Machine learning analyses identify multi-modal frailty factors that selectively discriminate four cohorts in the Alzheimer's disease spectrum: a COMPASS-ND study.

BACKGROUND: Frailty indicators can operate in dynamic amalgamations of disease conditions, clinical symptoms, biomarkers, medical signals, cognitive characteristics, and even health beliefs and practices. This study is the first to evaluate which, among these multiple frailty-related indicators, are important and differential predictors of clinical cohorts that represent progression along an Alzheimer's disease (AD) spectrum. We applied machine-learning technology to such indicators in order to identify the leading predictors of three AD spectrum cohorts; viz., subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and AD. The common benchmark was a cohort of cognitively unimpaired (CU) older adults. METHODS: The four cohorts were from the cross-sectional Comprehensive Assessment of Neurodegeneration and Dementia dataset. We used random forest analysis (Python 3.7) to simultaneously test the relative importance of 83 multi-modal frailty indicators in discriminating the cohorts. We performed an explainable artificial intelligence method (Tree Shapley Additive exPlanation values) for deep interpretation of prediction effects. RESULTS: We observed strong concurrent prediction results, with clusters varying across cohorts. The SCI model demonstrated excellent prediction accuracy (AUC = 0.89). Three leading predictors were poorer quality of life ([QoL]; memory), abnormal lymphocyte count, and abnormal neutrophil count. The MCI model demonstrated a similarly high AUC (0.88). Five leading predictors were poorer QoL (memory, leisure), male sex, abnormal lymphocyte count, and poorer self-rated eyesight. The AD model demonstrated outstanding prediction accuracy (AUC = 0.98). Ten leading predictors were poorer QoL (memory), reduced olfaction, male sex, increased dependence in activities of daily living (n = 6), and poorer visual contrast. CONCLUSIONS: Both convergent and cohort-specific frailty factors discriminated the AD spectrum cohorts. Convergence was observed as all cohorts were marked by lower quality of life (memory), supporting recent research and clinical attention to subjective experiences of memory aging and their potentially broad ramifications. Diversity was displayed in that, of the 14 leading predictors extracted across models, 11 were selectively sensitive to one cohort. A morbidity intensity trend was indicated by an increasing number and diversity of predictors corresponding to clinical severity, especially in AD. Knowledge of differential deficit predictors across AD clinical cohorts may promote precision interventions.

Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study.

BACKGROUND: Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting. METHODS: A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains. RESULTS: In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus. CONCLUSION: Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.

Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors.

BACKGROUND: Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors. AIMS AND OBJECTIVES: The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties. DESIGN: This was a mixed-method study. METHODS: The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity. RESULTS: A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well. CONCLUSIONS: The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.

Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population.

A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0-17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0-6 and 3.3 for children aged 7-17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.

[Analysis and Research on Comprehensive Evaluation Method of Operation Performance of Hospital Valuable Equipment].

OBJECTIVE: To study the effective method of comprehensive evaluation and analysis of hospital valuable medical equipment performance. METHODS: The operation performance of 6 valuable equipment was evaluated by cost-benefit method, comprehensive index method and public evaluation method. RESULTS: Utilize equipment information management methods for data collection and evaluation, and construct an assessment data model based on evaluation indicators from three aspects: equipment operation status, profitability status, and scientific research contribution. CONCLUSIONS: Through the performance analysis of different types of valuable medical equipment, a more real and comprehensive quantitative analysis is carried out, which plays a key role in the reasonable purchase, efficient operation and avoiding idling.

Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy.

OBJECTIVE: To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC). METHODS: In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain. RESULTS: OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836). CONCLUSION: We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care.

Promoting continence in older people.

The prevalence of urinary incontinence (UI) is strongly associated with increasing age. Twenty five percent of women over 80 years of age have clinically significant symptoms in population surveys, but prevalence is as high as 70% in older hospital in-patients and residents of care homes with nursing. UI substantially affects quality of life and well-being, and generates significant economic burden for health and social care. Sadly, UI is considered as taboo by society, leading to isolation, depression and reluctance to seek help. As with all aspects of care of older people, a multi-modal approach to assessment and management is needed. Key to effective management of incontinence is recognition. As a minimum, clinicians should actively ask patients about continence, especially in older adults living with frailty. Careful evaluation and establishment of any underpinning diagnosis and aetiological factors requires comprehensive, multimodal, usually multidisciplinary, assessment. A lack of awareness of the problem and what can be done about it exists in both laypeople and clinicians, this needs correcting. An interdisciplinary approach to research and management must be the way into the future.

Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial.

BACKGROUND: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.

Substitution strategies for cooking energy: To use gas or electricity?

The Chinese government has called for clean and effective energy substitution for cooking in rural areas. This paper assesses the environmental and economic impacts of various types of cooking fuels and stoves. According to the assessment results, the environmental impacts are highly influenced by the types of fuels and the efficiency of stoves used for cooking. Using biogas, liquefied petroleum gas (LPG), and natural gas for cooking instead of solid fuels can significantly reduce environmental emissions. To provide 1 megajoule (MJ) of useful cooking heat, the environmental costs of lump coal, honeycomb briquettes, and straw are the largest, estimated to be 80.4 yuan/MJ, 73.1 yuan/MJ, and 71.4 yuan/MJ, respectively. In addition, the economic assessment results show that the most expensive source of cooking fuel is LPG, with an average annual cost of 1700 yuan, while the cost of straw and firewood is the cheapest, at less than 100 yuan. The average annual cost of electricity is higher than that of natural gas. Regarding the substitution effects, using natural gas for cooking is better than using electricity. The environmental benefit of electricity substitution is only 10%-20% of natural gas substitution, and the corresponding increasing cost for residents is 1.5 times that of natural gas substitution.

Health-related quality of life in older people with functional independence or mild dependence.

BACKGROUND: The concept of Health-Related Quality of Life (HRQOL) has grown in importance in the elderly population (PM), which is due to the increase in life expectancy of contemporary societies and the desire of people to live the most advanced years in good condition. OBJECTIVE: To know the effect of the epidemiological dimensions, functional capacity, social and psychological well-being on the HRQL of a group of senior people from the Borough of Puente Alto intervened by the multidimensional model of the Integral Center for Happy Aging, CIEF, Universidad de los Andes. RESULTS: Correlation was observed between the dimensions mentioned above, as well as the improvement in the predictive models of HRQL in the extent to which social and psychological variables are incorporated into the morbidity and functional capacity dimension, the latter strongly related to HRQL according to the scientific literature. CONCLUSION: The study shows the relevance of incorporating measures of social and psychological well-being in the evaluation of HRQL, especially with a view to the design of multidimensional interventions that encompass individual content and the environment in which seniors develop.

Water quality and health risk assessment of the water bodies in the Yamdrok-tso basin, southern Tibetan Plateau.

Water resources in good quality guarantee the primary condition for the maintenance and development of the natural ecosystem and human society. Water quality status and health risk of the lake water bodies in the national nature reserve, the Yamdrok-tso basin, in the southern Tibetan Plateau are assessed by 25 water parameters including 12 heavy metal(loid)s. Results reveal that the lake water bodies possess relatively high pH (9.68), high concentrations of F (1.66 mg/L), Cu (13.92 µg/L), As (41.60 µg/L), Pb (26.69 µg/L), and U (19.53 µg/L), and a low value of dissolved oxygen (19.30%). The pollution indices (heavy metal pollution index of 0.88-22.88, heavy metal evaluation index of 0.18-3.75, and the degree of contamination of -8.82 to -5.25) demonstrate that the lake water bodies are in a low pollution level with respect to heavy metal(loid)s. The evaluation of water quality based on the fuzzy comprehensive assessment method suggests that 75.56% of the water samples meet the regulation of the China National Standard for water resources in national nature reserves. Health risk assessment shows that potential hazards exist on this region when the residents under long-term exposure to the lake water through oral and dermal pathways, of which children and adults are mostly exposed to As and F for non-carcinogenic and As for carcinogenic risks, especially for children. Results of this study contribute to targeted water resources management in the national nature reserves.

Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. / Recomendaciones sobre la valoración integral y multidimensional del anciano hospitalizado. Posicionamiento de la Sociedad Española de Medicina Interna.

This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.

"Establishing the criterion validity of the interRAI Check-Up Self-Report instrument".

BACKGROUND: Low and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons. METHODS: We evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights. RESULTS: Based on Cohen's Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00. CONCLUSION: Our findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa's.

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial.

BACKGROUND: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. OBJECTIVES: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. METHODS: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. SETTING: Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. PARTICIPANTS: From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). INTERVENTION: The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. MEASUREMENTS: The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. RESULTS: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. CONCLUSIONS: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

[Comprehensive Assessment and Treatment of Cataracts].

