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Predicting dementia from primary care records: A systematic review and meta-analysis
Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care.
We conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies. From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer's (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results.
These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should also be explored in future studies.
Journal Article
Masculinity, Class and Same-Sex Desire in Industrial England, 1895-1957
Masculinity, Class and Same-Sex Desire in Industrial England, 1895-1957 explores the experiences of men who desired other men outside of the capital. In doing so, it offers a unique intervention into the history of sexuality but it also offers new ways to understand masculinity, working-class culture, regionality and work in the period.
eBook
Size-selective opening of the blood–brain barrier by targeting endothelial sphingosine 1–phosphate receptor 1
The vasculature of the central nervous system (CNS) forms a selective barrier termed the blood–brain barrier (BBB). Disruption of the BBB may contribute to various CNS diseases. Conversely, the intact BBB restricts efficient penetration of CNS-targeted drugs. Here, we report the BBB-regulatory role of endothelial sphingosine 1–phosphate (S1P) receptor-1, a G protein-coupled receptor known to promote the barrier function in peripheral vessels. Endothelial-specific S1pr1 knockout mice (S1pr1iECKO
) showed BBB breach for small-molecular-mass fluorescence tracers (<3 kDa), but not larger tracers (>10 kDa). Chronic BBB leakiness was associated with cognitive impairment, as assessed by the novel object recognition test, but not signs of brain inflammation. Brain microvessels of S1pr1iECKO
mice showed altered subcellular distribution of tight junctional proteins. Pharmacological inhibition of S1P₁ function led to transient BBB breach. These data suggest that brain endothelial S1P₁ maintain the BBB by regulating the proper localization of tight junction proteins and raise the possibility that endothelial S1P₁ inhibition may be a strategy for transient BBB opening and delivery of small molecules into the CNS.
Journal Article
Global perspectives on teacher motivation
\"Many studies of teacher motivation have been conducted in different contexts over time. However, until fairly recently there has not been a reliable measure available to allow comparisons across samples and settings. This has resulted in an abundance of findings which cannot be directly compared or synthesised. The FIT-Choice instrument offers the opportunity to examine motivations across settings. The various studies in this book suggest that people who choose teaching as a career are motivated by a complex interaction of factors embedded within communities and cultural expectations, but seem generally to embrace a desire to undertake meaningful work that makes for a better society. Unlike some careers, where rewards are in the form of salary and status, by and large these factors are not strong drivers for people who want to become teachers. They want to work with children and adolescents, and believe they have the ability to teach\" -- Provided by publisher.
Book
Altered temporal stability in dynamic neural networks underlies connectivity changes in neurodevelopment
Network connectivity is an integral feature of human brain function, and characterising its maturational trajectory is a critical step towards understanding healthy and atypical neurodevelopment. Here, we used magnetoencephalography (MEG) to investigate both stationary (i.e. time averaged) and rapidly modulating (dynamic) electrophysiological connectivity, in participants aged from mid-childhood to early adulthood (youngest participant 9 years old; oldest participant 25 years old). Stationary functional connectivity (measured via inter-regional coordination of neural oscillations) increased with age in the alpha and beta frequency bands, particularly in bilateral parietal and temporo-parietal connections. Our dynamic analysis (also applied to alpha/beta oscillations) revealed the spatiotemporal signatures of 8 dynamic networks; these modulate on a ∼100 ms time scale, and temporal stability in attentional networks was found to increase with age. Significant overlap was found between age-modulated dynamic networks and inter-regional oscillatory coordination, implying that altered network dynamics underlie age related changes in functional connectivity. Our results provide novel insights into brain network electrophysiology, and lay a foundation for future work in childhood disorders.
•We studied static and dynamic connectivity change between mid-childhood and adulthood.•Static (time averaged) connectivity increases with age in alpha and beta bands.•Connectivity changes with age are strongest in attentional networks.•Temporal stability in attentional networks was found to increase with age.•Changing network dynamics underlies changes in time averaged functional connectivity.
Journal Article
أسس اللسانيات النفسية
كتاب \"أسس اللسانيات النفسية\" لفيرنانديز وكيرنز كتاب شامل جمع بين دفتيه مسائل ومباحث هذا العلم التي تشمل فهم الكيفية التي يكتسب لها الناس اللغة والكيفية التي يستعملون بها اللغة ليتحادثوا ويتفاهموا والكيفية التي يتم بها تمثيل اللغة ومعالجتها في الدماغ فتضمن الكتاب استعراضا موسعا للأسس الأحيائية للغة البشرية بالإضافة إلى بيان الكيفية التي يتم بها إنتاج الجمل وإستيعابها وبوصف الخطوات المتتابعة لهذه العملية منذ اللحظة الأولى التي تتم فيها ولادة الفكرة في ذهن المتكلم حتى اللحظة التي يتم فيها فهمها في ذهن السامع.
BOOK
Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research
Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.
We searched 19 electronic databases (1966-February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms \"Tuberculosis AND (adherence OR compliance OR concordance)\". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies.
Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.
Journal Article