Digital therapautic effective in managing metabolic syndrome parameters

Introduction

Lifestyle change is a class one therapeutic indication for persons with overweight, obesity, metabolic syndrome and cardiovascular risk factors including type II diabetes, hypertension and dyslipidaemia. There is synergism in reducing multiple cardiovacular risk factors simultaneously. Currently there is a need for a formalised prescribed digital therapeutic to enact lifestyle change optimally. We have developed a real-time telemedicine lifestyle change digital therapeutic for persons with these conditions with substantive positive impact on weight, Body Mass Index (BMI), blood pressure (BP), and metabolic syndrome parameters.

Purpose

To evaluate a digital lifestyle change therapeutic in subjects with metabolic syndrome parameters in primary care, corporate and pharmacy settings.

Methods

Cohorts of patients were enrolled through primary care physician referrals and in corporate or pharmacy settings; in a GDPR compliant format between 2015–2020 (n=323). The programme offers patient education, guideline dietary recommendations and lifestyle advice specific to the patients requirements via smartphone, tablet or computer. Nudge psychology educational videos, compliment exercise monitored by a smart device and weight loss recorded by a wireless scales. Point of care bloods were tested pre and post-enrollment. Asynchronous dietary advice from a dietician, peer to peer support and an artificial intelligence chat-bot are available at all times via a smartphone application. Statistics used was student two-tailed t-test comparing pretest parameters to those post lifestyle intervention.

Results

Cohort results are delineated below. As the programme underwent refinement more parameters were added. Nevertheless similar trends are seen in each cohort with statistically meaningful reductions in weight, BMI, systolic and diastolic blood pressure, HbA1c and lipids obtained.

Reductions in HbA1c and systolic blood pressure approach or equate with those obtained using drug monotherapy. Moreover the patients Quality of Life is improved.

Conclusion

A real-time internet-based prescribed lifestyle digital therapeutic results in clinically meaningful reductions in weight, BMI, blood pressure, HbA1c and lipids. Results in various cohorts are similar, indicating a reproducible effect of this cost effective scalable digital therapeutic across a spectrum of metabolic risk factors in a variety of settings.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): RedicareDiabetes Ireland Table 1

An enigmatic mass mortality event of Blanding’s Turtles (Emydoidea blandingii) in a protected area

Mass mortality events (MMEs) can remove up to 90% of individuals in a population and are especially damaging to population viability of long-lived species with slow life histories. Our goal was to elucidate the cause(s) of a MME of 53 Blanding’s Turtles (Emydoidea blandingii (Holbrook, 1838)), a globally endangered species, in a protected area. We investigated disease, winter-kill, and depredation as potential causes of the mortality. The turtle carcasses lacked soft tissue to test for disease, so we examined tissue from co-occurring live Leopard Frogs (Lithobates pipiens (Schreber, 1782)) and found no evidence of ranavirus, indicating that the disease was not present at our study site. Water temperature and dissolved aquatic oxygen at known overwintering sites and sites which yielded carcasses did not differ, suggesting that winter-kill did not cause the MME. Carcass condition, comparisons with descriptions of turtle depredation events in the literature, and trail cameras paired with turtle decoys identified potential predators within the study site and suggested that mass depredation, enabled by low water levels and a concomitant reduction in aquatic habitat, was the most likely cause of mortality. Our study can inform conservation of the study population and the management of MMEs of long-lived species elsewhere.

Should MRI Be the Imaging Modality of Choice in Suspected Appendicitis During Pregnancy?

Aim The aim of this review was to evaluate the efficacy of magnetic resonance imaging (MRI) in determining appendicitis during pregnancy. Methods We retrospectively reviewed the clinical course for all pregnant patients with suspected appendicitis from 2013-2018. We evaluated the efficacy of MRI and Alvarado scoring and its impact on management. Results Twenty-nine pregnant patients with suspected appendicitis had an MRI. The majority (90%, n=26/29) had normal diagnostics with two patients (10.3%) having findings consistent with acute appendicitis. Two other patients proceeded to laparoscopy, one with an inconclusive MRI, and one patient with clinical appendicitis. We found no accurate correlation between pregnancy and Alvarado scoring. Conclusion MRI is a safe adjunct in accurately diagnosing appendicitis in pregnancy. Its routine use could help reduce rates of negative appendectomies and the potential risk to maternal and fetal health.

Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: a study protocol

PLAIN ENGLISH SUMMARY

Tailoring and testing a peer support decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol.First Nations, Inuit and Métis (FNIM) people face higher risks for cancer compared to non-FNIM populations. They also face cultural barriers to health service use. Within non-FNIM populations an approach to health decision making, called shared decision making (SDM), has been found to improve the participation of people in their healthcare. Peer support with SDM further improves these benefits. The purpose of this study is to tailor and test a peer support SDM strategy with community support workers to increase FNIM people's participation in their cancer care.This project has two phases that will be designed and conducted with a Steering Committee that includes members of the FNIM and cancer care communities. First, a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings, and training in the SDM strategy developed for community support workers. Three communities will be supported for participation in the study and community support workers who are peers from each community will be trained to use the SDM strategy.Next, each community support worker will work with a community member who has a diagnosis of cancer or who has supported a family member with cancer. Each community support worker and community member pair will use the SDM strategy. The participation and experience of the community support worker and community member will be evaluated.The research will be used to develop strategies to support people who are making decisions about their health.

ABSTRACT

Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol Background First Nations, Inuit and Métis ("FNIM") people face increased cancer risks in relation to general populations and experience barriers to health service use. Shared decision making (SDM) has been found to improve peoples' participation and outcomes in healthcare and peer support with SDM further improves these benefits. The purpose of this study is to tailor and then field test, by and with FNIM communities, a peer support SDM strategy for use in cancer care. Methods This project has 2 theory-driven phases and 5 stages (a-e). A core research team that includes members of the Aboriginal Cancer Control Unit of Cancer Care Ontario communities and academic researchers, will work with a Steering Committee. In phase 1, (stage a) a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings and (stage b), training developed that will i) introduce participant communities to SDM, and ii) train community support workers (CSWs) within these communities. Next (stage c), three communities will be approached for voluntary participation in the study. These communities will be introduced to SDM in community meetings, and if in agreement then CSWs from each community will be recruited to participate in the study. One volunteer CSW from each community will be trained to use the peer support SDM strategy to enable phase 2 (field test of the peer support SDM strategy).During phase 2 (stage d), each CSW will be matched to a volunteer community member who has had a diagnosis of cancer or has supported a family member with cancer and is familiar with Ontario cancer systems. Each CSW-community member pair (3 to 4 pairs/community) will use the tailored peer support SDM strategy; their interaction will be audio-recorded and their participation and experience evaluated (total of 9 to 12 interviews). As well (stage e), data will be collected on health systems' factors related to the use of the peer support SDM strategy. Discussion Findings will develop peer support SDM strategies to enhance participation of FNIM people in cancer care decisions, advance knowledge translation science, and support a proposal to conduct a multi-site implementation trial.

DNA methylation of Th2 lineage determination genes at birth is associated with allergic outcomes in childhood

BACKGROUND

There is now increasing evidence that asthma and atopy originate in part in utero, with disease risk being associated with the altered epigenetic regulation of genes.

OBJECTIVE AND METHODS

To determine the relationship between variations in DNA methylation at birth and the development of allergic disease, we examined the methylation status of CpG loci within the promoter regions of Th1/2 lineage commitment genes (GATA3, IL-4, IL-4R, STAT4 and TBET) in umbilical cord DNA at birth in a cohort of infants from the Southampton Women's Survey (n = 696) who were later assessed for asthma, atopic eczema and atopy.

RESULTS

We found that higher methylation of GATA3 CpGs -2211/-2209 at birth was associated with a reduced risk of asthma at ages 3 (median ratio [median methylation in asthma group/median methylation in non-asthma group] = 0.74, P = .006) and 6-7 (median ratio 0.90, P = .048) years. Furthermore, we demonstrated that the GATA3 CpG loci associated with later risk of asthma lie within a NF-κB binding site and that methylation here blocks transcription factor binding to the GATA3 promoter in the human Jurkat T-cell line. Associations between umbilical cord methylation of CpG loci within IL-4R with atopic eczema at 12 months (median ratio 1.02, P = .028), and TBET with atopy (median ratio 0.98, P = .017) at 6-7 years of age were also observed.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings provide further evidence of a developmental contribution to the risk of later allergic disorders and suggest that involvement of epigenetic mechanisms in childhood asthma is already demonstrable at birth.

