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Introduction: Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment., Methods: This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses., Results: The mean age of the 298 patients included was 83.5 years  ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases., Discussion: The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.

Intense blooms of the toxic dinoflagellate Ostreopsis have been a recurrent phenomenon along several Mediterranean coasts. Blooms have been associated with noxious effects on human health and mortality of marine organisms, due to the production of palytoxin-like compounds. We analyzed the toxin concentrations throughout an O. cf. ovata bloom to highlight their relationships with environmental parameters in the Conero Riviera, northern Adriatic Sea. High temperature and balanced nutrient conditions were the optimal environmental conditions to start and sustain blooms as well as to maximize toxin production. Ostreopsis showed a gradual decrease of toxin content throughout the bloom ascribed to the occurring of the same non-optimal conditions that led to the bloom decline. Moreover, our results suggest that toxin fraction released during bloom could be higher than that released in batch culture. Results from this study pointed out that the first bloom phase is potentially the most dangerous to human health., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The production of polyunsaturated aldehydes (PUAs) has been reported by many planktonic diatoms, where they have been implicated in deleterious effects on copepod reproduction and growth of closeby microbes or suggested as infochemicals in shaping plankton interactions. This study investigates the production of PUAs by diatoms commonly occurring in the microphytobenthic communities in temperate regions: Tabularia affinis, Proschkinia complanatoides and Navicula sp. Results highlight the production of PUAs by the three benthic diatoms during stationary and decline phases, with intracellular concentrations from 1.8 to 154.4 fmol cell -1 , which are within the range observed for planktonic species. The existence of a large family of PUAs, including some with four unsaturations, such as decatetraenal, undecatetraenal and tridecatetraenal, was observed. Since particulate and dissolved PUAs were positively correlated, together with cell lysis, equivalent concentrations may be released during late growth stages, which may affect benthic invertebrates grazing on them and other microalgae., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Ostreopsis blooms regularly occur in many Mediterranean coastal areas in late summer-autumn. In the northern Adriatic Sea, Ostreopsis blooms affect diatom-dominated microphytobenthic communities. In this study, the effects of the filtrates of some diatom species, both benthic (Tabularia affinis, Proschkinia complanatoides and Navicula sp.) and planktonic (Thalassiosira sp. and Skeletonema marinoi) on cell morphology, cytological features and growth of O. cf. ovata were investigated. Our results showed a marked decrease of O. cf. ovata growth when cells were exposed to all diatom filtrates tested. The highest inhibitions were observed for exposures to P. complanatoides and Navicula sp. filtrates (92.5% and 80%, respectively) and increased with the age of diatom culture. Moreover, a clear DNA degradation and abnormal forms of O. cf. ovata cells (83.8% of the total) were found at the highest concentrations using Navicula sp. filtrate after 10 days of the inoculum., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Diatoms have been shown to produce and release a wide range of secondary metabolites that mediate interactions between individuals of different species. Among these compounds, different types of fatty acid derived long-chained polyunsaturated aldehydes (PUAs) have been related to multiple functions such as intra- or interspecific signals and adverse effect on the reproduction of marine organisms. Several studies have reported changes on growth, cell membrane permeability, flow cytometric properties and cell morphology in phytoplankton organisms exposed to PUAs, but little information is available on the effect of these compounds on benthic microalgae. Ostreopsis cf. ovata is a toxic benthic dinoflagellate which causes massive blooms along the Mediterranean coasts typically during the late summer period. In this study the effects of three toxic PUAs known to be produced by several algae (2E,4E-decadienal, 2E,4E-octadienal and 2E,4E-heptadienal) on the growth, cytological features and cell morphology of O. cf. ovata were investigated. Our results show a clear decrease of O. cf. ovata growth with longer-chain molecules than with shorter-chain ones, confirmed also by EC50 values calculated at 48h for 2E,4E-decadienal and 2E,4E-octadienal (6.6±1.5, 17.9±2.6μmolL(-1) respectively) and at 72h for 2E,4E-heptadienal (18.4±0.7μmolL(-1)). Moreover, morphological analysis highlighted up to 79% of abnormal forms of O. cf. ovata at the highest concentrations of 2E,4E-decadienal tested (9, 18 and 36μmolL(-1)), a gradual DNA degradation and an increase of lipid droplets with all tested PUAs. Further studies are needed to better clarify the interactions between diatoms and O. cf. ovata, especially on bloom-forming dynamics., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Composition and temporal variation of the microphytobenthos communities of the Conero Riviera (northern Adriatic Sea) were investigated in the course of an annual cycle, focusing on their relationships with blooms of the benthic dinoflagellate Ostreopsis cf. ovata. Sampling was carried out from March 2009 to March 2010 on undisturbed benthic substrata (macroalgae and pebbles). Samples for the study of microphytobenthos were collected with a monthly frequency, while those for the study of Ostreopsis bloom weekly. Benthic diatoms dominated the microphytobenthos communities for most of the annual cycle (except the summer), both in terms of abundance and biomass. In summer, cyanobacteria were dominant (54.04±9.18 and 24.29±11.11% of total abundance and biomass, respectively), while benthic dinoflagellates were an important component of the community in terms of biomass only at the peak of the Ostreopsis bloom in late summer (up to 91% of the total biomass). Among diatoms, the most abundant forms throughout the year were motile species (77.5±3.71% of the population), while erect diatoms formed the majority of the biomass in winter and spring (48.66±16.66 and 48.05±5.56% of total population, respectively). Diatoms were mainly affected by DIN availability, while the patterns of biomass of O. cf. ovata and cyanobacteria were related to salinity and temperature. The biomass of Ostreopsis was also affected by the availability of phosphorus. The results of this study suggest that the proliferation of Ostreopsis affected the structure of the benthic diatom community: motile diatoms were significantly more abundant during the Ostreopsis bloom peak than during the rest of summer, probably because they benefited from the abundant mucilaginous mat covering the benthic substrata. In the course of the O. cf. ovata bloom the diversity of the microphytobenthos was significantly lower than during the rest of the year, suggesting an influence of both the shading produced by the mucous mat and allelopathic compounds possibly produced by O. cf. ovata., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: To determine the association between rapid cognitive decline and burden of comorbidities as assessed using the Charlson Comorbidity Index in individuals aged 65 and older with Alzheimer's disease (AD)., Design: Retrospective cohort study., Setting: Memory clinic at the University Hospital of Nantes., Participants: Individuals aged 65 and older with AD (n=170)., Measurements: Subjects were followed for 1 year. Rapid cognitive decline was defined as a decrease of 3 or more points on the Mini-Mental State Examination per 12-month period. Variables studied were the Charlson Comorbidity Index (measure of comorbidity burden), age, sex, AD stage, type of residence (living at home or not), presence of caregiver, functional abilities (Lawton and Katz scales), risk of malnutrition or depression, and intercurrent events (hospitalization or initiating home care)., Results: Rapid cognitive decline at 1-year follow-up occurred in 65 subjects (38.2%). In fully adjusted logistic regression analysis, Charlson Comorbidity Index was significantly associated with rapid cognitive decline (odds ratio (OR)=1.30, P=.03). Moderate stage of AD (OR=2.07, P=.04) and living at home (OR=4.17, P=.04) were also associated with rapid cognitive decline., Conclusion: Comorbidity burden was associated with rapid cognitive decline in subjects with AD., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)

