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GST Primary GST Primary Best Strategies for Health Care Quality Im... Best Strategies for Health Care Quality Improvement - Diabetes Quality Improvement Strategies for Antibio... Kathryn McDonald, Stanford-UCSF Evidence-b... Systematic review assessing the effect of ... Quality Improvement Strategies for Antibiotics Management Kathryn McDonald, Stanford-UCSF Evidence-based Practice Center, 117 Encina Commons, Stanford, CA 94305-6019, Kathy.mcdonald@stanford.edu Systematic review assessing the effect of quality improvement strategies on appropriate prescribing of antibiotics and appropriate choice of antibiotics. Adherence Adherence Assistive Devices Assistive Devices Childhood Burn Hanson MacMillan Childhood Burn Hanson MacMillan CLSA_9 CLSA_9 Cyberabuse Cyberabuse Cognitive Behavioural Therapy for Violent ... This review included randomized trials abo... Cognitive Behavioural Therapy for Violent Men who Batter Their Partners This review included randomized trials about the effects of cognitive behavioral therapy on domestic violence. The intervention included programs based on the Duluth Model. The violence had to be committed by a male toward his female partner. The violence also had to be physical. The primary outcomes were new arrests and convictions, and new reports of violence. CABG vs PCI CABG vs PCI Quality Improvement Strategies for Prevent... Quality Improvement Strategies for Preventing Nosocomial Infections (Created 17-Feb-06) Quality Improvement Strategies for Asthma ... Quality Improvement Strategies for Asthma Control Erectile Dysfunction (Created 30-Jan-06) Erectile Dysfunction (Created 30-Jan-06) Inequality - Smoking Cessation to Reduce S... This review was the first part of a projec... Inequality - Smoking Cessation to Reduce Socio-Economic Differences This review was the first part of a project about inequality. It included randomized trials about the effect of smoking cessation interventions on reducing socio-economic differences. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Diet and Physical Activity to Reduce Socio... This review was the second part in a proje... Diet and Physical Activity to Reduce Socio-Economic Differences This review was the second part in a project about inequality. It included randomized trials about the effect of interventions on reducing socio-economic differences in diet and physical activity. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Workfare The data in SRS are not identical to the d... Workfare The data in SRS are not identical to the data in the published report. We used SRS only for an updated search. The review included randomized trials about the effect of welfare-to-work programs. Participants were welfare recipients. There were basically two types of programs. The educational type tried to build knowledge and skills in order to help the welfare recipients acquire jobs that could support them economically. The "work first" approach was more aimed at getting the participants quickly into a job. Exercise interventions for the management ... The objective of this systematic review wa... Exercise interventions for the management of frailty The objective of this systematic review was to examine the effectiveness of current exercise interventions on the management of frailty. A comprehensive search of Medline, Embase, Psycinfo, Cinahl, Scopus, Ageline, Eric, and SportDiscus databases was conducted and produced 1808 citations. So far we have completed 2 levels of “title and abstract” screening and we ended up with 262 articles. We have just started the full text screening. Eligibility criteria included original studies whose participants were identified as frail or prefrail with specific criteria and in which structured physical activity was included as at least one component of the intervention. Create a free account, build a dictionary with saved terms to re-use later! Public Domestic Violence - Using Cognitive Behavior Therapy Smoking Cessation to Reduce Socio-Economic Differences Diet and Physical Activity to Reduce Socio-Economic Differences Workfare Exercise Interventions for the Management of Frailty Search     Simple Advanced Refine (4 coded questions)  Any of these:   Exact Phrase: All of these: None of these: Author: Periodical: Projects: No restrictions   Libraries: Public   Select SRS Projects Show Saved Terms Select Library Show articles that do not have abstracts  Type of Article Clinical Trial Editorial Letter Meta-Analysis Practice Guideline Randomized Controlled Trial Review Addresses Bibliography Biography Case Reports Classical Article Clinical Conference Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Comment Comparative Study Consensus Development Conference Consensus Development Conference, NIH Controlled Clinical Trial Corrected and Republished Article Dictionary Directory Duplicate Publication English Abstract Evaluation Studies Festschrift Government Publications Guideline Historical Article Interview In Vitro Journal Article Lectures Legal Cases Legislation Multicenter Study News Newspaper Article Overall Patient Education Handout Periodical Index Published Erratum Retracted Publication Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. 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Retraction of Publication Scientific Integrity Review Support of Research Technical Report Twin Study Validation Studies Not a Primary Study or Review Unknown Primary Study Case Series Case Control Cohort Study Observational Study Qualitative Research CBA or ITS Registry Double Blind Controlled before after study Quasi-randomized trial Simple before after study Cluster-RCT Non-Randomized Study Report Book Book chapter Dissertation Conference procedings Secondary Research Not RCT Humans or Animals Humans Animals Ages All Infant: birth-23 months All Child: 0-18 years All Adult: 19+ years Newborn: birth-1 month Infant: 1-23 months Preschool Child: 2-5 years Child: 6-12 years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Middle Aged + Aged: 45+ years Aged: 65+ years 80 and over: 80+ years Undetermined Language English French German Italian Japanese Russian Spanish Afrikaans Albanian Unknown