Younger-onset dementia (YOD) refers to a dementia where symptom onset occurs when the patient is less than 65 years of age. YOD is far less common than late-onset dementia (occurring when patients ...are over 65 years old) and more challenging to diagnose due to its heterogeneous presentation. There have been relatively few studies describing demographic and diagnostic characteristics of patients with YOD in the community, particularly with follow-up information.
A retrospective cohort study was performed of inpatients admitted to a tertiary neuropsychiatry service, located in metropolitan Victoria, Australia, from 2009 to 2019. Inpatients with a YOD diagnosis were identified and data regarding diagnosis, demographics and investigations were obtained.
There were 849 individual inpatients who were admitted to the service in the 10-year period and received comprehensive assessment. There were 306 individuals who received a YOD diagnosis, using contemporaneous diagnostic criteria (frequency 36%). The most common diagnoses were Alzheimer's disease (24.2%), frontotemporal dementia (23.1%), Huntington's disease (16.7%) and vascular dementia (7.8%). More than half of these inpatients were followed up and 6.5% had a diagnostic change when reviewed.
This study reports on the largest cohort of YOD to date, with diagnostic breakdown similar to previous retrospective file reviews. The neuropsychiatry service is funded to follow-up its patients, thus allowing re-assessment and continuity of care. While there are limitations in this study such as the lack of neuropathological outcomes, the findings emphasise the strengths of follow-up and appropriate service provision for these patients.
Background International consensus guidelines to guide management of intraductal papillary mucinous neoplasms (IPMN) were revised in Fukuoka and published in 2012. However, despite widespread ...acceptance of the Fukuoka Consensus Guidelines (FCG), the utility of these guidelines have not been well-validated. This systematic review was performed to evaluate the clinical utility of the FCG. Design A computerized search of the PubMed and Scopus databases was performed to identify all studies evaluating the utility of the FCG in surgically resected IPMN. IPMN were stratified according to the FCG as high risk (HR), worrisome risk (WR), and low risk (LR). HR and WR IPMN were termed FCG+ve and LR IPMN were termed FCG-ve. Results Seven studies analyzing 1,382 patients were included. There were 402 malignant neoplasms (29%), including 242 invasive IPMNs. There were 1,000 IPMN classified as FCG+ve. The FCG+ve group had a positive predictive value (PPV) ranging from 27 to 62% and the FCG-ve group had negative predictive value ranging from 82 to 100%. Pooled analysis demonstrated that there was 362 of 1,000 (36%) malignant FCG+ve IPMN and 342 of 382 (90%) benign FCG-ve IPMN. PPV of the HR group and the WR groups alone were 104 of 158 (66%) and 75 of 261 (29%), respectively. Forty of 382 (11%), including 22 (6%) invasive FCG-ve IPMN, were malignant. Twenty-six malignant including 18 invasive FCG-ve IPMN were reported from a single study. When the results from this study were excluded, there were only 14 of 241 malignant neoplasms (6%), including 4 of 241 (2%) invasive FCG-ve IPMN in the remaining 6 studies. Conclusion The FCG+ve criteria had a similarly low PPV compared with the 2006 consensus criteria. Stratification of IPMN into HR and WR groups resulted in a higher PPV in the HR group. Some malignant and even invasive IPMN may be missed by the FCG criteria.
The estimation of the costs of a product or project and the decisions based on these forecasts are subject to much uncertainty relating to factors like unknown future developments. This has been ...addressed repeatedly in research studies focusing on different aspects of uncertainty; unfortunately, this interest has not yet been adopted in practice. One reason can be found in the inadequate representation of uncertainty. This paper introduces an experiment, which engages different approaches to displaying cost forecasting information to gauge the consideration of uncertainty in the subsequent decision-making process. Three different approaches of displaying cost-forecasting information including the uncertainty involved in the data were tested, namely a three point trend forecast, a bar chart, and a FAN-diagram. Furthermore, the effects of using different levels of contextual information about the decision problem were examined. The results show that decision makers tend to simplify the level of uncertainty from a possible range of future outcomes to the limited form of a point estimate. Furthermore, the contextual information made the participants more aware of uncertainty. In addition, the fan-diagram prompted 75.0% of the participants to consider uncertainty even if they had not used this type of diagram before; it was therefore identified as the most suitable method of graphical information display for encouraging decision makers to consider the uncertainty in cost forecasting.
