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Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p =.012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = −.738, p <.001) and in thoracic expansion (r =.544, p =.020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to understand intentions, sleep location preferences, and satisfaction with co‐sleeping (including bed‐sharing) arrangements in an internet‐based sample of self‐identified co‐sleeping parents. Background: Western‐centric ideologies favor independent, self‐regulated, and consolidated sleep. Safe‐sleep recommendations advise against all forms of parent–child bed‐sharing while promoting room‐sharing. Co‐sleeping including bed‐sharing and room‐sharing is widely practiced globally and rates continue to increase in Western countries. Yet perspectives of co‐sleeping parents remain under‐researched. Method: A cross‐sectional study design was used to understand co‐sleeping parents' (n = 3,146) intentions, preferences, and satisfaction with co‐sleeping (room‐sharing and bed‐sharing) choices through a survey. Results: Co‐sleeping practices were nuanced and varied with parents and children transitioning between sleep location and surfaces through the night. Although 64% of parents did not intend to co‐sleep before the birth of their child, 88% preferred the current co‐sleeping location, and 81% indicated satisfaction with it. Parental intention to co‐sleep (including bed‐share) was related to satisfaction with the arrangement. Parents who did not prefer any co‐sleeping arrangement at the current time were likely to be parenting older children. A thematic analysis yielded themes relating to the motivations underlying intent and preference, as well as reluctance and dissatisfaction with co‐sleeping arrangements. Conclusion: Co‐sleeping including bed‐sharing continues to be practiced by parents in Western countries. Despite a lack of intent to engage with co‐sleeping including bed‐sharing, the majority of the parents in this sample were bed‐sharing with their infants and young children. Parents choose to room‐share and bed‐share for a range of reasons. Implications: Parents voices highlight the need for safe co‐sleeping including bed‐sharing education. Considerations must be given to parents' perspectives in implementing nighttime infant care practices, including facilitating collaborative discussions with parents to assess and minimize potential risks associated with bed‐sharing. [ABSTRACT FROM AUTHOR]

COVID-19 presented a range of challenges to the delivery of school psychology services in countries around the world. The current study aimed to investigate the practices of school psychologists from the United States of America, Australia, Germany, Canada, and the United Kingdom, including changes to practice and exploration of the factors that supported the delivery of school psychology services during the pandemic. Quantitative and qualitative data were collected from 1,030 school psychologists and analyzed using a mixed methods, multiple case study design. Differing impacts of the pandemic on the working hours of school psychologists were reported across countries. Participants in all countries reported a shift to online working, with an increased focus on consultation and intervention and a reduction in psychoeducational assessments. School psychologists from all nations emphazised the importance of self-care strategies, social connections and physical activity and the role of support via supervision or professional networks. Access to appropriate technology and responsive workplace policies and procedures were also identified as important. Results have implications for the internationalization of the school psychology profession and can inform international school psychology planning in response to future crises. [ABSTRACT FROM AUTHOR]

Young people have emerged as one of the most impacted groups from the COVID-19 pandemic and related restrictions to daily activities, with disruptions to schooling, social interactions, and connections. Simultaneously, students' access to school mental health professionals were restricted or modified. The aim of this paper was to identify how school mental health professionals supported and addressed the mental health needs of young people during COVID-19 restrictions in Australia. School mental health professionals were surveyed during the 2020 lockdowns using a questionnaire designed by researchers in the United States of America. The innovations school mental health staff adopted to support students during lockdowns and remote learning were presented, including telehealth services, digital resources, and the online training and support they received/provided. The barriers and facilitators to providing counselling and assessment services during lockdowns were identified, including issues with providing psychometric assessments during remote learning, and ethical concerns when delivering remote counselling to students. Recommendations have been included, which address how school mental health professionals could be supported to assess and treat young people during future pandemics and school restrictions. [ABSTRACT FROM AUTHOR]

Schoolteacher and early childhood educator wellbeing is associated with their ability to provide high-quality educational experiences to students and children in their care. Given the importance of this topic, this systematic review sought to (1) identify available evidence-based wellbeing initiatives for educators and schoolteachers, (2) appraise the quality of evidence demonstrating the efficacy of these initiatives, and (3) summarise the characteristics of these initiatives. In total, 23 studies on 19 distinct initiatives were identified. Although most initiatives improved schoolteacher wellbeing, the quality of available evidence is modest, especially for early childhood educators. Existing teacher and educator wellbeing initiatives predominantly target individual and not systematic determinants of educator wellbeing, even though wellbeing of these groups is determined by a combination of personal and education setting influences. More research is needed to improve the evidence on teacher and early childhood educator wellbeing initiatives, as well as development of initiatives that aim to change workplace demands and education setting culture. [ABSTRACT FROM AUTHOR]