Arabic Armenian Azerbaijani Bosnian Bulgarian Catalan Chinese Croatian Czech Danish Dutch Esperanto Estonian Finnish Georgian Greek, Modern Hebrew Hindi Hungarian Icelandic Indonesian Kinyarwanda Korean Latin Latvian Lithuanian Macedonian Malay Malayalam Maori Multiple Languages Norwegian Persian Polish Portuguese Pushto Romanian Sanskrit Scottish gaelic Serbian Slovak Slovenian Swedish Thai Turkish Ukrainian Vietnamese Not English Not French Results(1-25 of 218) Sort By: Publication Date Relevance Took: 1.198 seconds to search 17,750,454  Action: Copy Results to new Clipboard Build Search Link Page 1 of 9 1 2 3 4 > Last >> (218 articles found) Physical demands of firefighter search and rescue in ambient environmental conditions. Jul 2008 V L Richmond,M P Rayson,D M Wilkinson,J M Carter,S D Blacker This study investigated the physiological responses and limitations to a simulated search and rescue scenario in a high-rise building under ambient conditions. Sixteen firefighters performed the scenario under four conditions: standard duration breathing apparatus (SDBA) and 45 mm hose; extended du... ( view more )ration breathing apparatus (EDBA) and 45 mm hose; SDBA and 70 mm hose; EDBA and 70 mm hose. Core temperature, skin temperature and heart rate were monitored. In four of 32 trials the casualty was rescued; the remainder of the trials were terminated for safety, high core temperature or shortage of air. Final core temperature and heart rate were higher in the EDBA (39.1 degrees C; 72% heart rate reserve (HRR)) than SDBA conditions (38.6 degrees C; 67%HRR). No differences were observed between hose sizes. The scenario proved too onerous to complete successfully in the majority of cases. Replacing SDBA with EDBA eliminates air supply as a limiting factor, but brings with it challenges of managing thermal strain. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Development of an operational fitness test for the Royal Air Force. Jun 2008 Victoria L Richmond,Mark P Rayson,David M Wilkinson,James M Carter,Sam D Blacker,Alan Nevill,Jill Du Ross,Steve Moore Since 2002, the Royal Air Force (RAF) has been working towards developing role-related physical tests for use as an operational fitness test (OFT). The purpose of this study was to establish reliability of the OFT (comprising four tests), investigate gym-based tests as predictors of performance and... ( view more ) establish performance standards. Fifty-eight RAF personnel performed the OFT on three occasions. A separate cohort carried out fitness and anthropometric tests before performing the OFT, by way of establishing performance predictors. Documented evidence and views of an expert panel were used to determine OFT standards. Reliability ranged from moderate to good for three tests, with one test (Dig) showing poor reliability. The 95% limits of agreement for the prediction models ranged from good to poor (6.7-34.2%). The prediction models were not sufficiently accurate to estimate confidently OFT performance, but could be used as a guide to quantify likely outcome and training needs. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Hippocampal activation in adults with mild cognitive impairment predicts subsequent cognitive decline. Jun 2008 S L Miller,E Fenstermacher,J Bates,D Blacker,R A Sperling,B C Dickerson OBJECTIVE: To use functional MRI (fMRI) to investigate whether hippocampal activation during a memory task can predict cognitive decline in individuals with mild cognitive impairment (MCI). METHODS: 25 older individuals with MCI performed a visual scene encoding task during fMRI scanning, and were ... ( view more )followed clinically for at least 4 years after scanning. A hypothesis driven analysis of fMRI data was performed. First, fMRI data were analysed at the group level to identify the regions of the hippocampal formation that were engaged by this memory task. Parameter estimates of each subject's memory related hippocampal activation (% signal change) were extracted and were analysed with a linear regression model to determine whether hippocampal activation predicted the degree or rate of cognitive decline, as measured by change in Clinical Dementia Rating Sum-of-Boxes (CDR-SB). RESULTS: Over 5.9 (1.2) years of follow-up after scanning, subjects varied widely in degree and rate of cognitive decline (change in CDR-SB ranged from 0 to 6, and the rate ranged from 0 to 1 CDR-SB unit/year). Greater hippocampal activation predicted greater degree and rate of subsequent cognitive decline (p<0.05). This finding was present even after controlling for baseline degree of impairment (CDR-SB), age, education and hippocampal volume, as well as gender and apolipoprotein E status. In addition, an exploratory whole brain analysis produced convergent results, demonstrating that the hippocampal formation was the only brain region where activation predicted cognitive decline. CONCLUSIONS: In individuals with MCI, greater memory task related hippocampal activation is predictive of a greater degree and rate of cognitive decline subsequent to scanning. fMRI may provide a physiological imaging biomarker useful for identifying the subgroup of MCI individuals at highest risk of cognitive decline for potential inclusion in disease modifying clinical trials. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles APOE epsilon 4 allele predicts faster cognitive decline in mild Alzheimer disease. May 6, 2008 S Cosentino,N Scarmeas,E Helzner,M M Glymour,J Brandt,M Albert,D Blacker,Y Stern OBJECTIVE: To determine whether APOE epsilon 4 predicts rate of cognitive change in incident and prevalent Alzheimer disease (AD). METHODS: Individuals were recruited from two longitudinal cohort studies-the Washington Heights and Inwood Columbia Aging Project (WHICAP; population-based) and the Pre... ( view more )dictors Study (clinic-based)--and were followed for an average of 4 years. Three samples of participants diagnosed with AD, with diverse demographic characteristics and baseline cognitive functioning, were studied: 1) 199 (48%) of the incident WHICAP cases; 2) 215 (54%) of the prevalent WHICAP cases; and 3) 156 (71%) of the individuals diagnosed with AD in the Predictors Study. Generalized estimating equations were used to test whether rate of cognitive change, measured using a composite cognitive score in WHICAP and the Mini-Mental State Examination in Predictors, varied as a function of epsilon 4 status in each sample. RESULTS: The presence of at least one epsilon 4 allele was associated with faster cognitive decline in the incident population-based AD group (p = 0.01). Parallel results were produced for the two prevalent dementia samples only when adjusting for disease severity or excluding the most impaired participants from the analyses. CONCLUSION: APOE epsilon 4 may influence rate of cognitive decline most significantly in the earliest stages of Alzheimer disease. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Impaired medial temporal repetition suppression is related to failure of parietal deactivation in Alzheimer disease. Apr 2008 Maija Pihlajamäki,Kristina M DePeau,Deborah Blacker,Reisa A Sperling OBJECTIVES: Neural networks supporting encoding of new information are affected early in the course of Alzheimer disease (AD). Functional magnetic resonance imaging (fMRI) studies in AD have reported decreased medial temporal lobe (MTL) activation when comparing novel versus repeated stimuli. It is... ( view more ), however, unclear whether this finding is related to a failure of normal suppression of MTL activity to repeated stimuli in AD. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Twenty-nine healthy older subjects comprising a comparison group (OC) and 15 mild AD patients underwent fMRI during an associative memory paradigm in an academic medical center. The task consisted of blocks of Novel and Repeated face-name pairs and visual Fixation. To reveal neural correlates of processing repeatedly presented stimuli, Repeated blocks were contrasted to Fixation. RESULTS: AD patients demonstrated greater activation during Repeated stimuli in the MTL and in prefrontal and superior parietal cortices, compared with OC. In contrast, OC showed greater parietal task-induced deactivation than AD. Increased MTL activity during Repeated was correlated with more impaired parietal deactivation and poorer performance of the postscan recognition memory test of encoding the face-name pairs. CONCLUSION: Reduction of MTL activity to repeated stimuli, which become highly familiarized to healthy OC, was impaired in AD. This abnormal increased MTL activation was related to disrupted parietal deactivation and to poor recognition memory performance. These preliminary results suggest that the typical episodic memory impairment seen in mild AD may manifest as a failure of normal repetition suppression and loss of "beneficial" deactivation in the MTL-parietal memory networks. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Spatial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Apr 2008 Christopher M Holland,Eric E Smith,Istvan Csapo,Mahmut Edip Gurol,Douglas A Brylka,Ronald J Killiany,Deborah Blacker,Marilyn S Albert,Charles R G Guttmann,Steven M Greenberg BACKGROUND AND PURPOSE: White-matter hyperintensities (WMHs) detected by magnetic resonance imaging are thought to represent the effects of cerebral small-vessel disease and neurodegenerative changes. We sought to determine whether the spatial distribution of WMHs discriminates between different di... ( view more )sease groups and healthy aging individuals and whether these distributions are related to local cerebral perfusion patterns. METHODS: We examined the pattern of WMHs by T2/fluid-attenuated inversion recovery-weighted magnetic resonance imaging in 3 groups of subjects: cerebral amyloid angiopathy (n=32), Alzheimer disease or mild cognitive impairment (n=41), and healthy aging (n=29). WMH frequency maps were calculated for each group, and spatial distributions were compared by voxel-wise logistic regression. WMHs were also analyzed as a function of normal cerebral perfusion patterns by overlaying a single photon emission computed tomography atlas. RESULTS: Although WMH volume was greater in cerebral amyloid angiopathy and Alzheimer disease/mild cognitive impairment than in healthy aging, there was no consistent difference in the spatial distributions when controlling for total WMH volume. Hyperintensities were most frequent in the deep periventricular WM in all 3 groups. A strong inverse correlation between hyperintensity frequency and normal perfusion was demonstrated in all groups, demonstrating that WMHs were most common in regions of relatively lower normal cerebral perfusion. CONCLUSIONS: WMHs show a common distribution pattern and predilection for cerebral WM regions with lower atlas-derived perfusion, regardless of the underlying diagnosis. These data suggest that across diverse disease processes, WM injury may occur in a pattern that reflects underlying tissue properties, such as relative perfusion. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Differential item functioning between ethnic groups in the epidemiological assessment of depression. Apr 2008 Joshua Breslau,Kristin N Javaras,Deborah Blacker,Jane M Murphy,Sharon-Lise T Normand A potential explanation for the finding that disadvantaged minority status is associated with a lower lifetime risk for depression is that individuals from minority ethnic groups may be less likely to endorse survey questions about depression even when they have the same level of depression. We exa... ( view more )mine this possibility using a nonparametric item response theory approach to assess differential item functioning (DIF) in a national survey of psychiatric disorders, the National Comorbidity Survey. Of 20 questions used to assess depression symptoms, we found evidence of DIF in 3 questions when comparing non-Hispanic blacks with non-Hispanic whites and in 3 questions when comparing Hispanics with non-Hispanic whites. However, removal of the questions with DIF did not alter the relative prevalence of depression between ethnic groups. Ethnic differences do exist in response to questions concerning depression, but these differences do not account for the finding of relatively low prevalence of depression among minority groups. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles An investigation of a novel three-dimensional activity monitor to predict free-living energy expenditure. Apr 2008 James Carter,David Wilkinson,Sam Blacker,Mark Rayson,James Bilzon,Rachel Izard,Andy Coward,Antony Wright,Alan Nevill,Kirsten Rennie,Tracey McCaffrey,Barbara Livingstone The aim of this study was to assess the capability of the 3dNX accelerometer to predict energy expenditure in two separate, free-living cohorts. Twenty-three adolescents and 14 young adults took a single dose of doubly labelled water and wore a 3dNX activity monitor during waking hours for a 10-day... ( view more ) period while carrying out their normal routines. Multiple linear regression with backward elimination was used to establish the strength of the associations between various indices of energy expenditure, physical activity counts, and anthropometric variables. 3dNX output accounted for 27% and 35% of the variance in the total energy expenditure of the adolescent and young adult cohort, respectively. The explained variance increased to 78%, with a standard error of estimate of 7%, when 3dNX output was combined with body composition variables. The 3dNX accelerometer can be used to predict free-living daily energy expenditure with a standard error of estimate of 1.65 MJ in adolescents and 1.52 MJ in young adults. The inclusion of anthropometric variables reduces the error to approximately 1 MJ. Although it remains to cross-validate these models in other populations, early indications suggest that the 3dNX provides a useful method of predicting energy expenditure in free-living individuals. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The effect of cool water ingestion on gastrointestinal pill temperature. Mar 2008 David M Wilkinson,James M Carter,Victoria L Richmond,Sam D Blacker,Mark P Rayson Telemetric gastrointestinal (GI) temperature pills are now commonly used to measure core body temperature and could minimize the risk of heat illness while maximizing operational effectiveness in workers subject to high levels of thermal strain. PURPOSE: To quantify the effect of repeated cool wate... ( view more )r ingestion on the accuracy of GI pill temperature. METHODS: Ten operational firefighters ingested a pill to measure GI temperature (T1int) before overnight sleep. Two hours following breakfast and 11.5 h after ingesting T1int, the firefighters ingested a second pill (T2int) before performing 8.5 h of intermittent activity (repetitive cycles of 30 min of seated rest followed by 30 min of general firefighter duties). During the first 2 min of each 30-min rest period, the firefighters consumed 250 mL of chilled water (5-8 degrees C). RESULTS: Water ingestion had a highly variable effect both within and between subjects in transiently (32 +/- 10 min) reducing the temperature of T2int in comparison with T1int. In general, this transient reduction in T2int became progressively smaller as time following ingestion increased. In some firefighters, the difference between T1int and T2int became negligible (+/- 0.1 degrees C) after 3 h, whereas in two others, large differences (peaking at 2.0 degrees C and 6.3 degrees C) were still observed when water was consumed 8 h after pill ingestion. CONCLUSION: These results show that a GI pill ingested immediately prior to physical activity cannot be used to measure core body temperature accurately in all individuals during the following 8 h when cool fluids are regularly ingested. This makes GI temperature measurement unsuitable for workers who respond to emergency deployments when regular fluid consumption is recommended operational practice. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Risk factors for training injuries among British Army recruits. Mar 2008 Sam D Blacker,David M Wilkinson,James L J Bilzon,Mark P Rayson This study aimed to identify risk factors for training injuries resulting in referral to a remedial instructor (RI) or medical discharge (MD) among British Army recruits undertaking initial training. Physical performance and anthropometric data for 11,937 male and 1,480 female recruits were examine... ( view more )d as potential risk factors for RI referral and MD, using Cox regression. There was a trend showing that female recruits' MD rates were higher than male recruits' rates (p = 0.096), and RI referral rates were significantly greater for women than for men (p = 0.041). The independent risk factors for MD were 2.4-km run time, ethnicity, and Army training regiment attended (p < 0.001), and those for RI referral were 2.4-km run time, ethnicity, Army training regiment attended, and body mass index (p < 0.001). Gender was not an independent risk factor for injury, suggesting that lower levels of aerobic fitness are the primary cause of the greater incidence of injury among female recruits during British Army initial training. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Home health and informal care utilization and costs over time in Alzheimer's disease. 2008 Carolyn W Zhu,Rebecca Torgan,Nikolaos Scarmeas,Marilyn Albert,Jason Brandt,Deborah Blacker,Mary Sano,Yaakov Stern OBJECTIVES: To (1) compare home health and informal (unpaid) services utilization among patients with Alzheimer's disease (AD), (2) examine longitudinal changes in services use, and (3) estimate possible interdependence of home health and informal care utilization. METHODS: The sample is drawn from... ( view more ) the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers. Bivariate probit models estimated the effects of patient characteristics on home health and informal care utilization. RESULTS: A large majority of the patients (80.6%) received informal care with a smaller proportion (18.6%) receiving home health services. Home health services utilization increased from 9.9% at baseline to 34.5% in year 4. Among users, number of days that services were provided in three-month recall increased from 21.9 to 56 days over time. Home health services utilization was significantly associated with function, depressive symptoms, being female, and not living with a spouse. Informal care utilization was significantly associated with cognition, function, comorbidities, and living with a spouse or child. CONCLUSIONS: Home health and informal care utilization relate differently to patient characteristics. Utilization of home health care or informal care was not influenced by utilization of the other. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Magnetic resonance imaging white matter hyperintensities and brain volume in the prediction of mild cognitive impairment and dementia. Jan 2008 Eric E Smith,Svetlana Egorova,Deborah Blacker,Ronald J Killiany,Alona Muzikansky,Bradford C Dickerson,Rudolph E Tanzi,Marilyn S Albert,Steven M Greenberg,Charles R G Guttmann OBJECTIVE: To determine whether magnetic resonance imaging (MRI) white matter hyperintensities (WMH), whole-brain atrophy, and cardiovascular risk factors predict the development of cognitive decline and dementia. DESIGN: Subjects were recruited into this prospective cohort study and followed for i... ( view more )ncident cognitive decline for mean (SD) 6.0 (4.1) years. Magnetic resonance imaging dual-echo sequences, obtained at baseline, were used to determine the volume of WMH and the brain parenchymal fraction (BPF), the proportion of the intracranial cavity occupied by brain. White matter hyperintensity volume was analyzed as the percentage of intracranial volume (WMHr); "high WMH" was defined as a WMHr more than 1 SD above the mean. SETTING: General community. PATIENTS: Volunteer sample consisting of 67 subjects with normal cognition and 156 subjects with mild cognitive impairment (MCI). MAIN OUTCOME MEASURES: Time to diagnosis of MCI (among those with normal cognition at baseline) or time to diagnosis of dementia, either all-cause or probable Alzheimer disease (AD) (among those with MCI at baseline). Cox proportional hazards models were used for multivariable analysis. RESULTS: High WMH was a predictor of progression from normal to MCI (adjusted hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.33-8.17; P= .01) but not conversion from MCI to all-cause dementia. Conversely, BPF did not predict progression from normal to MCI but did predict conversion to dementia (adjusted HR, 1.10 for each 1% decrease in BPF; 95% CI, 1.02-1.19; P= .02). When conversion to AD dementia was considered as the outcome, BPF was likewise a predictor (adjusted HR, 1.16 for each 1% decrease in BPF; 95% CI, 1.08-1.24; P< .001), but high WMH was not. Past tobacco smoking was associated with both progression from normal to MCI (adjusted HR, 2.71; 95% CI, 1.12-6.55; P= .03) and conversion to all-cause dementia (adjusted HR, 2.08; 95% CI, 1.13-3.82; P= .02), but not AD dementia. CONCLUSIONS: These findings suggest that WMH are associated with the risk of progressing from normal to MCI. In persons whose cognitive abilities are already impaired, BPF predicts the conversion to dementia. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Detection of cortical thickness correlates of cognitive performance: Reliability across MRI scan sessions, scanners, and field strengths. Jan 1, 2008 B C Dickerson,E Fenstermacher,D H Salat,D A Wolk,R P Maguire,R Desikan,J Pacheco,B T Quinn,A Van der Kouwe,D N Greve,D Blacker,M S Albert,R J Killiany,B Fischl In normal humans, relationships between cognitive test performance and cortical structure have received little study, in part, because of the paucity of tools for measuring cortical structure. Computational morphometric methods have recently been developed that enable the measurement of cortical th... ( view more )ickness from MRI data, but little data exist on their reliability. We undertook this study to evaluate the reliability of an automated cortical thickness measurement method to detect correlates of interest between thickness and cognitive task performance. Fifteen healthy older participants were scanned four times at 2-week intervals on three different scanner platforms. The four MRI data sets were initially treated independently to investigate the reliability of the spatial localization of findings from exploratory whole-cortex analyses of cortical thickness-cognitive performance correlates. Next, the first data set was used to define cortical ROIs based on the exploratory results that were then applied to the remaining three data sets to determine whether the relationships between cognitive performance and regional cortical thickness were comparable across different scanner platforms and field strengths. Verbal memory performance was associated with medial temporal cortical thickness, while visuomotor speed/set shifting was associated with lateral parietal cortical thickness. These effects were highly reliable - in terms of both spatial localization and magnitude of absolute cortical thickness measurements - across the four scan sessions. Brain-behavior relationships between regional cortical thickness and cognitive task performance can be reliably identified using an automated data analysis system, suggesting that these measures may be useful as imaging biomarkers of disease or performance ability in multicenter studies in which MRI data are pooled. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles A combined drama-based and CBT approach to working with self-reported anger aggression. 2008 Janine Blacker,Andy Watson,Anthony R Beech BACKGROUND: A drama-based programme, called 'Insult to Injury', was designed to explore the processes of anger, aggression and violence. The aim of the programme was to enable offenders to identify and generate strategies and skills for dealing with potentially volatile situations, and to provide a... ( view more ) safe and supportive environment in which to practice and evaluate these strategies. AIMS An active drama-based approach combined with cognitive-behavioural techniques was used to explore issues such as masculinity, power and control, pride and shame and victim awareness. Reductions in anger were hypothesized. METHOD A single group pre/post design assessed the levels of anger before and after the course. RESULTS Sixty-two adult male offenders from six prison establishments in the UK took part in the nine-day course. As hypothesised, significant reductions in anger were found in pre- to post-course assessment. CONCLUSIONS: These results suggest that a drama-based approach may be a promising adjunct to traditional anger management programmes for violent offenders. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Exploring candidate gene associations with neuropsychological performance. Dec 5, 2007 Matthew B McQueen,Lars Bertram,Christoph Lange,K D Becker,Marilyn S Albert,Rudolph E Tanzi,Deborah Blacker We hypothesize that quantitative phenotypes related to Alzheimer's disease (AD), rather than the dichotomous disease phenotype, will increase the statistical power for identifying genetic risk factors. Neuropsychological test scores, which allow for the measurement of loss of cognitive function ove... ( view more )r time, are a particularly promising option for this approach. Using data from a cohort study of prodromal AD in 365 community-recruited subjects with and without memory problems with a baseline and often one or more follow-up administrations of a detailed neuropsychological test battery, we performed both cross-sectional and longitudinal analyses using the known AD gene APOE and four other putative AD genes as predictors. APOE and a promoter polymorphism in insulin degrading enzyme (IDE_4U) showed evidence for association with cross-sectional and longitudinal changes in memory (P = 0.016-0.025) and other cognitive functions. APOE and a polymorphism in the alpha-2-macroglobulin gene (A2M18i) also showed evidence for association with cross-sectional and longitudinal changes in executive functioning (P = 0.010-0.042). In some cases, longitudinal analysis offered stronger evidence for association than could be seen cross-sectionally. These preliminary results suggest that this approach has promised the development of a quantitative phenotype related to AD, but more elaborate methods will be required to address multiple comparisons issues in the setting of correlated data. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Disruptive behavior as a predictor in Alzheimer disease. Dec 2007 Nikolaos Scarmeas,Jason Brandt,Deborah Blacker,Marilyn Albert,Georgios Hadjigeorgiou,Bruno Dubois,Davangere Devanand,Lawrence Honig,Yaakov Stern BACKGROUND: Disruptive behavior is common in Alzheimer disease (AD). There are conflicting reports regarding its ability to predict cognitive decline, functional decline, institutionalization, and mortality. OBJECTIVE: To examine whether the presence of disruptive behavior has predictive value for ... ( view more )important outcomes in AD. DESIGN: Using the Columbia University Scale for Psychopathology in Alzheimer Disease (administered every 6 months, for a total of 3438 visit-assessments and an average of 6.9 per patient), the presence of disruptive behavior (wandering, verbal outbursts, physical threats/violence, agitation/restlessness, and sundowning) was extracted and examined as a time-dependent predictor in Cox models. The models controlled for the recruitment cohort, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and functional performance, and neuroleptic use. SETTING: Five university-based AD centers in the United States and Europe (Predictors Study). PARTICIPANTS: Four hundred ninety-seven patients with early-stage AD (mean Folstein Mini-Mental State Examination score, 20 of 30 at entry) who were recruited and who underwent semiannual follow-up for as long as 14 (mean, 4.4) years. MAIN OUTCOME MEASURES: Cognitive (Columbia Mini-Mental State Examination score, < or = 20 of 57 [approximate Folstein Mini-Mental State Examination score, < or = 10 of 30]) and functional (Blessed Dementia Rating Scale score, parts I and II, > or = 10) ratings, institutionalization equivalent index, and death. RESULTS: At least 1 disruptive behavioral symptom was noted in 48% of patients at baseline and in 83% at any evaluation. Their presence was associated with increased risks of cognitive decline (hazard ratio 1.45 [95% confidence interval (CI), 1.03-2.03]), functional decline (1.66 [95% CI, 1.17-2.36]), and institutionalization (1.47 [95% CI, 1.10-1.97]). Sundowning was associated with faster cognitive decline, wandering with faster functional decline and institutionalization, and agitation/restlessness with faster cognitive and functional decline. There was no association between disruptive behavior and mortality (hazard ratio, 0.94 [95% CI, 0.71-1.25]). CONCLUSION: Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Dec 2007 Bradford C Dickerson,Reisa A Sperling,Bradley T Hyman,Marilyn S Albert,Deborah Blacker OBJECTIVE: To determine whether clinical assessment methods that grade the severity of impairments within the spectrum of mild cognitive impairment (MCI) can predict clinical course, particularly among very mildly impaired individuals who do not meet formal MCI criteria as implemented in clinical t... ( view more )rials. DESIGN: Cohort. SETTING: Community volunteers. PARTICIPANTS: From a longitudinal study of normal (Clinical Dementia Rating [CDR] = 0; n = 77) and mildly impaired (CDR = 0.5; n = 167) participants with 5 or more annual clinical assessments, baseline level of cognitive impairment in daily life was graded using CDR sum of boxes (CDR-SB) and level of cognitive performance impairment was graded using neuropsychological test scores. MAIN OUTCOME MEASURES: Five-year outcome measures included (1) probable Alzheimer disease (AD) diagnosis and (2) clinical "decline" (CDR-SB increase > or = 1.0). Logistic regression models were used to assess the ability of baseline measures to predict outcomes in the full sample and separately in the subjects who did not meet formal MCI criteria as implemented in a multicenter clinical trial (n = 125; "very mild cognitive impairment" [vMCI]). RESULTS: The presence of both higher CDR-SB and lower verbal memory and executive function at baseline predicted greater likelihood of probable AD and decline. Five-year rates of probable AD and decline in vMCI (20%, AD; 49%, decline) were intermediate between normal participants (0%, AD; 28%, decline) and participants with MCI (41%, AD; 62%, decline). Within vMCI, likelihood of probable AD was predicted by higher CDR-SB and lower executive function. CONCLUSIONS: Even in very mildly impaired individuals who do not meet strict MCI criteria as implemented in clinical trials, the degree of cognitive impairment in daily life and performance on neuropsychological testing predict likelihood of an AD diagnosis within 5 years. The clinical determination of relative severity of impairment along the spectrum of MCI may be valuable for trials of putative disease-modifying compounds, particularly as target populations are broadened to include less impaired individuals. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Asymmetric transfer hydrogenation of ketones with bifunctional transition metal-based molecular catalysts. Dec 2007 Takao Ikariya,A John Blacker Recent development of conceptually new chiral bifunctional transition metal based catalysts for asymmetric reductive transformations is described. The chiral bifunctional molecular catalyst promoted reduction is now realized to be a powerful tool to access chiral compounds in organic synthetic proc... ( view more )edures in both academia and industry. Based on structural investigation of the actual catalyst and its intermediates and a deep understanding of the reaction mechanism, this asymmetric reduction system can be widely used to produce valuable chiral alcohols and is now is applicable to commercial scale production. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Genome-wide linkage analysis of 723 affected relative pairs with late-onset Alzheimer's disease. Nov 15, 2007 Marian L Hamshere,Peter A Holmans,Dimitrios Avramopoulos,Susan S Bassett,Deborah Blacker,Lars Bertram,Howard Wiener,Nan Rochberg,Rudolph E Tanzi,Amanda Myers,Fabienne Wavrant-De Vrièze,Rodney Go,Daniele Fallin,Simon Lovestone,John Hardy,Alison Goate,Michael O'Donovan,Julie Williams,Michael J Owen Previous attempts to identify genetic loci conferring risk for late-onset Alzheimer's disease (LOAD) through linkage analysis have observed some regions of linkage in common. However, due to the sometimes-considerable overlap between the samples, some of these reports cannot be considered to be ind... ( view more )ependent replications. In order to assess the strength of the evidence for linkage and to obtain the best indication of the location of susceptibility genes, we have amalgamated three large samples to give a total of 723 affected relative pairs (ARPs). Multipoint, model-free ARP linkage analysis was performed. Genome-wide significant evidence for linkage was observed on 10q21.2 (LOD=3.3) and genome-wide suggestive evidence was observed on 9q22.33 (LOD=2.5) and 19q13.32 (LOD=2.0). One further region on 9p21.3 was identified with an LOD score>1. We observe no evidence to suggest that more than one locus is responsible for the linkage to 10q21.2, although this linked region may harbour more than one susceptibility gene. Evidence of allele-sharing heterogeneity between the original collection sites was observed on chromosome 9 but not on chromosome 10 or 19. Evidence for an interaction was observed between loci on chromosomes 10 and 19. Where samples overlapped, the genotyping consistency was high, estimated to average at 97.3%. Our large-scale linkage analysis consolidates clear evidence for a susceptibility locus for LOAD on 10q21.2. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles New chiral binaphthalene-derived iminium salt organocatalysts for asymmetric epoxidation of alkenes. Jun 8, 2007 Philip C Bulman Page,Mohamed M Farah,Benjamin R Buckley,A John Blacker A series of binaphthalene-fused azepinium salts has been generated and used as organocatalysts in the asymmetric epoxidation of unfunctionalized alkenes, giving rise to ees of up to 84%. View Full Abstract View Article Details   Related Articles Neuropsychological measures in normal individuals that predict subsequent cognitive decline. Jun 2007 Deborah Blacker,Hang Lee,Alona Muzikansky,Emily C Martin,Rudolph Tanzi,John J McArdle,Mark Moss,Marilyn Albert OBJECTIVE: To examine neuropsychological measures among normal individuals that predict time to subsequent cognitive decline. DESIGN: Cognitive performance, as measured by 6 neuropsychological tests, was examined at baseline. Participants were followed up for approximately 5 years. Cox proportional... ( view more ) hazards models were used to evaluate the neuropsychological measures at baseline that predicted time to progression from normal cognition to mild impairment. Comparable data also examined time to progression from mild impairment to a diagnosis of Alzheimer disease. SETTING: Community volunteer-based sample examined at a medical institution. PARTICIPANTS: One hundred and seven individuals who were cognitively normal and 235 individuals with mild cognitive impairment at baseline. MAIN OUTCOME MEASURES: Time to progression from normal cognition to mild impairment and time to progression from mild impairment to a diagnosis of Alzheimer disease. RESULTS: The risk of progressing from normal to mild impairment was considerably greater among those with lower scores on tests of episodic memory (eg, hazard ratio for a 1-SD decrease in the California Verbal Learning Test, 0.55; P<.001). Normal individuals who carried at least 1 copy of the apolipoprotein E epsilon2 allele were less likely to develop cognitive impairments over time than individuals with no epsilon2 allele (hazard ratio for presence of allele, 0.13; P = .006). Measures of both episodic memory and executive function were significant predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease (eg, hazard ratio for a 1-SD decrease in California Verbal Learning Test score, 0.67; P = .005; hazard ratio for a 1-SD increase in the time to complete part B of the Trail Making test, 1.40; P = .007). Among individuals with mild impairments, the apolipoprotein E epsilon4 allele increased risk for Alzheimer disease in a dose-dependent manner; however, this effect was not significant within the context of multivariable models. CONCLUSIONS: Episodic memory performance among normal individuals predicts time to progression to mild impairment while apolipoprotein E epsilon2 status is associated with lower risk of cognitive decline among normal individuals. Tests of both episodic memory and executive function are predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Follow-up mapping supports the evidence for linkage in the candidate region