Managing open loop water resource value chain through IoT focused decision and information integration (DII) modelling using fuzzy MCDM approach.

Water is a limited and invaluable resource that is essential for human survival. Negligence and unregulated water use have brought about a global water crisis. Proper management with a relevant decision and information integration approach can aid water to continue as a renewable resource. The water and wastewater industry must shift from outmoded, inefficient techniques to more sustainable, data-driven solutions to address water concerns and improve public health. The Internet of Things (IoT) has emerged as an innovative strategy for decision and information integration to drive an open-loop Water Value Chain (WVC) efficiently. The IoT-driven network allows objects to connect and communicate, gather data in real-time, analyze data and develop reasonable decision - making insights instantaneously. This study aims to find the enablers of IoT for an open-loop WVC. It examines 25 factors for IoT implementation in the open-loop WVC. The 25 factors are clustered into seven enablers using Principal Component Analysis (PCA). These principal components are analyzed by employing a Multi-Criteria Decision Making (MCDM) approach, i.e., the Fuzzy Decision-Making Trial and Evaluation Laboratory (DEMATEL), which helps to find the cause-effect relationship to prioritize the enablers. The fuzzy set theory is used to address the uncertainty and vagueness in experts' opinions and data deficiency problems. The study reveals that the Ecosystem of an IoT network, IoT network configuration and adaptation and data mobility in an IoT network are the most prominent enablers to consider for the implementation of IoT in an open loop WVC. The study may be helpful for regulatory agencies and enterprises in water distribution and processing for identifying and prioritizing the potential enablers of IoT in an open-loop WVC.

A mHealth-Supported Volunteer-Assisted Spiritual Well-Being Intervention for Discharged Older Patients: A Tripartite Collaboration.

Spiritual well-being (SWB) is a key construct in a holistic health model. This study applied a theory-driven mobile health-supported volunteer-assisted self-help (mVS) intervention to enhance SWB for discharged older patients through a medical-social-academia tripartite collaboration. This study followed a quasi-experimental design, conducted from 2017 to 2019. Data were collected from pre- and post-intervention assessment and Clinical Management System under the Hospital Authority in Hong Kong. SWB was assessed by the Spirituality Scale for Chinese Elders with seven domains, a validated scale suitable for the non-religious context. A total of 161 discharged older patients were recruited, 101 received the mVS intervention and 60 received standardized usual volunteer visits. mVS intervention was assisted by volunteers supported by a corresponding mobile application Fu Le Man Xin. The final analysis included 137 older patients living in Hong Kong aged 61 to 94 years. Repeated measures ANOVA showed mVS intervention significantly enhanced two domains of SSCE: meaning of life (F(1, 64) = 4.029, p = .049) and relationship with others (F(1, 57) = 6.428, p = .014). This study shows that mVS intervention is a feasible medical-social-academia tripartite collaboration that improves two domains of the SWB of discharged older patients: meaning of life and relationship with others.

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review.

BACKGROUND: Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. AIM: This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. METHODS: Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non-English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. RESULTS: Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534-0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465-0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66-4.05, P < 0.001). CONCLUSION: Evidence for improved detection of endometrial premalignancies and malignancies using alternative endometrial thickness thresholds is not rigorous. Evidence for improved outcomes using alternative thresholds is inadequate. Observation of asymptomatic postmenopausal women without risk factors and with an endometrial thickness of less than 10 mm may be reasonable.

An extended multi-criteria group decision-making method with psychological factors and bidirectional influence relation for emergency medical supplier selection.

