Σάββατο, 11 Ιουνίου 2016

Estimation of radionuclide (137Cs) emission rates from a nuclear power plant accident using the Lagrangian Particle Dispersion Model (LPDM)

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Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): Soon-Ung Park, In-Hye Lee, Jae-Won Ju, Seung Jin Joo
A methodology for the estimation of the emission rate of 137Cs by the Lagrangian Particle Dispersion Model (LPDM) with the use of monitored 137Cs concentrations around a nuclear power plant has been developed. This method has been employed with the MM5 meteorological model in the 600 km × 600 km model domain with the horizontal grid scale of 3 km × 3 km centered at the Fukushima nuclear power plant to estimate 137Cs emission rate for the accidental period from 00 UTC 12 March to 00 UTC 6 April 2011. The Lagrangian Particles are released continuously with the rate of one particle per minute at the first level modelled, about 15 m above the power plant site. The presently developed method was able to simulate quite reasonably the estimated 137Cs emission rate compared with other studies, suggesting the potential usefulness of the present method for the estimation of the emission rate from the accidental power plant without detailed inventories of reactors and fuel assemblies and spent fuels. The advantage of this method is not so complicated but can be applied only based on one-time forward LPDM simulation with monitored concentrations around the power plant, in contrast to other inverse models. It was also found that continuously monitored radionuclides concentrations from possibly many sites located in all directions around the power plant are required to get accurate continuous emission rates from the accident power plant. The current methodology can also be used to verify the previous version of radionuclides emissions used among other modeling groups for the cases of intermittent or discontinuous samplings.



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Environmental risks of radioactive discharges from a low-level radioactive waste disposal site at Dessel, Belgium

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Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): J. Vives i Batlle, L. Sweeck, J. Wannijn, H. Vandenhove
The potential radiological impact of releases from a low-level radioactive waste (Category A waste) repository in Dessel, Belgium on the local fauna and flora was assessed under a reference scenario for gradual leaching. The potential impact situations for terrestrial and aquatic fauna and flora considered in this study were soil contamination due to irrigation with contaminated groundwater from a well at 70 m from the repository, contamination of the local wetlands receiving the highest radionuclide flux after migration through the aquifer and contamination of the local river receiving the highest radionuclide flux after migration through the aquifer. In addition, an exploratory study was carried out for biota residing in the groundwater.All impact assessments were performed using the Environmental Risk from Ionising Contaminants: Assessment and Management (ERICA) tool. For all scenarios considered, absorbed dose rates to biota were found to be well below the ERICA 10 μGy h−1 screening value. The highest dose rates were observed for the scenario where soil was irrigated with groundwater from the vicinity of the repository. For biota residing in the groundwater well, a few dose rates were slightly above the screening level but significantly below the dose rates at which the smallest effects are observed for those relevant species or groups of species. Given the conservative nature of the assessment, it can be concluded that manmade radionuclides deposited into the environment by the near surface disposal of category A waste at Dessel do not have a significant radiological impact to wildlife.



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Predictors of Exercise Adherence in Patients with Meniscal Tear and Osteoarthritis

Publication date: Available online 11 June 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yetsa A. Tuakli-Wosornu, Faith Selzer, Elena Losina, Jeffrey N. Katz
ObjectiveTo identify predictors of poor exercise adherence in patients with osteoarthritis (OA) and meniscal tear.DesignSecondary analysis of data gathered over the first 12 weeks in the Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, a multicenter, randomized controlled trial.SettingSeven referral centers in the US.ParticipantsThis analysis was conducted in 325 of the 351 MeTeOR patients, each of whom was ≥ 45 years old and had meniscal tear and osteoarthritic changes on imaging studies; 26 were excluded due to missing data from which to derive the primary outcome variable.InterventionsAll patients received a structured supervised exercise program focused on strengthening, along with prescribed home exercises; half were randomized to also receive arthroscopic partial meniscectomy.Main Outcome MeasurePoor exercise adherence through 12 weeks, defined as performing <50% of prescribed exercise.Results38% of the MeTeOR cohort showed poor exercise adherence. In the multivariate model, adjusting for treatment group, those who earned ≤ $29,000/year had 1.64 times the risk of non-adherence (95% CI: 1.10, 2.43) than those who earned >$100,000 /year; and, those without baseline pain with pivoting and twisting had 1.60 times greater risk of non-adherence than those with these symptoms (95% CI: 1.14, 2.25).ConclusionLow income was associated with poor exercise adherence among patients ≥ 45 with osteoarthritis and meniscal tear, as was absence of pain with pivoting and twisting. Our findings highlight the need for further research into exercise adherence and for interventions to enhance adherence among those with low incomes.