Noise trauma induced plastic changes in brain regions outside the classical auditory pathway

The effects of intense noise exposure on the classical auditory pathway have been extensively investigated; however, little is known about the effects of noise-induced hearing loss on non-classical auditory areas in the brain such as the lateral amygdala (LA) and striatum (Str). To address this issue, we compared the noise-induced changes in spontaneous and tone-evoked responses from multiunit clusters (MUC) in the LA and Str with those seen in auditory cortex (AC) in rats. High-frequency octave band noise (10-20 kHz) and narrow band noise (16-20 kHz) induced permanent threshold shifts at high-frequencies within and above the noise band but not at low frequencies. While the noise trauma significantly elevated spontaneous discharge rate (SR) in the AC, SRs in the LA and Str were only slightly increased across all frequencies. The high-frequency noise trauma affected tone-evoked firing rates in frequency and time-dependent manner and the changes appeared to be related to the severity of noise trauma. In the LA, tone-evoked firing rates were reduced at the high-frequencies (trauma area) whereas firing rates were enhanced at the low-frequencies or at the edge-frequency dependent on severity of hearing loss at the high frequencies. The firing rate temporal profile changed from a broad plateau to one sharp, delayed peak. In the AC, tone-evoked firing rates were depressed at high frequencies and enhanced at the low frequencies while the firing rate temporal profiles became substantially broader. In contrast, firing rates in the Str were generally decreased and firing rate temporal profiles become more phasic and less prolonged. The altered firing rate and pattern at low frequencies induced by high-frequency hearing loss could have perceptual consequences. The tone-evoked hyperactivity in low-frequency MUC could manifest as hyperacusis whereas the discharge pattern changes could affect temporal resolution and integration.

Geometrical frustration in amorphous and partially crystallized packings of spheres

We study the persistence of a geometrically frustrated local order inside partially crystallized packings of equal-sized spheres. Measurements by x-ray tomography reveal previously unseen grain scale rearrangements occurring inside large three-dimensional packings as they crystallize. Three successive structural transitions are detected by a statistical description of the local volume fluctuations. These compaction regimes are related to the disappearance of densely packed tetrahedral patterns of beads. Amorphous packings of monodisperse spheres are saturated with these tetrahedral clusters at Bernal's limiting density (φ≈64%). But, no periodic lattice can be built upon these patterns; they are geometrically frustrated and are thus condemned to vanish while the crystallization occurs. Remarkably, crystallization-induced grain rearrangements can be interpreted in terms of the evolution of key topological features of these aggregates.

Reliable automatic alignment of tomographic projection data by passive auto-focus

PURPOSE

The authors present a robust algorithm that removes the blurring and double-edge artifacts in high-resolution computed tomography (CT) images that are caused by misaligned scanner components. This alleviates the time-consuming process of physically aligning hardware, which is of particular benefit if components are moved or swapped frequently.

METHODS

The proposed method uses the experimental data itself for calibration. A parameterized model of the scanner geometry is constructed and the parameters are varied until the sharpest 3D reconstruction is found. The concept is similar to passive auto-focus algorithms of digital optical instruments. The parameters are used to remap the projection data from the physical detector to a virtual aligned detector. This is followed by a standard reconstruction algorithm, namely the Feldkamp algorithm. Feldkamp et al. [J. Opt. Soc. Am. A 1, 612-619 (1984)].

RESULTS

An example implementation is given for a rabbit liver specimen that was collected with a circular trajectory. The optimal parameters were determined in less computation time than that for a full reconstruction. The example serves to demonstrate that (a) sharpness is an appropriate measure for projection alignment, (b) our parameterization is sufficient to characterize misalignments for cone-beam CT, and (c) the procedure determines parameter values with sufficient precision to remove the associated artifacts.

CONCLUSIONS

The algorithm is fully tested and implemented for regular use at The Australian National University micro-CT facility for both circular and helical trajectories. It can in principle be applied to more general imaging geometries and modalities. It is as robust as manual alignment but more precise since we have quantified the effect of misalignment.