► Displaying uncertain information can impact their interpretation. ► This paper describes an experiment to test this interpretation in cost forecasting. ► This experiment was undertaken with cost estimation experts from industry. ► Tested were 3 approaches: a three point estimate, a bar-chart, and a fan diagram. ► The optimal approach for displaying uncertainty was identified as a fan-diagram.
Feed deprivation in poultry farming imposes some degree of stress to the birds, and adversely affects their well -being. Serum levels of acute phase proteins (APP) are potential physiological ...indicators of stress attributed to feed deprivation. However, it has not been determined how long it takes for a measurable APP response to stressors to occur in avian species. An experiment was designed to delineate the APP and circulating levels of corticosterone responses in commercial broiler chickens to feed deprivation for 30 h. It was hypothesized that feed deprivation would elicit both APP and corticosterone (CORT) reactions within 30 h that is probably associated with stress of hunger. Twenty-one day old birds were subjected to one of 5 feed deprivation periods: 0 (ad libitum, AL), 6, 12, 18, 24, and 30 h. Upon completion of the deprivation period, blood samples were collected to determine serum CORT, ovotransferrin (OVT), α1-acid glycoprotein (AGP), and ceruloplasmin (CP) concentrations. Results showed that feed deprivation for 24 h or more caused a marked elevation in CORT (P = 0.002 and P < 0.0001, respectively) when compared to AL. However, increases in AGP (P = 0.0005), CP (P = 0.0002), and OVT (P = 0.0003) were only noted following 30 h of feed deprivation. It is concluded that elicitation of AGP, CP, and OVT response may represent a more chronic stressful condition than CORT response in assessing the well-being of broiler chickens.
Osteoporosis is a bone disorder with remarkable changes in bone biologic material and consequent bone structural distraction, affecting millions of people around the world from different ethnic ...groups. Bone fragility is the worse outcome of the disease, which needs long term therapy and medical management, especially in the elderly. Many involved genes including environmental factors have been introduced as the disease risk factors so far, of which genes should be considered as effective early diagnosis biomarkers, especially for the individuals from high-risk families. In this review, a number of important criteria involved in osteoporosis are addressed and discussed.
Introduction
The Sendai Consensus Guidelines (SCG) was formulated in 2006 to guide the management of intraductal papillary mucinous neoplasms (IPMN). The main area of controversy is the criteria for ...selection of branch duct (BD)-IPMN for resection. Although these guidelines have gained widespread acceptance, there is limited data to date supporting its use. This systematic review is performed to evaluate the utility of the Sendai Consensus Guidelines (SCG) for BD-IPMN.
Methods
Studies evaluating the clinical utility of the SCG in surgically resected neoplasms were identified. The SCG were retrospectively applied to all resected neoplasms in these studies. BD-IPMNs which met the criteria for resection were termed SCG+ve and those for surveillance were termed SCG−ve.
Results
Twelve studies were included, of which, 9 were suitable for pooled analysis. There were 690 surgically resected BD-IPMNs, of which, 24 % were malignant. Five hundred one BD-IPMNs were classified as SCG+ve and 189 were SCG−ve. The positive predictive value (PPV) of SCG+ve neoplasms ranged from 11 to 52 % and the NPV of SCG−ve neoplasms ranged from 90 to 100 %. Overall, there were 150/501 (29.9 %) of malignant BD-IPMNs in the SCG+ve group and 171/189 (90 %) of benign BD-IPMNs in the SCG−ve group. Of the 18 reported malignant (11 invasive) BD-IPMNs in the SCG−ve group, 17 (including all 11 invasive) were from a single study. When the results from this single study were excluded, 170/171 (99 %) of SCG−ve BD-IPMNs were benign.