The challenges and changes driven by the Coronavirus Disease 2019 (COVID-19) pandemic in the education sector have been linked to high rates of anxiety, depression, and post-traumatic symptoms in school-aged populations. Despite this, it is also acknowledged that children and young people can be resilient and adaptable, with the right support in place. In schools, psychologists play an important role in supporting students' learning, behavior, wellbeing, and mental health. The aim of this study is to investigate the practices of Australian school psychologists during COVID-19 related school closures, focusing on their experiences and challenges and how they adapted their practices. Twelve Australian school psychologists were interviewed and, after member checks were undertaken, interview transcripts were analyzed using thematic analysis. Six interrelated themes were identified including: (a) heightened student psychological stress, (b) alternative delivery modes and associated challenges, (c) close collaboration with families, (d) participants personal challenges during COVID-19, (e) assessment during COVID-19, and (f) possible long-term practice changes post pandemic. The results of this study have implications for policies to support students in future pandemics or where physical school attendance is disrupted (e.g., natural disasters). [ABSTRACT FROM AUTHOR]

Identifying biological correlates of late life cognitive function is important if we are to ascertain biomarkers for, and develop treatments to help reduce, age-related cognitive decline. Here, we investigated the associations between plasma levels of 90 neurology-related proteins (Olink® Proteomics) and general fluid cognitive ability in the Lothian Birth Cohort 1936 (LBC1936, N = 798), Lothian Birth Cohort 1921 (LBC1921, N = 165), and the INTERVAL BioResource (N = 4451). In the LBC1936, 22 of the proteins were significantly associated with general fluid cognitive ability (β between −0.11 and −0.17). MRI-assessed total brain volume partially mediated the association between 10 of these proteins and general fluid cognitive ability. In an age-matched subsample of INTERVAL, effect sizes for the 22 proteins, although smaller, were all in the same direction as in LBC1936. Plasma levels of a number of neurology-related proteins are associated with general fluid cognitive ability in later life, mediated by brain volume in some cases. Late-life cognitive dysfunction is common, but the biological substrates are largely unknown. Here, the authors examined a panel of 90 neurology-related protein biomarkers and show that plasma levels of 22 of these proteins are associated with general fluid cognitive ability in later life. [ABSTRACT FROM AUTHOR]

Higher blood pressure, blood pressure variability, and leukoaraiosis are risk factors for early adverse events and poor functional outcome after ischemic stroke, but prior studies differed on whether leukoaraiosis was associated with blood pressure variability, including in ischemic stroke.In the Third International Stroke Trial, blood pressure was measured in the acute phase of ischemic stroke immediately prior to randomization, and at 0.5, 1, and 24 h after randomization. Masked neuroradiologists rated index infarct, leukoaraiosis, and atrophy on CT using validated methods. We characterized blood pressure variation by coefficient of variance and three other standard methods. We measured associations between blood pressure, blood pressure variability, and leukoaraiosis using generalized estimating equations, adjusting for age, and a number of covariates related to treatment and stroke type/severity.Among 3017 patients, mean (±SD) systolic and diastolic blood pressure decreased from 155(±24)/82(±15) mmHg pre-randomization to 146(±23)/78(±14) mmHg 24 h later (P < 0.005). Mean within-subject coefficient of variance was 0.09 ± 0.05 for systolic and 0.11 ± 0.06 for diastolic blood pressure. Patients with most leukoaraiosis were older and had higher blood pressure than those with least (P < 0.0001). Although statistically significant in simple pairwise comparisons, no measures of blood pressure variability were associated with leukoaraiosis when adjusting for confounding variables (P > 0.05), e.g. age.Our results suggest that blood pressure variability is not a potential mechanism to explain the association between leukoaraiosis and poor outcome after acute stroke. [ABSTRACT FROM AUTHOR]

Adaptive behaviour has been viewed broadly as an individual's ability to meet the standards of social responsibilities and independence; however, this definition has been a source of debate amongst researchers and clinicians. Based on the rich history and the importance of the construct of adaptive behaviour, the current study aimed to provide a comprehensive overview of the application of adaptive behaviour models to assessment tools, through a systematic review. A plethora of assessment measures for adaptive behaviour have been developed in order to adequately assess the construct; however, it appears that the only definition on which authors seem to agree is that adaptive behaviour is what adaptive behaviour scales measure. The importance of the construct for diagnosis, intervention and planning has been highlighted throughout the literature. It is recommended that researchers and clinicians critically review what measures of adaptive behaviour they are utilising and it is suggested that the definition and theory is revisited. [ABSTRACT FROM AUTHOR]

