RESUMEN
The COHERENT Collaboration searched for scalar dark matter particles produced at the Spallation Neutron Source with masses between 1 and 220 MeV/c^{2} using a CsI[Na] scintillation detector sensitive to nuclear recoils above 9 keV_{nr}. No evidence for dark matter is found and we thus place limits on allowed parameter space. With this low-threshold detector, we are sensitive to coherent elastic scattering between dark matter and nuclei. The cross section for this process is orders of magnitude higher than for other processes historically used for accelerator-based direct-detection searches so that our small, 14.6 kg detector significantly improves on past constraints. At peak sensitivity, we reject the flux consistent with the cosmologically observed dark-matter concentration for all coupling constants α_{D}<0.64, assuming a scalar dark-matter particle. We also calculate the sensitivity of future COHERENT detectors to dark-matter signals which will ambitiously test multiple dark-matter spin scenarios.
RESUMEN
Using an 185-kg NaI[Tl] array, COHERENT has measured the inclusive electron-neutrino charged-current cross section on ^{127}I with pion decay-at-rest neutrinos produced by the Spallation Neutron Source at Oak Ridge National Laboratory. Iodine is one the heaviest targets for which low-energy (≤50 MeV) inelastic neutrino-nucleus processes have been measured, and this is the first measurement of its inclusive cross section. After a five-year detector exposure, COHERENT reports a flux-averaged cross section for electron neutrinos of 9.2_{-1.8}^{+2.1}×10^{-40} cm^{2}. This corresponds to a value that is â¼41% lower than predicted using the MARLEY event generator with a measured Gamow-Teller strength distribution. In addition, the observed visible spectrum from charged-current scattering on ^{127}I has been measured between 10 and 55 MeV, and the exclusive zero-neutron and one-or-more-neutron emission cross sections are measured to be 5.2_{-3.1}^{+3.4}×10^{-40} and 2.2_{-0.5}^{+0.4}×10^{-40} cm^{2}, respectively.
RESUMEN
We measured the cross section of coherent elastic neutrino-nucleus scattering (CEvNS) using a CsI[Na] scintillating crystal in a high flux of neutrinos produced at the Spallation Neutron Source at Oak Ridge National Laboratory. New data collected before detector decommissioning have more than doubled the dataset since the first observation of CEvNS, achieved with this detector. Systematic uncertainties have also been reduced with an updated quenching model, allowing for improved precision. With these analysis improvements, the COHERENT Collaboration determined the cross section to be (165_{-25}^{+30})×10^{-40} cm^{2}, consistent with the standard model, giving the most precise measurement of CEvNS yet. The timing structure of the neutrino beam has been exploited to compare the CEvNS cross section from scattering of different neutrino flavors. This result places leading constraints on neutrino nonstandard interactions while testing lepton flavor universality and measures the weak mixing angle as sin^{2}θ_{W}=0.220_{-0.026}^{+0.028} at Q^{2}≈(50 MeV)^{2}.
RESUMEN
We report the first measurement of coherent elastic neutrino-nucleus scattering (CEvNS) on argon using a liquid argon detector at the Oak Ridge National Laboratory Spallation Neutron Source. Two independent analyses prefer CEvNS over the background-only null hypothesis with greater than 3σ significance. The measured cross section, averaged over the incident neutrino flux, is (2.2±0.7)×10^{-39} cm^{2}-consistent with the standard model prediction. The neutron-number dependence of this result, together with that from our previous measurement on CsI, confirms the existence of the CEvNS process and provides improved constraints on nonstandard neutrino interactions.
RESUMEN
Stereo-video scuba transects were conducted during daylight hours from June to September 2013 within a proposed marine protected area (MPA) in the Firth of Clyde, west of Scotland. More juvenile Atlantic cod Gadus morhua of fork length (LF ) range 6-11 cm were observed in substrata containing mixed gravel, including maerl, than in boulder-cobble substrata with high algal cover, or sand with low density seagrass. Community composition was significantly different between substratum types. A decrease in G. morhua abundance was observed over the period of data collection. Over time, mean and variance in G. morhua LF increased, indicating multiple recruitment events. Protecting mixed gravel substrata could be a beneficial management measure to support the survival and recruitment of juvenile G. morhua; other substrata might be important at night given their diel migratory behaviour. Stereo-video cameras provide a useful non-destructive fisheries-independent method to monitor species abundance and length measurements.