Cataract is a global disease that may cause blindness. Due to the slow pace of disease progression, patients often presume incorrectly that their blurred vision is caused by excessive fatigue or lack of sleep. In addition to their role in causing blindness, cataracts that are diagnosed late into their progression are more difficult to treat with corrective surgery. Furthermore, many older individuals believe incorrectly that declines in vision are part of the natural course of aging and accept these declines as inevitable. Reduced vision has a significant and negative effect on quality of life. Although aging is one of the main causes of cataracts, other major factors include common chronic diseases and the side effects of drugs. In addition, lifestyle factors such as diet, activity, and environmental exposure to ultraviolet rays and radiation are factors in cataract development. Surgery is the only treatment for cataracts currently available. Healthcare professionals not only consider a patient's background but also whether surgery may promote quality of life. While preoperative evaluation requires a holistic and comprehensive approach, postoperative care is also important to the overall success of cataract surgery. For example, instructions in topical-drop application, wound assessment, and symptoms of comorbidities are crucial for patients. Therefore, a critical literature review was used in this article to establish a strategy for the holistic evaluation of and perioperative nursing care and prevention strategies for cataracts. In addition, recommendations for the comprehensive assessment of and nursing care for patients with cataracts are provided to healthcare professionals article in hopes of improving the quality of care provided to patients with cataracts.

Development and validation of the comprehensive assessment scale for chemotherapy-induced peripheral neuropathy in survivors of cancer.

BACKGROUND: Appropriate assessment is essential for the management of chemotherapy-induced peripheral neuropathy (CIPN), an intractable symptom that cannot yet be palliated, which is high on the list of causes of distress for cancer patients. However, objective assessment by medical staff makes it easy to underestimate the symptoms and effects of CIPN in cancer survivors. As a result, divergence from subjective evaluation of cancer survivors is a significant problem. Therefore, there is an urgent need to develop a subjective scale with high accuracy and applicability that reflects the experiences of cancer patients. We developed a comprehensive assessment scale for CIPN in cancer survivors, named the Comprehensive Assessment Scale for Chemotherapy-Induced Peripheral Neuropathy in Survivors of Cancer (CAS-CIPN), and demonstrated its reliability and validity. METHODS: We developed a questionnaire based on qualitative studies of peripheral neuropathy in Japanese cancer patients and literature review. Twelve cancer experts confirmed the content validity of the questionnaire. A draft version comprising 40 items was finalized by a pilot test on 100 subjects. The participants in the present study were 327 Japanese cancer survivors. Construct validity was determined by factor analysis, and internal validity by confirmation factor analysis and Cronbach's α. RESULTS: Factor analysis showed that the structure consisted of 15 items in four dimensions: "Threatened interference in daily life by negative feelings", "Impaired hand fine motor skills", "Confidence in choice of treatment/management," and "Dysesthesia of the palms and soles." The CAS-CIPN internal consistency reliability was 0.826, and the reliability coefficient calculated using the Spearman-Brown formula [q = 2r/(1 + r)] was 0.713, confirming high internal consistency and stability. Scores on this scale were strongly correlated with Gynecologic Oncology Group-Neurotoxicity scores (r = 0.714, p < 0.01), confirming its criterion-related validity. CONCLUSIONS: The CAS-CIPN is an assessment tool with high reliability and validity for the comprehensive evaluation of CIPN in cancer survivors. The CAS-CIPN is simple to use, and can be used by medical professionals for appropriate situational assessment and intervention.

Learning to trust: social feedback normalizes trust behavior in first-episode psychosis and clinical high risk.

BACKGROUND: Psychosis is characterized by problems in social functioning that exist well before illness onset, and in individuals at clinical high risk (CHR) for psychosis. Trust is an essential element for social interactions that is impaired in psychosis. In the trust game, chronic patients showed reduced baseline trust, impaired response to positive social feedback, and attenuated brain activation in reward and mentalizing areas. We investigated whether first-episode psychosis patients (FEP) and CHR show similar abnormalities in the neural and behavioral mechanisms underlying trust. METHODS: Twenty-two FEP, 17 CHR, and 43 healthy controls performed two trust games, with a cooperative and an unfair partner in the fMRI scanner. Region of interest analyses were performed on mentalizing and reward processing areas, during the investment and outcome phases of the games. RESULTS: Compared with healthy controls, FEP and CHR showed reduced baseline trust, but like controls, learned to trust in response to cooperative and unfair feedback. Symptom severity was not associated with baseline trust, however in FEP associated with reduced response to feedback. The only group differences in brain activation were that CHR recruited the temporo-parietal junction (TPJ) more than FEP and controls during investment in the unfair condition. This hyper-activation in CHR was associated with greater symptom severity. CONCLUSIONS: Reduced baseline trust may be associated with risk for psychotic illness, or generally with poor mental health. Feedback learning is still intact in CHR and FEP, as opposed to chronic patients. CHR however show distinct neural activation patterns of hyper-activation of the TPJ.