Purpose: Quantitative assessment of white matter hyperintensities (WMH) on structural Magnetic Resonance Imaging (MRI) is challenging. It is important to harmonise results from different software tools considering not only the volume but also the signal intensity. Here we propose and evaluate a metric of white matter (WM) damage that addresses this need. Methods: We obtained WMH and normal-appearing white matter (NAWM) volumes from brain structural MRI from community dwelling older individuals and stroke patients enrolled in three different studies, using two automatic methods followed by manual editing by two to four observers blind to each other. We calculated the average intensity values on brain structural fluid-attenuation inversion recovery (FLAIR) MRI for the NAWM and WMH. The white matter damage metric is calculated as the proportion of WMH in brain tissue weighted by the relative image contrast of the WMH-to-NAWM. The new metric was evaluated using tissue microstructure parameters and visual ratings of small vessel disease burden and WMH: Fazekas score for WMH burden and Prins scale for WMH change. Results: The correlation between the WM damage metric and the visual rating scores (Spearman ρ > =0.74, p < 0.0001) was slightly stronger than between the latter and WMH volumes (Spearman ρ > =0.72, p < 0.0001). The repeatability of the WM damage metric was better than WM volume (average median difference between measurements 3.26% (IQR 2.76%) and 5.88% (IQR 5.32%) respectively). The follow-up WM damage was highly related to total Prins score even when adjusted for baseline WM damage (ANCOVA, p < 0.0001), which was not always the case for WMH volume, as total Prins was highly associated with the change in the intense WMH volume ( p = 0.0079, increase of 4.42 ml per unit change in total Prins, 95%CI [1.17 7.67]), but not with the change in less-intense, subtle WMH, which determined the volumetric change. Conclusion: The new metric is practical and simple to calculate. It is robust to variations in image processing methods and scanning protocols, and sensitive to subtle and severe white matter damage. [ABSTRACT FROM AUTHOR]

Although women have made progress in entering scientific careers in biology, they remain underrepresented in mathematically intensive fields such as physics. We investigated whether gender differences in mathematics motivation and socialisers' perceptions impacted choices for diverse STEM careers of varying mathematical intensity. Drawing on expectancy-value theory, we tested structural equation models in which adolescents' preferred careers related to each of physics, biology, chemistry, and mathematics were predicted by prior mathematical performance, motivations, and mothers' perceptions. We explored potential differences in gendered processes of influence using multigroup models. Samples were 331 Australian adolescents followed from 9th to 11th grade in 1998 and 277 U.S. adolescents from 9th to 12th grade in 2009-10. In both samples female adolescents preferred biological careers more than males did; male adolescents preferred physics-related careers and also mathematical careers in the Australian sample. Mothers' perceptions were important to female and male adolescents' mathematics motivations; gendered motivations were more evident in the Australian sample. Mathematics interest played the strongest role in male adolescents' preferred careers, whereas actual or perceived mathematical achievements were most important for females, demonstrating the impacts of mathematical motivations on preferences for diverse STEM careers. [ABSTRACT FROM AUTHOR]

Objective Telepsychology has the potential to revolutionise the provision of psychological service not only to those in remote locations, or with mobility issues, but also for those who prefer flexible access to services. Rapid developments in internet communications technology have yielded new and diverse methods of telepsychology. As a result, ethical regulatory and advisory guidelines for practice have often been developed and disseminated reactively. This article investigates how the core ethical principles of confidentially, consent and competence are challenged in telepsychological practice. Method Through the application of existing ethical standards, advances in communications technology are considered and their ethical use in psychological contexts explored. Conclusion It is expected that psychologists will have basic competencies for the use of everyday technology in their practice. However, the use of internet communications technology for telepsychology has created new opportunities and challenges for ethical practice. For example, telepsychology is geographically flexible, but there can be privacy concerns in cross-border information flow. Psychologists who engage in telepsychology require a particularly thorough understanding of concepts such as data mining, electronic storage, and internet infrastructure. This article highlights how existing technology and communication tools both challenge and support ethical practice in telepsychology in an Australian regulatory context. [ABSTRACT FROM AUTHOR]

Synesthesia is an inherited condition causing unusual secondary sensations (e.g, sounds might be experienced as both auditory and visual percepts). The condition has been linked with cognitive and perceptual benefits and is considered a benign alternative form of perception. Here, we investigate self-referred synesthete populations and their rates of radiologically determined white matter hyperintensities (WMH) of a type compatible with the McDonald imaging criteria for the diagnosis of multiple sclerosis (MS). MS is a chronic condition resulting in damage to myelination surrounding nerve fibers of the central nervous system (CNS). Magnetic resonance imaging (MRI) features highly suggestive of MS without overt clinical symptoms are termedradiologically isolated syndrome(RIS). We present data showing that the shared MRI profile of MS and RIS has been significantly overrepresented in synesthetes who have participated in neuroimaging research. We present validation of the clinical and MRI status of these synesthetes and an analysis showing the significant probability their unusual numbers may not have arisen by chance. We discuss how to interpret significant data based on small case numbers and consider the implications of our findings for synesthesia’s clinical status. [ABSTRACT FROM AUTHOR]