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Intra-Individual Changes in Ambulation Associated with Falls in a Population of Vulnerable Older Adults in Long-Term Care

Publication date: Available online 11 June 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mary Elizabeth Bowen, Meredeth Rowe
ObjectivesThe aim of this pilot study is to examine how intra-individual changes in ambulation characteristics may be used to predict falls.DesignLongitudinal study design.SettingAssisted Living Facility (ALF).ParticipantsAmbulatory older adults (N=26, mean age 79).Main Outcome MeasuresContinuous measure of average weekly ambulation characteristics [time and distance walked, speed, path measures (e.g., path time and distance, number of paths (where at path is at least 60 seconds of uninterrupted walking separated by at least a 30 second stop)], accounting for weekly changes in these ambulation characteristics on an individual-level over time, along with falls (yes/no) and cognitive impairment (CI; measured by the Montreal Cognitive Assessment).ResultsIn Hierarchical Linear Models (HLM) accounting for intra-individual changes in ambulation characteristics over the eight month course of the study and level of CI, path distance (OR=1.02; p≤0.001) was associated with an increased risk for a fall. In the short term, intra-individual changes in path distance were associated with a fall within the 4-week interval the change was noted. Path distance had fair sensitivity (0.74) and specificity (0.66) to a fall (AUC=0.70).ConclusionStudy findings suggest that falls may have specific predictors - specifically that older adults with CI are more likely to fall when walking continuously with little/no breaks. Interventions focused on reducing path-associated fatigue may effectively reduce fall incidence in this population.



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Unexpected Pathology of an Enlarging Lung Mass in a Patient with Metastatic Mixed Papillary and Oncocytic Variant Thyroid Carcinoma

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 186-190.


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Reclassification of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma As a Benign Condition Will Reduce the Incidence of Malignancy in the Indeterminate FNA Categories

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 167-170.


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What Predicts Thyroid Hormone Nonadherence in Pregnancy?

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 178-180.


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Thyroxine Reduces Epicardial Fat Tissue Mass in Subclinical Hypothyroidism

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 181-183.


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Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Cancer May Not Be a Cancer

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 163-166.


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Normalization of TSH in Women with Mild Subclinical Hypothyroidism During Pregnancy Bears a Low Risk of Overtreatment

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 174-177.


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Mass Ultrasound Screening Yields a High Incidence of Thyroid Cancer in Children Exposed to the Fukushima Nuclear Accident

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 171-173.


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Are There Compounds in Herbs That Can Stimulate Thyroid Function in Hashimoto's Thyroiditis?

Clinical Thyroidology Jun 2016, Vol. 28, No. 6: 184-185.


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On The Use of Human Tissues in Research and Practice

2016-06-11T16-09-28Z
Source: Journal of Interdisciplinary Histopathology
Sergei V. Jargin.
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Intact Semantic Priming of Critical Lures in Alzheimers Disease: Implications for False Memory

Objectives:

The present study examines the question of the activation of the critical lure (CL) in Alzheimer's patients with a Deese–Roediger–McDermott (DRM)-like task. More precisely, older adults and Alzheimer's patients performed a lexical decision task in which they were asked to categorize strings of letters as words or nonwords. Contrary to the DRM paradigm in which the activation of the CL is inferred from its production at recall, such a lexical decision task does not require the joint use of intentional recovery strategies and source-monitoring processes that are known to be particularly impaired in Alzheimer's patients. The performance at the lexical decision therefore reflects the activation of the CL without contamination from such strategic processes.

Method:

Twenty-nine older adults and 25 Alzheimer's patients performed a lexical decision task with DRM lists intermixed with neutral words and nonwords.

Results:

Analysis indicated that older adults as well as Alzheimer's patients showed shorter lexical decision latencies for CLs than for other types of words.

Discussion:

Contrary to the existing literature, our results suggest that the activation of the CL is preserved in Alzheimer's patients at mild to moderate stages of the disease.



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Older Adults Attitudes Toward Cohabitation: Two Decades of Change

Objectives:

Our study tracks cohort change in the attitudes of adults aged 50 and older toward cohabitation from 1994 to 2012.

Method:

We used data from the 1994, 2002, and 2012 waves of the General Social Survey to examine the roles of cohort replacement and intracohort change in the trend toward favorable cohabitation attitudes and to examine sociodemographic variation in patterns of support for cohabitation.

Results:

Support for cohabitation accelerated over time with nearly half (46%) of older adults reporting favorable attitudes toward cohabitation in 2012 versus just 20% in 1994. This shift in older adults' attitudes largely reflected cohort replacement rather than intracohort change. Some of the factors associated with later life cohabitation experience were linked to supportive attitudes.

