Non-memory subjective cognitive concerns predict incident motoric cognitive risk syndrome.

BACKGROUND AND PURPOSE: Motoric cognitive risk syndrome (MCR) is a predementia condition that combines slow gait and subjective cognitive concerns. As the earliest markers of MCR are relatively unknown, the role of subjective cognitive concerns was investigated to predict incident MCR in a well-characterized prospective cohort of non-demented older adults. METHODS: Non-demented MCR-free older adults (n = 476) from the Central Control of Mobility in Aging cohort completed gait, subjective cognition and neuropsychological assessment at baseline and follow-up. Subjective concerns were analyzed via responses to 12 items from three validated measures, the Late-Life Function and Disability Instrument - Disability Component, the Activities of Daily Living Prevention Instrument and the Geriatric Depression Scale, and were independent of items utilized to diagnose MCR. Cox proportional hazard models examined the association between cognitive concerns and incident MCR. RESULTS: After 2.36 ± 1.4 years, 28 participants developed MCR. Executive functioning (adjusted hazard ratio 2.458, 95% confidence interval 1.094-5.524, P = 0.029) and mental clarity concerns (adjusted hazard ratio 3.917, 95% confidence interval 1.690-9.077, P = 0.001) were associated with incident MCR, controlling for age, sex, education and gait speed. CONCLUSIONS: Subjective cognitive concerns in non-memory cognitive domains predict incident MCR. Although most MCR studies assess cognitive concerns about memory, our findings suggest the need to broaden the scope of subjective cognitive assessment to enhance the accuracy of diagnosis and prediction of future cognitive decline.

Accuracy of influenza vaccination rate estimates in United States nursing home residents.

The US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010-2011 and 2011-2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors.

BACKGROUND: Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required. REVIEW: The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed. RECOMMENDATIONS: (1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption. CONCLUSION: Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Preplacement assessments. Impact on injury outcomes.

Evaluation of the impact of preplacement assessments is important given the resources companies and occupational health nurses allocate to screening and the ambiguity of the literature about the effectiveness of such assessments. This study examined the effects of preplacement assessments on employee injuries. All individuals screened by an occupational health clinic in the upper Midwest and given work restrictions during a 3 year period were identified as cases (n = 67). Cases were matched with controls without work restrictions (n = 264) on the basis of employer, gender, and job. Age was controlled for statistically. Chi-square analysis, used to test differences in percent distribution of injuries between cases and controls, found no statistically significant differences in musculoskeletal injuries between the groups. Work restrictions recommended as a result of preplacement assessments appear to protect vulnerable workers.

New endeavors and innovative programs in end of life care.

This paper presents summaries of initiatives and demonstration programs developed by professional and patient care organizations to improve care at the end of life.

Feed aversion learning in cattle with delayed negative consequences.

Two experiments were conducted to study the ingestive behavior of cattle when given a delayed dose of the aversive agent lithium chloride (LiCl) after eating a novel feed. In the first experiment, 20 calves were randomly divided into four groups (n = 5). The control group (G1) received 80 mg/kg BW of sodium chloride (NaCl) 4 h after eating a novel feed. Groups 2 (G2), 3 (G3), and 4 (G4) received 80 mg/kg of LiCl at 4, 8, and 12 h, respectively, after eating the novel feed. When calves were offered the novel feed on subsequent days, G2 and G3 ate less (P < .05) than G1. There was no difference (P > .05) in intakes between G1 and G4. In the second experiment, 15 calves were randomly divided into three groups (n = 5). The control group (G1) received 80 mg/kg BW of NaCl 12 h after eating a novel feed, whereas G2 and G3 received 80 and 160 mg/kg BW, respectively, of LiCl 12 h after eating the novel feed. When calves were offered the novel feed on subsequent days, G1 and G2 ate similar (P > .05) amounts, whereas G3 ate much less (P < .05) of it than the other groups. Cattle learned to avoid novel feeds even when they experienced negative postingestive consequences up to 12 h after they ate the feeds. The capacity for long-delay learning seems to be related to the severity of negative consequences experienced.

Olfactory bulbectomy as a model for agitated hyposerotonergic depression.

Ablation of olfactory bulbs in rats reduced male sexual behavior, and altered the distribution of wheel-running activity between the light and dark phases of a 12:12 LD photoperiod. These effects were partially reversed by the tricyclic antidepressant amitriptyline. Olfactory bulbectomy also altered serotonin metabolism (5-HIAA/5-HT ratio) in the frontal cortex, nucleus accumbens, hippocampus and corpus striatum. These observations support the hypothesis that olfactory bulbectomy in rodents serves as a model of agitated hyposerotonergic depression.

Influence of lasalocid and supplement level on productivity of gestating ewes grazing winter range.

Two winter feeding trials (1985-86; 1986-87) were conducted to evaluate the productivity of gestating ewes fed lasalocid (L) and two supplement levels while grazing Montana winter range. Five hundred range ewes were randomized within age and breed each year and allotted to .15 or .23 kg hd-1.d-1 of a 20% CP supplement and either no L or L at 70 mg hd-1.d-1. Feed treatments began on 18 Dec. approximately 100 d before the first expected lambing date and continued for 84 d. Ewes fed .23 kg of supplement per day gained more (P less than .01) total weight (4.9 vs 4.0 kg) during the 84-d experiment and had higher (P less than .05) grease fleece weights (4.2 vs 4.0 kg) than those fed .15 kg of supplement. Lasalocid had no effect (P greater than .05) on ewe weight change or grease fleece weights. Supplement level had no effect (P greater than .05) on reproduction, lamb mortality and lamb performance. Ewes fed L had a greater (P less than .05) percentage of lambs born per ewe than those not fed L (120.7 vs 112.1%); lamb performance was similar (P greater than .05) between treatments. However, because a greater percentage of lambs were born per ewe starting the experiment, ewes fed L produced more (P less than .05) kilograms of weaned lamb than those not fed L (25.9 vs 23.4 kg). In conclusion, ewes fed L and grazing winter range weaned more kg of lamb than did controls because of an improved lambing percentage.(ABSTRACT TRUNCATED AT 250 WORDS)