The COVID-19 pandemic outbreak spread rapidly worldwide, posing a severe threat to human life. Due to its unpredictability and destructiveness, the emergency has aroused great common in society. At the same time, the selection of emergency medical supplier is one of the critical links in emergency decision-making, so undertaking appropriate decision-making using scientific tools becomes the primary challenge when an emergency outbreak occurs. The multi criteria group decision-making (MCGDM) method is an applicable and common method for choosing supplier. Nevertheless, because emergency medical supplier selection should consider regarding many aspects, it is difficult for decision makers (DMs) to develop a comprehensive assessment method for emergency medical supplier. Therefore, few academics have focused on emergency situation research by the MCGDM method, and the existing MCGDM method has some areas for improvement. In view of this situation, in this study, we propose a new MCGDM method, which considers the bidirectional influence relation of the criteria, consensus and the psychological factors of DMs. It providers a good aid in emergency decision-making and it could apply to other types of MCGDM research. Firstly, DMs give their assessment in interval type-2 fuzzy sets (IT2FSs). Secondly, an extended IT2FSs assessment method and a novel ISM-BWM-Cosine Similarity-Max Deviation Method (IBCSMDM) are used for weighing all alternatives. The TODIM (an acronym for interactive and multi-criteria decision-making in Portuguese) can obtain the ranking results under different risk attenuation factors. Eventually, this extended IT2FSs-IBCSMDM-TODIM method is applied in a real case in Wuhan in the context of COVID-19 to illustrate the practicability and usefulness.

Leveraging AI for advanced analytics to forecast altered tourism industry parameters: A COVID-19 motivated study.

COVID-19 pandemic has given a sudden shock to economy indices worldwide and especially to the tourism sector, which is already very sensitive to such crises as natural calamities, terrorist activities, virus outbreaks and unwanted conditions. The economic implications for a reduction in tourism demand, and the need to analyse post-COVID-19 tourism motivates our research. This study aims to forecast the future trends for foreign tourist arrivals and foreign exchange earnings for India and to formulate a model to predict the future trends based on the COVID-19 parameters, vaccinations and stringency index (Government travelling guidelines). In the study, we have developed artificial intelligence models (random forest, linear regression) using the stacked based ensemble learning method for the development of base models and meta models for the study of COVID-19 and its effect on the tourism industry. The architecture of a stacking model consists of two or more base models, often referred to as level-0 models, and a meta-model that combines the predictions of the base models, and is referred to as a level-1 model (Smyth & Wolpert, 1999). The results show that the projected losses require quick action on developing new practices to sustain and complement the resilience of tourism per se.

Molecular regulation of brain metabolism underlying circadian epilepsy.

Extensive study has demonstrated that epilepsy occurs with greater frequency at certain times in the 24-h cycle. Although these findings implicate an overlap between the circadian rhythm and epilepsy, the molecular and cellular mechanisms underlying this circadian regulation are poorly understood. Because the 24-h rhythm is generated by the circadian molecular system, it is not surprising that this system comprised of many circadian genes is implicated in epilepsy. We summarized evidence in the literature implicating various circadian genes such as Clock, Bmal1, Per1, Rev-erb⍺, and Ror⍺ in epilepsy. In various animal models of epilepsy, the circadian oscillation and the steady-state level of these genes are disrupted. The downstream pathway of these genes involves a large number of metabolic pathways associated with epilepsy. These pathways include pyridoxal metabolism, the mammalian target of rapamycin pathway, and the regulation of redox state. We propose that disruption of these metabolic pathways could mediate the circadian regulation of epilepsy. A greater understanding of the cellular and molecular mechanism of circadian regulation of epilepsy would enable us to precisely target the circadian disruption in epilepsy for a novel therapeutic approach.

Short exposure to hyperoxia causes cultured lung epithelial cell mitochondrial dysregulation and alveolar simplification in mice.