Discussion:

Cohort succession is fueling the growing acceptance of cohabitation among older adults and coincides with the rapid growth in later life cohabitation that has occurred in recent decades.



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Psychological



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Relationship Status and Long-Term Care Facility Use in Later Life

Objectives:

Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk.

Method:

We fit hazard models to a sample of adults aged 65 and older from eight waves (1998–2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays.

Results:

Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use.

Discussion:

By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options.



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Psychological Sciences Table of Content



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Solving Tomorrows Problems Today? Daily Anticipatory Coping and Reactivity to Daily Stressors

Objectives:

The present study examined the day-to-day fluctuation of state-like anticipatory coping (coping employed prior to stressors) and how these coping processes relate to important outcomes for older adults (i.e., physical health, affect, memory failures).

Method:

Forty-three older adults aged 60–96 (M = 74.65, SD = 8.19) participated in an 8-day daily diary study of anticipatory coping, stressors, health, affect, and memory failures. Participants reported anticipatory coping behaviors on one day with respect to 6 distinct stressor domains that could occur the following day.

Results:

Multilevel models indicated that anticipatory coping changes from day to day and within stressor domains. Lagged associations suggested that yesterday's anticipatory coping for potential upcoming arguments is related to today's physical health and affect. Increased stagnant deliberation is associated with reduced cognitive reactivity (i.e., fewer memory failures) to arguments the next day.

Discussion:

Taken together, these findings suggest that anticipatory coping is dynamic and associated with important daily outcomes.



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Social



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Better Off Alone Than With a Smoker: The Influence of Partners Smoking Behavior in Later Life

Objectives:

We examine how the likelihood of smoking cessation among smokers and patterns of adherence to smoking cessation differ by partnership status, partnership changes, and partners' smoking behavior. The data are a nationally representative sample of smokers in middle and older age from the Health and Retirement Study (1992–2010).

Method:

We use multivariate logistic regression models to analyze the likelihood of smoking cessation among smokers and then estimate adherence to smoking cessation using discrete-time event history models.

Results:

Those partnered with smokers and those whose partners relapse into smoking are much less likely than the unpartnered to quit smoking and adhere to smoking cessation. Respondents partnered with non-smokers and those whose partners quit smoking are more likely to quit smoking than the unpartnered. Those recently widowed, divorced, and repartnered have similar smoking changes to the consistently unpartnered.

Discussion:

Being partnered does not always mean healthier behavior changes. Rather, the association between partnership status and smoking changes depends greatly on the health behavior changes of the partner. The partnership context at the time of smoking cessation sets the stage for longer term patterns of adherence, shaping health in older age.



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Social Sciences Table of Content



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Responses to Financial Loss During the Great Recession: An Examination of Sense of Control in Late Midlife

Objectives:

The "Great Recession" shocked the primary institutions that help individuals and families meet their needs and plan for the future. This study examines middle-aged adults' experiences of financial loss and considers how socioeconomic and interpersonal resources facilitate or hinder maintaining a sense of control in the face of economic uncertainty.

Method:

Using the 2006 and 2010 waves of the Health and Retirement Study, change in income and wealth, giving help to and receiving help from others, household complexity, and sense of control were measured among middle-aged adults (n = 3,850; age = 51–60 years).

Results:

Socioeconomic resources predicted both the level of and change in the engagement of interpersonal resources prior to and during the Great Recession. Experiences of financial loss were associated with increased engagement of interpersonal resources and decreased sense of control. The effect of financial loss was dampened by education. Sense of control increased with giving help and decreased with household complexity.

Discussion:

Findings suggest that, across socioeconomic strata, proportional loss in financial resources resulted in a loss in sense of control. However, responses to financial loss differed by socioeconomic status, which differentiated the ability to maintain a sense of control following financial loss.



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Subscriptions



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Cover



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Personality and Cognitive Decline in Older Adults: Data From a Longitudinal Sample and Meta-Analysis

Objectives:

Personality traits are associated with risk of dementia; less is known about their association with the trajectory of cognitive functioning. This research examines the association between the 5 major dimensions of personality and cognitive function and decline in older adulthood and includes a meta-analysis of published studies.

Method:

Personality traits, objective and subjective memory, and cognitive status were collected in a large national sample (N = 13,987) with a 4-year follow-up period. For each trait, the meta-analysis pooled results from up to 5 prospective studies to examine personality and change in global cognition.

Results:

Higher Neuroticism was associated with worse performance on all cognitive measures and greater decline in memory, whereas higher Conscientiousness and Openness were associated with better memory performance concurrently and less decline over time. All traits were associated with subjective memory. Higher Conscientiousness and lower Extraversion were associated with better cognitive status and less decline. Although modest, these associations were generally larger than that of hypertension, diabetes, history of psychological treatment, obesity, smoking, and physical inactivity. The meta-analysis supported the association between Neuroticism and Conscientiousness and cognitive decline.