In the last decade massive blooms of the Ostreopsis cf. ovata have occurred in the Mediterranean basin, posing great concern to both environmental and human health. Biotoxicological and chemical studies demonstrated that O. cf. ovata produces palytoxin and ovatoxins; besides direct respiratory effects on humans due to inhalation of marine toxic aerosols, O. cf. ovata blooms can cause adverse effects on benthic invertebrates. The main aim of this study was to highlight the role of immunological, cellular and oxidative mechanisms in modulating the toxicity induced by O. cf. ovata in mussels Mytilus galloprovincialis. Organisms were exposed in laboratory condition to O. cf. ovata and analysed after 7 and 14 days of exposure. Obtained results demonstrated a clear involvement of the immune system with a significant decrement of granulocytes respect to the hyalinocytes type cells, a diminished phagocytosis activity and a reduced lysosomal membrane stability in haemocytes, after both 7 and 14 days of exposure. Histological analyses showed a decrease of the digestive gland wall thickness, dilatation of the tubules, haemocytes infiltration into the digestive gland and a decrement of neutral lipid levels in exposed mussels; similar results suggest a possible inhibition of the feeding activity, with a consequent induction of authophagic phenomena and utilization of stored reserve products such as neutral lipids. Antioxidant parameters revealed a limited role of O. cf. ovata to induce oxidative stress in mussels exposed under laboratory conditions excepting for a certain increase of catalase, glutathione reductase and glutathione peroxidases activities, and a significantly higher capability to neutralize peroxyl radicals in mussels exposed for 14 days. Although the obtained results suggest a non-specific response of mussels to the O. cf. ovata exposure, observed effects on the general health status of exposed mussels should be adequately considered when assessing the ecological relevance of these algal blooms., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

We revue the epidemiology of cardiovascular disease in the elderly, their relationship to arterial stiffness. The measurement of arterial stiffness is of considerable increasing interest in this early 21 century. This paper is focusing on modeling, in different measurement methods. Several measurement techniques are presented. A review of the bibliography that explain the link between cardiovascular risk factors and arterial stiffness is summarized, as are the relationships between the various risk factors and arterial stiffness. The current role of these measurement methods seems to be time consuming although the European consensus recommends the measure once a year in the management of vascular patients. New techniques for the assessment of the arterial stiffness, more reproducible and easy to use, could ultimately trivialize this measurement, contributing in medical practice to the assessment and the management of the vascular risk.

