Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia.

Persons with mild dementia can effectively maintain and improve their quality of life (QOL) by regularly performing their daily activities. However, research on activities of daily living (ADL) in this population often fails to distinguish between ADL performance and ADL capability, that is, actual independence in daily lives and potential independence in an ideal setting. This study aimed to identify the potential gaps between ADL performance and capability in individuals with mild dementia. A total of 137 community-dwelling older adults (aged ≥ 65 years) who had been diagnosed with dementia and assessed as 0.5 and 1 on a global clinical dementia rating (CDR). Participants were evaluated for basic ADL (BADL) and instrumental ADL (IADL) using the Hyogo Activities of Daily Living Scale (HADLS). Around 35 individuals who met the inclusion criteria were enrolled in the study. BADL performance and BADL capacity were not significantly different (p = 0.128); however, participants rated IADL capacity significantly higher than IADL performance (p < 0.01). Gaps between performance and capability were observed for IADL but not for BADL. This study distinguishes between ADL performance and capability in individuals with mild dementia and is the first to identify the IADL-specific gap between these two components; pertinent targeted interventions are vital in closing this gap. Environmental adjustments are important to improve QOL of persons with mild dementia.

Inferring causal impacts of extreme water-level drawdowns on lake water clarity using long-term monitoring data.

Although long-term ecosystem monitoring provides essential knowledge for practicing ecosystem management, analyses of the causal effects of ecological impacts from large-scale observational data are still in an early stage of development. We used causal impact analysis (CIA)-a synthetic control method that enables estimation of causal impacts from unrepeated, long-term observational data-to evaluate the causal impacts of extreme water-level drawdowns during summer on subsequent water quality. We used more than 100 years of transparency and water level monitoring data from Lake Biwa, Japan. The results of the CIA showed that the most extreme drawdown in recorded history, which occurred in 1994, had a significant positive effect on transparency (a maximum increase of 1.75 m on average over the following year) in the north basin of the lake. The extreme drawdown in 1939 was also shown to be a trigger for an increase in transparency in the north basin, whereas that in 1984 had no significant effects on transparency. In the south basin, contrary to the pattern in the north basin, the extreme drawdown had a significant negative effect on transparency shortly after the extreme drawdown. These different impacts of the extreme drawdowns were considered to be affected by the timing and magnitude of the extreme drawdowns and the depths of the basins. Our approach of inferring the causal impacts of past events on ecosystems will be helpful in implementing water-level management for ecosystem management and improving water quality in lakes.

Successful occupational therapy at end of life for a patient with prostate sarcoma.

Most previous studies on palliative rehabilitation highlight medical care, with occupational therapy (OT) primarily focused on normal and instrumental activities of daily living. This clinical report describes the case of a 35-year-old patient with prostate sarcoma with a poor prognosis who received OT to help him focus on participating in a meaningful occupation. Initially, the patient was depressed and withdrawn, but with OT, he was able to participate in an occupation, and his life became more active. Although the patient was at the end of his life, he was able to maintain a high quality of life during the limited time period.

Population model analyses of the combined effects of insecticide use and habitat degradation on the past sharp declines of the dragonfly Sympetrum frequens.

In recent decades, many dragonfly species have become threatened with extinction. For example, populations of Sympetrum frequens, one of the most common dragonflies in rice paddy fields in Japan, decreased sharply around the late 1990s in many regions. Although previous studies suggested that the use of systemic insecticides (particularly fipronil) was likely a major cause of the decline, agronomic factors other than insecticide use and the combined effects of both have been not examined. Here, we developed an S. frequens population model using survival rate parameters associated with the farmland consolidation rate, midsummer drainage, area of crop rotation and abandoned rice paddies, insecticide use, and summer temperature and analyzed the effects of each factor on population dynamics by numerical simulations. Our population models substantially reproduced the past sharp population declines of the dragonfly in three regions. Numerical simulations using hypothetical parameters did not always suggest that the use of systemic insecticides is a sufficient cause of the sharp population declines, as the declines did not occur if the farmland consolidation rate remained at lower levels (before the 1980s). On the other hand, our findings suggest that the use of insecticides with high toxicity is a necessary cause of the sharp population declines, as the declines did not occur when simulated toxicity levels were lower than those actually used. Overall, our numerical simulations suggest that the sharp population declines of S. frequens around the late 1990s were caused by the combined effects of insecticide use and farmland consolidation, in which rice paddies are converted to well-drained paddy fields. Conservation planning for dragonflies needs to account for the combined effects of habitat degradation and use of insecticides.

Effect of Instrumental Activities of Daily Living habituation due to routinising therapy in patients with frontotemporal dementia.