Background: Perivascular spaces (PVS) are an important component of cerebral small vessel disease (SVD), several inflammatory disorders, hypertension and blood-brain barrier breakdown, but are difficult to quantify. A recent international collaboration of SVD experts has highlighted the need for a robust, easy-to-use PVS rating scale for the effective investigation of the diagnostic and prognostic significance of PVS. The purpose of the current study was to develop and extend existing PVS scales to provide a more comprehensive scale for the measurement of PVS in the basal ganglia, centrum semiovale and midbrain, and to test its intra- and inter-rater agreement, assessing reasons for discrepancy. Methods: We reviewed previously published PVS scales, including site of PVS assessed, rating method, and size and morphological criteria. Retaining key features, we devised a more comprehensive scale in order to improve the reliability of PVS rating. Two neuroradiologists tested the new scale in MRI brain scans of 60 patients from two studies (stroke, ageing population), chosen to represent a full range of PVS, and demonstrating concomitant features of SVD such as lacunes and white matter hyperintensities. We rated basal ganglia, centrum semiovale, and midbrain PVS. Basal ganglia and centrum semiovale PVS were rated 0 (none), 1 (1-10), 2 (11-20), 3 (21-40) and 4 (>40), and midbrain PVS were rated 0 (none visible) or 1 (visible). We calculated kappa statistics for rating, assessed consistency in use of PVS categories (Bhapkar test) and reviewed sources of discrepancy. Results: Intra- and inter-rater kappa statistics were highest for basal ganglia PVS (range 0.76-0.87 and 0.8-0.9, respectively) than for centrum semiovale PVS (range 0.68-0.75 and 0.61-0.8, respectively) or midbrain PVS (inter-rater range 0.51-0.52). Inter-rater consistency was better for basal ganglia compared to centrum semiovale PVS (Bhapkar statistic 2.49-3.72, compared to 6.79-21.08, respectively). Most inter-rater disagreements were due to very faint PVS, coexisting extensive white matter hyperintensities (WMH) or the presence of lacunes. Conclusions: We developed a more inclusive and robust visual PVS rating scale allowing rating of all grades of PVS severity on structural brain imaging. The revised PVS rating scale has good observer reliability for basal ganglia and centrum semiovale PVS, best for basal ganglia PVS, and moderate reliability for midbrain PVS. Agreement is influenced by PVS severity and the presence of background features of SVD. The current scale can be used in further studies to assess the clinical implications of PVS. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: Incidental findings in neuroimaging occur in 3% of volunteers. Most data come from young subjects. Data on their occurrence in older subjects and their medical, lifestyle and financial consequences are lacking. We determined the prevalence and medical consequences of incidental findings found in community-dwelling older subjects on brain magnetic resonance imaging. Design: Prospective cohort observational study. Setting: Single centre study with input from secondary care. Participants: Lothian Birth Cohort 1936, a study of cognitive ageing. Main Outcome Measures: Incidental findings identified by two consultant neuroradiologists on structural brain magnetic resonance imaging at age 73 years; resulting medical referrals and interventions. Primary and Secondary Outcome Measures: Prevalence of incidental findings by individual categories: neoplasms, cysts, vascular lesions, developmental, ear, nose or throat anomalies, by intra- and extracranial location; visual rating of white matter hyperintensities and brain atrophy. Results: There were 281 incidental findings in 223 (32%) of 700 subjects, including 14 intra- or extracranial neoplasms (2%), 15 intracranial vascular anomalies (2%), and 137 infarcts or haemorrhages (20%). Additionally, 153 had moderate/severe deep white matter hyperintensities (22%) and 176 had cerebral atrophy at, or above, the upper limit of normal (25%) compared with a normative population template. The incidental findings were unrelated to white matter hyperintensities or atrophy; about a third of subjects had both incidental findings and moderate or severe WMH and a quarter had incidental findings and atrophy. The incidental findings resulted in one urgent and nine non-urgent referrals for further medical assessment, but ultimately in no new treatments. Conclusions: In community-dwelling older subjects, incidental findings, including white matter hyperintensities and atrophy, were common. However, many findings were not of medical importance and, in this age group, most did not result in further assessment and none in change of treatment. [ABSTRACT FROM AUTHOR]

Objective: Cerebral atrophy and white matter lesions (WMLs) are common in older people with common risk factors, but it is unclear if they are related. We investigated whether and to what degree they are related in deep and superficial structures using both volumetric and visual ratings. Methods: The intracranial, total brain tissue (TBV), cerebrospinal fluid (CSF), ventricular superficial subarachnoid space (SSS), grey matter, normal-appearing white matter, WMLs, and combined CSF, venous sinuses and dural volumes were measured. WMLs were also rated using the Fazekas scale. Results: Amongst 672 adults (mean age 73 ± 1 years), WMLs were associated with global brain atrophy (TBV, β = −0.43 mm, P < 0.01) and specifically with deep (ventricular enlargement, β = 0.10 mm, P = 0.03) rather than superficial (SSS, β = 0.09 mm, P = 0.55) atrophy. A 1 mm increase in WML volume was associated with a 0.43 mm decrease in TBV and 0.10 mm increase in ventricular volume. WMLs were associated with combined CSF + Venous Sinuses + Meninges volumes, but not CSF volume alone. Some of the associations were attenuated after correcting for vascular risk factors. The associations were similar for visually scored WMLs. Conclusion: WMLs are associated with brain atrophy, primarily with deep brain structures. Measures of brain atrophy should include all intracranial structures when assessing brain shrinkage. Key Points: • Increasing age- related white matter lesions ( WML) are modestly associated with brain atrophy. • Most associated atrophy affects deep structures ( white matter, basal ganglia, etc.). • This is true whether WMLs are assessed volumetrically or visually scored. • Precise evaluation of brain atrophy requires assessment of all intracranial tissues. [ABSTRACT FROM AUTHOR]