Asunto(s)
Distribución Animal , Gadus morhua/fisiología , Animales , Conducta Animal/fisiología , Tamaño Corporal , Ecosistema , Explotaciones Pesqueras , Gadus morhua/crecimiento & desarrollo , Escocia , Encuestas y Cuestionarios , Grabación en VideoRESUMEN
Following the repeal in 1962 of a long-standing ban on trawling, yields of demersal fish from the Firth of Clyde, southwest Scotland, increased to a maximum in 1973 and then declined until the directed fishery effectively ceased in the early 2000s. Since then, the only landings of demersal fish from the Firth have been by-catch in the Norway lobster fishery. We analysed changes in biomass density, species diversity and length structure of the demersal fish community between 1927 and 2009 from scientific trawl surveys, and related these to the fishery harvesting rate. As yields collapsed, the community transformed from a state in which biomass was distributed across numerous species (high species evenness) and large maximum length taxa were common, to one in which 90 per cent of the biomass was vested in one species (whiting), and both large individuals and large maximum length species were rare. Species evenness recovered quickly once the directed fishery ceased, but 10 years later, the community was still deficient in large individuals. The changes partly reflected events at a larger regional scale but were more extreme. The lag in response with respect to fishing has implications for attempts at managing a restoration of the ecosystem.
Asunto(s)
Biota , Peces/fisiología , Animales , Océano Atlántico , Biomasa , Tamaño Corporal , Conservación de los Recursos Naturales , Ecosistema , Explotaciones Pesqueras , Densidad de Población , Escocia , Estaciones del AñoRESUMEN
The coherent elastic scattering of neutrinos off nuclei has eluded detection for four decades, even though its predicted cross section is by far the largest of all low-energy neutrino couplings. This mode of interaction offers new opportunities to study neutrino properties and leads to a miniaturization of detector size, with potential technological applications. We observed this process at a 6.7σ confidence level, using a low-background, 14.6-kilogram CsI[Na] scintillator exposed to the neutrino emissions from the Spallation Neutron Source at Oak Ridge National Laboratory. Characteristic signatures in energy and time, predicted by the standard model for this process, were observed in high signal-to-background conditions. Improved constraints on nonstandard neutrino interactions with quarks are derived from this initial data set.
RESUMEN
Samples of altered or carious dentin for microbiological culture were obtained from 301 primary root-caries lesions in 59 patients by means of a standardized sampling procedure. This involved the cleansing of each root surface of extraneous supragingival plaque by means of a hand-held toothbrush and distilled water and the collection of the sample with a sterile dental excavator passed through the entire vertical dimension of each lesion. The total number of colony-forming units (cfu) in each sample and the numbers of mutans streptococci (primarily Streptococcus mutans), lactobacilli, yeasts, and Gram-positive pleomorphic rods (GPPR) were determined. Individual bacterial counts were expressed as log10 (cfu per sample), as a percentage of the total number of bacteria per sample, and as a frequency of isolation from lesions with different clinical diagnostic criteria. Clinical measurements of each lesion were made for color, texture, position relative to the gingival margin, and treatment need. Lesions classified as soft yielded significantly more bacteria, mutans streptococci, lactobacilli, and GPPR than leathery lesions, which yielded more bacteria than hard lesions. Lesions were classified into 5 treatment categories: soft and restore, leathery and restore, leathery and debride of caries; leathery and treat therapeutically; and hard no treatment. The total numbers of bacteria, mutans streptococci, lactobacilli, GPPR, and yeasts decreased significantly with decreasing treatment need. The frequency of isolation of mutans streptococci, lactobacilli, and yeasts was significantly greater from lesions requiring restoration and from lesions situated within 1 mm of the gingival margin. We suggest that the majority of root caries is initiated adjacent to the gingival margin.