Discussion:

Personality is associated with cognitive decline in older adults, with effects comparable to established clinical and lifestyle risk factors.



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The Baltimore Experience Corps Trial: Enhancing Generativity via Intergenerational Activity Engagement in Later Life

Objectives:

Being and feeling generative, defined as exhibiting concern and behavior to benefit others, is an important developmental goal of midlife and beyond. Although a growing body of evidence suggests mental and physical health benefits of feeling generative in later life, little information exists as to the modifiability of generativity perceptions. The present study examines whether participation in the intergenerational civic engagement program, Experience Corps (EC), benefits older adults' self-perceptions of generativity.

Method:

Levels of generativity were compared in older adults randomized to serve as EC volunteers or controls (usual volunteer opportunities) in the Baltimore Experience Corps Trial at 4-, 12-, and 24-month evaluation points over the 2-year trial. Analyses utilized intention-to-treat and complier average causal effects (CACE) analyses which incorporate degree of intervention exposure in analytic models.

Results:

Participants randomized to the EC group had significantly higher levels of generative desire and perceptions of generative achievement than controls at each follow-up point; CACE analyses indicate a dose–response effect with a greater magnitude of intervention effect with greater exposure to the EC program.

Discussion:

Results provide the first-ever, large-scale experimental demonstration that participation in an intergenerational civic engagement program can positively alter self-perceptions of generativity in older adulthood.



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"My Parent is so Stubborn!"--Perceptions of Aging Parents Persistence, Insistence, and Resistance

Objective:

Aging parents may respond to advice or help with daily problems from their grown children by insisting, resisting, or persisting in their ways or opinions, behaviors which are commonly viewed as stubbornness. Research has not examined how frequently such behaviors occur and what factors are associated with these behaviors.

Methods:

Middle-aged adults and parents (N = 189 dyads) reported the prevalence of parental behaviors attributed to stubbornness. Utilizing hierarchical linear regression and multilevel modeling this exploratory study examined the association of parent stubbornness with individual and relationship-based characteristics and concordance in reports within dyads.

Results:

Over 77% of children and 66% of parents reported parents acting in ways attributed to stubbornness at least sometimes. Children reported higher levels of parental stubbornness than parents self-reported. Children's perceptions of occurrence were related to parent disability and relationship characteristics, while parents' self-reports were associated with their own personalities. Discrepancies in reports between parents and children were associated with child and parent characteristics.

Discussion:

This novel exploration demonstrated that individual and relationship-based factors are linked to the perceived expression of stubbornness by parents and that there is discordance in perceptions within families. Findings suggest a need for intervention to increase understanding within families.



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Subjective Age and Changes in Memory in Older Adults

Objective:

The subjective experience of aging, indexed by how old or young an individual feels, has been related to well-being and health-related outcomes among older adults. The present study examined whether subjective age is associated with memory level and changes, as indexed by measures of immediate and delayed recall. A complementary purpose was to test the mediating role of depressive symptoms and physical activity in the relation between subjective age and memory changes.

Method:

Participants were drawn from three waves of the Health and Retirement Study. Subjective age, baseline memory measures, and covariates were assessed during the 2008 wave (N = 5809), depressive symptoms and physical activity were assessed again in the 2010 wave, and the follow-up memory measures were assessed in the 2012 wave.

Results:

Regression analyses that included demographic, metabolic, and vascular covariates revealed that a younger subjective age at baseline was associated with better concurrent performance and with slower decline in immediate and delayed recall. Bootstrap procedures indicated that fewer depressive symptoms mediated these associations. Additional analyses revealed that memory level and change were unrelated to changes in subjective age.

Conclusion:

Beyond chronological age, the subjective experience of age is associated with cognitive aging.



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Age-Related Differences in Plausibility-Checking Strategies During Arithmetic Problem Verification Tasks

Objectives:

We examined whether older adults use plausibility-checking strategies while verifying arithmetic problems. We also tested trial-to-trial modulations of plausibility-checking strategies, and aging effects on these sequential modulations.

Method:

We asked young and older adults to verify arithmetic problems that violated or respected arithmetic rules (i.e., 5x16 = 87. True/False?).

Results:

Both young and older adults solved problems violating parity rule and five rule more quickly than problems violating no rule. We also found that both age groups had better performance when both five rule and parity rule are violated than when only one or no rules are violated. These results suggest age invariance in using rule-violation checking strategies and a smaller, but still efficient, strategy combination in older adults. Finally, for young adults only, strategy combination was larger following problems violating rules than after problems respecting rules.