BACKGROUND: Prolonged exposure to high oxygen concentrations in premature infants, although lifesaving, can induce lung oxidative stress and increase the risk of developing BPD, a form of chronic lung disease. The lung alveolar epithelium is damaged by sustained hyperoxia, causing oxidative stress and alveolar simplification; however, it is unclear what duration of exposure to hyperoxia negatively impacts cellular function. METHODS: Here we investigated the role of a very short exposure to hyperoxia (95% O2, 5% CO2) on mitochondrial function in cultured mouse lung epithelial cells and neonatal mice. RESULTS: In epithelial cells, 4 h of hyperoxia reduced oxidative phosphorylation, respiratory complex I and IV activity, utilization of mitochondrial metabolites, and caused mitochondria to form elongated tubular networks. Cells allowed to recover in air for 24 h exhibited a persistent global reduction in fuel utilization. In addition, neonatal mice exposed to hyperoxia for only 12 h demonstrated alveolar simplification at postnatal day 14. CONCLUSION: A short exposure to hyperoxia leads to changes in lung cell mitochondrial metabolism and dynamics and has a long-term impact on alveolarization. These findings may help inform our understanding and treatment of chronic lung disease. IMPACT: Many studies use long exposures (up to 14 days) to hyperoxia to mimic neonatal chronic lung disease. We show that even a very short exposure to hyperoxia leads to long-term cellular injury in type II-like epithelial cells. This study demonstrates that a short (4 h) period of hyperoxia has long-term residual effects on cellular metabolism. We show that neonatal mice exposed to hyperoxia for a short time (12 h) demonstrate later alveolar simplification. This work suggests that any exposure to clinical hyperoxia leads to persistent lung dysfunction.

The role of astrocytes in seizure generation: insights from a novel in vitro seizure model based on mitochondrial dysfunction.

Approximately one-quarter of patients with mitochondrial disease experience epilepsy. Their epilepsy is often severe and resistant towards conventional antiepileptic drugs. Despite the severity of this epilepsy, there are currently no animal models available to provide a mechanistic understanding of mitochondrial epilepsy. We conducted neuropathological studies on patients with mitochondrial epilepsy and found the involvement of the astrocytic compartment. As a proof of concept, we developed a novel brain slice model of mitochondrial epilepsy by the application of an astrocytic-specific aconitase inhibitor, fluorocitrate, concomitant with mitochondrial respiratory inhibitors, rotenone and potassium cyanide. The model was robust and exhibited both face and predictive validity. We then used the model to assess the role that astrocytes play in seizure generation and demonstrated the involvement of the GABA-glutamate-glutamine cycle. Notably, glutamine appears to be an important intermediary molecule between the neuronal and astrocytic compartment in the regulation of GABAergic inhibitory tone. Finally, we found that a deficiency in glutamine synthetase is an important pathogenic process for seizure generation in both the brain slice model and the human neuropathological study. Our study describes the first model for mitochondrial epilepsy and provides a mechanistic insight into how astrocytes drive seizure generation in mitochondrial epilepsy.

Emissions and health risks from the use of 3D printers in an occupational setting.

The aim of this study was to determine concentrations of particulates and volatile organic compounds (VOCs) emitted from 3D printers using polylactic acid (PLA) filaments at a university workroom to assess exposure and health risks in an occupational setting. Under typical-case (one printer) and worst-case (three printers operating simultaneously) scenarios, particulate concentration (total and respirable), VOCs and formaldehyde were measured. Air samples were collected in the printing room and adjacent hallway. Size-resolved levels of nano-diameter particles were also collected in the printing room. Total particulate levels were higher in the worst-case scenario (0.7 mg/m3) vs. typical-case scenario (0.3 mg/m3). Respirable particulate and formaldehyde concentrations were similar between the two scenarios. Size-resolved measurements showed that most particles ranged from approximately 27 to 116 nm. Total VOC levels were approximately 6-fold higher during the worst-case scenario vs. typical situation with isopropyl alcohol being the predominant VOC. Airborne concentrations in the hallway were generally lower than inside the printing room. All measurements were below their respective occupational exposure limits. In summary, emissions of particulates and VOCs increased when multiple 3D printers were operating simultaneously. Airborne levels in the adjacent hallway were similar between the two scenarios. Overall, data suggest a low risk of significant and persistent adverse health effects. Nevertheless, the health effects attributed to 3D printing are not fully known and adherence to good hygiene principles is recommended during use of this technology.

