Search

Background/Objective: The corticobasal syndrome (CBS) is a complex asymmetric movement disorder, with cognitive impairment. Although commonly associated with the primary 4‐repeat‐tauopathy of corticobasal degeneration, clinicopathological correlation is poor, and a significant proportion is due to Alzheimer's disease (AD). Synaptic loss is a pathological feature of many clinical and preclinical tauopathies. We therefore measured the degree of synaptic loss in patients with CBS and tested whether synaptic loss differed according to β‐amyloid status. Methods: Twenty‐five people with CBS, and 32 age‐/sex‐/education‐matched healthy controls participated. Regional synaptic density was estimated by [11C]UCB‐J non‐displaceable binding potential (BPND), AD‐tau pathology by [18F]AV‐1451 BPND, and gray matter volume by T1‐weighted magnetic resonance imaging. Participants with CBS had β‐amyloid imaging with 11C‐labeled Pittsburgh Compound‐B ([11C]PiB) positron emission tomography. Symptom severity was assessed with the progressive supranuclear palsy‐rating‐scale, the cortical basal ganglia functional scale, and the revised Addenbrooke's Cognitive Examination. Regional differences in BPND and gray matter volume between groups were assessed by ANOVA. Results: Compared to controls, patients with CBS had higher [18F]AV‐1451 uptake, gray matter volume loss, and reduced synaptic density. Synaptic loss was more severe and widespread in the β‐amyloid negative group. Asymmetry of synaptic loss was in line with the clinically most affected side. Discussion: Distinct patterns of [11C]UCB‐J and [18F]AV‐1451 binding and gray matter volume loss, indicate differences in the pathogenic mechanisms of CBS according to whether it is associated with the presence of Alzheimer's disease or not. This highlights the potential for different therapeutic strategies in CBSs. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

In order to reduce aviation's CO2 emissions and comply with current climate targets, the European Union plans a mandatory quota of 2% sustainable aviation fuel (SAF) by 2025, rising up to ≥ 70% SAF by 2050. In addition to a reduction of life cycle CO2-emissions the use of SAF can also have a positive impact on particle emissions and contrail properties. In this study we present observations from the ECLIF3 (Emission and CLimate Impact of alternative Fuels) aircraft campaign, which investigated exhaust and contrail characteristics of an Airbus A350-941 equipped with Rolls-Royce Trent XWB-84 engines. For the first time, non-volatile and total particle emissions of 100% HEFA-SPK (Hydro-processed Esters and Fatty Acids - Synthetic Paraffinic Kerosene) SAF, a blended fuel and a reference Jet A-1 were measured in flight. A maximum reduction in non-volatile particle number emissions of ~41 % compared to the reference Jet A-1 fuel was measured at low cruise engine power settings when using 100% HEFA-SPK. The reduction decreases to ~29% for typical cruise engine settings and to ~22% at high cruise engine power settings. The size of non-volatile particles was slightly smaller for HEFA-SPK compared to Jet A-1. We show a comprehensive analysis of the hydrogen content of globally available fuels. Our results demonstrate the impact of the fuel composition in terms of its aromatic, hydrogen and sulfur content as well as of the effect of engine power settings on particle emissions. We demonstrate that the use of HEFA-SPK can significantly reduce particle emissions and thus contrail ice particles, and therefore can provide an aviation climate benefit. [ABSTRACT FROM AUTHOR]

Powering aircraft by sustainable aviation fuels (SAFs) is a pathway to reduce the climate impact of aviation by lowering aviation lifecycle CO2 emissions and by reducing ice crystal numbers and radiative forcing from contrails. While the effect of SAF blends on contrails has been measured previously, here we present novel measurements on particle emission and contrails from 100 % SAF combustion. During the ECLIF3 (Emission and CLimate Impact of alternative Fuels) campaign, a collaboration between the Deutsches Zentrum für Luft- und Raumfahrt (DLR), Airbus, Rolls-Royce, and Neste, the DLR Falcon 20 research aircraft performed in situ measurements following an Airbus A350-941 source aircraft powered by Rolls-Royce Trent XWB-84 engines in 1 to 2 min old contrails at cruise altitudes. Apparent ice emission indices of 100 % HEFA-SPK (hydro-processed esters and fatty acids–synthetic paraffinic kerosene) were measured and compared to Jet A-1 fuel contrails at similar engine and ambient ice-supersaturated conditions within a single flight. A 56 % reduction in ice particle numbers per mass of burned fuel was measured for 100 % HEFA-SPK compared to Jet A-1 under engine cruise conditions. The measured 35 % reduction in soot particle numbers suggests reduced ice activation by the low-sulfur HEFA fuel. Contrail properties are consistently modeled with a contrail plume model. Global climate model simulations for the 2018 fleet conservatively estimate a 26 % decrease in contrail radiative forcing and stronger decreases for larger particle reductions. Our results indicate that higher hydrogen content fuels as well as clean engines with low particle emissions may lead to reduced climate forcing from contrails. [ABSTRACT FROM AUTHOR]