Adults with Down syndrome: a comprehensive approach to manage complexity.

BACKGROUND: Down syndrome (DS) is characterised by premature ageing that affects selected organ systems, and persons with this condition can present patterns of co-morbidities and deficits often observed in the older population without DS. However, information on the characteristics of adult persons with DS is limited. The objective of the study is to describe characteristics of adults with DS collected with a standardised, comprehensive assessment instrument. METHODS: Cross-sectional study. Four hundred thirty adults with DS (age range 18/75 years) from three countries (Italy, n = 95; USA, n = 175; and Canada, n = 160). A standardised assessment instrument (interRAI intellectual disability) was used to assess sample characteristics. RESULTS: Mean age ranged from 35.2 (standard deviation 12.0) years in the US sample to 48.8 (standard deviation 9.0) years in the Canadian sample. Most participants in the Italian and US sample were living in private homes, while more than half of those in the Canadian sample were institutionalised. Prevalences of geriatric conditions, including cognitive deficits, disability in the common activities of daily living, symptoms of withdrawal or anhedonia, aggressive behaviour, communication problems, falls and hearing problems were high in the study sample. Gastrointestinal symptoms, skin and dental problems and obesity were also frequently observed. CONCLUSIONS: Adults with DS present with a high level of complexity, which may suggest the need for an approach based on a comprehensive assessment and management that can provide adequate care. Further research is needed to understand better the effectiveness of such an approach in the DS population.

Study on Health Assessment Method of a Braking System of a Mine Hoist.

This paper presents a method for calculating the health degree (HD) of a braking system of a mine hoist combined with three-level fuzzy comprehensive assessment (TLFCA) and a back-propagation neural network (BPNN). Firstly, the monitored values of a sensor are fused by multi-time fusion and the fuzzy comprehensive assessment values (FCAVs) of the health condition (HC) of the sensor are obtained. Secondly, the FCAVs of all sensors in a subsystem are fused by multi-sensor fusion, and FCAVs of the subsystem are obtained. Then the FCAVs of all subsystems are fused by multi-subsystem fusion and FCAVs of the system are obtained. All the FCAVs are fed into a pre-trained neural network, and the corresponding HD of the sensor, subsystem and system is obtained. Finally, the practicability, reliability and sensitivity of the proposed method are verified by the monitored values of the test rig. This paper presents a method to provide technical support for intelligent maintenance, and also provides necessary data for further prognostics health management (PHM) of the braking system. The method presented in this paper can also be used as a reference for the HD calculation of the whole hoist and other complicated equipment.

Comprehensive Exercise Capacity and Quality of Life Assessments Predict Mortality in Patients with Pulmonary Arterial Hypertension.

BACKGROUND: The 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) are exercise tests associated with physical function, quality of life and hemodynamic data in patients with pulmonary arterial hypertension (PAH). This study was conducted to assess correlations between exercise capacity, quality of life and disease functional classification, and to analyze the value of comprehensive assessments in predicting mortality in patients with PAH. METHODS: Fifty-four patients with PAH were enrolled. Comprehensive assessments including exercise capacity evaluated using the 6MWT and CPET, and health-related quality of life evaluated using the Short Form 36 (SF-36) questionnaire were performed in all participants. The patients were followed for 2 years with the end point of mortality. RESULTS: The survivors had a longer 6-minute walking distance, higher peak oxygen uptake and higher physical component score of the SF-36 than the non-survivors. In addition, exercise capacity combined with SF-36 predicted 2-year mortality in the patients with PAH. The patients with lower peak oxygen uptake (peak VO2 < 11.03 mL/kg/ min) and lower physical component score (score < 44.54) had a higher mortality rate than those with a higher peak VO2 and higher physical component score (adjusted hazard ratio = 19.95, p = 0.011). CONCLUSIONS: Comprehensive assessments of exercise capacity and quality of life can be used to predict 2-year mortality in patients with PAH.