Assessment of Cognitive Impairment in Patients with Chronic Obstructive Pulmonary Disease Using the Rapid Cognitive Screen

OBJECTIVES

To determine the prevalence of cognitive impairment in chronic obstructive pulmonary disease (COPD) patients using the Rapid Cognitive Screen (RCS).

DESIGN

Cross sectional study.

PARTICIPANTS

A total of 106 men and women with COPD 50 years of age or older.

SETTING

Pulmonary ambulatory clinic in a tertiary academic center in St. Louis, Missouri, USA.

MEASUREMENTS

We enrolled patients with COPD who completed the RCS tool. Patients were classified as having normal cognition, mild cognitive impairment (MCI), or dementia if they scored ≥ 8, 6-7, or ≤ 5, respectively. The prevalence of each category was measured, and patients' baseline characteristics were compared.

RESULTS

One hundred and six patients completed the RCS. Of those, 36 (33.9%) patients scored ≤ 5 on the RCS, 33 (31.1%) scored 6 or 7, and 37 (34.9%) scored ≥ 8. The prevalence of dementia, MCI, and normal cognition were 33.9%, 31.1%, and 34.9%, respectively. Baseline lung function was not different between patients with normal cognition and those with abnormal cognition (FEV1 1.53 ± 0.39 vs 1.45 ± 0.32 L). In patients with abnormal cognition, there was no difference in patients' characteristics between patients with MCI or dementia.

CONCLUSION

Cognitive impairment is highly prevalent in patients with COPD. RCS successfully identified cognitive impairment in COPD. We recommend performing RCS in patients with COPD routinely.

Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study

AIMS

To examine the prevalence and person-level predictors of undiagnosed Type 2 diabetes among adults with elevated HbA_1c values.

METHODS

We identified adults without diabetes who had a first elevated HbA_1c (index HbA_1c ≥ 48 mmol/mol; ≥ 6.5%) between January 2014 and December 2015, and classified them by Type 2 diabetes diagnosis status at 1 year following this result. Multilevel modelling techniques were used to examine the association of individual demographic, clinical, and utilization characteristics with remaining undiagnosed. We quantified differences in early Type 2 diabetes care between diagnosed and undiagnosed individuals.

RESULTS

Of the 18 356 adults with a first elevated index HbA_1c , 30.2% remained undiagnosed with Type 2 diabetes 1 year later. Individuals with lower index HbA_1c values [adjusted odds ratio (aOR) 5.95, 95% confidence interval (CI) 5.21-6.78 for 48 to <53 mmol/mol (6.5% to 7.0%); referent 53 to <64 mmol/mol (7.0% to <8.0%)], who were ≥ 70 years old (aOR 1.40, 95% CI 1.24-1.59; referent 50-59 years), and who had a prior prediabetes diagnosis (aOR 1.35, 95% CI 1.24-1.47; referent no prediabetes) had increased odds of remaining undiagnosed. After adjusting for age, race, and index HbA_1c , remaining undiagnosed was associated with lower odds of initiating metformin (aOR 0.06, 95% CI 0.05-0.07).

CONCLUSIONS

Almost one-third of adults with an elevated HbA_1c value were not diagnosed with Type 2 diabetes within 1 year. Undiagnosed Type 2 diabetes, in turn, was associated with differences in early care. Strategies that leverage the electronic health record to facilitate earlier diagnosis may help reduce delays and allow for early intervention towards the goal of improved outcomes.

Criteria and indicators for foot and mouth disease control strategy decision-making in Asia-Oceania countries

The objective of this study is to identify the relative importance of criteria that could be used to evaluate control strategies for foot and mouth disease (FMD). A questionnaire was distributed to 21 Chief Veterinary Officers (CVOs), or their representatives, at the 28th Conference of the Regional Commission for Asia, the Far East and Oceania of the World Organisation for Animal Health (OIE), held on 18-22 November 2013 in Cebu, the Philippines. The CVOs/CVO representatives were present on behalf of 21 of the 31 OIE Member Countries in the region, and the questionnaire evaluated the importance of epidemiologic, economic and social- environmental criteria in the FMD control strategy decision-making process. Within the epidemiologic criterion, the size of an FMD outbreak area, with a median relative importance score of 90 (range 45-100), was viewed as the most important indicator, while the direct cost of FMD control measures was considered to be the most important economic indicator, with a median relative importance score of 80 (range 30-100). Finally, within the social-environmental criterion, the mental health of FMD-affected farmers was viewed as the most important indicator, with a median relative importance score of 70 (range 5-100). With respect to the FMD status of a country, the economic criterion was considered more important in 'FMD-free' countries (countries where an FMD outbreak had not been reported to the OIE in the ten years prior to the survey) than in 'FMD-experienced' countries (countries where an FMD outbreak had been reported to the OIE within the same period). The median relative importance scores of FMD-experienced countries and FMD-free countries were 80 (range 50-95) and 95 (range 40-100), respectively. Regarding the percentage contribution of the agriculture sector to a country's gross domestic product, a statistically significant difference was not found between countries and indicators. In the future, the current survey of the relative importance of criteria and indicators should facilitate a transparent discussion on the implications of FMD control strategies and rapid response during an FMD outbreak.

Demonstration of Dispersive Rarefaction Shocks in Hollow Elliptical Cylinder Chains

We report an experimental and numerical demonstration of dispersive rarefaction shocks (DRS) in a 3D-printed soft chain of hollow elliptical cylinders. We find that, in contrast to conventional nonlinear waves, these DRS have their lower amplitude components travel faster, while the higher amplitude ones propagate slower. This results in the backward-tilted shape of the front of the wave (the rarefaction segment) and the breakage of wave tails into a modulated waveform (the dispersive shock segment). Examining the DRS under various impact conditions, we find the counterintuitive feature that the higher striker velocity causes the slower propagation of the DRS. These unique features can be useful for mitigating impact controllably and efficiently without relying on material damping or plasticity effects.