Discussion:

These findings have important implications regarding mechanisms underlying age-related differences in using rule-violation checking strategies to verify arithmetic problems and in combining two strategies into a single, more efficient one



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Sexual Health and Positive Subjective Well-Being in Partnered Older Men and Women

Objectives:

We examine the associations between different patterns of sexual behavior and function and three indicators of subjective well-being (SWB) covering eudemonic, evaluative, and affective well-being in a representative sample of partnered older people.

Method:

Using data from a Sexual Relationships and Activities Questionnaire (SRA-Q) in Wave 6 of the English Longitudinal Study of Ageing, latent class analysis identified groups characterized by distinctive patterns of sexual behavior and function and then examined their link to SWB. Eudemonic SWB was measured using a revised 15-item version of the CASP-19, evaluative SWB using the Satisfaction With Life Scale, and affective SWB using the 8-item version of the Centre for Epidemiologic Studies-Depression scale.

Results:

Sexual behavior and function was best described by six classes among men and five classes among women. These ranged from high sexual desire, frequent partnered sexual activities, and few sexual problems (Class 1) to low sexual desire, infrequent/no sexual activity, and problems with sexual function (Class 5[women]/6[men]). Men and women who reported either infrequent/no sexual activity, or were sexually active but reported sexual problems, generally had lower SWB than those individuals identified in Class 1. Poorer SWB in men was more strongly associated with sexual function difficulties, whereas in women desire and frequency of partnered activities appeared more important in relation to SWB.

Discussion:

Within the context of a partnered relationship continuing sexual desire, activity and functioning are associated with higher SWB, with distinctive patterns for women and men.



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Long-Term Maintenance of Inhibition Training Effects in Older Adults: 1- and 3-Year Follow-Up

Objectives:

The aim of this study is to examine the long-term maintenance of training benefits in inhibition, as measured with the Stroop task, in older adults over 1- and 3-year periods.

Methods:

Participants from an original 6-session Stroop training study (Wilkinson & Yang, 2012 [Wilkinson, A. J., & Yang, L. (2012). Plasticity of inhibition in older adults: Retest practice and transfer effects. Psychology and Aging, 27, 606–615. doi:10.1037/a0025926]) were invited to come back to the lab to complete a single session of the Stroop task at 2 different time points. Thirty-three older adults returned for the 1-year follow-up session, and 26 of them returned for the 3-year follow-up session.

Results:

The results revealed maintenance of the training-induced inhibition gains at both follow-up sessions. Furthermore, performance at the 2 follow-up sessions was better (i.e., reduced Stroop ratio interference score) than baseline level.

Discussion:

The findings demonstrate the durability of inhibition training gains in older adults for up to a 3-year period. These results further extend the literature on long-term maintenance of cognitive training benefits in older adults by examining the durability of training effects in inhibition, an important executive function, and by covering a substantial maintenance period (i.e., up to 3 years).



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Centenarians Marital History and Living Arrangements: Pathways to Extreme Longevity

Objectives:

Mortality risk for older persons is associated with marital status and living arrangements, for example, living alone, with a spouse, with others but without a spouse, or in a collective household. This study analyzed the marital history and living arrangements of centenarians with the aim of identifying which trajectories are associated with reaching an advanced age.

Method:

Original longitudinal register-based data for 3,000 Belgian centenarians born between the years 1893 and 1903 were used to reconstruct their marital history and living arrangements during their later life (from age 60 to 100).

Results:

The marital history and living arrangements for male and female centenarians were strikingly different after they reached the age of 60. From age 60 to 100, male centenarians lived twice as long with their wife as female centenarians did with their husband. Female centenarians lived alone for more than half of their lives. Male centenarians had younger wives and female centenarians had older husbands than non-centenarians. More than half of the widowers remarried and did so with a woman who was generally more than 10 years younger. Most centenarians ended their life in a nursing home but entered it very late in life.

Discussion:

In very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse. This study compares the marital history and living arrangement trajectory of centenarians with people who did not live as long to determine associated mortality risks confirming that men are often not able to live by themselves, whereas women seem to have few problems to manage on their own.



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Real-time multi-channel monitoring of burst-suppression using neural network technology during pediatric status epilepticus treatment

Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (Trinka et al., 2015). Convulsive SE is the most common childhood neurological emergency in developed countries with 18-20 episodes per 100,000 cases per year in children younger than 16 years old (Chin et al., 2004; 2006). Because of its significant morbidity and mortality (Logroscino et al., 2001; Claassen et al., 2002; DeLorenzo et al., 1996), SE requires prompt diagnosis and treatment.

