Risk, protective, and biomarkers of dementia in Indigenous peoples: A systematic review.

INTRODUCTION: Dementia is an emergent health priority for Indigenous peoples worldwide, yet little is known about disease drivers and protective factors. METHODS: Database searches were conducted in March 2022 to identify original publications on risk, protective, genetic, neuroradiological, and biological factors related to dementia and cognitive impairment involving Indigenous peoples. RESULTS: Modifiable risk factors featured across multiple studies include childhood adversity, hearing loss, low education attainment, unskilled work history, stroke, head injury, epilepsy, diabetes, hypertension, hyperlipidemia, depression, low BMI, poor mobility, and continence issues. Non-modifiable risk factors included increasing age, sex, and genetic polymorphisms. Education, ex-smoking, physical and social activity, and engagement with cultural or religious practices were highlighted as potential protective factors. There is a paucity of research on dementia biomarkers involving Indigenous peoples. DISCUSSION: Greater understanding of modifiable factors and biomarkers of dementia can assist in strength-based models to promote healthy ageing and cognition for Indigenous peoples.

Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial.

BACKGROUND: Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. METHODS/DESIGN: The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. DISCUSSION: The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. TRIAL REGISTRATION: ACTRN12618001485224. Date of registration: 04 of September 2019.

Computed tomographic characteristics of the cisterna chyli in dogs.

Previous lymphangiographic studies have investigated the use of computed tomography (CT) for characterizing the thoracic duct and its tributaries in dogs. However, there is limited published information on the appearance of the canine cisterna chyli using CT. The objective of this retrospective study was to describe the features of the canine cisterna chyli in pre- and post-contrast abdominal CT studies. The presence, location, shape, maximum width, size compared with the aortic diameter (Ao:cisterna chyli ratio) and mean attenuation of the cisterna chyli were recorded from archived abdominal CT scans of 30 dogs. Breed, age, sex and neutering status were also noted. A cisterna chyli was identified in 26 of the dogs (87%). In 22 cases a cisterna chyli could be reliably identified prior to intravenous contrast administration and in all 26 cases in postcontrast images. The cisterna chyli was most commonly located right dorsolateral to the abdominal aorta between L1 and L4. Shape varied on transverse images from crescent-like to globular and maximum diameters ranged from 5 to 9 mm. The Ao:cisterna chyli ratio varied between 0.29 and 0.71 (mean value-males: 0.32; females: 0.38). On pre-contrast images the mean Hounsfield units were 21.3HU (range: -3.8 to 64.25). Mild enhancement of the cisterna chyli post-contrast was observed in 24 dogs (80%). Findings supported the use of pre- and post-contrast abdominal CT as a non-invasive method for assessing qualitative and quantitative characteristics of the canine cisterna chyli.

Elastography of the normal canine liver, spleen and kidneys.

Elastography is a simple, expedient and noninvasive technique that may be used to assess the elasticity or stiffness of a tissue, in conjunction with traditional B-mode ultrasonography. Quantitative assessment of tissue stiffness can be made which involves measurement of the shear wave velocity within the tissue of interest. The goal of this study was to assess the feasibility of elastography for clinical use in the abdomen of conscious small animals and to investigate factors that affect shear wave velocity measurement. Elastography was performed on the liver, spleen, and kidneys of 15 dogs at predefined depths within the parenchyma. Breed, age, gender, neuter status, and weight were documented for each animal. Depth at which measurements were taken had a significant negative relationship with the shear wave velocity value obtained. Individual dog effects, such as weight and gender, also appeared to have a significant effect on the shear wave velocity measurement for specific organs; weight had a significant positive effect on the shear wave velocity for each of the organs examined, whereas the effect of gender was inconsistent between organs (having a positive effect for the liver and a negative effect for the spleen). It is hoped that these results may act as a baseline to guide further work into the field of elastography in companion animals.

The radiographic appearance of the canine femoral nutrient foramen for dogs undergoing total hip replacement is consistent, with some variations.

