A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment

OBJECTIVES: To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment. DESIGN: Prospective observational cohort study. SETTING: Rehabilitation unit for older people. SUBJECTS: A total of 116 patients (70F) mean age (SD) 86.3 (6.4). Group 1: 89 patients with moderate cognitive impairment (Mini-Mental State Examination 11-20); and Group 2: 27 patients with severe cognitive impairment (Mini-Mental State Examination 0-10). INTERVENTION: A personalised rehabilitation plan. MAIN MEASURES: Barthel Activity of Daily Living score on admission and discharge, length of stay and discharge destination. RESULTS: Of 116 patients, 64 (55.2%) showed an improvement in Barthel score. Mini-Mental State Examination was significantly higher in those who improved, 15.4 (SD 3.7) vs.13.2 (SD 5.1): p = 0.01. The mean Barthel score improved in both groups; Group 1 - 14.7 (SD 19.1) vs. Group 2 - 9.3 (SD 16.3): p = 0.17. Of 84 home admissions in Group 1, more patients returning home showed improvements of at least 5 points in the Barthel score compared with nursing/residential home discharges (32/37 - 86.5% vs. 10/28 - 35.7%: p = 0.0001). In Group 2 of 17 home admissions, 6/6 (100%) home discharges showed improvement compared with 3/7 (42.8%) discharges to nursing/residential home (p = 0.07). In Group 1, a discharge home was associated with significantly greater improvement in number of Barthel items than a nursing/residential home discharge (3.27 (SD 2.07) vs. 1.86 (SD 2.32): p = 0.007). A similar non-significant pattern was noted for severe cognitive impairment patients (3.5 (3.06) vs. 1.14 (1.06); p = 0.1). CONCLUSION: Patients with moderate to severe cognitive impairment demonstrated significant improvements in Barthel score and Barthel items showing that such patients can and do improve with rehabilitation.published_or_final_versio

Physical realization of coupled Hilbert-space mirrors for quantum-state engineering

Manipulation of superpositions of discrete quantum states has a mathematical counterpart in the motion of a unit-length statevector in an N-dimensional Hilbert space. Any such statevector motion can be regarded as a succession of two-dimensional rotations. But the desired statevector change can also be treated as a succession of reflections, the generalization of Householder transformations. In multidimensional Hilbert space such reflection sequences offer more efficient procedures for statevector manipulation than do sequences of rotations. We here show how such reflections can be designed for a system with two degenerate levels - a generalization of the traditional two-state atom - that allows the construction of propagators for angular momentum states. We use the Morris-Shore transformation to express the propagator in terms of Morris-Shore basis states and Cayley-Klein parameters, which allows us to connect properties of laser pulses to Hilbert-space motion. Under suitable conditions on the couplings and the common detuning, the propagators within each set of degenerate states represent products of generalized Householder reflections, with orthogonal vectors. We propose physical realizations of this novel geometrical object with resonant, near-resonant and far-off-resonant laser pulses. We give several examples of implementations in real atoms or molecules.Comment: 15 pages, 6 figure

Heterogeneity of impacts of high CO2 on the North Western European Shelf

The increase in atmospheric CO2 is a dual threat to the marine environment: from one side it drives climate change, leading to modifications in water temperature, circulation patterns and stratification intensity; on the other side it causes a decrease in marine pH (ocean acidification, or OA) due to the increase in dissolved CO2. Assessing the combined impact of climate change and OA on marine ecosystems is a challenging task. The response of the ecosystem to a single driver can be highly variable and remains still uncertain; additionally the interaction between these can be either synergistic or antagonistic. In this work we use the coupled oceanographic–ecosystem model POLCOMS-ERSEM driven by climate forcing to study the interaction between climate change and OA. We focus in particular on carbonate chemistry, primary and secondary production. The model has been run in three different configurations in order to assess separately the impacts of climate change on net primary production and of OA on the carbonate chemistry, which have been strongly supported by scientific literature, from the impact of biological feedbacks of OA on the ecosystem, whose uncertainty still has to be well constrained. The global mean of the projected decrease of pH at the end of the century is about 0.27 pH units, but the model shows significant interaction among the drivers and high variability in the temporal and spatial response. As a result of this high variability, critical tipping point can be locally and/or temporally reached: e.g. undersaturation with respect to aragonite is projected to occur in the deeper part of the central North Sea during summer. Impacts of climate change and of OA on primary and secondary production may have similar magnitude, compensating in some area and exacerbating in others

Classifying atopic dermatitis: protocol for a systematic review of subtypes (phenotypes) and associated characteristics.

INTRODUCTION: Atopic dermatitis is a complex disease with differing clinical presentations. Many attempts have been made to identify uniform subtypes, or phenotypes, of atopic dermatitis in order to identify different aetiologies, improve diagnosis, estimate more accurate clinical prognoses, inform treatment andmanagement or predict treatment efficacy andeffectiveness. However, no consensus yet exists on exactly what defines these phenotypes or how many there are and whether they are genuine or statistical artefacts. This review aims to identify previously reported phenotypes of atopic dermatitis, the features used to define them and any characteristics or clinical outcomes significantly associated with them. METHODS AND ANALYSIS: We will search Ovid Embase, Ovid MEDLINE and Web of Science from inception to the latest available date at the time of the search for studies attempting to classify atopic dermatitis in humans using any cross-sectional or longitudinal epidemiological or interventional design. Primary outcomes are atopic dermatitis phenotypes, features used to define them and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. Two reviewers will independently screen titles and abstracts for inclusion, extract data and assess study quality. We will present the results of this review descriptively and with frequencies where possible. ETHICS AND DISSEMINATION: Ethical approval is not required for this study as it is a systematic review. We will report results from this systematic review in a peer-reviewed journal. The main value of this study will be to inform further research. PROSPERO REGISTRATION NUMBER: CRD42018087500