Child health, developmental plasticity, and epigenetic programming

Plasticity in developmental programming has evolved in order to provide the best chances of survival and reproductive success to the organism under changing environments. Environmental conditions that are experienced in early life can profoundly influence human biology and long-term health. Developmental origins of health and disease and life-history transitions are purported to use placental, nutritional, and endocrine cues for setting long-term biological, mental, and behavioral strategies in response to local ecological and/or social conditions. The window of developmental plasticity extends from preconception to early childhood and involves epigenetic responses to environmental changes, which exert their effects during life-history phase transitions. These epigenetic responses influence development, cell- and tissue-specific gene expression, and sexual dimorphism, and, in exceptional cases, could be transmitted transgenerationally. Translational epigenetic research in child health is a reiterative process that ranges from research in the basic sciences, preclinical research, and pediatric clinical research. Identifying the epigenetic consequences of fetal programming creates potential applications in clinical practice: the development of epigenetic biomarkers for early diagnosis of disease, the ability to identify susceptible individuals at risk for adult diseases, and the development of novel preventive and curative measures that are based on diet and/or novel epigenetic drugs.

Morphological clues to wet granular pile stability

When a granular material such as sand is mixed with a certain amount of liquid, the surface tension of the latter bestows considerable stiffness to the material, which enables, for example, sand castles to be sculpted. The geometry of the liquid interface within the granular pile is of extraordinary complexity and strongly varies with the liquid content. Surprisingly, the mechanical properties of the pile are largely independent of the amount of liquid over a wide range. We resolve this puzzle with the help of X-ray microtomography, showing that the remarkable insensitivity of the mechanical properties to the liquid content is due to the particular organization of the liquid in the pile into open structures. For spherical grains, a simple geometric rule is established, which relates the macroscopic properties to the internal liquid morphologies. We present evidence that this concept is also valid for systems with non-spherical grains. Hence, our results provide new insight towards understanding the complex physics of a large variety of wet granular systems including land slides, as well as mixing and agglomeration problems.

US Food and Drug Administration office of women's health: update

The Food and Drug Administration's commitment to women's health issues began a new chapter with the establishment of the Office of Women's Health in 1994. This office has worked on the regulation of various products, on FDA policy relating to the inclusion of women of childbearing potential in early-phase drug trials, and on gender analysis of drugs. This commitment to women's health issues had its beginnings in the early 1980s. Actions taken by the agency since then include focusing on approving new drugs for diseases that specifically afflict women, taking steps to increase data on how drugs affect women, strengthening labeling information to give women a more accurate understanding of how certain drugs will affect them, and conducting public education campaigns. The Office of Women's Health will continue the agency's wide-ranging efforts from drug development and approval, to labeling, to policy formulation, to public education.

Parental separation: effects on children; implications for services

It is commonly assumed that the children of separated or divorced parents are disadvantaged financially and in terms of social development. A small-scale study was designed involving 14 volunteer parents who were separated from their spouses/partners and their 28 children, ranging in age from 5 to 12 years. Structured interviews examined the families' attitudes and feelings about the separation, the mental health of the parents, the emotional and behavioural reactions of the children, and the families' use of services. The results suggested that over 60% of the girls showed internalizing, and over 60% of the boys displayed externalizing behavioural difficulties. About 40% of the children suffered psychosomatic disorders. Nearly 75% of the parents suffered depression before and after separation. Depression, itself, may act to exacerbate children's emotional and behavioural difficulties. Although all the parents had received medication for their depression, few of the children had received any help for their difficulties. The urgent need for services to help such children is discussed.

Stable topological spatial solitons in optical parametric oscillators

We predict that nearly resonant optical parametric oscillators support stable topological spatial solitons as a result of the interplay between diffraction and parametric amplification due to chi((2)) nonlinearities. Robust soliton stripes are observed in two transverse dimensions. Their stability is ensured by the phase-sensitive nature of the underlying parametric process.

Evaluation of anti-viral filters

The purification processes used to prepare medicines from human and animal cell lines provide one of the major opportunities for virus risk reduction. The purification process can be validated for its ability to remove a range of viruses and can be shown to provide a significant barrier to the transmission of viruses from cell substrates and raw materials to the patient. Ultrafiltration membranes which are manufactured with extremely tight control on pore size distribution can remove a broad spectrum of viruses with high efficiency. A scheme is described for the evaluation of anti-viral filters and the results from evaluation of two filters are presented. The experiments carried out with ultrafiltration membranes suggest that they can provide significant additional virus risk reduction factors for biopharmaceuticals.

Career development in intensive care: 2

In part 1 of this article, intensive care nursing and the career opportunities that are available were discussed. Part 2 will examine postregistration intensive care training and career progressions from grade D level to senior/specialist posts.