Bockground: White matter lesions (WML) increase with age and are associated with stroke, cognitive decline and dementia. They can be visually rated or computationally assessed. Methods: We compared WML Fazekas visual rating scores and volumes, determined using a validated multi-spectral image-fusion technique, in Magnetic Resonance Imaging from 672 participants of the Lothian Birth Cohort 1936 and sought explanations for subjects in whom the correlation (Spearman's p) between the total Fazekas score (summed deep and periventricular ratings, 0-6) and WML volume did not concur (z-score difference >1). Infarcts were identified separately. Results: The median WML Faz score was 2 [inter-quartile range (IQR): 2], median WML vol ume 7.7 ml (IQR: 13.6 ml) and median infarct volume (n = 95) 0.98 ml. Score and volume were highly correlated (Spearman's p = 0.78, p < 0.001). Infarcts did not alter the correlatetion. Minor discordance occurred in 94/672 (14%) subjects, most with total Fazekas score of 1 (n = 20, WML volume =4.5-14.8 ml) or 2 (n = 50, WML volume = 0.1-34.4 ml). The main reasons were: subtle WML identified visually but omitted from the volume; prominent ventricular caps but thin body lining giving a periventricular score of 1/2 but large WML volume, and small deep focal lesions which increase the score disproportionally when beginning to coalesce with little change in WML volume. Conclusions: WML rating scores and volumes provide near-equivalent estimates of WML burden, therefore either can be used depending on research circumstances. Even closer agreement could result--from improved computational detection of subtle WML and modified visual ratings to differentiate prominent ventricular caps from thin periventricular linings, and small non-co-alescent from early coalescent deep WML. [ABSTRACT FROM AUTHOR]

Background: White matter lesions (WML) increase with age and are associated with stroke, cognitive decline and dementia. They can be visually rated or computationally assessed. Methods: We compared WML Fazekas visual rating scores and volumes, determined using a validated multispectral image-fusion technique, in Magnetic Resonance Imaging from 672 participants of the Lothian Birth Cohort 1936 and sought explanations for subjects in whom the correlation (Spearman's ρ) between the total Fazekas score (summed deep and periventricular ratings, 0-6) and WML volume did not concur (z-score difference >1). Infarcts were identified separately. Results: The median WML Fazekas score was 2 [inter-quartile range (IQR): 2], median WML volume 7.7 ml (IQR: 13.6 ml) and median infarct volume (n = 95) 0.98 ml. Score and volume were highly correlated (Spearman's ρ = 0.78, p < 0.001). Infarcts did not alter the correlation. Minor discordance occurred in 94/672 (14%) subjects, most with total Fazekas score of 1 (n = 20, WML volume = 4.5-14.8 ml) or 2 (n = 50, WML volume = 0.1-34.4 ml). The main reasons were: subtle WML identified visually but omitted from the volume; prominent ventricular caps but thin body lining giving a periventricular score of 1/2 but large WML volume, and small deep focal lesions which increase the score disproportionally when beginning to coalesce with little change in WML volume. Conclusions: WML rating scores and volumes provide near-equivalent estimates of WML burden, therefore either can be used depending on research circumstances. Even closer agreement could result from improved computational detection of subtle WML and modified visual ratings to differentiate prominent ventricular caps from thin periventricular linings, and small non-coalescent from early coalescent deep WML. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Acute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases. Methods: We searched EMBASE and Medline databases for papers reporting imaging in adults with symptomatic hypoglycaemia. We analysed the clinical presentation, outcome, brain imaging findings, duration and severity of hypoglycaemia, time course of lesion appearance, including two new cases. Results: We found 42 papers describing computed tomography or magnetic resonance imaging in 65 patients, plus our two cases with symptomatic hypoglycaemia. Imaging abnormalities on computed tomography and magnetic resonance were uni or bilateral, cortical or sub-cortical. Thirteen (20%) mimicked cortical or lacunar stroke. Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. The association between the depth or duration of hypoglycaemia, the severity or extent of neurological deficit, and the imaging abnormalities, was weak. Conclusion: Imaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. Blood glucose testing should be routine in all patients with acute neurological impairment and hypoglycaemia should be included in the differential diagnosis of imaging appearances in patients presenting with acute stroke. [ABSTRACT FROM AUTHOR]