OBJECTIVE: This study aimed to document the radiographic appearance of the femoral nutrient foramina and the variation of this in dogs undergoing total hip replacement (THR). Our hypothesis was that the radiographic appearance of the foramen would be consistent with the previously described anatomy, with some variations. ANIMALS: 89 client-owned dogs. METHODS: Preoperative radiographs were retrospectively analyzed for dogs undergoing THR at a single referral center. The signalment of all dogs was recorded. Radiographs were retrospectively examined to describe the number, direction, appearance, and foraminal index of the femoral nutrient foramen. RESULTS: Radiographs of 89 dogs and 102 femurs were examined. In 73 cases, a single foramen was seen; in 19 cases, no foramen was visible; and in 10 cases, 2 foramina were visible. The median foraminal index was 33.1% (range, 26% to 55.3%). On the mediolateral view, 72 were of proximocaudal-to-distocranial orientation, 19 were proximocranial to distocaudal, and 1 was atypical. On the craniocaudal or ventrodorsal views, the foramen was seen as a focal round radiolucency in 65 cases, was curved or atypical in 13 cases, and was not visible in 14. CLINICAL RELEVANCE: Radiolucent lines across the cortices that do not fit these criteria should raise suspicion of a femoral fissure, particularly within the context of THR.

Investigating the distribution of primary and secondary care referrals for public-funded bariatric surgery at Counties Manukau Health (CMH).

AIMS: This study investigated variations in referral rates for bariatric surgery from primary and secondary care providers across the Counties Manukau district health board (CMDHB), with the aim of identifying "hot spots" for referrals so that intervention to help achieve equitable access to bariatric surgery can be implemented. METHODS: Referral data was gathered from hospital referral records from January 2017 to January 2019 (n=1,440). Referral rate per geographical location within the CMDHB catchment was calculated using 2018 census figures. RESULTS: Of the 1,195 referrals included, 1040 (87%) referrals were from primary care. The referrals came from 328 general practitioners (GPs) across 158 practices. There was considerable regional variation in referral rates per 1000 people, from a peak of 71.5/1000 to a low of 0.2/1000. Eighty-six percent of secondary care referrals were received from the public system and the remainder from private practice. The most common referral specialty was diabetes, followed by general surgery and orthopaedics. Out of these referrals, 434 (36%) proceeded to bariatric surgery. Pakeha (50%) were more likely to proceed to surgery than Maori (31%) and Pasifika (22%), despite similar referral numbers. CONCLUSION: There is significant variation in referrals for bariatric surgery across CMDHB. Systematic discussion of bariatric surgery with every patient who is likely to benefit is not occurring, given relatively low referral volumes.

Comparison of three radiographic assessment methods for detecting slipped capital femoral epiphyses in cats: Klein's line, modified Klein's line and the S-sign.

OBJECTIVES: The aim of the present study was to investigate whether diagnostic assessment methods used on radiographs in humans with slipped capital femoral epiphysis (SCFE) can be used in cats. METHODS: The ventrodorsal (VD) extended-leg and VD frog-leg pelvic radiographs of 20 cats with SCFE without fully displaced femoral capital epiphyses (FCE), eight cats with fully displaced FCE and five control cats with normal pelvic anatomy were assessed by five observers on two separate occasions 3 months apart. The Klein's line and modified Klein's line were assessed on each VD extended-leg radiograph, and the S-sign was assessed on each VD extended-leg and VD frog-leg radiograph. RESULTS: Excluding cases of fully displaced FCE, the S-sign on the VD frog-leg radiographs more accurately diagnosed SCFE than the S-sign on the VD extended-leg radiographs and the Klein's line (92.4% vs 88.8% vs 60.6%, respectively), and had the greatest sensitivity (93.9% vs 79.2% vs 30.6%, respectively). The S-sign on the VD extended-leg radiographs had greater specificity than the Klein's line and S-sign on the VD frog-leg radiographs (99.2% vs 97.9% vs 90.9%, respectively). The modified Klein's line detected SCFE in 40.2% of cases that were negative for the Klein's line. CONCLUSIONS AND RELEVANCE: The S-sign in both VD extended-leg and VD frog-leg views successfully detected SCFE in cats and can be used to increase early diagnosis and treatment in cats with SCFE that have only subtle radiographic changes.