Asunto(s)
Bacterias/aislamiento & purificación , Caries Radicular/microbiología , Caries Radicular/terapia , Actinomyces/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Clorhexidina/administración & dosificación , Clorhexidina/uso terapéutico , Recuento de Colonia Microbiana , Color , Desbridamiento , Restauración Dental Permanente , Femenino , Fluoruros Tópicos/uso terapéutico , Geles , Bacilos Grampositivos/aislamiento & purificación , Humanos , Lactobacillus/aislamiento & purificación , Masculino , Persona de Mediana Edad , Antisépticos Bucales , Caries Radicular/patología , Streptococcus mutans/aislamiento & purificación , Streptococcus sobrinus/aislamiento & purificación , Levaduras/aislamiento & purificaciónRESUMEN
Multivariate step-wise regression analyses demonstrated that in a population of 146 elderly dental patients (mean age 69.8 yr) the salivary level of mutans streptococci was unrelated to the root DFS score, unlike the levels of lactobacilli and yeasts. Mutans streptococci were related to the wearing of partial dentures and the number of snacks eaten per day, while salivary lactobacillus levels were also related to the number of snacks eaten per day and to denture wearing, and negatively related to saliva buffering. Salivary yeast levels were also related to the wearing of partial dentures and the number of snacks eaten per day, and negatively related to salivary neuraminidase activity. The R2 values ranged from 0.21 to 0.28. Salivary level of black-pigmented Bacteroides spp. were related to maximum CPITN score, mean bleeding index and salivary trypsin-like activity (R2 was 0.08).
Asunto(s)
Bacteroides/aislamiento & purificación , Lactobacillus/aislamiento & purificación , Salud Bucal , Saliva/microbiología , Streptococcus mutans/aislamiento & purificación , Levaduras/aislamiento & purificación , Anciano , Tampones (Química) , Índice CPO , Femenino , Humanos , Masculino , Análisis Multivariante , Índice Periodontal , Saliva/enzimología , Saliva/metabolismo , Saliva/fisiología , Tasa de Secreción , Streptococcus mutans/clasificaciónRESUMEN
Complete feeding sequences (bite to terminal swallow) were recorded in 11 individuals (Class I occlusions) feeding on apple, banana and biscuit (hard cookie) to establish whether jaw movements characteristic of the stage I transport, chewing, stage II transport and swallowing processes found in non-human mammals could be identified in man. All participants took large natural bites (known weight) of each food, but seven were supplied standard 6-g pieces of apple. Jaw movements (three axes) were recorded using a locally calibrated Sirognathograph. Discrete stage I transport movements (bite moved from incisors to postcanines), were found in most records, but least frequently for banana. The number of chewing cycles before the first in-sequence swallow increased in the order: banana, ( = ) apple without peel, apple with peel, biscuit. Chewing cycles showed subtle changes in gape profile but significant variation in mediolateral movement cycle to cycle. Morphologically distinct stage II transport cycles could not be identified. Swallows occurred intermittently during chewing (79% of all sequences, n = 146) with cycle durations in excess of 1 s in contrast to the range for chewing (0.6-0.7 s). Almost all sequences ended with a period, clearance, of highly irregular jaw movements often including swallows. Clearance has not been described in other mammals. Food consistency affected feeding behaviour. The "chew/swallow' ratio (total number of chews/total number of swallows) increased with food hardness. The number of chewing cycles before the first in-sequence swallow also increased. Food type significantly affected sequence duration. The duration of clearance was also affected by bite weight and food hardness. It is concluded that initial food consistency determines the number of chewing cycles before the first swallow and overall sequence duration. The change in the pattern of jaw movement in both the vertical and mediolateral directions cycle to cycle suggests continuous sensory modulation of the motor output to the mandibular musculature.