Career development in intensive care: 1

Nursing is becoming more specialized and leaner in terms of structure and therefore competition for positions is increasing. It is essential for nurses who are considering a career in intensive care to commence the planning process as early as possible. In this, the first of two articles, intensive care nursing and the career opportunities available will be examined.

Compartmentation and glycoprotein substrates of calpain in the developing rat brain

An activated form of calpain I associates with telencephalic membranes in a developmentally regulated fashion during early postnatal ontogeny. During this period, the cytoskeletal component spectrin is available and appears to be differentially susceptible to calpain-mediated cleavage. Lectin blotting techniques demonstrated that the leupeptin-sensitive action of calpain is primarily directed toward large proteins which are glycoconjugate in nature; neuronal cell adhesion molecules are among the glycoproteins whose associations with the telencephalic membranes decrease due to calpain activity. These data suggest that cytoplasmic calpain is translocated to the membrane during early brain development in order to act on the cytoskeletal and adhesive structures responsible in part for neuronal shape and function.

Antibodies to the alpha v beta 3 integrin label a protein concentrated in brain synaptosomal membranes

Immunochemical methods were used to test whether vitronectin receptors exist in synaptosomal membranes (SPMs) and hence are positioned to play a role in synaptic adhesion. Antibodies against the alpha v beta 3 integrin detected proteins in brain homogenates that correspond to conventional integrin subunits. Conversely, these antigens were not found in SPMs prepared from the same brain tissue. The antibodies did, however, express strong immunoreactivity towards a 27 kDa polypeptide that was greatly concentrated in SPMs from major brain regions and that was not found in tissues other than brain. This is an example of an integrin epitope contained in a synaptic polypeptide that is too small to be a conventional matrix receptor, thus, suggesting the possibility that synaptic adhesion involves unusual proteins.

Proteolytic modification of neural cell adhesion molecule (NCAM) by the intracellular proteinase calpain

The neural cell adhesion molecule, NCAM, is concentrated in synaptic regions and thus may contribute to the formation and maintenance of connections between brain cells. We present evidence that the cytoplasmic domain of NCAM can be experimentally modified by the intracellular calcium-dependent proteinase, calpain. This degradation could provide a mechanism for rapidly uncoupling and reorganizing synaptic contacts.

Fibronectin binding by brain synaptosomal membranes may not involve conventional integrins

Synaptosomal plasma membranes (SPMs) from adult rat brain tested for fibronectin binding and antigenicity toward antibodies against integrin-type fibronectin receptors. Binding (1-10 pmol mg-1 protein) was considerably greater in SPMs than in homogenates for hippocampus and neocortex but not for brain stem. The tetrapeptide L-arginyl-glycyl-L-aspartyl-L-serine blocked up to 90% of the binding indicating that integrin-type receptors are present. Antibodies against two sub-classes of integrins detected high Mr integrin subunits in homogenates but not in SPMs. However, antibodies against hamster ovarian fibronectin receptor reacted intensely with polypeptides of 55,000 and 40,000 Mr that were concentrated 20 to 40-fold in SPMs compared to homogenates. These peptides may constitute a new class of matrix receptor involved in synaptic adhesion.

Comparison of different medium bases for the semiquantitative isolation of anaerobes from vaginal secretions

Two studies were performed to determine the best medium for the isolation of anaerobes from vaginal secretions. In the first, three different medium bases (brucella, Centers for Disease Control [CDC], and Schaedler) were compared semiquantitatively for ability to support the growth of gram-negative anaerobes from vaginal fluid. Media were supplemented with laked sheep blood, kanamycin, and vancomycin. The brucella base agar formulation supported the growth of anaerobic gram-negative bacilli better than either the CDC or Schaedler base agar formulation. In a second study, nonselective brucella and CDC base sheep blood agar were compared for ability to support the growth of anaerobic gram-positive cocci. Anaerobic gram-positive cocci grew in higher concentrations on CDC base agar than on brucella base agar. On the basis of these observations, we recommend that a CDC base sheep blood agar be used for the nonselective plate and a brucella base plate supplemented with laked sheep blood, kanamycin, and vancomycin be used for isolation of gram-negative bacilli in studies of the anaerobic flora of the female genital tract.

