Parkinsonian gait in elderly people: Significance of the threshold value of two and more falls per year

OBJECTIVES

Parkinsonism in the elderly presents a major risk factor for recurrent falls (2 and more falls per year), which is associated with increased morbidity. The main objective was to investigate explanatory variables relating to the risk of being recurrent fallers (RF) in persons with parkinsonian gait.

METHODS

Seventy-nine among 172 eligible persons were enrolled in this prospective study, the findings of which were analyzed at 12 months. Motor and non-motor features, as well as follow-up interviews to identify falls, loss of ability to walk, fluctuating cognition, traumatic falls, all-cause hospitalizations and deaths were collated and results compared between non RF (zero and one fall per year) and RF. Bayesian model averaging was used to predict the probability of patients being RF from their medical history as well as from cognitive assessment, gait velocity, vision and posture.

RESULTS

N=79, 0.58 men, 50% had Parkinson's disease, 14% other neurodegenerative parkinsonian syndrome, 23% vascular parkinsonism and 13% Lewy body disease, 58% were RF. Median age 81.2 years and median MMSE 25/30. A history of falls and of hallucinations, median odds ratio respectively 9.06 (CI 2.34-38.22), 4.21 (CI 1.04-18.67) were associated with the highest odds ratios along with fluctuating cognition and abnormal posture. Two or more falls a year was a relevant threshold to distinguish a population with a high risk of comorbidity.

CONCLUSION

The whole history of falls, hallucinations and fluctuating cognition can be considered predictive of recurrent falls in elderly people with parkinsonian gait and provide a tracking tool for patient management.

Combining Defaults and Transparency Information to Increase Policy Compliance

Abstract. Combining the strengths of defaults and transparency information is a potentially powerful way to induce policy compliance. Despite negative theoretical predictions, a recent line of research revealed that default nudges may become more effective if people are informed why they should exhibit the targeted behavior. Yet, it is an open empirical question whether the increase in compliance came from setting a default and consequently disclosing it, or the provided information was sufficient to deliver the effect on its own. Results from an online experiment indicate that both defaulting and transparency information exert a statistically independent effect on compliance, with highest compliance rates observed in the combined condition. Practical and theoretical implications are discussed.

The architecture of prototype preferences: Typicality, fluency, and valence

A classic phenomenon known as prototype preference effect (PPE) or beauty-in-averageness effect is that prototypical exemplars of a neutral category are preferred over atypical exemplars. This PPE has been explained in terms of deviance avoidance, hedonic fluency, or preference for certainty and familiarity. However, typicality also facilitates greater activation of category-related information. Thus, prototypes rather than atypical exemplars should be more associated with the valence of the category, either positive or negative. Hence, we hypothesize that the evaluation of a prototype depends on the valence of its category. Results from three experiments crossing a standard PPE paradigm with an evaluative conditioning procedure support our hypothesis. We show that for positive categories, greater typicality increases liking. Critically, for negative categories, greater typicality decreases liking. This pattern of results challenges dominant explanations of prototype evaluation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Single-cycle, MHz repetition rate THz source with 66 mW of average power

We demonstrate terahertz (THz) generation using the tilted pulse front method in lithium niobate, driven at an unprecedented high average power of more than 100 W and at a 13.3 MHz repetition rate, provided by a compact amplifier-free mode-locked thin-disk oscillator. The conversion efficiency was optimized with respect to the pump spot size and pump pulse duration, enabling us to generate a maximum THz average power of 66 mW, which is, to the best of our knowledge, the highest reported to date from a laser-driven, few-cycle THz source. Furthermore, we identify beam walk-off as the main obstacle that currently limits the conversion efficiency in this excitation regime (with moderate pulse energies and small spot sizes). Further upscaling to the watt level and beyond is within reach, paving the way for linear and nonlinear high average power THz spectroscopy experiments with an exceptional signal-to-noise ratio at megahertz repetition rates.

Topochemical Fluorination of n = 2 Ruddlesden-Popper Type Sr3Ti2O7 to Sr3Ti2O5F4 and Its Reductive Defluorination