Christine Gibbs.

A pioneer of veterinary radiology, she was a born teacher and a role model.

Validation of the Good Spirit, Good Life quality-of-life tool for older Aboriginal Australians.

OBJECTIVE: Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians. METHODS: One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity. RESULTS: GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external. CONCLUSIONS: The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.

Identification of the peptide-binding motif recognized by the pigtail macaque class I MHC molecule Mane-A1*082:01 (Mane A*0301).

Rhesus and pigtail macaques have proven to be valuable animal models for several important human diseases, including HIV, where they exhibit similar pathology and disease progression. Because rhesus macaques have been extensively characterized in terms of their major histocompatibility complex (MHC) class I alleles, their demand has soared, making them increasingly difficult to obtain for research purposes. This problem has been exacerbated by a continued export ban in place since 1978. Pigtail macaques represent a potential alternative animal model. However, because their MHC class I alleles have not been characterized in detail, their use has been hindered. To address this, in the present study, we have characterized the peptide binding specificity of the pigtail macaque class I allele Mane-A1*082:01 (formerly known as Mane A*0301), representative of the second most common MHC class I antigen detected across several cohorts. The motif was defined on the basis of binding studies utilizing purified MHC protein and panels of single amino acid substitution analog peptides, as well as sequences of peptide ligands eluted from Mane-A1*082:01. Based on these analyses, Mane-A1*082:01 was found to recognize a motif with H in position 2 and the aromatic residues F and Y, or the hydrophobic/aliphatic residue M, at the C-terminus. Finally, analysis of the binding of a combinatorial peptide library allowed the generation of a detailed quantitative motif that proved effective in the prediction of a set of high-affinity binders derived from chimeric SIV/HIV, an important model virus for studying HIV infection in humans.

A shared MHC supertype motif emerges by convergent evolution in macaques and mice, but is totally absent in human MHC molecules.

The SIV-infected rhesus macaque (Macaca mulatta) is the most established model of AIDS disease systems, providing insight into pathogenesis and a model system for testing novel vaccines. The understanding of cellular immune responses based on the identification and study of Major Histocompatibility Complex (MHC) molecules, including their MHC:peptide-binding motif, provides valuable information to decipher outcomes of infection and vaccine efficacy. Detailed characterization of Mamu-B*039:01, a common allele expressed in Chinese rhesus macaques, revealed a unique MHC:peptide-binding preference consisting of glycine at the second position. Peptides containing a glycine at the second position were shown to be antigenic from animals positive for Mamu-B*039:01. A similar motif was previously described for the D(d) mouse MHC allele, but for none of the human HLA molecules for which a motif is known. Further investigation showed that one additional macaque allele, present in Indian rhesus macaques, Mamu-B*052:01, shares this same motif. These "G2" alleles were associated with the presence of specific residues in their B pocket. This pocket structure was found in 6% of macaque sequences but none of 950 human HLA class I alleles. Evolutionary studies using the "G2" alleles points to common ancestry for the macaque sequences, while convergent evolution is suggested when murine and macaque sequences are considered. This is the first detailed characterization of the pocket residues yielding this specific motif in nonhuman primates and mice, revealing a new supertype motif not present in humans.

MRI findings of a middle ear cholesteatoma in a dog.

This article describes the MRI features of a middle ear cholesteatoma in an 8 yr old flat-coated retriever. Physical examination revealed pain on opening the jaw, and otoscopic examination showed tympanic membrane rupture associated with hyperplastic tissue at the entrance of the middle ear. Standard MRI sequences allowed for the identification of a severely expanded bulla containing material that was isointense to brain tissue on T1-weighted images and of mixed intensity on T2-weighted and fluid-attenuated inversion recovery sequences. No postcontrast enhancement of the content was present, but the lining of the bulla was partially enhanced. The images allowed evaluation of the surgical margins and the secondary changes due to the expansion of the mass. Surgery was performed and histopathology confirmed the presumptive diagnosis of cholesteatoma. In the present case, MRI appeared to serve as a good alternative to computed tomography for the diagnosis of cholesteatoma.