Looking back at superfluid helium

A few years after the discovery of Bose Einstein condensation in several gases, it is interesting to look back at some properties of superfluid helium. After a short historical review, I comment shortly on boiling and evaporation, then on the role of rotons and vortices in the existence of a critical velocity in superfluid helium. I finally discuss the existence of a condensate in a liquid with strong interactions, and the pressure variation of its superfluid transition temperature.Comment: Conference "Bose Einstein Condensation", Institut henri Poincare, Paris, 29 march 200

Spontaneous Stratification in Granular Mixtures

Granular materials size segregate when exposed to external periodic perturbations such as vibrations. Moreover, mixtures of grains of different sizes spontaneously segregate in the absence of external perturbations: when a mixture is simply poured onto a pile, the large grains are more likely to be found near the base, while the small grains are more likely to be near the top. Here, we report a spontaneous phenomenon arising when we pour a mixture between two vertical plates: the mixture spontaneously stratifies into alternating layers of small and large grains whenever the large grains are rougher than the small grains. In contrast, we find only spontaneous segregation when the large grains are more rounded than the small grains. The stratification is related to the occurrence of avalanches; during each avalanche the grains comprising the avalanche spontaneously stratify into a pair of layers through a "kink" mechanism, with the small grains forming a sublayer underneath the layer of large grains.Comment: 4 pages, 6 figures, http://polymer.bu.edu/~hmakse/Home.htm

Examining the Relationships among the Coaching Climate, Life Skills Development and Well-Being in Sport

Using Benson and Saito's framework for positive youth development, we investigated the relationships between the coaching climate, young people's perceived life skills development within sport, and their psychological well-being. British youth sport participants (N=326, Mage=13.81, range=11–18 years) completed a survey assessing the coaching climate, participants' perceived life skills development (teamwork, goal setting, time management, emotional skills, interpersonal communication, social skills, leadership, and problem solving and decision making) and psychological well-being (self-esteem, positive affect, and satisfaction with life). In all analyses, the coaching climate was positively related to young peoples' perceived development of life skills within sport and their psychological well-being. Total life skills development (a summative score of all eight life skills scores) was positively related to all three psychological well-being indicators – providing support for the "pile-up" effect – and partially mediated the relationships between the coaching climate and participants' psychological well-being. Interpretation of the results indicated that coaches should foster the development of multiple life skills in youth sport participants, as they are associated with participants' psychological well-being. One way this can be achieved is through autonomy-supportive coaching behaviours

Longitudinal study of trachomatous trichiasis in The Gambia: barriers to acceptance of surgery.

PURPOSE: Investigation of compliance with surgery for trachomatous trichiasis has become a priority of the World Health Organization. This study was conducted to investigate attitudes toward trichiasis and its treatment and to determine the rate of surgical uptake in The Gambia. METHODS: A 1-year longitudinal study was performed in 190 subjects with trichiasis. Persons with major trichiasis (involving five lashes or more) were referred for surgery, and those with minor trichiasis were advised to epilate. Outcome measures included attitudes toward trichiasis and its treatment, reported barriers to surgical uptake, acceptance rates for surgery, and factors affecting acceptance. RESULTS: Twenty-three percent (95% confidence interval [CI] 16.5%-30.6%) of subjects with major trichiasis attended for surgery during the year. Degree of ignorance about surgery, symptoms impeding work, and a multiple income source for the head of household predicted attendance. Reported lack of time predicted nonattendance. Sixty-eight percent of patients who had undergone surgery were trichiasis free at last follow-up. CONCLUSIONS: Poor attendance for surgery remains a problem in The Gambia. Barriers include ignorance and lack of time and money. Health education and surgical delivery strategies are needed to overcome these barriers. Regular audit of surgical results is necessary, with retraining where indicated

A four-helix bundle stores copper for methane oxidation

Methane-oxidising bacteria (methanotrophs) require large quantities of copper for the membrane-bound (particulate) methane monooxygenase (pMMO). Certain methanotrophs are also able to switch to using the iron-containing soluble MMO (sMMO) to catalyse methane oxidation, with this switchover regulated by copper. MMOs are Nature’s primary biological mechanism for suppressing atmospheric levels of methane, a potent greenhouse gas. Furthermore, methanotrophs and MMOs have enormous potential in bioremediation and for biotransformations producing bulk and fine chemicals, and in bioenergy, particularly considering increased methane availability from renewable sources and hydraulic fracturing of shale rock. We have discovered and characterised a novel copper storage protein (Csp1) from the methanotroph Methylosinus trichosporium OB3b that is exported from the cytosol, and stores copper for pMMO. Csp1 is a tetramer of 4-helix bundles with each monomer binding up to 13 Cu(I) ions in a previously unseen manner via mainly Cys residues that point into the core of the bundle. Csp1 is the first example of a protein that stores a metal within an established protein-folding motif. This work provides a detailed insight into how methanotrophs accumulate copper for the oxidation of methane. Understanding this process is essential if the wide-ranging biotechnological applications of methanotrophs are to be realised. Cytosolic homologues of Csp1 are present in diverse bacteria thus challenging the dogma that such organisms do not use copper in this location

A survey on managing users' preferences in ambient intelligence

Understanding the importance of preference management in ambient intelligent environments is key to providing systems that are better prepared to meet users' expectations. This survey provides an account of the various ways that preferences have been handled in Artificial Intelligence. Our analysis indicates that most of those techniques lack the ability to handle ambiguity and the evolution of preferences over time. Further exploration shows that argumentation can provide a feasible solution to complement existing work. We illustrate our claim by using an intelligent environment case study