Asunto(s)
Fuerza de la Mordida , Deglución/fisiología , Ingestión de Alimentos/fisiología , Conducta Alimentaria , Masticación/fisiología , Adulto , Análisis de Varianza , Electromiografía , Femenino , Alimentos , Dureza , Humanos , Maxilares/fisiología , Registro de la Relación Maxilomandibular , Masculino , Músculos Masticadores/fisiología , Persona de Mediana Edad , Movimiento , Tamaño de la Partícula , Procesamiento de Señales Asistido por Computador , Factores de TiempoRESUMEN
Mixtures of particles of different sizes, as obtained after chewing, were analysed. Coarse, medium and fine mixtures of particles of an artificial (Optosil) test food were used. Mixtures of Optosil particles of known form and size (half-cubes) were used to validate the analytical methods. The results of both methods were described by particle size distributions based on the volume of the particles. Complete agreement between methods was found for the mixtures of half-cubes. In order to determine the median particle size by volume from the results of optical scanning an assumption on the form of the chewed particles had to be made. Using the assumption that, on average, the particles resemble spheres a slight overestimate of the median particle size was obtained for scanning as compared to sieving. It can be concluded that, although different aspects of the fragmented particles are measured, sieving and optical scanning are both adequate methods for quantifying mixtures of chewed food particles and yield similar results for the degree of particle size reduction.
Asunto(s)
Alimentos , Masticación/fisiología , Calibración , Humanos , Óptica y Fotónica , Tamaño de la Partícula , Elastómeros de Silicona/química , Siliconas/química , Propiedades de SuperficieRESUMEN
Three mixtures of chewed food particles (coarse, medium and fine) were quantified by measuring the particle sizes with an optical scanning device. The particle sizes were described by three different particle-size distributions: a cumulative volume, a volume and a number distribution. The median particle size was determined from each of the distribution functions. Suitability for characterizing a mixture of chewed food particles was tested, showing that the median particle size as obtained from a cumulative volume (or weight) distribution should be preferred. It was shown to be the most sensitive measure for characterizing mixtures of chewed food.
Asunto(s)
Alimentos , Masticación/fisiología , Calibración , Eficiencia , Humanos , Tamaño de la Partícula , Elastómeros de Silicona/química , Siliconas/química , Propiedades de Superficie , Factores de TiempoRESUMEN
Whether the motor programme executed by the digastric muscles during a forceful bite is modified according to a subject's expectation that the resistance between the teeth will change was investigated. There were two experimental conditions: (1) tracking a ramp (drawn on an oscilloscope screen) by biting (isometrically) on a force transducer and holding it at 120 N, and (2) tracking the same ramp with a sudden unloading at 100 N. There were two groups of experiments: (1) control experiments in which subjects underwent a sudden and unexpected unloading of the jaw, and (2) experiments in which subjects were previously informed whether or not there was to be an unloading. In all experiments the subjects co-contracted their digastric muscles during the bite as compared to the state at rest. The subjects' responses fell into the three different types: (i) those who varied the level of tonic digastric activity only as a function of the experimental condition, (ii) those who co-contracted the digastric muscles at the same time as the masseter muscles, and (iii) those who changed the contraction pattern of the digastric muscles as a function of the experimental condition. If modulation of the digastric muscles occurred this is a 'feedforward' strategy mainly based on immediate past performance.
Asunto(s)
Fuerza de la Mordida , Aprendizaje , Destreza Motora/fisiología , Músculos del Cuello/fisiología , Electromiografía , Humanos , Contracción Isométrica/fisiología , Músculo Masetero/fisiología , Contracción Muscular/fisiología , Tono Muscular/fisiología , Tiempo de Reacción , Reflejo/fisiología , Estrés MecánicoRESUMEN
It is essential to know the limitations of any equipment used for research or clinical purposes. Clinical electronic equipment is commonly sold for "black box" use without specification of artifacts. This study tested the technical and clinical limitations of the Sirognathograph, which is a device used for recording mandibular movement. From a technical point of view, the Sirognathograph's slow sampling speed and sample artifacts have been shown to be the system's main limitations; however, it was possible to eliminate sampling artifacts by using a customized pulse generator and software for controlled data acquisition. Clinically, the Sirognathograph appears to have some inherent limitations in its accuracy. The effect of cranial movements during mastication can cause a baseline drift with consequent errors in the recording of mandibular position. This problem was controlled in this study by using a headband to stabilize the cranial movements during mastication. Also, the spatial relationships between the aerial and both the cranial base and the magnet were found to be critical for repeatability of the recordings.