Aim: Pulse wave velocity does not correlate to age in the upper limb but in the aorta and lower limb. We studied the link between ageing and pulse wave transit time (PWtt) indexes at the toe and finger., Patients and Methods: Measurements were performed in 300 patients in occupational medicine and primary care after 5minutes supine rest using the device studied (pOpmètre(®), Axelife SAS, France). It measures transit time between R-ECG and finger or toe pulse signal (ttf or ttt respectively). We define as follows three indexes: difference between transit times: Dtf=ttt-ttf; pulse wave velocity PWVft=k*subjects height/Dtf (m/s); and the pOpscore(®) as the ratio of toe PWV/fingerPWV., Results: Of the 300 tested patients, 147 were analysed using univariate correlation: age (P<10(-4)), SBP (P<10(-4)), DBP (P<0.02) and BMI (P<0.04) correlated to Dtf, PWVtf and pOpscore(®). Using stepwise regression analysis with Age, BMI, SBP, DBP, MBP: Dtf was dependent with age (P<10(-4)) and SBP (P<0.01); PWVtf with age (P<0.0001), SBP (P<0.01) and DBP (P<0.05); pOpscore(®) was dependent only to age (P<10(-4))., Conclusion: In this study, in contrast with the other vascular indexes studied dependent to age and blood pressure, pOpscore(®) was dependent only to ageing. pOpmètre(®) is a promising technique for routine determination of arterial stiffness and pOpscore(®) appears to be appropriate to study the structural vascular ageing in outpatient., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Osteoporosis concerns 50% of women over 80 years. Prevalence of energizing and protein malnutrition is high as for institutional elderly people as for community dwelling elderly people. Malnutrition, physical inactivity and many etiological factors lead to tissular losses especially on protein compartment, named sarcopenia. Among the common etiological factors, some cytokines have an effect on proteolysis and bone restructuring, interfering with osteoclast metabolism. Inflammation or stress, mechanisms which product cytokines, are responsible for unfavourable bone restructuring and for a loss of protein mass, deteriorating the muscular functional prognostic. We researched articles on Medline® between 1980 and 2010 about relations between protein compartment, malnutrition and bone density. Several studies in literature suggest that increase in protein intake in daily caloric needs could have a positive effect on bone mineral density and functional performances (in primary prevention as in secondary prevention). So, primary and secondary preventive measures must comprise an increase in protein intake and a sufficient physical activity.

This study assessed the use of microswitch technology to promote mouth-drying responses and thereby reduce the effects of drooling by two adults with severe intellectual and multiple disabilities. Mouth-drying responses were performed via a special napkin that contained pressure sensors, a microprocessor and an MP3 to monitor the responses and ensure positive stimulation contingent on them. Initially, the responses produced 10 or 15 s of preferred stimulation. Subsequently, preferred stimulation was supplemented with matching periods of lower-grade stimulation to extend the inter-response intervals. Results showed that both participants (a) learned to dry their mouth consistently and reduce their chin wetness during the intervention, (b) stabilized their responding at lower frequencies as the lower-grade stimulation was added to the preferred stimulation, and (c) maintained the latter levels at a 3-month follow-up. Procedure and response conditions and outcome implications are discussed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This study assessed a simple behavioral strategy for reducing stereotypic tongue protrusion and forward head tilting displayed by a woman and a man with severe to profound intellectual disabilities. The strategy involved (a) auditory prompting (i.e., verbal encouragement to keep the tongue in the mouth or the head upright) delivered automatically at fixed intervals via a portable device, and (b) social approval delivered by a research assistant at adjustable intervals for the absence of the inappropriate behavior. The intervals arranged for the delivery of approval were extended if the inappropriate behavior occurred in concomitance with the expected delivery. Data showed that the intervention strategy was effective in reducing the stereotypic tongue protrusion and forward head tilting. Their occurrences dropped from above 40% (tongue protrusion) and close to 80% (head tilting) of the observation instances during the initial baseline to around or slightly above 10% of those instances during the second intervention period and the 3-month postintervention check.

Many persons with developmental and physical disabilities experience drooling (i.e., loss of saliva from the mouth). Technology was recently developed to help two of these persons reduce the negative effects of drooling by increasing mouth-wiping responses. This study upgraded our initial approach and tested it with the two persons who we previously treated. Upgrading ensured that all technology components, including the stimulation sources, were on the participant's body and that stimulation for mouth wiping caused no (or limited) environmental disturbance. We also conducted a social validation assessment of the new technology and its effects, employing university students as social raters. Evidence showed that the participants used the upgraded technology successfully in settings attended by varieties of other persons. The university students involved in the social validation viewed the use of the technology as enjoyable, beneficial, and environmentally acceptable, and they largely supported it.

Two men with profound developmental disabilities used a mouth-wiping response instrumental to reduce drooling via a micro-switch-based program (i.e., a program in which the response was automatically monitored and followed by positive stimulation). The wiping response was performed via a napkin or a handkerchief placed inside a belt pocket. The micro-switch technology consisted of two mini-tilt sensors and a radio transmitter hidden inside the napkin, or an optic sensor and a radio transmitter fixed inside the belt pocket. The study was carried out according to a multiple baseline across participants and included a 3-month postintervention check. During the baseline, the participants' mean frequencies of mouth wiping were near zero, and mean percentages of wet chin intervals were about 45 and 50. During the intervention, the mean wiping frequencies increased to 1.6 and 1.9 per min, whereas the mean percentages of wet-chin intervals were mostly below 10. These values were maintained at the postintervention check. Implications of the findings and limitations of the study are discussed.