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The brainstem in late preterm birth: born small-for-gestational-age is the “tip of the iceberg”

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Publication date: Available online 11 June 2016
Source:Clinical Neurophysiology
Author(s): Dimitrios I Zafeiriou




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Assessment of Clinical Governance Climate in Hospitals: An Example of a Teaching Hospital

2016-06-10T20-52-35Z
Source: Gulhane Medical Journal
NECMETTİN CİHANGİROĞLU, ABDULKADİR TEKE, YASİN UZUNTARLA.
The hospitals which are leading institutions in the public service sector, in which technology is used intensively, which highlights the professionalism and team work, necessitates the understanding of corporate governance. In this study, we undertook a cross-sectional analysis of voluntarily 220 personnel in a teaching hospital between September-November 2011 using Clinical Governance Climate Questionnaire developed by Freeman.We found significant differences on planned and integrated quality improvement programme, proactive risk management, training and development opportunities and organisational learning dimensions between doctors and assisting health personnel. Additionally, while the evaluations of the doctors on quality improvement dimension are more positive than assisting personel, the evaluations of assisting personnel on the proactive risk management, training and improvement and the organizational learning dimensions are more positive.


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A pragmatic comparison of noise burst and electric shock unconditioned stimuli for fear conditioning research with many trials

Abstract

Several methods that are promising for studying the neurophysiology of fear conditioning (e.g., EEG, MEG) require a high number of trials to achieve an adequate signal-to-noise ratio. While electric shock and white noise burst are among the most commonly used unconditioned stimuli (US) in conventional fear conditioning studies with few trials, it is unknown whether these stimuli are equally well suited for paradigms with many trials. Here, N = 32 participants underwent a 260-trial differential fear conditioning and extinction paradigm with a 240-trial recall test 24 h later and neutral faces as conditioned stimuli. In a between-subjects design, either white noise bursts (n = 16) or electric shocks (n = 16) served as US, and intensities were determined using the most common procedure for each US (i.e., a fixed 95 dB noise burst and a work-up procedure for electric shocks, respectively). In addition to differing US types, groups also differed in closely linked US-associated characteristics (e.g., calibration methods, stimulus intensities, timing). Subjective ratings (arousal/valence), skin conductance, and evoked heart period changes (i.e., fear bradycardia) indicated more reliable, extinction-resistant, and stable conditioning in the white noise burst versus electric shock group. In fear conditioning experiments where many trials are presented, white noise burst should serve as US.



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A rare case of in vitro fertilization: Patau syndrome associated with bilateral anophthalmia

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Mehmet Şah İpek, Uğur Değer, Yunus Çavuş.
Background: Although the practice of preimplantation genetic diagnosis has seen major advances in both obstetrical and reproductive sciences in recent years, the methods used still have technical limitations that include the possibility of a false result. Method: A case of neonate born from twin pregnancy, which a product of in vitro fertilization, was reviewed. Result: The one of twin babies was diagnosed with Patau syndrome and bilateral anophthalmia, while the other was normal. Conclusion: Because of high risk of aneuploid embryos in women undergoing in vitro fertilization, genetic counselling must be provided to ensure that couples fully understand the risk of early pregnancy loss and having an affected child.


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GluA4 subunit of AMPA receptors mediates the early synaptic response to altered network activity in the developing hippocampus

Development of the neuronal circuitry involves both Hebbian and homeostatic plasticity mechanisms that orchestrate activity-dependent refinement of the synaptic connectivity. AMPA receptor subunit GluA4 is expressed in hippocampal pyramidal neurons during early postnatal period and is critical for neonatal long-term potentiation; however, its role in homeostatic plasticity is unknown. Here we show that GluA4-dependent plasticity mechanisms allow immature synapses to promptly respond to alterations in network activity. In the neonatal CA3, the threshold for homeostatic plasticity is low, and a 15-h activity blockage with tetrodotoxin triggers homeostatic upregulation of glutamatergic transmission. On the other hand, attenuation of the correlated high-frequency bursting in the CA3-CA1 circuitry leads to weakening of AMPA transmission in CA1, thus reflecting a critical role for Hebbian synapse induction in the developing CA3-CA1. Both of these developmentally restricted forms of plasticity were absent in GluA4–/– mice. These data suggest that GluA4 enables efficient homeostatic upscaling and responsiveness to temporal activity patterns during the critical period of activity-dependent refinement of the circuitry.



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Primary Care Practise in Turkey and Training of Contracted Family Physicians

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Yıldız Yardımcı, Derya İren Akbıyık, Cenk Aypak, Hulya Yıkılkan, Süleyman Görpelioğlu.
The official organization of family practice was renewed by Ministry of Health in Turkey and practicaly started in Duzce at 09.15th. 2005. It become widespread across Turkey by the end of 2010. In the mean time, specialists and practitioners who wanted to work as contracted family physicians were trained by a standardized training module and started working. First in 2014, as a part of the project aiming to train contracted family physicians to grow up as specialists (SAHU), Turkish Community Health Institution (THSK) started to recruit family medicine residents by an elective examination in 2014. This article targets to define the changes appeared in the process, evaluate the progress and revise the problems that might be a concerne in the future.