Asunto(s)
Diagnóstico por Imagen/normas , Registro de la Relación Maxilomandibular/instrumentación , Mandíbula/fisiología , Adolescente , Adulto , Artefactos , Femenino , Cabeza , Humanos , Magnetismo , Masculino , Masticación/fisiología , Movimiento , Postura , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
Two groups of patients were provided with implant-stabilized mandibular overdentures supported by straight ovoid prefabricated bars with a resilient joint or parallel-sided bars with a rigid joint. Measurements of plaque index, mucosal cuff health and height, marginal bone height, pathology of the denture-bearing mucosa, and patient satisfaction were correlated with the different bar designs. Ovoid bars with a resilient joint between the denture and the bar have been shown to give a slightly increased incidence of problems associated with the denture-bearing mucosa. Furthermore, the only significant mean increase in recession of the mucosal cuff was found on the distal surfaces of the distal abutments in this group of patients.
Asunto(s)
Implantes Dentales , Diseño de Prótesis Dental , Retención de Dentadura/instrumentación , Prótesis de Recubrimiento , Pérdida de Hueso Alveolar/etiología , Fuerza de la Mordida , Pilares Dentales , Implantación Dental Endoósea , Índice de Placa Dental , Análisis del Estrés Dental , Prótesis de Recubrimiento/efectos adversos , Femenino , Humanos , Hiperplasia , Masculino , Mandíbula , Persona de Mediana Edad , Mucosa Bucal/patología , Satisfacción del Paciente , Estomatitis Subprotética/etiología , Encuestas y CuestionariosRESUMEN
Nine clinical centers participated in a prospective study of overdentures supported by Brånemark implants in the maxilla or mandible. The study initially comprised 133 patients provided with 117 implants placed in the maxilla and 393 implants placed in the mandible. The preliminary results indicate a success rate in the mandible comparable with the reports on fixed prostheses. Conversely, overdenture treatment in the maxilla seems to be less favorable than previous reports of fixed restorations. The differences between the fixed and the present overdentures in the maxilla were mainly based on differences in patient selection and bone quality. A total of 32 implants was mobile and removed and another 29 implants were lost to follow-up because of patient dropout up to the first annual checkup after denture placement. A higher implant failure rate occurred in the maxilla. Mucosal reactions were also more unfavorable around implants placed in the maxilla.
Asunto(s)
Implantes Dentales , Prótesis de Recubrimiento , Adulto , Anciano , Pérdida de Hueso Alveolar/etiología , Distribución de Chi-Cuadrado , Implantes Dentales/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mandíbula , Maxilar , Persona de Mediana Edad , Estudios Prospectivos , Falla de Prótesis , Resultado del TratamientoRESUMEN
An international prospective study of Brånemark implants retaining overdentures was conducted at nine clinical centers. One hundred thirty-three subjects were recruited in a 12-month period and provided with 510 implants, 117 of which were in maxillae and 393 were in mandibles. This study reports the 3-year follow-up status of 120 overdentures and 444 implants. There were 11 overdenture failures (9.2%). Maxillary overdenture failure rates (27.6%) were nearly nine times greater than mandibular overdenture failure rates (3.3%). Maxillary overdenture treatment was less successful than previously reported fixed implant-supported restorations. However, their mandibular counterparts had success rates slightly higher than those reported for fixed implant-supported restorations. At 3 years, 150 implants remained submerged and 66 implants had been withdrawn because the subjects discontinued study participation. Eleven mandibular and 29 maxillary implants had failed and had been removed from 21 subjects. Logistic regression with forward model selection indicated that one two-way interaction was significantly related to implant failure. At highest risk were the subjects who possessed dental arches with bone quantity E and bone quality 4. Subjects with one implant failure were likely to have more than one failure. The Generalized Estimating Equation was used to adjust for the cluster effect in this population because multiple implants (2 to 6) were placed and evaluated in each of the 133 subjects.