Conclusion
The results of this review confirm the limitations of the SCG for BD-IPMN. The PPV of the SCG in predicting a malignant BD-IPMN was low and some malignant lesions may be missed based on these guidelines.
Background
The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to ...evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms.
Study Design
Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR
SCG
) and low risk (LR
SCG
), and according to the FCG as high risk (HR
FCG
), worrisome (W
FCG
), and low risk (LR
FCG
). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology.
Results
The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR
SCG
and HR
ICG2012
for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR.
Conclusion
The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR
FCG
group can be safely managed conservatively, and those in the HR
FCG
group should undergo resection.
Thirty-two male goats were randomly assigned to four dietary treatments namely, basal diet 70% concentrate and 30% oil palm fronds (control, CN), CN
+
400
mg/kg vitamin E (VE), 0.5% turmeric (TU) or ...0.5%
Anderographis paniculata (AP). After 100
days of feeding, the goats were slaughtered and
longissimus dorsi (LD) muscle was sampled. The muscle was vacuum-packaged and conditioned for 0, 7 and 14
days in a chiller (4
°C). The drip loss of the LD muscle increased (
P
<
0.05) with aging time. Meat tenderness was improved (
p
<
0.05) at 14
days aging. All antioxidant supplements improved (
P
<
0.05) colour of the meat. The TBARS value increased (
P
<
0.05) at 7
days of aging while the fatty acid composition was not affected by the dietary supplements. It is concluded that TU and AP are potential dietary antioxidant supplements, for the purpose of improving the quality of chevon.
This experiment aimed to determine microbial spoilage and lipid and protein oxidation during aerobic refrigerated (4°C) storage of rabbit meat. Forty male New Zealand white rabbits were slaughtered ...according to the Halal slaughter procedure. The hind limbs were used for microbial analysis while the Longissimus lumborum m. was used for determination of lipid and protein oxidation. Bacterial counts generally increased with aging time and the limit for fresh meat (108cfu/g) was reached at d 7 postmortem. Significant differences in malondialdehyde content were observed after 3d of storage. The thiol concentration significantly decreased with increase in aging time. The band intensities of myosin heavy chain and troponin T significantly reduced with increased refrigerated storage while actin remained relatively stable. This study thus proposes protein oxidation as a potential deteriorative change in refrigerated rabbit meat along with microbial spoilage and lipid oxidation.
•Microbial spoilage and lipid and protein oxidation in rabbit meat were studied.•Microbial analysis indicated a shelf life of 7d.•Malondialdehyde content increased with aging time.•Myosin heavy chain and troponin T were degraded.•Actin remained stable.
The defect identification process within the UK rail industry has seen significant improvements over the past decade with the introduction of new measurement systems and defect detection systems. ...Although significant work has been on the defect identification little work has been done on the process after the defect has been detected. This repair process is still extremely manual. Due to the current process being manual the repair operation has very little traceability and transparency. This paper has therefore presented the need for not only a defect detection system but a defect repair system for the UK railway industry. Further to this, this paper has acknowledged that the rise of defects occurring on the UK railway lines requires a solution that can fully repair a defect with little to no user intervention in a timely manner. To address this, this paper has taken the extremely manual process of rail repair and has laid out the possibilities to automate this process. By doing this a work flow diagram has been generated to show how the system could be used to repair surface defects with a specific focus being made on squat defects. To achieve this a defect detection and measurement system has been explored, as this will make up the first stage of the automated repair system. The literature on various defect detection algorithms was reviewed and two variations of existing defect detection algorithms were created, i.e. the Covariance method and the Normal Intersection method. These algorithms have been tested against 100 simulated squat defects and have been verified using 4 experimentally generated defects. Both algorithms have been proven to not only identify the approximate size of the defect but also its location. This successful defect identification will be integrated into an automated rail repair system.
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