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Dementia and significant cognitive decline are frequent sequelae of stroke, but are difficult to evaluate when aphasia and/or motor impairment are present. The linguistic and motor requirements of commonly employed screening tests render them problematic for use post-stroke. The present study examines the validity of the Nonverbal BriefScreen, a brief screening method with limited verbal and motor requirements, in groups of patients with known cognitive impairment using the MMSE as a gold standard. Participants were 137 healthy middle aged and older community dwellers, 21 patients with MCI/early dementia and 35 patients with different types of dementia. The sensitivity and specificity of the Nonverbal BriefScreen were calculated for various cutoff scores, with the MMSE as comparison. The Nonverbal BriefScreen was effective in discriminating between healthy controls and patients with dementia, as well as between healthy controls and all patients, with areas under the ROC curve similar to that of the MMSE. ROC analyses with a smaller sample of 35 age-matched healthy controls showed adequate discriminant ability to detect cognitive impairment. The Nonverbal BriefScreen was shown to be a valid method for screening for cognitive impairment that could be employed as a screening method for patients with limited language.

Background Erdheim-Chester Disease (ECD) is a clonal non-Langerhans histiocytosis, classified as a macrophage-dendritic cell neoplasm in the 2016 WHO classification. The exact cell of origin of ECD is unknown, although some limited evidence suggests that it arises from myeloid progenitors. Case presentation A 43-year-old patient, diagnosed with BRAF V600E mutated ECD, developed NPM1+/FLT3+ acute myeloid leukemia (AML) with wild-type BRAF, 15 months after the initial ECD diagnosis. The patient received intensive chemotherapy plus midostaurin, followed by midostaurin maintenance. Six months into maintenance, the patient remains in complete remission with low-level measurable residual disease, whereas ECD shows a sustained partial metabolic response. Molecular karyotype at several distinct timepoints, namely ECD diagnosis, AML diagnosis, and following treatment of AML, highlighted a molecular signature, indicative of a persistent, underlying clonal hematopoiesis. Conclusion This case report suggests that ECD and AML might represent an expansion of two distinct clones in a background of clonal hematopoiesis, indicating their shared origin. Moreover, molecular karyotype might serve as a strong, inexpensive tool for revealing clonal hematopoiesis in cases of negative targeted next-generation sequencing. Finally, the moderate response of ECD to midostaurin suggests that kinase inhibition might have a potential role in ECD treatment.

The efficacy of the most widely used tests for dementia screening is limited in populations characterized by low levels of education. This study aimed to validate the face-to-face administered Telephone Interview for Cognitive Status (TICS) for detection of dementia and mild cognitive impairment (MCI) in a population-based sample of community dwelling individuals characterized by low levels of education or illiteracy in rural Greece.The translated Greek version of TICS was administered through face-to-face interview in 133 elderly residents of Velestino of low educational level (12 years). We assessed its internal consistency and test-retest reliability, its correlation with sociodemographic parameters, and its discriminant ability for cognitive impairment and dementia, as defined by a brief neurological evaluation, including assessment of cognitive status and level of independence.TICS was characterized by adequate internal consistency (Cronbach's α: .72) and very high test-retest reliability (intra-class correlation coefficient: .93); it was positively correlated with age and educational years. MCI and dementia were diagnosed in 18 and 10.5% of the population, respectively. Its discriminant ability for detection of dementia was high (Area under the curve, AUC: .85), with a sensitivity and specificity of 86 and 82%, respectively, at a cut-off point of 24/25. TICS did not perform well in differentiating MCI from cognitively normal individuals though (AUC: .67).The directly administered TICS questionnaire provides an easily applicable and brief option for detection of dementia in populations of low educational level and might be useful in the context of both clinical and research purposes.

The C9orf72 repeat expansion is a common genetic cause of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) in European populations. A previous study has reported a high frequency of the expansion in Greek ALS. However, no data have been reported on the frequency of the expansion in Greek FTD. Currently, we investigated the frequency of the C9orfF72 expansion in a well-characterized cohort of 64 Greek FTD patients. We detected the C9orf72 repeat expansion in 9.3% of cases. Overall, 27.7% of familial and 2.2% of sporadic cases were expansion-positive. Five out of 6 cases had a diagnosis of behavioral variant FTD. All expansion-positive cases had fairly typical FTD presentations. Clinical features included motor neuron disease, Parkinsonism and hallucinations. We conclude that the overall frequency of C9orf72-positive cases in Greek FTD is high, comparable to Greek ALS, similar to some Western European, but significantly higher than some Mediterranean FTD populations.