Rationale As the population of the world ages, age-related cognitive decline is becoming an ever-increasing problem. However, the changes in brain structure that accompany normal aging, and the role they play in cognitive decline, remain to be fully elucidated. Aims This study aims to characterize changes in brain structure in old age, and to investigate relationships between brain aging and cognitive decline using the Lothian Birth Cohort 1936. Here, we report the rationale, design and methodology of the brain and neurovascular imaging protocol developed to study this cohort. Design An observational, longitudinal study of the Lothian Birth Cohort 1936, which comprises 1091 relatively healthy individuals now in their 70s and living in the Edinburgh area. They are surviving participants of the Scottish Mental Survey 1947, which involved a test of general intelligence taken at age 11 years. At age 70 years, the Lothian Birth Cohort 1936 undertook detailed cognitive, medical and genetic testing, and provided social, family, nutritional, quality of life and physical activity information. At mean age 73 years they underwent detailed brain MRI and neurovascular ultrasound imaging, repeat cognitive and other testing. The MRI protocol is designed to provide qualitative and quantitative measures of gray and white matter atrophy, severity and location of white matter lesions, enlarged perivascular spaces, brain mineral deposits, microbleeds and integrity of major white matter tracts. The neurovascular ultrasound imaging provides velocity, stenosis and intima-media thickness measurements of the carotid and vertebral arteries. Study This valuable imaging dataset will be used to determine which changes in brain structural parameters have the largest effects on cognitive aging. Analysis will include multimodal image analysis and multivariate techniques, such as factor analysis and structural equation modelling. Especially valuable is the ability within this sample to examine the influence that early life intelligence has on brain structural parameters in old age, and the role of genetic, vascular, educational and lifestyle factors. Outcomes Final outcomes include associations between early and late life cognition and integrity of key white matter tracts, volume of gray and white matter, myelination, brain water content, and visible abnormalities such as white matter lesions and mineral deposits; and influences of vascular risk factors, diet, environment, social metrics, education and genetics on healthy brain aging. It is intended that this information will help to inform and develop strategies for successful cognitive aging. [ABSTRACT FROM AUTHOR]

Background: There is an increasing recognition that modelling and simulation can assist in the process of designing health care policies, strategies and operations. However, the current use is limited and answers to questions such as what methods to use and when remain somewhat underdeveloped. Aim: The aim of this study is to provide a mechanism for decision makers in health services planning and management to compare a broad range of modelling and simulation methods so that they can better select and use them or better commission relevant modelling and simulation work. Methods: This paper proposes a modelling and simulation method comparison and selection tool developed from a comprehensive literature review, the research team's extensive expertise and inputs from potential users. Twenty-eight different methods were identified, characterised by their relevance to different application areas, project life cycle stages, types of output and levels of insight, and four input resources required (time, money, knowledge and data). Results: The characterisation is presented in matrix forms to allow quick comparison and selection. This paper also highlights significant knowledge gaps in the existing literature when assessing the applicability of particular approaches to health services management, where modelling and simulation skills are scarce let alone money and time. Conclusions: A modelling and simulation method comparison and selection tool is developed to assist with the selection of methods appropriate to supporting specific decision making processes. In particular it addresses the issue of which method is most appropriate to which specific health services management problem, what the user might expect to be obtained from the method, and what is required to use the method. In summary, we believe the tool adds value to the scarce existing literature on methods comparison and selection. [ABSTRACT FROM AUTHOR]

Objective To quantify the prevalence of incidental findings on magnetic resonance imaging (MRI) of the brain. Design Systematic review and meta-analysis of observational studies. Data sources Ovid Medline (1950 to May 2008), Embase (1980 to May 2008), and bibliographies of relevant articles. Review methods Two reviewers sought and assessed studies of people without neurological symptoms who underwent MRI of the brain with or without intravenous contrast for research purposes or for occupational, clinical, or commercial screening. Main outcome measures Overall disease specific and age specific prevalence of incidental brain findings, calculated by rneta-analysis of pooled proportions using DerSimonian-Laird weights in a random effects model. Results In 16 studies, 135 of 19 559 people had neoplastic incidental brain findings (prevalence 0.70%, 95% confidence interval 0.47% to 0.98%), and prevalence increased with age (χ² for linear trend, P=0.003). In 15 studies, 375 of 15 559 people had non-neoplastic incidental brain findings (prevalence 2.0%, 1.1% to 3.1%, excluding white matter hyperintensities, silent infarcts, and microbleeds). The number of asymptomatic people needed to scan to detect any incidental brain finding was 37. The prevalence of incidental brain findings was higher in studies using high resolution MRI sequences than in those using standard resolution sequences (4.3% v 1.7%, P<0.001). The prevalence of neoplastic incidental brain findings increased with age. Conclusions Incidental findings on brain MRI are common, prevalence increases with age, and detection is more likely using high resolution MRI sequences than standard resolution sequences. These findings deserve to be mentioned when obtaining informed consent for brain MRI in research and clinical practice but are not sufficient to justify screening healthy asymptomatic people. [ABSTRACT FROM AUTHOR]

