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BACKGROUND: Palliative care has the potential to address significant unmet needs in people with Parkinsons disease and related disorders, but models that rely on in-person specialty palliative care teams have limited scalability. AIM: To describe patient and care partner experiences with a novel, community-based palliative care intervention for Parkinsons disease. DESIGN: Qualitative study embedded in a randomized clinical trial to document participant experiences with a novel palliative care intervention (community neurologist training and remote team-based specialist palliative care). Transcripts were coded and thematically analyzed through a combination of team-based inductive and deductive coding. SETTING/PARTICIPANTS: Twenty-eight patients and 33 care partners purposively sampled from participants in a randomized clinical trial of a palliative care intervention for Parkinsons disease and related disorders conducted at nine sites. RESULTS: Benefits of the intervention included management of a wider range of non-motor symptoms, facilitation of conversations about the future, greater engagement with the health care team, and increased referrals to resources. Participants identified areas of improvement, including uptake of palliative care training by community neurologists, additional prognostic counseling, and clarity and timeliness of communication with the multidisciplinary team. CONCLUSIONS: Clinicians caring for people with Parkinsons disease and related disorders should screen for non-motor symptoms, provide regular prognostic counseling, and refer to specialty palliative care services earlier in the course of illness. Future interventions should be designed to promote uptake of palliative care training by community neurologists and further optimize referral to and coordination with in-person or remote specialty palliative teams.

CONTEXT: Parkinsons disease and related disorders (PDRD) are fatal neurodegenerative disorders characterized by a fluctuating course that can complicate prognostication. The surprise question (SQ: Would you be surprised if your patient died in the next year?) has been used to identify patients with limited prognosis but has not been assessed in PDRD. OBJECTIVES: To determine the validity of the SQ in predicting 12-month mortality in PDRD. METHODS: Data was analyzed from 301 patients and 34 community-based neurologists who were participating in a clinical trial of outpatient palliative care for patients with PDRD. Clinicians answered the SQ for each patient at baseline. Descriptive statistics at baseline, chi-square tests of independence, 2 × 2 and 2 × 3 cross tables were used. Survival analysis compared SQ responses using Kaplan-Meier curves. Risk estimate analyses identified patient characteristics associated with clinicians responses. RESULTS: Mortality was 10.3% (N = 31) at 1 year. The sensitivity and specificity of the SQ was 80.7% and 58.9%, respectively with AUC = 0.70, positive predictive value of 18.4% and negative predictive value of 96.4%. Older age, atypical parkinsonism, and dementia were associated with responding no to the SQ. CONCLUSION: The SQ is sensitive to 12-month mortality in PDRD, with a high negative predictive value. The SQ may be useful for identifying patients less likely to die within a year and may be useful for identifying patients with palliative care needs outside of end-of-life care. This latter use may assist in mobilizing early and timely referral to specialist palliative care.

IntroductionWe studied a registry of Emergency Medical Systems (EMS) identified prehospital suspected stroke patients brought to an academic endovascular capable hospital over 1 year to assess the prevalence of disease and externally validate large vessel occlusion (LVO) stroke prediction scales with a focus on predictive values.MethodsAll patients had last known well times within 6 hours and a positive prehospital Cincinnati Prehospital Stroke Scale. LVO prediction scale scores were retrospectively calculated from emergency department arrival National Institutes of Health Stroke Scale scores. Final diagnoses were determined by chart review. Prevalence and diagnostic performance statistics were calculated. We prespecified analyses to identify scale thresholds with positive predictive values (PPVs) ≥80% and negative predictive values (NPVs) ≥95%. A secondary analysis identified thresholds with PPVs ≥50%.ResultsOf 220 EMS transported patients, 13.6% had LVO stroke, 15.9% had intracranial haemorrhage, 20.5% had non-LVO stroke and 50% had stroke mimic diagnoses. LVO stroke prevalence was 15.8% among the 184 diagnostic performance study eligible patients. Only Field Assessment Stroke Triage for Emergency Destination (FAST-ED) ≥7 had a PPV ≥80%, but this threshold missed 83% of LVO strokes. FAST-ED ≥6, Prehospital Acute Severity Scale =3 and Rapid Arterial oCclusion Evaluation ≥7 had PPVs ≥50% but sensitivities were

Recently, both sociology of science and policy research have shown increased interest in scientific uncertainty. To contribute to these debates and create an empirical measure of scientific uncertainty, we inductively devised two systems of classification or ontologies to describe scientific uncertainty in a large corpus of food safety risk assessments with the help of machine learning (ML). We ask three questions: (1) Can we use ML to assist with coding complex documents such as food safety risk assessments on a difficult topic like scientific uncertainty? (2) Can we assess using ML the quality of the ontologies we devised? (3) And, finally, does the quality of our ontologies depend on social factors? We found that ML can do surprisingly well in its simplest form identifying complex meanings, and it does not benefit from adding certain types of complexity to the analysis. Our ML experiments show that in one ontology which is a simple typology, against expectations, semantic opposites attract each other and support the taxonomic structure of the other. And finally, we found some evidence that institutional factors do influence how well our taxonomy of uncertainty performs, but its ability to capture meaning does not vary greatly across the time, institutional context, and cultures we investigated.