Good Spirit, Good Life: A Quality of Life Tool and Framework for Older Aboriginal Peoples.

BACKGROUND AND OBJECTIVES: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. RESEARCH DESIGN AND METHODS: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semistructured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. RESULTS: The participants preferred the term "a good life" to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. DISCUSSION AND IMPLICATIONS: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide.

Effects of herbivory on the reproductive effort of 4 prairie perennials.

BACKGROUND: Herbivory can affect every aspect of a plant's life. Damaged individuals may show decreased survivorship and reproductive output. Additionally, specific plant species (legumes) and tissues (flowers) are often selectively targeted by herbivores, like deer. These types of herbivory influence a plant's growth and abundance. The objective of this study was to identify the effects of leaf and meristem removal (simulated herbivory within an exclosure) on fruit and flower production in four species (Rhus glabra, Rosa arkansana, Lathyrus venosus, and Phlox pilosa) which are known targets of deer herbivory. RESULTS: Lathyrus never flowered or went to seed, so we were unable to detect any treatment effects. Leaf removal did not affect flower number in the other three species. However, Phlox, Rosa, and Rhus all showed significant negative correlations between seed mass and leaf removal. Meristem removal had a more negative effect than leaf removal on flower number in Phlox and on both flower number and seed mass in Rosa. CONCLUSIONS: Meristem removal caused a greater response than defoliation alone in both Phlox and Rosa, which suggests that meristem loss has a greater effect on reproduction. The combination of leaf and meristem removal as well as recruitment limitation by deer, which selectively browse for these species, is likely to be one factor contributing to their low abundance in prairies.

Evaluation of the repeatability of ultrasound scanning for detection of feline polycystic kidney disease.

Polycystic kidney disease (PKD) is the most prevalent inherited genetic disease in cats with Persian and Persian-related breeds predominantly affected. Diagnosis of PKD relied on ultrasound scanning until the recent development of the PKD gene test. However, gene testing has limitations as it will only identify the autosomal dominant form of PKD and not other forms of cystic kidney disease. Ultrasound scanning also has the advantage of being able to assess the severity and progression of disease in PKD affected cats. The aim of this study was to demonstrate the repeatability of ultrasound scanning in the detection of PKD and to assess progression of the disease over time. This study demonstrated 100% repeatability of ultrasound scanning in the detection of PKD and has also demonstrated progression of disease in 75% of PKD positive cats assessed over a 1-year period.

Radiographic and ultrasonographic features of canine paraprostatic cysts.

Mineralization of paraprostatic cysts is reported to be uncommon. This retrospective study was performed to review the imaging findings of eight histologically confirmed canine paraprostatic cysts. Radiographic patterns of mineralization seen are described. Four of the eight dogs had mineralized cysts. Mineralization seen on radiography was not consistently seen on ultrasonography, probably due to the lack of acoustic shadowing artefact from the small depth of mineralized tissue. It is thus concluded that mineralization of paraprostatic cysts is more common than implied in the literature, and that radiography is superior to ultrasonography in identifying its presence.

Ecosystem assembly and terrestrial carbon balance under elevated CO(2).

Research aimed at understanding how the global carbon balance will change with elevated CO(2) has largely ignored the responses of individual species and genotypes. Yet, plant traits strongly influence the biogeochemical cycling of carbon. Here, we illustrate how differences in inter- and intraspecific responses to elevated CO(2) affect not only physiology and growth, but also higher order biotic interactions and lifetime fitness, ultimately leading to new ecosystem assemblages. We assert that the unique combination of inter- and intraspecific traits in these ecosystem assemblages ultimately determine how ecosystems respond to elevated atmospheric CO(2). Thus, the identity of species and genotypes in an ecosystem is a crucial element to consider in forecasts of global carbon balance.