Balint groups use case-based discussions to explore, reflect on, and enhance the clinician-patient relationship. They facilitate the development of empathy and reflective practice and reduce burnout. This study aimed to explore how the benefits of a traditional Balint group format can be accessed and optimised for medical students during a one-year pilot programme. Eight medical student Balint groups ran for six weeks during 2022–2023, with 90 students participating. Themes were identified from student feedback using qualitative content analysis. Group leaders kept reflective session notes and used these alongside student feedback to undertake a strengths, weaknesses, opportunities, and threats analysis. Strengths of the programme were emotional containment, learning to reflect, and community identity. Weaknesses were themed as strange situations, dragging along, and facilitator as an object. Opportunities were identified in expanding the scope and sharpening focus. Psychological defences and the engagement dilemma threatened the future success of the Balint group programme. Medical student Balint groups provide a unique space to combine learning and emotional support with personal, professional and community development. However, the traditional Balint group format may need adapting to be widely accessible to undergraduate learners. Sustainably integrating Balint groups into the medical school curriculum requires ongoing engagement work at both an individual and organisational level. [ABSTRACT FROM AUTHOR]

Powering aircraft by sustainable aviation fuels (SAF) is a pathway to reduce the climate impact of aviation by lowering aviation life-cycle CO2 emissions and by reducing ice crystal numbers and radiative forcing from contrails. While the effect of SAF blends on contrails has been measured previously, here we present novel measurements on particle emission and contrails from 100 % SAF combustion. During the ECLIF3 (Emission and CLimate Impact of alternative Fuels) campaign, a collaboration between DLR, AIRBUS, ROLLS-ROYCE and NESTE, the DLR Falcon 20 research aircraft performed in situ measurements following an Airbus A350-941 source aircraft powered by Rolls-Royce Trent XWB-84 engines in 1 to 2 min old contrails at cruise altitudes. Apparent ice emission indices of 100 % HEFA-SPK (Hydro-processed Esters and Fatty Acids - Synthetic Paraffinic Kerosene) were measured and compared to Jet A-1 fuel contrails at similar engine and ambient ice-supersaturated conditions within a single flight. A 56 % reduction of ice particle numbers per mass of burned fuel was measured for 100 % HEFA-SPK compared to Jet A-1 at engine cruise conditions. The measured 35 % reduction in soot particle numbers suggest reduced ice activation by the low sulfur HEFA fuel. Contrail properties are consistently modelled with a contrail plume model. Global climate model simulations for the 2018 fleet conservatively estimate a 26 % decrease in contrail radiative forcing and stronger decreases for larger particle reductions. Our results indicate that higher hydrogen content fuels as well as clean engines with low particle emissions may lead to reduced climate forcing from contrails. [ABSTRACT FROM AUTHOR]

Background Although liaison services in acute hospitals are now the norm, the reverse is not usually available for patients in mental health trusts. Following the introduction of support from geriatricians to older people's mental health inpatient wards, we wanted to see if this intervention was effective and acceptable to clinicians. Methods We performed a retrospective cohort service evaluation on the impact of a liaison geriatrician, using routinely collected data, and assessed acceptability among medical staff by semi-structured interview. Intervention Our service introduced regular sessions from consultant community geriatricians across older adults psychiatric wards including a mixture of video conference and face-to-face input. Results There was no significant decrease in emergency transfers but there was a significant reduction in length of stay with an associated cost benefit for the service after the introduction of a liaison geriatrician. There was a significant increase in geriatrician consultations and a decrease in specialty consultations to other specialists. There was no change in discharge prescriptions or destination. There was a significant reduction in falls in the intervention arm but not in falls leading to emergency hospital admissions geriatricians gave confidence to psychiatrists of all grades to treat physical health care issues. Conclusions A liaison geriatrician service may be a component in reducing length of stay (although there are many others) and improving continuity of care, although it confers no impact on emergency transfers. The intervention was highly acceptable to clinicians. [ABSTRACT FROM AUTHOR]

Background: Synaptic loss is characteristic of many neurodegenerative diseases; it occurs early and is strongly related to functional deficits. Objective: In this longitudinal observational study, we determine the rate at which synaptic density is reduced in the primary tauopathies of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), and we test the relationship with disease progression. Methods: Our cross‐sectional cohort included 32 participants with probable PSP and 16 with probable CBD (all amyloid‐negative corticobasal syndrome), recruited from tertiary care centers in the United Kingdom, and 33 sex‐ and age‐matched healthy control subjects. Synaptic density was estimated by positron emission tomography imaging with the radioligand [11C]UCB‐J that binds synaptic vesicle 2A. Clinical severity and cognition were assessed by the PSP Rating Scale and the Addenbrooke's cognitive examination. Regional [11C]UCB‐J nondisplaceable binding potential was estimated in Hammersmith Atlas regions of interest. Twenty‐two participants with PSP/CBD had a follow‐up [11C]UCB‐J positron emission tomography scan after 1 year. We calculated the annualized change in [11C]UCB‐J nondisplaceable binding potential and correlated this with the change in clinical severity. Results: We found significant annual synaptic loss within the frontal lobe (−3.5%, P = 0.03) and the right caudate (−3.9%, P = 0.046). The degree of longitudinal synaptic loss within the frontal lobe correlated with the rate of change in the PSP Rating Scale (R = 0.47, P = 0.03) and cognition (Addenbrooke's Cognitive Examination–Revised, R = −0.62, P = 0.003). Conclusions: We provide in vivo evidence for rapid progressive synaptic loss, correlating with clinical progression in primary tauopathies. Synaptic loss may be an important therapeutic target and outcome variable for early‐phase clinical trials of disease‐modifying treatments. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]