Background: Despite accumulating evidence correlating oxidative stress with lupus disease activity, the brain redox pathways are still poorly investigated. Cinnamomum cassia, a widely used spice with powerful antioxidant properties, could be a novel therapeutic candidate in lupus. Methods: C57BL/6J female mice were divided into five groups: sham, sham-cinnamon, lupus, lupus-cinnamon starting from induction, and lupus-cinnamon starting two weeks before induction. Lupus was induced by skin application on the right ear with 1.25 mg of 5% imiquimod cream three times per week for six weeks. Cinnamomum cassia was given orally, five days per week, at 200 mg/kg. Results: Concomitant to TLR7-MYD88 pathway activation, the p-NRF2/NRF2 and p-FOXO3/FOXO3 ratios were increased in the hippocampus and alleviated by cinnamon treatment. BCL-2 positivity was enhanced in hippocampal neurons and reversed only by preventive cinnamon administration. In vitro, exposure of hippocampal cells to the plasma of different groups induced a surge in oxidative stress. This was associated with an increased t-BID/BID ratio. Cinnamon treatment, particularly in the preventive arm, normalized these modifications. Conclusions: Our study shows a neuroprotective effect of cinnamon by rescuing brain redox and apoptosis homeostasis in lupus, paving the way for its use as a natural therapeutic compound in the clinical management of lupus. [ABSTRACT FROM AUTHOR]

Background and purposeShorter time-to-thrombolysis in acute ischemic stroke (AIS) is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital.MethodsAll patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time. Here, we assess the relative impact of each intervention on DTN time.ResultsThe median DTN time pre- and postintervention decreased from 87 (interquartile range: 68-109) minutes to 49 (interquartile range: 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval: 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box.ConclusionsMultidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed.

Recently, both sociology of science and policy research have shown increased interest in scientific uncertainty. To contribute to these debates and create an empirical measure of scientific uncertainty, we inductively devised two systems of classification or ontologies to describe scientific uncertainty in a large corpus of food safety risk assessments with the help of machine learning (ML). We ask three questions: (1) Can we use ML to assist with coding complex documents such as food safety risk assessments on a difficult topic like scientific uncertainty? (2) Can we assess using ML the quality of the ontologies we devised? (3) And, finally, does the quality of our ontologies depend on social factors? We found that ML can do surprisingly well in its simplest form identifying complex meanings, and it does not benefit from adding certain types of complexity to the analysis. Our ML experiments show that in one ontology which is a simple typology, against expectations, semantic opposites attract each other and support the taxonomic structure of the other. And finally, we found some evidence that institutional factors do influence how well our taxonomy of uncertainty performs, but its ability to capture meaning does not vary greatly across the time, institutional context, and cultures we investigated.

Ferroelectric polarization induced by the magnetic field is one of the properties reported in honeycomb antiferromagnetic linear magnetoelectrics (LME) belonging to the A4M2O9P 3 ¯ c1 class of corundum compounds with A = Co, Fe, and Mn and M = Nb or Ta. Among them, Mn4Nb2O9 exhibits the highest TN of 108 K. We show that it can even be increased by substituting partly Mn by Fe. The study of Mn4−xFexNb2O9 allows one to reach a TN up to 126 K at x = 1.5. This beneficial effect, confirmed also for Fe substituted Mn4Ta2O9, is compared to substitutions by Co or by Zn, both cations inducing a TN decrease. The linear decrease in the unit cell volume with x in Mn4−xFexNb2O9 shows that the cation size effect only cannot be inferred to explain the TN(x) curve. Furthermore, the spin flop magnetic field of Mn4Nb2O9 decreases, thanks to the Fe for Mn substitution, a LME effect is evidenced at 10 K, ΔP(9T)10K = 11 μC/m2. These features, TN increase and LME properties, demonstrate the important role of substitutions to enhance the properties of such antiferrromagnets. [ABSTRACT FROM AUTHOR]

Ferroelectric polarization induced by the magnetic field is one of the properties reported in honeycomb antiferromagnetic linear magnetoelectrics (LME) belonging to the A4M2O9P 3 ¯ c1 class of corundum compounds with A = Co, Fe, and Mn and M = Nb or Ta. Among them, Mn4Nb2O9 exhibits the highest TN of 108 K. We show that it can even be increased by substituting partly Mn by Fe. The study of Mn4−xFexNb2O9 allows one to reach a TN up to 126 K at x = 1.5. This beneficial effect, confirmed also for Fe substituted Mn4Ta2O9, is compared to substitutions by Co or by Zn, both cations inducing a TN decrease. The linear decrease in the unit cell volume with x in Mn4−xFexNb2O9 shows that the cation size effect only cannot be inferred to explain the TN(x) curve. Furthermore, the spin flop magnetic field of Mn4Nb2O9 decreases, thanks to the Fe for Mn substitution, a LME effect is evidenced at 10 K, ΔP(9T)10K = 11 μC/m2. These features, TN increase and LME properties, demonstrate the important role of substitutions to enhance the properties of such antiferrromagnets. [ABSTRACT FROM AUTHOR]

Ni4Nb2O9 displays magnetization reversal, a particular behavior in which magnetization opposes an applied magnetic field. Previous studies have shown that this is caused by the antiferromagnetic coupling of two different layers of ferromagnetic Ni cations. In this work, magnetization reversal is controlled by the substitution of Ni by non-magnetic Zn. Ni4−xZnxNb2O9 materials with x = 0.25, 0.50, and 0.75 maintain the orthorhombic Ni4Nb2O9-type structure but display counterintuitive changes in the magnetic properties including increases in low-temperature net magnetizations, remnant magnetizations, and compensation temperatures. Furthermore, the magnetization reversal is significantly enhanced for x = 0.50 while supressed for x = 0.75, underscoring the strong effects of Zn substitution. [ABSTRACT FROM AUTHOR]