We examined whether Instrumental Activities of Daily Living (IADL) improves with routinising therapy for a patient with frontotemporal dementia (FTD) living in a group home. The patient exhibited symptoms of agitation, apathy, disinhibition, irritability and stereotyped behaviour. The care staff experienced long-term care burden and the patient was spending time idly. An occupational therapist, in collaboration with care staff, evaluated the patient and routinised the household chores included in IADL. Consequently, a routine of household chores was established, reducing behavioural and psychological symptoms of dementia and long-term care burden, and the quality of life (QOL) of the patient improved. The results suggested that routinising IADL of the patient with FTD reduced long-term care burden and improved QOL of the patient.

Author Correction: Investigating effect of climate warming on the population declines of Sympetrum frequens during the 1990s in three regions in Japan.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Investigating effect of climate warming on the population declines of Sympetrum frequens during the 1990s in three regions in Japan.

Climate warming is of concern as a key factor in the worldwide decline in insect populations. In Japan, numbers of a common dragonfly in rice paddy fields, Sympetrum frequens, decreased sharply in the 1990s. Because S. frequens migrates to cooler mountains in summer, climate warming has been suggested as one of the main causes of the population decline in addition to agronomic factors. Here, we analysed the relation between summer temperatures and population densities of S. frequens and the related S. infuscatum, which does not migrate to mountains in summer, using published population monitoring data and temperature data from three regions (Toyama, Ishikawa, and Shizuoka) in Japan. Decadal differences in summer temperatures lay within the range of fluctuations among years, suggesting that an increase in summer temperatures cannot explain the past sharp population declines. However, regression analyses using monitoring data from Toyama showed that the population dynamics of both species in autumn are negatively correlated with summer temperatures in the same year. These results suggest that high temperatures in summer directly affect adult mortality to an extent that results in a decrease in population growth.

Effects of systemic insecticides on the population dynamics of the dragonfly Sympetrum frequens in Japan: Statistical analyses using field census data from 2009 to 2016.

Since the mid-1990s, populations of the common Japanese dragonfly Sympetrum frequens in rice fields have declined severely. Application of systemic insecticides-especially fipronil-to nursery boxes of rice seedlings is suspected to be the main cause of the decline. However, until now there have been insufficient population data to test the causality. We conducted a dragonfly survey from 2009 to 2016 in four prefectures of Japan and compiled the data to enable the comparison of population growth rates along five main census routes over the years. We also estimated the use ratio of each insecticide applied to nursery boxes in rice fields (i.e., the area exposed to insecticide as a ratio of the total rice field area) by prefecture. We then statistically analyzed the effects of the insecticides on the dragonfly's population growth rates, taking into account the potential confounding factors based on current knowledge. There was a significant negative association between the annual increase in use ratio of the sum of systemic insecticides (e.g., fipronil, imidacloprid, and chlorantraniliprole) and the annual population growth rate of S. frequens. This association suggests that systemic insecticide use affected the decrease in population density of the dragonfly, although some agronomic factors need to be further examined as potential confounders.

Effects of liaison between physiotherapists and occupational therapists for home-visit rehabilitation: preliminary study.

[Purpose] Home-visit rehabilitation is used to restructure patients' home lives and involves comprehensive intervention. In Japan, liaison between physiotherapists and occupational therapists occurs, but impact of this cooperation is unclear. The present study aimed to investigate therapeutic efficacy of this liaison. [Participants and Methods] The study used a cross-sectional design. Participants were community-dwelling older adults who required long-term care and were receiving home-visit rehabilitation provided in the Chubu region. They were divided into a single-intervention group with either physiotherapy or occupational therapy alone, and a liaison-intervention group with therapy coordinated between the 2 professions. In addition to basic information, the Barthel Index, Frenchay Activities Index, Health Utility Index Mark 3, and subjective health assessments were evaluated. [Results] Eighteen participants were recruited. No significant differences were observed between groups for the Barthel Index, whereas the total Frenchay Activities Index score and items of the Frenchay Activities Index (outdoor domestic chores and outdoor activities) were significantly higher in the liaison-intervention group. The emotion item in the Health Utility Index Mark 3 and subjective health assessments were also significantly higher in the liaison-intervention group. [Conclusion] These findings suggest that this liaison is effective for improving activities of daily living and increasing quality of life. This is probably due to each therapist performing a specialized intervention and professional cooperation.

Constrained Deep Q-Learning Gradually Approaching Ordinary Q-Learning.

