Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to ...estimate the prevalence of Parkinson's disease in North America by combining data from a multi-study sampling strategy in diverse geographic regions and/or data sources. Five separate cohort studies in California (2), Minnesota (1), Hawaii USA (1), and Ontario, Canada (1) estimated the prevalence of PD from health-care records (3), active ascertainment through facilities, large group, and neurology practices (1), and longitudinal follow-up of a population cohort (1). US Medicare program data provided complementary estimates for the corresponding regions. Using our age- and sex-specific meta-estimates from California, Minnesota, and Ontario and the US population structure from 2010, we estimate the overall prevalence of PD among those aged ≥45 years to be 572 per 100,000 (95% confidence interval 537-614) that there were 680,000 individuals in the US aged ≥45 years with PD in 2010 and that that number will rise to approximately 930,000 in 2020 and 1,238,000 in 2030 based on the US Census Bureau population projections. Regional variations in prevalence were also observed in both the project results and the Medicare-based calculations with which they were compared. The estimates generated by the Hawaiian study were lower across age categories. These estimates can guide health-care planning but should be considered minimum estimates. Some heterogeneity exists that remains to be understood.
Parkinson disease (PD) is the second most common age-related neurodegenerative condition diagnosed in North America. We recently demonstrated, using multiple epidemiological data sources, that the ...prevalence of PD diagnoses was greater than previously reported and currently used for clinical, research, and policy decision-making. Prior PD incidence estimates have varied, for unclear reasons. There is a need for improved estimates of PD incidence, not only for care delivery planning and future policy but also for increasing our understanding of disease risk. The objective of this study was thus to investigate the incidence of Parkinson disease across five epidemiological cohorts in North America in a common year, 2012. The cohorts contained data on 6.7 million person-years of adults ages 45 and older, and 9.3 million person-years of adults ages 65 and older. Our estimates of age-sex-adjusted incidence of PD ranged from 108 to 212 per 100,000 among persons ages 65 and older, and from 47 to 77 per 100,00 among persons ages 45 and older. PD incidence increased with age and was higher among males. We also found persistent spatial clustering of incident PD diagnoses in the U.S. PD incidence estimates varied across our data sources, in part due to case ascertainment and diagnosis methods, but also possibly due to the influence of population factors (prevalence of genetic risk factors or protective markers) and geographic location (exposure to environmental toxins). Understanding the source of these variations will be important for health care policy, research, and care planning.
To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with ...improved clinical outcomes.
This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty.
More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio OR 0.78, 95% confidence interval CI 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79).
Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
Background and purpose
Visual dysfunction is a non‐motor symptom of Parkinson disease (PD), but its prevalence is unknown as population‐based data on the epidemiology of visual symptoms in PD are ...lacking. The objective was to determine the prevalence of visual dysfunction in PD.
Methods
This was a cross‐sectional analysis of data from adults ≥50 years old in the Survey of Health, Ageing and Retirement in Europe (SHARE), a multinational population‐based health survey of adults living in one of 27 European countries and Israel. PD diagnosis was self‐reported. Impairment in overall, distance or near eyesight was defined as a score of 4 or 5 on a 1–5 scale. Adjusted logistic regression was used to determine the association between PD and self‐reported vision.
Results
There were 115 240 age‐eligible participants in the SHARE study (mean age 64.3 years, 54% female), of whom 1438 (1.25%) reported a diagnosis of PD. In adjusted logistic regression models, PD was associated with increased odds of impaired overall odds ratio (OR) 2.67, 95% confidence interval (CI) 1.91–3.72, distance (OR 2.55, 95% CI 2.04–3.19) and near (OR 2.07, 95% CI 1.69–2.55) eyesight. Individuals with PD were also less likely to report having an eye examination within the previous 2 years (OR 0.59, 95% CI 0.38–0.92), but this did not remain statistically significant after adjusting for confounders (OR 0.76, 95% CI 0.47–1.24).
Conclusions
Visual dysfunction is significantly more common in PD than in the general adult population. Visual symptoms are a potentially under‐recognized and under‐treated source of reduced quality of life in PD patients that require further attention and study.
We use Swift BAT Earth occultation data at different geomagnetic latitudes to derive a sensitive measurement of the cosmic X-ray background (CXB) and of the Earth albedo emission in the 15-200 keV ...band. We compare our CXB spectrum with recent (INTEGRAL, BeppoSAX) and past results (HEAO-1) and find good agreement. Using an independent measurement of the CXB spectrum we are able to confirm our results. This study shows that the BAT CXB spectrum has a normalization image larger than the HEAO-1 measurement. The BAT accurate Earth albedo spectrum can be used to predict the level of photon background for satellites in low Earth and mid inclination orbits.
Nearly a century after Einstein first predicted the existence of gravitational waves, a global network of Earth-based gravitational wave observatories is seeking to directly detect this faint ...radiation using precision laser interferometry. Photon shot noise, due to the quantum nature of light, imposes a fundamental limit on the attometre-level sensitivity of the kilometre-scale Michelson interferometers deployed for this task. Here, we inject squeezed states to improve the performance of one of the detectors of the Laser Interferometer Gravitational-Wave Observatory (LIGO) beyond the quantum noise limit, most notably in the frequency region down to 150 Hz, critically important for several astrophysical sources, with no deterioration of performance observed at any frequency. With the injection of squeezed states, this LIGO detector demonstrated the best broadband sensitivity to gravitational waves ever achieved, with important implications for observing the gravitational-wave Universe with unprecedented sensitivity.