at 9q22 in the NIMH Alzheimer's disease Genetics Initiative cohort. Mar 5, 2007 Rodney T Perry,Howard Wiener,Lindy E Harrell,Deborah Blacker,Rudolph E Tanzi,Lars Bertram,Susan S Bassett,Rodney C P Go Other than the APOE peak at 19q13, the 9q22 region was identified in our original genomic scan as the candidate region with the highest multipoint lod score (MLS) in the subset of late onset Alzheimer's Disease (AD) families (MLS = 2.9 at 101 cM) from the NIMH Genetics Initiative sample. We have no... ( view more )w genotyped an additional 12 short tandem repeats (STR) in this region. Multipoint analysis shows the region remains significant with an increase in the peak MLS from 2.9 to 3.8 at 95 cM near marker D9S1815, and the 1 LOD interval narrows from 21.5 to 11 cM. HLOD scores also provide evidence for significant linkage (4.5 with an alpha = 31%) with a further narrowing of the region to 6.6 cM (92.2-98.8 cM). Single nucleotide polymorphisms (SNPs) in the Ubiquilin1 gene (UBQLN1), located at 83.3 cM, have been reported to be significantly associated to AD, accounting for a substantial portion of the original linkage signal [Bertram et al., 2005]. Our analyses of the higher resolution genotype data generated here provide further support for the existence of a least one additional locus on chromosome 9q22. In an effort to pinpoint this putative AD susceptibility gene, we have begun to analyze SNPs in other candidate genes in and around this narrowed region to test for additional associations to AD. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Longitudinal change in cognitive performance among individuals with mild cognitive impairment. Mar 2007 Marilyn Albert,Deborah Blacker,Mark B Moss,Rudolph Tanzi,John J McArdle The authors used mixed-effects growth models to examine longitudinal change in neuropsychological performance over a 4-year period among 197 individuals who were either normal or had mild cognitive impairment (MCI) at baseline. At follow-up, the participants were divided into 4 groups: (a) controls... ( view more ): participants who were normal at both baseline and follow-up (n = 33), (b) stables: participants with MCI whose Clinical Dementia Rating-Sum of Boxes (CDR-SB) score did not differ between the first and last evaluations (n = 22), (c) decliners: participants with MCI whose CDR-SB score declined between the first and last evaluations (n = 95), and (d) converters: participants who received a clinical diagnosis of Alzheimer's disease during the follow-up period (n = 47). Only the Episodic Memory factor showed a significantly greater rate of decline over the follow-up period among the converters. Two other factors were significantly lower in converters at baseline in comparison with other groups (the executive function factor and the general knowledge factor), but the rate of decline over time did not differ. Individuals with an APOE epsilon4 allele scored lower on the episodic memory and executive function factors at baseline. ( view less ) View Full Abstract View Article Details   Related Articles A response to criticism of our estimates of under-5 mortality in Iraq, 1980-98. Mar 2007 John Blacker,Mohamed M Ali,Gareth Jones According to estimates published in this journal, the number of deaths of children under 5 in Iraq in the period 1991-98 resulting from the Gulf War of 1991 and the subsequent imposition of sanctions by the United Nations was between 400,000 and 500,000. These estimates have since been held to be i... ( view more )mplausibly high by a working group set up by an Independent Inquiry Committee appointed by the United Nations Secretary-General. We believe the working group's own estimates are seriously flawed and cannot be regarded as a credible challenge to our own. To obtain their estimates, they reject as unreliable the evidence of the 1999 Iraq Child and Maternal Mortality Survey--despite clear evidence of its internal coherence and supporting evidence from another, independent survey. They prefer to rely on the 1987 and 1997 censuses and on data obtained in a format that had elsewhere been rejected as unreliable 30 years earlier. ( view less ) View Full Abstract View Article Details   Related Articles Single photon emission computed tomography perfusion differences in mild cognitive impairment. Mar 2007 K A Johnson,E K Moran,J A Becker,D Blacker,A J Fischman,M S Albert OBJECTIVE: To relate cerebral perfusion abnormalities to subsequent changes in clinical status among patients with mild cognitive impairment (MCI). METHODS: Perfusion single photon emission computed tomography (SPECT) images were acquired in 105 elderly patients without dementia with MCI, using 99m... ( view more )Tc-HMPAO. Clinical outcome after a 5-year follow-up period was heterogeneous. RESULTS: Baseline SPECT data differed in those patients with MCI who were later diagnosed with Alzheimer's disease (the converter group) from those patients with MCI who experienced clinically evident decline but did not progress to a diagnosis of Alzheimer's disease within the follow-up period (the decliner group), from patients with MCI who had no clinical evidence of progression (the stable group), and from a group of 19 normal subjects (the control group). The most consistent decreases in relative perfusion in converters compared with the normal, stable and decliner groups were observed in the caudal anterior cingulate, and in the posterior cingulate. In addition, converters showed increased relative perfusion in the rostral anterior cingulate in comparison to the stable and decliner groups. A group of patients with Alzheimer's disease were also included for purposes of comparison. The group of patients with Alzheimer's disease at baseline differed from each of the other groups, with temporoparietal regions showing the most significant reductions in perfusion. CONCLUSIONS: These results suggest that clinical heterogeneity in MCI is reflected in SPECT perfusion differences, and that the pattern of perfusion abnormalities evolves with increasing clinical severity. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Page 1 of 9 1 2 3 4 > Last >> (218 articles found)

      
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