A deep Q network (DQN) (Mnih et al., 2013) is an extension of Q learning, which is a typical deep reinforcement learning method. In DQN, a Q function expresses all action values under all states, and it is approximated using a convolutional neural network. Using the approximated Q function, an optimal policy can be derived. In DQN, a target network, which calculates a target value and is updated by the Q function at regular intervals, is introduced to stabilize the learning process. A less frequent updates of the target network would result in a more stable learning process. However, because the target value is not propagated unless the target network is updated, DQN usually requires a large number of samples. In this study, we proposed Constrained DQN that uses the difference between the outputs of the Q function and the target network as a constraint on the target value. Constrained DQN updates parameters conservatively when the difference between the outputs of the Q function and the target network is large, and it updates them aggressively when this difference is small. In the proposed method, as learning progresses, the number of times that the constraints are activated decreases. Consequently, the update method gradually approaches conventional Q learning. We found that Constrained DQN converges with a smaller training dataset than in the case of DQN and that it is robust against changes in the update frequency of the target network and settings of a certain parameter of the optimizer. Although Constrained DQN alone does not show better performance in comparison to integrated approaches nor distributed methods, experimental results show that Constrained DQN can be used as an additional components to those methods.

Were the sharp declines of dragonfly populations in the 1990s in Japan caused by fipronil and imidacloprid? An analysis of Hill's causality for the case of Sympetrum frequens.

Neonicotinoids and fipronil are the most widely used insecticides in the world. Previous studies showed that these compounds have high toxicity to a wide taxonomic range of non-target invertebrates. In rice cultivation, they are frequently used for nursery-box treatment of rice seedlings. The use of fipronil and neonicotinoid imidacloprid is suspected to be the main cause of population declines of red dragonflies, in particular Sympetrum frequens, because they have high lethal toxicity to dragonfly nymphs and the timing of the insecticides' introduction in Japan (i.e., the late 1990s) overlapped with the sharp population declines. However, a causal link between application of these insecticides and population declines of the dragonflies remains unclear. Therefore, we estimated the amount of the insecticides applied for nursery-box treatment of rice seedlings and analyzed currently available information to evaluate the causality between fipronil and imidacloprid usage and population decline of S. frequens using Hill's causality criteria. Based on our scoring of Hill's nine criteria, the strongest lines of evidence were strength, plausibility, and coherence, whereas the weakest were temporality and biological gradient. We conclude that the use of these insecticides, particularly fipronil, was a major cause of the declines of S. frequens in Japan in the 1990s, with a high degree of certainty. The existing information and our analyses, however, do not allow us to exclude the possibility that some agronomic practices (e.g., midsummer drainage or crop rotation) that can severely limit the survival of aquatic nymphs also played a role in the dragonfly's decline.

Relationship between salivary stress biomarker levels and cigarette smoking in healthy young adults: an exploratory analysis.

BACKGROUND: This study investigated the relationships among salivary stress biomarkers, cigarette smoking, and mood states. METHODS: The study population comprised 49 healthy sixth-year dental students at Fukuoka Dental College (39 men, 10 women; age, 23-31 years). Lifetime exposure to smoking was calculated using the Brinkman index (BI). Resting saliva samples were collected, and concentrations of cortisol, secretory immunoglobulin A (SIgA), interleukin (IL)-1ß, interleukin-6, and tumor necrosis factor (TNF)-α were determined. Mood states (tension-anxiety, depression-dejection, anger-hostility, fatigue, confusion, and vigor) over the previous week were assessed using the Profile of Mood States - Brief Japanese Version. RESULTS: Salivary IL-1ß levels were significantly higher in smokers than non-smokers (P = 0.044), regardless of the BI or mood state. A significant positive correlation was evident between the TNF-α level and the BI (P = 0.036), and the SIgA level was positively correlated with the BI (P = 0.067) but did not reach statistical significance. In terms of mood states, higher fatigue scores and lower vigor scores were observed in smokers. The TNF-α level and vigor score were negatively correlated (r = -0.229, P = 0.135), but the correlation did not reach statistical significance. However, the SIgA level and fatigue score were significantly positively correlated (r = 0.410, P = 0.005). CONCLUSIONS: The TNF-α and SIgA levels were both positively correlated with the BI. Furthermore, the TNF-α level was negatively correlated with the vigor score, whereas the SIgA level was positively correlated with the fatigue score. Thus, salivary levels of TNF-α and SIgA may be used as biomarkers of mood states in healthy young smokers.

Longitudinal functional changes, depression, and health-related quality of life among stroke survivors living at home after inpatient rehabilitation.