Polypropylene (PP) and its allotropic forms is one of the most important polymeric materials due to its wide commercial penetration and academic interest over the last decades. The current review deals with β-polypropylene, one of the most interesting crystalline forms of PP, due to its metastable nature and the various physical properties which it presents. The introduction of β-crystals into the PP structure can be either simple or more complex procedure and several strategies are discussed in the current manuscript. Also, the physical properties of the specific material including structure-property relationships, thermal properties, and supermolecular structure are presented in detail. Additionally, the presence of β-PP in polymeric blends is evaluated and the effect of each component and preparation method on the polymorphic composition is debated. Finally, β-PP has been used as a polymeric matrix in several polymer nanocomposites, therefore the performance, polymorphic composition, and preparation me...

DNA repair is an important defense mechanism that faces the difficult task of protecting the genome from the constant assaults caused by endogenous and exogenous agents. Since DNA repair mechanisms are responsible for correcting DNA damage and preserving genomic integrity, it is obvious that abnormalities of these mechanisms may result in neoplastic transformation. Hematological malignancies are characterized by genomic instability that is possibly related to underlying defects in DNA repair. The purpose of this review is to summarize the existing knowledge concerning abnormalities in DNA repair components and their influence on common hematological malignancies.

This article addresses points to consider when switching patients to the second-generation antipsychotic (SGA), ziprasidone, in everyday clinical practice: 1) the pharmacologic properties of the pre-switch antipsychotic and of ziprasidone; 2) switch and dosing strategies to ensure maintenance or attainment of efficacy; 3) recognition and management of possible rebound effects of the pre-switch medication discontinuation; 4) recognition and management of potential side effects of ziprasidone; and 5) education and support for patients/caregivers concerning correct ziprasidone administration.A Medline search (up to July 7, 2010) identified studies in which adult patients with schizophrenia were switched to ziprasidone from another antipsychotic. In addition, based on their extensive clinical experience, an expert faculty of European psychiatrists provided advice on identifying patients who may be appropriate candidates for switching to ziprasidone, and on establishing optimal strategies for switching to ziprasidone in everyday clinical practice.Data from 10 studies, in which 1395 patients were switched to ziprasidone, showed that switching from first-generation antipsychotics (FGAs) or SGAs generally resulted in maintenance or improvement of efficacy across all studied symptom domains, improvements in tolerability, and acute and long-term benefits regarding cardiometabolic parameters, including body weight. Maintenance of efficacy is most likely to be achieved using a plateau cross-titration strategy, with a rapid uptitration of ziprasidone to a dose range of 60 to 80 mg administered twice daily with food. Temporary coadministration of benzodiazepines, anticholinergics, or beta-blockers should be considered for the management of potential rebound effects.Optimal switching of patients with schizophrenia from FGAs or SGAs to ziprasidone requires careful attention to differences in the pharmacological profiles of the pre-switch medication and of ziprasidone, which may impact efficacy and tolerability. Good communication between the clinician and patient/caregiver about the goals of switching, the importance of adherence to the chosen switch strategy, and the correct administration of ziprasidone are essential.

Research has recently focused on cognitive dysfunction in multiple sclerosis (MS). Cognitive deficits are frequently encountered in patients and account for important impairment in quality of life, therefore posing a major therapeutic challenge for the disease. We presently review studies on cognitive effects of pharmacological treatments in MS. There is evidence for a possible beneficial effect of immunomodulatory treatments, particularly of interferons, and also of acetylcholinesterase inhibitors on cognition in MS, which, however, requires evaluation in larger, multi-centre, longitudinal studies. Methodological issues and future prospects regarding the investigation of this issue are also discussed.

Performance on neuropsychological tests is affected by age and education, which makes the early detection of cognitive impairment difficult when assessing individuals of varying levels of education. We examined the effects of age, education, and gender on three memory indexes of the Wechsler Memory Scale-III, Delayed Memory, Working Memory and the difference between Working-Delayed Memory in a sample of patients with amnestic Mild Cognitive Impairment, patients with mild probable Alzheimer's disease, and a nondemented elderly comparison group. Whereas Delayed and Working Memory scores were affected by participant type, age, and education, the Working-Delayed Memory difference score was affected by participant type, only. Our preliminary conclusions, pending replication of the findings with a larger sample, are that working-delayed memory difference was sensitive to early memory decline without being affected by age and education.

In this paper, three approaches for finding optimal parameters for supply chain systems are described and evaluated. The first approach is based on rigorous mixed integer linear programming concepts. Although using this approach guarantees finding the optimal solution for the policy parameters, the drawback of applying such a model to supply chain networks is the excessive computational requirements. The second approach is to combine a detailed stochastic simulation model with a simulated annealing algorithm. While optimality is no longer guaranteed with this approach, far larger problems should be tractable. Finally, a gradient-based approach is suggested, in which a higher-level optimiser utilises the results from the same detailed stochastic simulation model to obtain the optimal parameters. Results obtained when introducing small deviations to the policy parameters are used to estimate the gradients, which are used by the higher-level model. Two case studies are considered: a simple reorder-point ware...