Using a tripartite relational (R), individual (I) and collective (C) framework, three studies explored the health benefits of self-coping complexity (SCC). Study 1 ( N = 333) developed and validated RIC coping scales. Study 2 ( N = 346) identified two clusters of Australians, those with an expansive pattern of multiple self-aspects and coping styles, and those with a more restricted self-coping pattern. Both clusters reported similar stress, but the expansive high SCC cluster reported greater well-being. A culturally diverse sample ( N = 225) in Study 3 yielded the expected high SCC RIC self-coping cluster, plus interdependent RC and independent I clusters. Cluster membership was not associated with culture or gender in these studies, but greater SCC did confer a health advantage to men and women from both Eastern and Western cultures. [ABSTRACT FROM AUTHOR]

Gait and balance impairment is highly prevalent in older people. We aimed to assess whether and how single markers of small vessel disease (SVD) or a combination thereof explain gait and balance function in the elderly. We analysed 678 community-dwelling healthy subjects from the Lothian Birth Cohort 1936 at the age of 71-74 years who had undergone comprehensive risk factor assessment, gait and balance assessment as well as brain MRI. We investigated the impact of individual SVD markers (white matter hyperintensity - WMH, microbleeds, lacunes, enlarged perivascular spaces, brain atrophy) as seen on structural brain MRI and of a global SVD score on the patients' performance. A regression model revealed that age, sex, and hypertension significantly explained gait speed. Among SVD markers white matter hyperintensity (WMH) score or volume were additional significant and independent predictors of gait speed in the regression model. A similar association was seen with the global SVD score. Our study confirms a negative impact of SVD-related morphologic brain changes on gait speed in addition to age, sex and hypertension independent from brain atrophy. The presence of WMH seems to be the major driving force for SVD on gait impairment in healthy elderly subjects. [ABSTRACT FROM AUTHOR]

The author discusses the increase of the elderly population, and its affect on health care. The author says that there are two theories on how aging will affect health in the future: people will live longer with fewer years of disability or there will be a marked increase in chronic managed health conditions. The author discusses the future increase in need for health care personnel.

Background: Acute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases.Methods: We searched EMBASE and Medline databases for papers reporting imaging in adults with symptomatic hypoglycaemia. We analysed the clinical presentation, outcome, brain imaging findings, duration and severity of hypoglycaemia, time course of lesion appearance, including two new cases.Results: We found 42 papers describing computed tomography or magnetic resonance imaging in 65 patients, plus our two cases with symptomatic hypoglycaemia. Imaging abnormalities on computed tomography and magnetic resonance were uni or bilateral, cortical or sub-cortical. Thirteen (20%) mimicked cortical or lacunar stroke. Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. The association between the depth or duration of hypoglycaemia, the severity or extent of neurological deficit, and the imaging abnormalities, was weak.Conclusion: Imaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. Blood glucose testing should be routine in all patients with acute neurological impairment and hypoglycaemia should be included in the differential diagnosis of imaging appearances in patients presenting with acute stroke. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of size, site, and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children. Design: Observational study. Methodology: Children aged 5–18 years who identified as ATSI at seven Anangu community schools within the Anangu Pitjantjatjara Yankunytjatjara Lands and Maralinga Lands of South Australia underwent 4‐frequency pure‐tone audiometry (0.5, 1, 2, and 4 kHz) and video‐otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25%–50%, 50%–75%, or 75%–100%). Results: Five hundred seventy‐five VO files with matching audiological data were obtained. Active perforations (35 dBHL; 28–44 IQR) demonstrated greater HL than inactive perforations (31 dBHL; 29–39 IQR) p =.0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p <.0001) whereas for active perforations the significance changed to between <25% (p <.0001) and 25%–50% (p <.05) when compared to larger perforations. When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses, findings did not change when individual frequencies were compared to 4‐frequency pure‐tone average dBHL. Conclusion: In ATSI children from remote communities, HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

Firearm injuries are a leading cause of injury-related deaths in the U.S., but there is a dearth of federal funding for research on firearm injury prevention, compared to funding for research on other injuries and diseases. University research centers/institutes (C/Is) are in a position to help generate such research: they are multidisciplinary, have the capacity to conduct large-scale research projects, and commonly address complex health and social problems. In this article, we trace the history of research on firearm injury prevention, describe the different kinds of C/Is and C/I networks that have been developed to build knowledge in other areas of critical social concern, and argue for the development of a national coordinated network of firearm injury prevention C/Is. [ABSTRACT FROM AUTHOR]