Long-term use of low-dose aspirin for cancer prevention: A 10-year population cohort study in Hong Kong.

Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, has been found to possess protective effects against cancer development in the Western populations. Such effects among Asian populations remain uncertain. The objective of this study is to investigate the use of aspirin on prevention of different cancers among Chinese users. This population-based study utilized database from the Hong Kong Hospital Authority; adults with aspirin prescription for at least 6 months between 2000 and 2004 were included and followed up until 2013. Aspirin users were age-sex matched with non-aspirin users at a 1:2 ratio. Incidences of cancer were the primary outcome measured by relative risk (RR). A total of 204,170 aspirin users and 408,339 non-aspirin users were included, with the mean age 67.5 years, 7.7 years average duration of aspirin prescription and 80 mg as the median dose of aspirin. Cancer incidences were found in 26,929 (13.2%) aspirin users and 70,755 (17.3%) non-aspirin users. Compared with patients who had not been prescribed aspirin, aspirin usage led to significant reduction of cancers in liver (RR: 0.49), stomach (RR: 0.42), colorectum (RR: 0.71), lung (RR: 0.65), pancreas (RR: 0.54), oesophagus (RR: 0.59) and leukaemia (RR: 0.67). There was no demonstrable reduction of kidney cancer, bladder cancer, prostate cancer and multiple myeloma in association with the usage of aspirin. Risk of breast cancer was shown to marginally increase (RR: 1.14) with aspirin usage. This study demonstrated that the long-term use of low-dose aspirin is associated with the reduction in risk of various cancers but not for breast cancer. Further investigation is needed before promoting aspirin as a primary chemoprotective agent.

Low-dose aspirin can reduce colorectal cancer mortality after surgery: A 10-year follow-up of 13 528 colorectal cancer patients.

BACKGROUND AND AIM: The chemopreventive effect of aspirin in colorectal cancer (CRC) is well studied, but its benefit in patients after CRC diagnosis and surgery is unclear. This study aims to investigate the effects of low-dose aspirin use in mortality among CRC patients after surgery. METHODS: Patients were analyzed in two cohorts: (i) patients taking aspirin before CRC diagnosis and continued or discontinued aspirin after surgery and (ii) patients, who never used aspirin before CRC diagnosis, received or did not receive aspirin after surgery. CRC-related mortality and all-cause mortality were the primary and secondary outcomes. Sub-distribution hazard ratio (SHR) for competing-risk CRC mortality was fitted to adjust for other causes of death; hazard ratio (HR) was used to compare all-cause mortality. RESULTS: A total of 13 528 CRC patients were included. Among 3292 patients with regular aspirin use before CRC diagnosis, 2658 (80.7%) continued aspirin and 634 (19.3%) discontinued aspirin after surgery. Continuous use of aspirin significantly reduced CRC-related mortality (SHR: 0.69, 95% confidence interval [CI]: 0.59-0.81) and all-cause mortality (HR: 0.61, 95% CI: 0.55-0.68). Among 10 236 patients who did not use aspirin before CRC diagnosis, 1054 patients (10.3%) received aspirin after surgery and 9182 (89.7%) did not. Aspirin initiated after surgery reduced CRC-related mortality (SHR: 0.88, 95% CI: 0.80-0.98) and all-cause mortality (HR: 0.87, 95% CI: 0.81-0.94). CONCLUSIONS: Irrespective of aspirin use before surgery for CRC, low-dose aspirin after surgery lowers risk of both CRC-related mortality and overall mortality.

Prevalence of cognitive impairment among peritoneal dialysis patients: a systematic review and meta-analysis.