Within this study, we show that a sequence of substitutive topochemical fluorination of the n = 2 Ruddlesden-Popper type compounds Sr₃Ti₂O₇ to Sr₃Ti₂O₅F₄ followed by reductive topochemical defluorination reactions between the oxyfluoride and the reducing agent sodium hydride allows for a substantial reduction of the oxidation state of Ti due to selective extraction and hydride substitution of fluoride ions. The oxyfluoride Sr₃Ti₂O₅F₄ has been synthesized and characterized structurally for the first time. The defluorination experiments have been conducted at temperatures as low as 300 °C, enabling also the reduction of this metastable compound. The evolution of phase fractions and unit cell volumes of various reduced phases as well as of side products has been monitored by an X-ray diffraction study as a function of the amount of sodium hydride used. Strong structural changes within the reduced phases, involving considerable decreases in the c lattice parameters partly accompanied by symmetry, lowering have been observed. To gain a deeper understanding of the structural changes, selected reduction reaction products have been further investigated by coupled analysis of X-ray and neutron powder diffraction data. Moreover, changes in the oxidation state of Ti have been studied using magnetic measurements and X-ray photoelectron spectroscopy examining differences between the bulk and the surface properties. Additionally, similarities and differences between previously published results on the topochemical defluorination of the n = 1 Ruddlesden-Popper type compound Sr₂TiO₃F₂ are discussed.

Truth is in the mind, but beauty is in the eye: Fluency effects are moderated by a match between fluency source and judgment dimension

The eminent role of processing fluency in judgment and decision-making is undisputed. Not only is fluency affected by sources as diverse as stimulus repetition or visual clarity, but it also has an impact on outcomes as diverse as liking for a stimulus or the subjective validity of a statement. Although several studies indicate that sources and outcomes are widely interchangeable, recent research suggests that judgments are differentially affected by conceptual and perceptual fluency, with stronger effects of conceptual (vs. perceptual) fluency on judgments of truth. Here, we propose a fluency-specificity hypothesis according to which conceptual fluency is more informative for content-related judgments, but perceptual fluency is more informative for judgments related to perception. Two experimental studies in which perceptual and conceptual fluency were manipulated orthogonally show the superiority of content repetition on judgments of truth but the superiority of visual contrast on aesthetic evaluations. The theoretical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

State of the art review: oral and nasal vitamin B12 therapy in the elderly

The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by 'PubMed' and 'Scholar Google' search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the 'Cochrane Library' and the 'ISI Web of Knowledge'. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from 'CARE B12' research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

[Clinical semiology of anemia in patients over 75 years: a prospective study conducted in France by the SiFMI group]

INTRODUCTION

Anemia remains one of the main concerns of the day-today life of Internist since it ranks third among the pathologies seen in Internal Medicine Departments.

OBJECTIVE

it seemed appropriate for the SiFMI Group (Common Situations in Internal Medicine of the SNFMI) to carry out a study of anemia evaluating the contribution to the diagnosis of the «classical» semiology of the anemic syndrome. This work reports the results from the study of 204 patients aged 75 years and more.

METHOD

A prospective, non interventional multicenter study was carried out in Internal and Geriatric Departments in the period September 2015-September 2017. Clinical and biological variables were collected.

RESULTS

204 patients from 10 Internal or Geriatric Departments were included in the period September 2015-September 2017. They were assigned into two groups with and without anemia. According to this study, it seems that the following parameters : asthenia, dyspnea (NYHA stages III and IV), palpitations, chest pain, tachycardia, hypotension as well as confusion, falls, depression and MMSE showed no significant statistical difference between both groups in contrast to pallor, edema, albumin and ECG.

CONCLUSION

Clinical diagnosis of anemia in elderly individuals remains a challenge. It is difficult to establish a diagnostic protocol in this population.

Milliwatt-class broadband THz source driven by a 112 W, sub-100 fs thin-disk laser

We demonstrate a high repetition-rate, single-cycle THz source with a maximum average power of 1.35 mW, operating at a center frequency of 2 THz. This result was obtained by optical rectification (OR) in GaP using an amplifier-free, nonlinearly compressed modelocked thin-disk oscillator based on Yb:YAG, delivering 8.4 µJ pulses with 88 fs duration at a repetition rate of 13.4 MHz, resulting in driving pulses for OR with 112 W average power and 80 MW peak power. To the best of our knowledge, our result represents the highest average power so far achieved with OR in GaP. The demonstrated performance is very attractive for improving current linear THz time-domain spectroscopy experiments, which are currently restricted by low signal-to-noise ratio and long measurement times.

Plasma and serum brain-derived neurotrophic factor (BDNF) levels and their association with neurocognition in at-risk mental state, first episode psychosis and chronic schizophrenia patients

Objectives: Brain-derived neurotrophic factor (BDNF) is involved in numerous cognitive processes. Since cognitive deficits are a core feature of psychotic disorders, the investigation of BDNF levels in psychosis and their correlation with cognition has received increased attention. However, there are no studies investigating BDNF levels in individuals with an at-risk mental state (ARMS) for psychosis. Hence, the aims of the present study were: (1) assessing peripheral BDNF levels across different (potential) stages of psychosis; (2) investigating their association with cognition.Methods: Plasma and serum BDNF levels and neuropsychological performance were assessed in 16 ARMS, six first-episode psychosis (FEP), and 11 chronic schizophrenia (CS) patients. Neuropsychological assessment covered intelligence, verbal memory, working memory, attention and executive functioning.Results: Both plasma and serum BDNF levels were highest in CS, intermediate in FEP and lowest in ARMS. Multiple regression analysis revealed a significant positive association of plasma BDNF levels with planning ability across all groups.Conclusions: The lower peripheral BDNF levels in ARMS compared to FEP and CS might point towards an important drop of this neurotrophin prior to the onset of frank psychosis. The associations of peripheral BDNF with planning-abilities match previous findings.