Pollen records and macrobotanical remains indicate maize was grown minimally during the Middle Woodland (200 BCE - CE 500) in eastern North America. However, previous isotopic studies have found limited evidence of its consumption by people in archaeobotanical assemblages. Hypothetically, if deer (Odocoileus virginianus Zimmermann) were feeding on maize (Zea mays L.) in gardens prior to its adoption as a human dietary staple, this may indicate a niche construction process which would later lead to shifts in hunting strategies. This construction of garden spaces or niches has implications for decreased mobility and greater investment in garden crops. To evaluate this hypothesis in the Ohio River Valley, we measured stable nitrogen (δ15N) and carbon (δ13C) isotope compositions of bulk collagen in deer bones (N = 25) from archaeological sites spanning the Middle Woodland (200 BCE - CE 400/500) to Late Precontact (CE 1400-1630). Our hypothesis was not confirmed: little (one deer of 19) evidence for maize consumption occurred in the analyzed deer remains. Five deer of 19 did indicate the possibility of feeding in deeply wooded areas, reflecting canopy effect. Dog (Canis lupus familiaris L.) bone samples (N = 2) were also analyzed for these isotopes and one indicates some consumption of maize. [ABSTRACT FROM AUTHOR]

For a searchable version of these abstracts, please visit www.acrabstracts.org. [ABSTRACT FROM AUTHOR]

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In this article we present a case study on the contextualization of the CONDUCTOR metaphor in the most important discourse types of endocrinology. We examine the dynamic character of metaphor variation by detailing the usage of this specific metaphor by means of which the pituitary is conceptualized as the leader and conductor of the endocrine orchestra. It alternates with a structurally less rich metaphor which conceptualizes the pituitary as a part of an axis. The two metaphors are in a sort of complementary distribution along two dimensions: across time, i.e. diachronically, as well as across the social dimension. What is more, their distribution apparently challenges the established wisdom about the unidirectional process of the conventionalization of metaphors. The CONDUCTOR metaphor, being replaced by the AXIS metaphor in the scientific medical discourse, now seems to be fairly stable in non-scientific medical discourse (i.e. in the communication between health practitioners and patients, or between patients). However, an interesting twist can be observed, the CONDUCTOR metaphor recently making an unexpected comeback into the scientific discourse. [ABSTRACT FROM AUTHOR]

Background: To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients.Methods: A retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI).Results: A total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P<0.001). Reverse-dipper pattern (RD) and non-dipper pattern (ND) were found to be independent risk factors for ACI. In ACI patients, both RD and ND BP circadian rhythms were revealed to be independent risk factors for moderate-severe leukoaraiosis. In addition, in SCI patients, RD (OR = 1.7, 95% CI, 0.9-3.0; P = 0.047) or extreme-dipper pattern (ED) (OR = 2.9, 95% CI, 1.2-7.0; P = 0.015) were found to be independent risk factors for moderate-severe leukoaraiosis. Moreover, the greater the severity of leukoaraiosis was, the higher the ratio of abnormal BP circadian rhythms.Conclusion: RD and ND BP circadian rhythms might not only be relevant to the onset of ACI but also correlate with the severity of leukoaraiosis. Thus, when modulating BP with antihypertensive drugs, the BP circadian rhythms, and not merely the BP level, should warrant more attention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the atherosclerosis (AS), inflammatory factor level, cognitive disorder and vascular endothelial functions in patients with different grades of leukoaraiosis (LA), and to explore the correlations of different grades of LA with cognitive disorder. METHODS: A total of 180 patients with cerebral infarction admitted and treated in the Department of Neurology of our hospital were selected, and they were graded according to the Tarvonen-shcolder standard, with 45 patients in each group. The atherosclerotic plaques of the patients were detected via a color Doppler ultrasound system and magnetic resonance imaging (MRI). Their inflammatory factor levels were determined using enzyme-linked immunosorbent assay (ELISA). The cognitive function was scored based on the mini-mental state examination (MMSE), and the levels of malondialdehyde (MDA), superoxide dismutase (SOD), endothelin (ET) and nitric oxide (NO) were measured to evaluate vascular endothelial functions. RESULTS: According to the comparisons among four groups of the patients, the incidence rate of AS was gradually increased among patients with different grades of LA (p < 0.05). With the aggravation of LA, the levels of inflammatory factors in patients were obviously increased (p < 0.05). LA patients had evidently lowered MMSE scores and levels of SOD and NO, but notably raised inflammatory factors C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9) and vascular endothelial function indices MDA and ET (p < 0.05). CONCLUSION: The occurrence of LA is implicated with the increasing levels of inflammatory factors in the patients, aggregation of cognitive dysfunction and impairment vascular endothelial functions. [ABSTRACT FROM AUTHOR]

Thank you to all the reviewers who have contributed to I Behavioural and Cognitive Psychotherapy i during 2019 and 2020. Your expert opinion has been very much appreciated. [Extracted from the article]