Asunto(s)
Implantes Dentales , Prótesis de Recubrimiento , Adulto , Anciano , Densidad Ósea , Intervalos de Confianza , Retención de Dentadura , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Falla de Prótesis , Resultado del TratamientoRESUMEN
This report presents the results of a 5-year prospective multicenter study including nine centers worldwide. A total of 30 patients received 117 Brånemark implants in the maxillae, and 103 patients received 393 implants in the mandibles. According to the protocol, all integrated maxillary implants were to be loaded; however, only two of four mandibular implants were planned for support of the overdentures, leaving the remaining implants covered by mucosa as backup for possible implant failures. Thirty-five patients (26.3%) who were provided with 127 implants (24.9%) were withdrawn from the study. Six patients treated in the maxilla lost all their implants and resumed wearing complete dentures. The cumulative success rates for implants and for overdentures supported by two implants in the edentulous mandible were 94.5% and 100%, respectively. The corresponding cumulative success rates for implants and for overdentures supported by an optimal number of implants in the maxilla were 72.4% and 77.9%, respectively. Significantly better jawbone characteristics at the time of implant surgery were considered to contribute to the better cumulative success rates in the mandibles. Mean marginal bone loss was 0.8 mm (SD 0.8) and 0.5 mm (SD 0.8) for loaded implants during a 5-year period of time in the maxillae and mandibles, respectively. Measurements of the clinical height of the abutment cylinders indicated a mean recession (0.2 mm) of peri-implant mucosa during the follow-up period in the mandibles. Conversely, hyperplasia was observed in the maxillae.
Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Oseointegración , Adulto , Anciano , Resorción Ósea/patología , Dentadura Completa , Femenino , Estudios de Seguimiento , Encía/patología , Recesión Gingival/patología , Humanos , Hiperplasia , Arcada Edéntula/cirugía , Masculino , Mandíbula/cirugía , Enfermedades Mandibulares/patología , Maxilar/cirugía , Enfermedades Maxilares/patología , Persona de Mediana Edad , Estudios Prospectivos , Falla de Prótesis , Resultado del TratamientoRESUMEN
Root caries prevalence was recorded for a consecutive sample of dental patients (n = 146), aged over 55 yr and with at least 12 natural teeth. The mean root DFS score of the males (n = 49) was 6.34 +/- 4.55 and for the females (n = 97) 3.76 +/- 3.31 (P less than 0.001). The salivary levels of mutans streptococci, lactobacilli, and yeasts were determined in addition to salivary flow rate and buffering capacity. Subjects with greater than 1 root DFS had significantly higher salivary levels of mutans streptococci, lactobacilli, and yeasts. They also had fewer teeth and more exposed root surfaces. In step-wise multivariate analyses the factors significantly related to the root DFS score were the number of exposed root surfaces, number of teeth, sex and salivary yeast levels (R2 = 0.41). In the multivariate analyses salivary levels of mutans streptococci were not significantly related to any clinical measurement of root caries experience due to the greater strength of association between the root DFS score and salivary levels of yeasts. Subjects prescribed medicines with a reported xerostomic effect had significantly fewer active root lesions than those not prescribed such medicines and salivary levels of all microorganisms studied were significantly elevated in subjects prescribed medications containing sucrose.
Asunto(s)
Cuidado Dental para Ancianos , Caries Dental/epidemiología , Saliva/microbiología , Raíz del Diente , Anciano , Análisis de Varianza , Recuento de Colonia Microbiana , Estudios Transversales , Índice CPO , Caries Dental/microbiología , Femenino , Humanos , Lactobacillus/aislamiento & purificación , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Análisis de Regresión , Saliva/metabolismo , Tasa de Secreción , Factores Sexuales , Streptococcus mutans/aislamiento & purificación , Sacarosa/efectos adversos , Xerostomía/inducido químicamente , Levaduras/aislamiento & purificaciónRESUMEN
Simple methods are described for measuring masticatory effectiveness--the percentage of sugar chewed out of chewing gum in 20 strokes--and the height of residual mandibular bone using callipers. Both are objective methods, they are acceptable to the elderly, appropriate for denture wearers and practicable for use in domiciliary surveys. Using these and other methods, the masticatory effectiveness of housebound pensioners is shown to relate to maximum biting force, denture quality, remaining mandibular bone and dietary selection. However, opinions on the difficulty of mastication are completely unrelated to any of these measures. The level of compensation for inadequate mastication is indicated by the percentage of difficult foods eaten by geriatric hospital inpatients: there was complete overlap of percentages in those endentulous patients using dentures and those without dentures. Presumably many of these patients had adapted to swallowing very poorly chewed food. The contrasts shown between hospital inpatients and old people still at home indicate the progressive consequences of physical and neurological deterioration.