The Origin of Illusory Correlations

If the distributions of two binary variables are skewed, people erroneously perceive a correlation even if the variables are actually uncorrelated. Specifically, people perceive a correlation between the variables' infrequent (vs. frequent) levels. While such systematic Illusory Correlations (ICs) can account for important phenomena, including erroneous stereotypes linking minority groups with infrequent attributes, the theoretical explanation is still a matter of debate. As proposed in the distinctiveness-based account, ICs arise due to a memory advantage for infrequent events. Alternatively, it has been proposed that ICs reflect ad hoc inferences from univariate base rates. In two experiments, we tested the accounts' predictions using a standard IC paradigm followed by (1) a contingency judgment task, asking participants to directly report contingencies, and (2) a trial-by-trial source assignment task of group membership and attribute. Bayesian-hierarchical model analysis revealed that ICs in contingency judgments were positively correlated to ad hoc inferences, but uncorrelated to exemplar memory in participants' source assignments. Moreover, inducing a focus on infrequent events improved memory for distinct events, but did not result in stronger ICs. Thus, our results support the explanation of ICs as ad hoc inferences from base rates, rather than a memory advantage for distinctive item combinations.

Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors

Court-mandated treatments imply a dual role for therapy providers not only of caring for, but also of having control over, involuntary clients. The impact of legal coercion on the therapeutic relationship and feelings of stigma is widely regarded as negative and detrimental for treatment outcomes. This point of view stands in contrast to advocates of the perspective that involuntary treatment can ameliorate social functioning and thus promote a better quality of life. Regarding other outcome measures, there is evidence that offender treatment is effective and leads to reduced recidivism in criminal behavior. This narrative review provides an overview of research assessing the effects of mandatory treatment on therapeutic process and outcome factors. We conclude that legal mandatory treatment does not have to necessarily result in perceived coercion and reduced satisfaction with treatment and that a caring and authoritative treatment style aids a favorable therapeutic alliance, motivation, and therapy outcomes.

[Model-based treatment in surgery]

BACKGROUND

The "magic triangle" in surgery and other disciplines consists of the demand for increasingly gentler forms of treatment, simultaneous cost reduction and the fundamental primacy of improving the quality of results. The digitalization of medicine offers a promising opportunity to do justice to this, also in the sense of "Surgery 4.0". The aim is to create a cognitive, collaborative diagnostics and treatment environment to support the surgeon.

METHODS

In the sense of a "theory building" for analysis and planning, process modeling is the cornerstone for modern treatment planning. The main distinction is made between the patient model and the treatment model. The course of the actual surgical treatment can also be modeled: in principle it is possible to describe the course of an operation in such fine detail that the surgical procedure can be mapped and reproduced down to each single step, such as a single implementation of forceps. Basically, this has already been achieved. So-called neural networks also open up completely new forms of knowledge acquisition, machine learning and flexible reaction to nearly all conceivable possibilities in highly complex processes.

CONCLUSION

"Digitalization" is a necessary development in surgery. It offers not only countless possibilities to support the surgeon in the field of activity but also the chance of more precise data acquisition with respect to academic surgery. Modeling is an indispensable part of this and must be rigorously implemented and further developed.

Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations

BACKGROUND

Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources.

METHODS

We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach.

RESULTS

While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers.

CONCLUSIONS

Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.

Recombinant Polypeptides Derived from the Fibrin Binding Domain of Fibronectin Are Potential Agents for the Imaging of Blood Clots