BACKGROUND: Cognitive impairment (CI) is common among patients on peritoneal dialysis (PD), but it is under-recognized and systematic review on its prevalence and impact across different geographical locations or patient characteristics is lacking. METHODS: A search of the literature on CI in PD patients published between 1 Jan 1980 and 25.April 2019 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the prevalence of CI. Meta-regression was performed to identify factors contributing to the variance of prevalence rate. A systematic review was also performed to study risk factors of CI and its impact on clinical outcomes. RESULTS: Eight studies were included and the relevant data from 1736 patients were extracted for analysis. Meta-analysis revealed a pooled prevalence of CI at 28.7% (95% CI 15.9-46%). Meta-regression analyses showed that the prevalence of CI was unrelated to patient's age, gender, duration of PD, healthcare policy of dialysis modality, the prospective or retrospective nature of studies, or year of publication. Systematic review of 20 studies showed that older age, female sex and lower education were risk factors for CI. Potential reversible factors for CI include electrolytes disturbances, depression and vitamin D deficiency. Also, CI was associated with a higher risk of hospitalization, mostly due to PD-related peritonitis. CONCLUSIONS: CI is common in patients on long-term PD. Screening for CI should be considered in PD patients with increased risk.

Optimal Energy-Delay in Energy Harvesting Wireless Sensor Networks with Interference Channels.

In this work, we investigate the capacity allocation problem in the energy harvesting wireless sensor networks (WSNs) with interference channels. For the fixed topologies of data and energy, we formulate the optimization problem when the data flow remains constant on all data links and each sensor node harvests energy only once in a time slot. We focus on the optimal data rates, power allocations and energy transfers between sensor nodes in a time slot. Our goal is to minimize the total delay in the network under two scenarios, i.e., no energy transfer and energy transfer. Furthermore, since the optimization problem is non-convex and difficult to solve directly, by considering the network with the relatively high signal-to-interference-plus-noise ratio (SINR), the non-convex optimization problem can be transformed into a convex optimization problem by convex approximation. We attain the properties of the optimal solution by Lagrange duality and solve the convex optimization problem by the CVX solver. The experimental results demonstrate that the total delay of the energy harvesting WSNs with interference channels is more than that in the orthogonal channel; the total network delay increases with the increasing data flow for the fixed energy arrival rate; and the energy transfer can help to decrease the total delay.

Risk of gastrointestinal bleeding and benefit from colorectal cancer reduction from long-term use of low-dose aspirin: A retrospective study of 612 509 patients.

BACKGROUND AND AIM: Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, is well known to protect against development of colorectal cancer (CRC) but increases risk of gastrointestinal bleeding (GIB). This cohort study aims to evaluate the benefit of low-dose aspirin to prevent CRC and its associated risk of GIB. METHOD: A population-based dataset was used to compare incidence and mortality of CRC and GIB among patients receiving low-dose aspirin with sex-matched and age-matched controls (1:2). A total of 204 170 aspirin users taking aspirin for at least 6 months and 408 339 nonusers were analyzed. Patients' clinical outcomes were documented for up to 14 years or until death. RESULTS: A total of 612 509 patients were included; 5118 (2.51%) out of 204 170 aspirin users were diagnosed with CRC; and 2073 (1.02%) died of the malignancy. On the other hand, 13 336 (3.27%) out of 408 339 non-aspirin users were diagnosed with CRC, and 6953 (1.70%) died. Using the competing risk regression, aspirin usage significantly reduced CRC mortality (subdistribution hazard ratio = 0.59; 95% confidence interval = 0.56 to 0.62). A total of 9483 (4.64%) aspirin users developed GIB, and 820 (0.40%) died, while 11 198 (2.74%) nonusers developed GIB, and 1488 (0.36%) died. Aspirin usage marginally increased risk of bleeding-related mortality (subdistribution hazard ratio = 1.09; 95% confidence interval = 1.00 to 1.19). Subgroup analyses showed the use of acid-secreting agents significantly reduced aspirin-induced mortality. CONCLUSION: The long-term use of aspirin reduces both incidence and mortality of CRC and at the same time increases incidence and mortality risk of GIB. With combination use of acid-secreting agents, the bleeding risk can be reduced.