AIM: This study investigated changes in functional status in home-dwelling stroke survivors 1-3 years after inpatient rehabilitation. It also examined the factors associated with longitudinal functional changes and health-related quality of life. METHODS: Survey evaluations were conducted at the homes of 27 stroke survivors. The Functional Independence Measure (FIM), Short Form 36, Frenchay Activities Index, and Hamilton Depression Rating Scale were used to assess functional status, quality of life, social activity, and depression symptoms, respectively. RESULTS: From the time of discharge to follow-up (mean: 2.1 ± 0.6 years), total FIM and motor FIM scores were mildly improved, and cognitive FIM score was significantly improved. On the Short Form 36, physical functioning, general health, and vitality scores were lower than norm-based scores. Multiple regression analyses showed a positive association between change in motor FIM score and Frenchay Activities Index score and a negative association between change in cognitive FIM score and elapsed time after discharge. With regard to health-related quality of life, motor FIM score was associated with the physical component summary, whereas age and Hamilton Depression Rating Scale score were associated with the mental component summary. CONCLUSION: Social participation was associated with long-term improvement in activities of daily living, indicating that interventions targeting social function are important for maintaining and further improving activities of daily living in stroke survivors. Health-related quality of life was correlated with activities of daily living and depression; therefore, interventions targeting these parameters are important in improving the quality of life of stroke survivors.

Effects of S-PRG eluate on oral biofilm and oral malodor.

OBJECTIVES: This study evaluated the effects of a surface pre-reacted glass-ionomer (S-PRG) eluate on oral microbiota and dental biofilms in vitro, and on oral malodor and tongue bacterial loads clinically. STUDY DESIGN: The effect of S-PRG eluate on the growth and survival of salivary bacteria was examined under both aerobic and anaerobic conditions; its ability to inhibit new biofilm formation and disrupt mature biofilms was also evaluated. The concentration of volatile sulfur compounds (VSCs) was measured using a portable sulfide monitor before and after rinsing with S-PRG eluate or distilled water. The number of bacteria on the tongue surface was calculated using a portable bacterial counter before and after tongue scraping with S-PRG eluate or distilled water. RESULTS: No zone of inhibition was seen for S-PRG eluate against salivary microbiota under either aerobic or anaerobic conditions; however, treatment with ≥20% S-PRG eluate was sufficient to suppress biofilm formation relative to untreated controls. Mature biofilms were significantly disrupted following treatment with ≥60% S-PRG eluate relative to controls. Rinsing with S-PRG eluate significantly reduced the level of VSCs relative to baseline; this effect was not seen with distilled water alone. Waste fluids collected after oral rinsing with S-PRG eluate contained more bacteria than rinsing with distilled water alone. Finally, tongue scraping using S-PRG eluate was shown to significantly reduce the number of bacteria on the tongue surface. CONCLUSIONS: S-PRG eluate inhibits biofilm formation and disrupts mature biofilms, although its antibacterial activity is limited. Oral rinsing and tongue cleaning with S-PRG eluate may reduce oral malodor by effectively removing oral bacteria from the oral cavity.

Evaluating the quality of life of people with dementia in residential care facilities.

AIMS: Our purpose was to compare recipient and caregiver perception of the quality of life (QoL) of people with dementia in residential care facilities and to identify the factors associated with their perception of QoL. METHODS: Residents' QoL was evaluated by both the patient and the caregiver, using the Quality of Life in Alzheimer's Disease and several other indices. RESULTS: The correlation between the self-rated QoL score and the staff-rated QoL score was low. CONCLUSIONS: The staff tended to underestimate QoL. The main determinants of QoL were the functional status and depression. Improving physical function and mood may be beneficial in providing a better QoL.

Benidipine, a dihydropyridine-Ca2+ channel blocker, increases the endothelial differentiation of endothelial progenitor cells in vitro.

Benidipine is a dihydropyridine-Ca2+ channel blocker used in the treatment of hypertension and angina pectoris. In the present study, we examined the effects of benidipine on the endothelial differentiation of circulating endothelial progenitor cells (EPCs) using an in vitro culture method. Peripheral blood derived mononuclear cells (PBMCs) containing EPCs were isolated from C57BL/6 mice, and then the cells were cultured on vitronectin/gelatin-coated slide glasses. After 7 days of culture, endothelial cells differentiated from EPCs were identified as adherent cells with 1,1'-dioctadecyl-3,3,3',3'-tetramethyl-indocarbocyanine-labeled acetylated low density lipoprotein (Dil-Ac-LDL) uptake and lectin binding under a fluorescent microscope. Incubation of PBMCs for 7 days with benidipine (0.01-1 micromol/l) significantly increased the number of Dil-Ac-LDL+/fluorescein isothiocyanate-lectin (FITC-Lectin)+ cells. Wortmannin, a phosphoinositide-3 kinase (PI3K) inhibitor, selectively attenuated the effect of benidipine on the endothelial differentiation. In addition, benidipine treatment augmented the phosphorylation of Akt, indicating that the PI3K/Akt pathway contributed, at least in part, to the endothelial differentiation induced by benidipine. These results suggest that the treatment with benidipine may increase the endothelial differentiation of circulating EPCs and contribute to endothelial protection, prevention of cardiovascular disease, and/or an improvement of the prognosis after ischemic damage.