Thrombus formation in the circulation is accompanied by covalent linkage of fibronectin (FN) through transglutamination of glutamine no. 3 in the fibrin binding amino terminal domain (FBD) of FN. We have exploited this phenomenon for thrombus detection by the employment of radioactively-labelled recombinant polypeptide molecules derived from the 5-finger FBD of human FN. Three recombinant FBD polypeptides, 12 kDa (“2 fingers”), 18.5 kDa (“3 fingers”) and 31 kDa FBD (“5 fingers”), were prepared and compared to native FN-derived 31 kDa-FBD with respect to their ability to attach to fibrin clots in vitro and in vivo. The accessibility of Gln-3 in these molecules was demonstrated by the incorporation of stoichiometric amounts of 14C- putrescine in the presence of plasma transglutaminase. Competitive binding experiments to fibrin have indicated that, although the binding affinities of the FBD molecules are lower than that of FN, substantial covalent linkage was obtained in the presence of transglutaminase, and even in the presence of excess FN or heparin. The biological clearance rates of radioactively labelled FBD molecules in rats and rabbits were much higher than those of FN and fibrinogen, thus indicating their potential advantage for use as a diagnostic imaging tool. Of the three molecules, the 12 kDa FBD exhibited the highest rate of clearance. The potential of the 12 kDa and 31 kDa FBDs as imaging agents was examined in a stainless steel coil-induced thrombus model in rats and in a jugular vein thrombus model in rabbits, using either [125I] or [111ln]-labelled materials. At 24 h, clot-to-blood ratios ranged between 10 and 22 for [125I]-12 kDa FBD and 40 and 60 for [luIn]-12 kDa FBD. In the rat model, heparin did not inhibit the uptake of FBD. Taken together, the results indicate that recombinant 12 kDa FBD is a good candidate for the diagnosis of venous thrombosis.

Is Evaluative Conditioning Moderated by Big Five Personality Traits?

Evaluative conditioning (EC), a change in liking of a stimulus due to its paired presentation with a positive or negative stimulus, is a key concept in attitude formation. The present article examines to what extent EC effects are moderated by Big Five personality. For this purpose, 567 participants completed an EC procedure and the Big Five Inventory. People high on neuroticism and agreeableness showed stronger EC effects than people low on those personality traits. In conclusion, attitude formation via EC depends in part on Big Five personality. This novel insight has important ramifications for EC research and personality research. As to EC research, the moderation by neuroticism suggests that EC effects intensify with an increased focus on valent stimuli. As to personality research, our findings reinforce the fundamental nature of the Big Five because they are evidentially able to moderate such basic learning phenomena as EC.

Acid rain footprint three decades after peak deposition: Long-term recovery from pollutant sulphate in the Uhlirska catchment (Czech Republic)

The granitic Uhlirska headwater catchment with a size of 1.78km² is located in the Jizera Mountains in the northern Czech Republic and received among the highest inputs of anthropogenic acid depositions in Europe. An analysis of sulphate (SO₄^2-) distribution in deposition, soil water, stream water and groundwater compartments allowed to establish a SO₄^2- mass-balance (deposition input minus surface water export) and helped to evaluate which changes occurred since the last evaluation of the catchment in 1997. The determined SO₄^2- concentrations decreased in the following order: wetland groundwater>groundwater from 20m below ground level (bgl)>groundwater from 30m bgl>stream water>groundwater from10m bgl>hillslope soil water>wetland soil water>bulk deposition with median values of 0.24, 0.21, 0.17, 0.15, 0.11, 0.07, 0.03 and 0.01mmolL^-1, respectively. Our results show that average deposition reductions of 62% did not result in equal changes of the sulphate mass-balance, which changed by only 47%. This difference occurs because sulphate originates from internal sources such as the groundwater and soil water. The Uhlirska catchment is subject to delayed recovery from anthropogenic acid depositions and remains a net source of stored sulphur even after three decades of declining inputs. The wetland groundwater and soil water provide environmental memories of legacy pollutant sulphate. Elevated stream water sulphate concentrations after the unusually dry summer 2015 imply importance of weather and climate patterns for future recovery from acidification.

Category structure determines the relative attractiveness of global versus local averages

Stimuli that capture the central tendency of presented exemplars are often preferred-a phenomenon also known as the classic beauty-in-averageness effect. However, recent studies have shown that this effect can reverse under certain conditions. We propose that a key variable for such ugliness-in-averageness effects is the category structure of the presented exemplars. When exemplars cluster into multiple subcategories, the global average should no longer reflect the underlying stimulus distributions, and will thereby become unattractive. In contrast, the subcategory averages (i.e., local averages) should better reflect the stimulus distributions, and become more attractive. In 3 studies, we presented participants with dot patterns belonging to 2 different subcategories. Importantly, across studies, we also manipulated the distinctiveness of the subcategories. We found that participants preferred the local averages over the global average when they first learned to classify the patterns into 2 different subcategories in a contrastive categorization paradigm (Experiment 1). Moreover, participants still preferred local averages when first classifying patterns into a single category (Experiment 2) or when not classifying patterns at all during incidental learning (Experiment 3), as long as the subcategories were sufficiently distinct. Finally, as a proof-of-concept, we mapped our empirical results onto predictions generated by a well-known computational model of category learning (the Generalized Context Model [GCM]). Overall, our findings emphasize the key role of categorization for understanding the nature of preferences, including any effects that emerge from stimulus averaging. (PsycINFO Database Record