An Extension to Deng's Entropy in the Open World Assumption with an Application in Sensor Data Fusion.

Quantification of uncertain degree in the Dempster-Shafer evidence theory (DST) framework with belief entropy is still an open issue, even a blank field for the open world assumption. Currently, the existed uncertainty measures in the DST framework are limited to the closed world where the frame of discernment (FOD) is assumed to be complete. To address this issue, this paper focuses on extending a belief entropy to the open world by considering the uncertain information represented as the FOD and the nonzero mass function of the empty set simultaneously. An extension to Deng’s entropy in the open world assumption (EDEOW) is proposed as a generalization of the Deng’s entropy and it can be degenerated to the Deng entropy in the closed world wherever necessary. In order to test the reasonability and effectiveness of the extended belief entropy, an EDEOW-based information fusion approach is proposed and applied to sensor data fusion under uncertainty circumstance. The experimental results verify the usefulness and applicability of the extended measure as well as the modified sensor data fusion method. In addition, a few open issues still exist in the current work: the necessary properties for a belief entropy in the open world assumption, whether there exists a belief entropy that satisfies all the existed properties, and what is the most proper fusion frame for sensor data fusion under uncertainty.

Predicted Increases in Incidence of Colorectal Cancer in Developed and Developing Regions, in Association With Ageing Populations.

BACKGROUND & AIMS: Population growth and changes in demographic structure are linked to trends in colorectal cancer (CRC) incidence. The aim of this study is to estimate future CRC incidence in the ageing population, and compare trends across developing and developed regions. METHODS: Cancer and population data were extracted from the International Agency for Research on Cancer. Annual incidence rates for the major types of cancer in 118 selected populations were extracted from 102 cancer registries in 39 countries worldwide. We selected 8 jurisdictions (from the United States, Europe, and Asia) that reported 20-year cancer incidence rates since 1988. Time series models were constructed to project cancer incidence, by sex and age, to 2030. Incidence rates for persons older than 65 years were combined and further adjusted for change of ageing population. We compared age-adjusted incidence rates among the jurisdictions. RESULTS: The total population older than 65 years old was 12,917,794 in 1988, and the number increased by almost 40% to 17,950,115 in 2007. In developed countries in the West CRC incidence is predicted to decrease by 16.3% in the United States, increase by 4.8% in the United Kingdom, and increase by 4.7% in Sweden by 2030. In developing countries, such as China (Shanghai), Croatia, and Costa Rica, CRC incidence is predicted to increase in a steep curve by 2030 because of the growing population and ageing effect; in 2030, the incidence increases were 60.5% for China, 47.0% for Croatia, and 18.5% for Costa Rica. We also predict CRC incidence will increase greatly by 2030 in Japan and Hong Kong, which are developed regions. CONCLUSIONS: With the exception of the United States, the incidence of CRC is expected to continue to rise in most regions in the coming decades, due to population growth and changes in demographic structure. The predicted increases are more marked in developing regions with limited health care resources.

Cancer burden with ageing population in urban regions in China: projection on cancer registry data from World Health Organization.

Background: China is facing the challenges of an expanding ageing population and the impact of rapid urbanization, cancer rates are subsequently increasing. This study focuses on the changes of the ageing population and projects the incidence of common ageing-related cancers in the urban regions in China up to 2030. Sources of data: Cancer incidence data and population statistics in China were extracted from the International Agency for Research on Cancer. Areas of agreement: Due to improving longevity in China, continuous and remarkable increasing trends for the lung, colorectal and prostate cancers are expected. Growing points: The rate of expanding ageing population was taken into account when predicting the trend of cancer incidence; the estimations of ageing-related cancers were more factual and significant than using the conventional approach of age standardization. Areas timely for developing research: The incidence rates of lung, colorectal and prostate cancers will continue to rise in the future decades due to the rise of ageing population. Lifestyle modification such as cutting tobacco smoking rates and promoting healthier diets as well as cancer screening programs should be a health system priority in order to decrease the growing burden of cancer-related mortality and morbidity.