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VIP+ interneurons control neocortical activity across brain states

GABAergic interneurons are positioned to powerfully influence the dynamics of neural activity, yet the interneuron-mediated circuit mechanisms that control spontaneous and evoked neocortical activity remains elusive. Vasoactive intestinal peptide (VIP+) interneurons are a specialized cell class which synapse specifically on other interneurons, potentially serving to facilitate increases in cortical activity. In this study, using in vivo Ca2+ imaging, we describe the interaction between local network activity and VIP+ cells and determine their role in modulating neocortical activity in mouse visual cortex. VIP+ cells were active across brain states including locomotion, nonlocomotion, visual stimulation, and under anesthesia. VIP+ activity correlated most clearly with the mean level of population activity of nearby excitatory neurons during all brain states, suggesting VIP+ cells enable high-excitability states in the cortex. The pharmacogenetic blockade of VIP+ cell output reduced network activity during locomotion, nonlocomotion, anesthesia, and visual stimulation, suggesting VIP+ cells exert a state-independent facilitation of neural activity in the cortex. Collectively, our findings demonstrate that VIP+ neurons have a causal role in the generation of high-activity regimes during spontaneous and stimulus evoked neocortical activity.



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SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE PATIENTS REGISTERED BY HOME CARE SERVICES UNIT OF A STATE HOSPITAL

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Nevgül Demir, Didem Sunay, Feyza Yücel, Tanyel Sema Dağdeviren, Rukiyye Türker, Ayben Kocaöz, Osman Özcan Arıman.
Aim: To determine the quality of home care given and the socio-demographic and clinical characteristics of patients registered by home care services. Materials and methods: In this descriptive study, medical records of 800 patients registered by home care services of Kecioren Training and Research Hospital were analyzed retrospectively. Sociodemographic and clinical characteristics of the patients and types of services they received were evaluated. The data were analyzed by SPSS statistical software. Numerical variables were expressed as mean ± standard deviations and categorical variables as numbers and percentages (n, %). Results: Of the 800 patients 37.3 % were male and 62.7 % were female. Mean age of the patients was 75.6±15.3. Mean age of the males and females were 70.8±17.6 and 78.4±12.9, respectively and 2.9 % of them had no health insurance. Mean number of diseases was 2.6±1.3 and 41.4% of patients had hypertension and 27.3% had various neurological diseases such as Alzheimer, Parkinson, traumatic sequels, 13% had decubitus ulcers. The leading cause of home care visit request of the patients was to have a physical examination. Conclusion: Patients receiving home care services had various types of disease patterns and disabilities. Therefore, expectations about home care services were vary by patients and their family members.


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Decreased otolith-mediated vestibular response in 25 astronauts induced by long-duration spaceflight

The information coming from the vestibular otolith organs is important for the brain when reflexively making appropriate visual and spinal corrections to maintain balance. Symptoms related to failed balance control and navigation are commonly observed in astronauts returning from space. To investigate the effect of microgravity exposure on the otoliths, we studied the otolith-mediated responses elicited by centrifugation in a group of 25 astronauts before and after 6 mo of spaceflight. Ocular counterrolling (OCR) is an otolith-driven reflex that is sensitive to head tilt with regard to gravity and tilts of the gravito-inertial acceleration vector during centrifugation. When comparing pre- and postflight OCR, we found a statistically significant decrease of the OCR response upon return. Nine days after return, the OCR was back at preflight level, indicating a full recovery. Our large study sample allows for more general physiological conclusions about the effect of prolonged microgravity on the otolith system. A deconditioned otolith system is thought to be the cause of several of the negative effects seen in returning astronauts, such as spatial disorientation and orthostatic intolerance. This knowledge should be taken into account for future long-term space missions.



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Using simulation-based education to improve residents’ clinical decision making skills in developing countries

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Ibrahim Bashan, James M Cooke, Deborah M Rooney.
Background Recently, a significant increase occured in the use of medical simulation technology for teaching and assessment. Improved patient safety during medical education has driven simulation-based education (SBE), particularly in resident education. Although many countries have integrated SBE into their undergraduate programs, some developing countries, including Turkey, have been slow to apply SBE into their graduate programs. We propose a review of existing examples of SBE used which may promote the implementation of similar curricula in developing countries. Methods To derive a representative sample of relevant curricula, we performed a web-based literature review using the search terms simulation and ( graduate, resident) and (clinical decision-making or clinical reasoning) and training. Results Of the 83 original articles, ten resulting articles were relevant to SBE used to support residents clinical decision-making in six clinical areas. We summarize the ten curricula and discuss them in the context of three primary considerations (course administration, content development, and assessment program evaluation) so they may be applied in similar graduate curricula in Turkey and others. Conclusions It is obvious that simulation-based education offers benefits. In particular, graduate-level training programs used to support clinical decision-making are critical to the development of competent physicians around the world.