Randomised controlled trials (RCTs) have observed contrasting results on the effects of vitamin C on circulating biomarkers of glycaemic and insulin regulation. We conducted a systematic review and ...meta-analysis of RCTs testing the effect of vitamin C administration on glucose, HbA1c and insulin concentrations. Four databases (PubMed, Embase, Scopus and Cochrane Library) were used to retrieve RCTs published from inception until April 2016 and testing the effects of vitamin C in adult participants. The screening of 2008 articles yielded 22 eligible studies (937 participants). Overall, vitamin C did not modify glucose, HbA1c and insulin concentrations. However, subgroup analyses showed that vitamin C significantly reduced glucose concentrations (-0.44 mmol/l, 95% CI: -0.81, -0.07, P=0.01) in patients with type 2 diabetes and in interventions with a duration greater than 30 days (-0.53%, 95% CI: -0.79, -0.10, P=0.02). Vitamin C administration had greater effects on fasting (-13.63 pmol/l, 95% CI: -22.73, -4.54, P<0.01) compared to postprandial insulin concentration. Meta-regression analyses showed that age was a modifier of the effect of vitamin C on insulin concentration. Furthermore, the effect size was associated with baseline BMI and plasma glucose levels, and with the duration of the intervention. In conclusion, greater reduction in glucose concentrations observed in patients with diabetes, older individuals and with more prolonged supplementation. Personalised interventions with vitamin C may represent a feasible future strategy to enhance benefits and efficacy of interventions. Nevertheless, results need to be interpreted cautiously due to limitations in the primary studies analysed.
ABSTRACT The discovery of the gravitational-wave (GW) source GW150914 with the Advanced LIGO detectors provides the first observational evidence for the existence of binary black hole (BH) systems ...that inspiral and merge within the age of the universe. Such BH mergers have been predicted in two main types of formation models, involving isolated binaries in galactic fields or dynamical interactions in young and old dense stellar environments. The measured masses robustly demonstrate that relatively "heavy" BHs ( ) can form in nature. This discovery implies relatively weak massive-star winds and thus the formation of GW150914 in an environment with a metallicity lower than about 1/2 of the solar value. The rate of binary-BH (BBH) mergers inferred from the observation of GW150914 is consistent with the higher end of rate predictions ( Gpc−3 yr−1) from both types of formation models. The low measured redshift ( ) of GW150914 and the low inferred metallicity of the stellar progenitor imply either BBH formation in a low-mass galaxy in the local universe and a prompt merger, or formation at high redshift with a time delay between formation and merger of several Gyr. This discovery motivates further studies of binary-BH formation astrophysics. It also has implications for future detections and studies by Advanced LIGO and Advanced Virgo, and GW detectors in space.
In this paper, it is shown that the occurrence of dislocation pileups across grain boundaries, as well as subsequent emission to the adjacent grains, is captured theoretically by gradient plasticity ...and confirmed experimentally by nanoindentation. From a theoretical point of view, this is accomplished (within a deformation theory framework applicable to continued loading) by accounting for a specific interfacial term in the overall potential of the material, in terms of which its response, taken to conform to strain gradient plasticity, is defined. The main features that result from the addition of this interfacial term are (i) significant size effects of Hall–Petch type in the overall stress–strain response of polycrystals and (ii) the determination of an analytical expression for the stress corresponding to the onset of dislocation transfer across interfaces. From an experimental point of view, the effective stress at which dislocation transfer takes place across an interface can be obtained from nanoindentations performed in close proximity to an Fe–2.2
wt.% Si grain boundary, since they exhibit a distinct strain burst that is related to the presence of the boundary. It is possible, therefore, to fit the theoretically determined analytical expression for the interfacial yield stress to the experimental data. From this fit, first estimates are obtained for key material parameters, namely the interfacial term and the internal length, that are required for the theoretical formulation. Dislocation mechanics are employed to provide physical insight of these parameters.
ABSTRACT A transient gravitational-wave signal, GW150914, was identified in the twin Advanced LIGO detectors on 2015 September 2015 at 09:50:45 UTC. To assess the implications of this discovery, the ...detectors remained in operation with unchanged configurations over a period of 39 days around the time of the signal. At the detection statistic threshold corresponding to that observed for GW150914, our search of the 16 days of simultaneous two-detector observational data is estimated to have a false-alarm rate (FAR) of , yielding a p-value for GW150914 of . Parameter estimation follow-up on this trigger identifies its source as a binary black hole (BBH) merger with component masses at redshift (median and 90% credible range). Here, we report on the constraints these observations place on the rate of BBH coalescences. Considering only GW150914, assuming that all BBHs in the universe have the same masses and spins as this event, imposing a search FAR threshold of 1 per 100 years, and assuming that the BBH merger rate is constant in the comoving frame, we infer a 90% credible range of merger rates between (comoving frame). Incorporating all search triggers that pass a much lower threshold while accounting for the uncertainty in the astrophysical origin of each trigger, we estimate a higher rate, ranging from depending on assumptions about the BBH mass distribution. All together, our various rate estimates fall in the conservative range .
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