Extensive respiratory chain defects in inhibitory interneurones in patients with mitochondrial disease.

AIMS: Mitochondrial disorders are among the most frequently inherited cause of neurological disease and arise due to mutations in mitochondrial or nuclear DNA. Currently, we do not understand the specific involvement of certain brain regions or selective neuronal vulnerability in mitochondrial disease. Recent studies suggest γ-aminobutyric acid (GABA)-ergic interneurones are particularly susceptible to respiratory chain dysfunction. In this neuropathological study, we assess the impact of mitochondrial DNA defects on inhibitory interneurones in patients with mitochondrial disease. METHODS: Histochemical, immunohistochemical and immunofluorescent assays were performed on post-mortem brain tissue from 10 patients and 10 age-matched control individuals. We applied a quantitative immunofluorescent method to interrogate complex I and IV protein expression in mitochondria within GABAergic interneurone populations in the frontal, temporal and occipital cortices. We also evaluated the density of inhibitory interneurones in serial sections to determine if cell loss was occurring. RESULTS: We observed significant, global reductions in complex I expression within GABAergic interneurones in frontal, temporal and occipital cortices in the majority of patients. While complex IV expression is more variable, there is reduced expression in patients harbouring m.8344A>G point mutations and POLG mutations. In addition to the severe respiratory chain deficiencies observed in remaining interneurones, quantification of GABAergic cell density showed a dramatic reduction in cell density suggesting interneurone loss. CONCLUSIONS: We propose that the combined loss of interneurones and severe respiratory deficiency in remaining interneurones contributes to impaired neuronal network oscillations and could underlie development of neurological deficits, such as cognitive impairment and epilepsy, in mitochondrial disease.

Neural Plastic Effects of Cognitive Training on Aging Brain.

Increasing research has evidenced that our brain retains a capacity to change in response to experience until late adulthood. This implies that cognitive training can possibly ameliorate age-associated cognitive decline by inducing training-specific neural plastic changes at both neural and behavioral levels. This longitudinal study examined the behavioral effects of a systematic thirteen-week cognitive training program on attention and working memory of older adults who were at risk of cognitive decline. These older adults were randomly assigned to the Cognitive Training Group (n = 109) and the Active Control Group (n = 100). Findings clearly indicated that training induced improvement in auditory and visual-spatial attention and working memory. The training effect was specific to the experience provided because no significant difference in verbal and visual-spatial memory between the two groups was observed. This pattern of findings is consistent with the prediction and the principle of experience-dependent neuroplasticity. Findings of our study provided further support to the notion that the neural plastic potential continues until older age. The baseline cognitive status did not correlate with pre- versus posttraining changes to any cognitive variables studied, suggesting that the initial cognitive status may not limit the neuroplastic potential of the brain at an old age.

Prevention in primary care is better than cure: The Hong Kong Reference Framework for Preventive Care for Older Adults--translating evidence into practice.

An ageing population is posing a great challenge to Hong Kong. Maintaining health and functional independence among older adults is of utmost importance, and requires the collaborative efforts of multiple health care disciplines from both the private and public sectors. The Reference Framework for Preventive Care for Older Adults, developed by the Task Force on Conceptual Model and Preventive Protocols under the auspices of the Working Group on Primary Care, aims to enhance primary care for this population group. The reference framework emphasises a comprehensive, integrated, and collaborative approach that involves providers of primary care from multiple disciplines. In addition to internet-based information, helpful tools in the form of summary charts and Cue Cards are also produced to facilitate incorporation of recommendations by primary care providers into their daily practice. It is anticipated that wide adoption of the reference framework will contribute to improving older adults' health in our community.