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Barriers to Drug Adherence

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Akatlı Kürşad Özşahin, Filiz Ekşi Haydardedeoğlu.
Barriers to Drug Adherence Abstract Objective: Lately, several phases to accomplish that patients continue therapy for chronic conditions for long periods has passed. Initially the patient was thought to be core of the problem of compliance. The role of the health care providers was also addressed soon. Now we acknowledge that a system approach is required. The idea of compliance is associated too closely with blame, be it of providers or patients and the concept of adherence is a better way for understanding the dynamic changes required to maintain health over long periods of time. This manuscript aims to uncover the patient side of the problem through indirect method of adherence measurement via patient questionnarie. Material and Method: 792 patients of family practice outpatient clinic ( 400 female and 392 male )were recruited and given a questionnarie as to list their reasons for drug inadherence Results: Reasons for inadherence were as follows; Unwillingness to use drugs (42,04%), Media effects (38,76%), Forgetfullness (34,59%), Poor communication with health care provider (33,58%), Drug side effects (24,11%), Refusing the disease (22,22%), Multiple drug use (19,06%), Concerns for accuracy of treatment (10,6%), and High costs of drugs (6,1%) Conclusion: Patients are explicitly effected by many factors for adherence. Improved adherence is primarily driven by improved management of diseases, including the increase awareness of issues surrounding adherence. That counts the physicians too. Inadherence warrants a bio-psychosocial approach and seemingly inadherent patients must be provided with a higher level of communication


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Retinal cross talk in the mammalian visual system

The existence and functional relevance of efferent optic nerve fibers in mammals have long been debated. While anatomical evidence for cortico-retinal and retino-retinal projections is substantial, physiological evidence is lacking, as efferent fibers are few in number and are severed in studies of excised retinal tissue. Here we show that interocular connections contribute to retinal bioelectrical activity in adult mammals. Full-field flash electroretinograms (ERGs) were recorded from one or both eyes of Brown-Norway rats under dark-adapted (n = 16) and light-adapted (n = 11) conditions. Flashes were confined to each eye by an opaque tube that blocked stray light. Monocular flashes evoked a small (5–15 μV) signal in the nonilluminated eye, which was named "crossed ERG" (xERG). The xERG began under dark-adapted conditions with a positive (xP1) wave that peaked at 70–90 ms and ended with slower negative (xN1) and positive (xP2) waves from 200 to 400 ms. xN1 was absent under light-adapted conditions. Injection of tetrodotoxin in either eye (n = 15) eliminated the xERG. Intraocular pressure elevation of the illuminated eye (n = 6) had the same effect. The treatments also altered the ERG b-wave in both eyes, and the alterations correlated with xERG disappearance. Optic nerve stimulation (n = 3) elicited a biphasic compound action potential in the nonstimulated nerve with 10- to 13-ms latency, implying that the xERG comes from slow-conducting (W type) fibers. Monocular dye application (n = 7) confirmed the presence of retino-retinal ganglion cells in adult rats. We conclude that mammalian eyes communicate directly with each other via a handful of optic nerve fibers. The cross talk alters retinal activity in rats, and perhaps other animals.



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Waterpipe Smoking: An İncidios Threat For The Young

2016-06-10T17-09-06Z
Source: Turkish Journal of Family Medicine & Primary Care
Süheyl Asma, Çiğdem Gereklioğlu, Aslı Korur, Soner Solmaz.
Various use types of tobacco include chewing tobacco, pipe, cigar, cigarette smoking and waterpipe smoking. Waterpipe is mostly used by the elderly in middle-east countries.Its use is gradually increasing among the young worldwide and also in our country. It is rapidly becoming common among the young due to newly produced aromatic forms. Tobacco and waterpipe smoking is a serios public health problem. Waterpipe smoking-related health risks are known. Prevention and information done by law makers, local authoroties beside media are of importance for reducing its use. In addition, in the context of community-oriented patient care , proper and effective interventions and improvement of health and wellness principles of family medicine, family physicians being a pioneer for providing sufficient information particulary for the young, family members and the community about this issue and taking measures is of great importance. In this review, it was aimed to improve the awareness of family physicians about waterpipe smoking.


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