A mathematical programming approach to optimize process plant performance subject to equipment failure is presented. The optimal production planning and scheduling in multipurpose process plants involves the efficient utilization of assets and resources to produce a number of products so as to satisfy market demands while optimizing a performance criterion. However, the degree of utilization of process plant components, within the time horizon of operation, critically depends on the level of equipment availability. The interactions between production and maintenance planning as well as the necessary links to quantify the strong interactions between them are studied. The preventive maintenance planning and crew allocation problem are used to demonstrate the effectiveness of the proposed approach. The overall problem is first formulated as an optimal control problem by integrating an aggregate production planning model with a continuous time Markov chain maintenance model. The resulting problem is then transformed into a mixed-integer linear programming model by using an Euler discretization scheme and appropriate linearizations of bilinear terms. Finally, extensions to include design aspects are also discussed. The applicability of the proposed approach is demonstrated by a number of illustrative examples.

We present the equations of condition up to sixth order for Runge-Kutta (RK) methods, when integrating scalar autonomous problems. Two RK pairs of orders 5(4) are derived. The first at a cost of only five stages per step, while the other having an extremely small principal truncation error. Numerical tests show the superiority of the new pairs over traditional ones.

A 63-year-old male with a 6-month history of generalized lymphadenopathy underwent a cervical lymph node biopsy (1st biopsy). Histology showed a mostly necrotic tumor, with a few viable, CD20 immun...

The main objective of this paper is to give an example of how expert systems techniques for distributed decision-making can be combined with contemporary numerical optimization techniques for the purposes of supply chain optimization and to describe the resulting software implementation. In this paper, multi-agent modelling techniques are applied to simulate and control a simple demand-driven supply chain network system, with the manufacturing component being optimized through mathematical programming. The system measures supply chain performance and the effect of different parameters in the replenishment control system, and can be used to simulate the behaviour of a system that uses optimization for part of its decision-making. The objective of this supply chain network system is to reduce operating cost, while maintaining a high level of customer order fulfilment.

A synchronous Hopfield-type neural network model containing units with analog input and binary output, which is suitable for parallel implementation, is examined in the context of solving discrete optimization problems. A hybrid parallel update scheme concerning the stochastic input-output behaviour of each unit is presented. This parallel update scheme maintains the solution quality of the Boltzmann Machine optimizer, which is inherently sequential. Experimental results on the Maximum Independent Set problem demonstrate the benefit of using the proposed optimizer in terms of computation time. Excellent speedup has been obtained through parallel implementation on both shared memory and distributed memory architecures. International Journal of Computer Mathematics

Computer assisted derivation and improved techniques have led to effective explicit Runge-Kutta methods of higher order. These methods become inefficient when the step size must be reduced often to produce approximations at specified points. Considerable effort has been devoted to providing Runge-Kutta methods with an interpolation capability, so that approximations can be produced inexpensively at intermediate points of a successful step. New high order Hermite interpolants for two well known embedded Runge-Kutta methods of orders 7 and 8 are presented. These interpolants are constructed using values from two successive integration steps, are locally of O(h 8) or O(h 9), and require only one or four extra function evaluations per step respectively.

A Runge-Kutta-Nystrom (RKN) formula becomes inefficient when the step size must be reduced often to produce answers at specified points. The last years an effort has been started to providing Runge-Kutta-Nystrom methods with an interpolation capability. Then approximations can be produced on intermediate points of a successful step inexpensively. New high order Hermite type interpolants for (RKN) methods are presented. The interpolants which approximate the solution is of O(h 9) and C 2 while the interpolants which approximate the corresponding derivative is of O(h 8) and C1. These interpolants have been constructed in two ways, using values from one and two steps respectively.

A way is proposed to compare all the well-known explicit Runge-Kutta methods of fourth-order. The comparison is based on the local error estimators of these methods and it is applied for a class of linear ordinary differential equations of the form y′ = By + Ax + C, where A B C are constants.

New Runge-Kutta-Nystrom algorithms are presented which determine an approximation of the solution and its derivative of the second order differential equation y = f(x,y) at intermediate points of a given integration step, as well as at the end of each step. These new algorithms, called scaled Runge-Kutta-Nystrom (SRKN) methods, are designed to be used with existing Runge-Kutta-Nystrom (RKN) formulas, using the function evaluations of these methods as the core of the new system. Thus, for a slight increase of the cost, the solution may be generated within a successful step, improving so the efficiency of the existing RKN methods.

A robust design method is presented for linear dynamical uncertain systems. The model uncertainties are expressed in terms of large parameter variations with known statistical properties. Feedback gains are determined so as lo minimize a quadratic cost functional, as well as its sensitivity, in the presence of the uncertainties.

The interaction of instability and local truncation error estimate for the general explicit Runge-Kutta method of order p is discussed. It is proved that this estimate indicates the presence of instability when the above method is applied to the numerical solution of the initial value problem. It is also shown why a test designed to monitor the local truncation error estimate does in fact also monitor the stability of the integration.