Use of the fluorescent dye, fast blue, to label sympathetic postganglionic neurones supplying mesenteric arteries and enteric neurones of the rat

Neuronal pathways in the peripheral nervous system have been traced using the fluorescent dye, Fast blue. Following implantation of a gelatin pellet containing the dye, or direct injection of the dye into the mesentery beside an artery, Fast blue is taken up by both nerve terminals and axons of passage, retrogradely transported by large numbers of sympathetic neurones and retained within the neurones for long periods of time without diffusion. Neurones projecting to both blood vessels of the mesentery and submucosa and to enteric ganglia of the segment supplied by the artery were found labelled in prevertebral and paravertebral ganglia as well as in ganglia lying along the major splanchnic nerves. Attempts to separate the vascular component from those neurones innervating enteric ganglia suggest that the latter are located in the prevertebral, coeliac and superior mesenteric ganglia and to a lesser extent in the splanchnic ganglia, while the vasomotor neurones are located in prevertebral, paravertebral and splanchnic ganglia.

A study of the substance P innervation of the intermediate zone of the thoracolumbar spinal cord

Immunocytochemical procedures have been used to examine the distributions of substance P (SP)-positive fibres within the intermediate zone of the thoracolumbar spinal cords of rabbits, cats, and monkeys. In all three species SP fibres were concentrated in areas known to contain sympathetic preganglionic neurones. These included the intermediolateral nucleus and the funiculus just lateral to it, the medial gray matter in the area of the nucleus intercalatus, and the paracentral region. The density of the SP innervation varied in a characteristic way both between these subpopulations of sympathetic neurones and in its overall input to different segmental levels. Generally the greatest accumulations of SP fibres were found in the T3-T5 and L2-L4 regions and these were concentrated in the intermediolateral nucleus (ILN). The highest densities of SP fibres in the lateral funiculus were in the upper thoracic and upper lumbar segments whereas SP fibres forming transverse bands, possibly in association with neurones in the nucleus intercalatus, were most prominent in T5-T8. Substance P fibres adjacent to the midline were more or less equally dense throughout the segments examined. Substance P-positive cell bodies situated immediately lateral to the central canal were present at a density of 200-300 per segment throughout the cat thoracolumbar cord. These neurones may be the cells of origin of at least some of the SP fibres in the intermediate zone. The close association of sympathetic preganglionic neurones with SP fibres, many of which are thought to be derived from cells in the medulla, suggests a role for SP-containing fibres in the modulation of sympathetic activity. The variation in input to different segments and classes of sympathetic neurones further suggests a specificity which may be related to the different functions of the neurones innervated.

Localization in transcortical sensory aphasia

Transcortical sensory aphasia is a syndrome characterized by poor comprehension but excellent repetition. The lesions shown on computed tomography and isotope scans of 15 patients who satisfied the objective criteria based on test scores were studied. The overlap technique showed a unique posterior parieto-occipital location of lesions. The lesions seem to separate into two groups: one is more medial, inferior, and posterior and is clearly in the posterior cerebral artery territory, and the other is relatively more lateral, superior, and anterior and seems to be in a watershed area between middle cerebral and posterior cerebral arteries. The lesion sizes correlated with severity. Frequent recovery and good prognosis are associated with this entity. Association with transient visual agnosia and hemianopsia confirmed the anatomical correlation.

The epidemiology of aphasic and cognitive impairment in stroke: age, sex, aphasia type and laterality differences

Sex differences and age distribution are examined in various types of aphasia and in right hemisphere-damaged patients due to acute infarct. The language and performance deficits were measured by a standardized test allowing us to group patients meaningfully. The higher male to female ratio of aphasia is shown to relate to a similar sex distribution in infarcts rather than to sex differences in cerebral organization. Broca's aphasics were somewhat younger than the other groups and the slight difference may be related to pathophysiological factors favouring embolic strokes in the anterior territory of the middle cerebral artery. Sex and aphasia types were not significantly different in various age groups except about 50 years of age where the female aphasics reversed the ratio.

Response to cartoons and attitudes toward aging

Although it has commonly been asserted that cartoon images of aging convey deep psychological significance, the relationship between attitudes and cartoon appreciation has received little systematic attention. The present study examined the relationship between responses to cartoons and attitudes toward aging among college students. Subjects rated the funniness of 60 cartoons and completed the Attitudes Toward Aging Inventory, Tuckman-Lorge, and Semantic Differential. Factor analysis revealed four categories of cartoons on aging: Disparagement, Ineffectuality, Obsolescence, and Isolation. No significant relationships were found between attitudes and humor appreciation, although age and education were inversely related to several cartoon themes.