial activity and SOC mineralization during 30-day incubation. Conventional fertilization caused microbial activation and destabilized SOC by priming, resulting in increased CO2 efflux. Glyphosate application plus fertilization further increased microbial activity contradicting our hypothesis. In combination with high fertilizer amounts, glyphosate strongly increased microbial activity. NPK might occupy a greater share of sorption capacities; hence, glyphosate is still available and can act as an additional source of C and possibly N and P. Therefore, SOC decomposition was 1.5 accelerated compared to the control when glyphosate and fertilizer application were combined. In contrast, reduced SOC decomposition, i.e., a strong negative priming effect (−47.9 μg g −1), occurred under reduced NPK fertilization without herbicides suggesting positive effects on C accumulation and storage. Our results emphasize the risk of management intensification and the need for a low-impact management strategy to maintain soil fertility and the function as a C reservoir.
Summary of research outcomes: Decomposition responses towards contrasting management practices. Faster decomposition and higher CO2 efflux under conventional fertilization level and herbicide application. Retarded SOC decomposition and support of SOC accumulation under reduced fertilization and mechanical weeding. Effects most prominent in the WC. IRs mostly characterized by missing C input and C limitation. No effects of management extensification could be found in the IRs. Display omitted
•High NPK fertilization in combination with glyphosate increases CO2 emissions from soil.•Glyphosate acts as additional nutrient source for microorganisms.•Negative priming effects under low NPK fertilization and mechanical weed control, implying retardation of SOC decomposition.•Harvesting paths are strictly nutrient and C limited.
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