Alzheimer's Disease Biomarker Decision-Making among Patients with Mild Cognitive Impairment and Their Care Partners

BACKGROUND

Alzheimer's disease (AD) biomarker tests can be ordered as part of the diagnostic workup of patients with mild cognitive impairment (MCI). Little is known about how patients with MCI and their care partners decide whether to pursue testing.

OBJECTIVE

To examine factors that influence AD biomarker testing decisions among patients with MCI and their care partners.

DESIGN

We performed structured research interviews with patients with MCI and their study partners to assess the importance of eight factors in the decision whether to undergo AD biomarker testing (6-point Likert scale; 1-extremely unimportant to 6-extremely important): cost, fear of testing procedures, learning if AD is the cause of cognitive problems, concern about health insurance, instructing future planning, informing treatment decisions, family members' opinions, and doctor recommendation.

SETTING

Two researchers administered interviews with participants in-person (i.e., participant home, research center) or remotely (i.e., telephone, video-conference).

PARTICIPANTS

We completed interviews with 65 patients with a diagnosis of MCI and 57 study partners, referred by dementia specialist clinicians from the University of California, Irvine health system.

MEASUREMENTS

We used generalized estimating equations (GEE) to examine the mean importance of each factor among patients and study partners, and the mean difference in importance of each factor within dyads.

RESULTS

One third of participants reported the patient had previously undergone AD biomarker testing. Fifty-five percent of patients and 65% of study partners who reported no previous testing indicated a desire for the patient to be tested. GEE analyses found that patients and study partners rated the following factors with highest importance: informing treatment decisions (mean score 5.29, 95% CI: 5.06, 5.52 for patients; mean score 5.56, 95% CI: 5.41, 5.72 for partners); doctor recommendation (4.94, 95% CI: 4.73, 5.15 for patients; 5.16, 95% CI: 4.97, 5.34 for partners); and instructing future planning (4.88, 95% CI: 4.59, 5.16 for patients; 5.11, 95% CI: 4.86, 5.35 for partners). High dyadic agreement was observed for all factors except fear of testing, which patients rated with lower importance than their study partners.

CONCLUSIONS

Biomarker testing for AD in patients with MCI is a rapidly evolving practice and limited data exist on patient perspectives. In this study, most patients and their care partners were interested in testing to help inform treatment decisions and to plan for the future. Participants placed high importance on clinician recommendations for biomarker testing, highlighting the need for clear communication and education on the options, limitations, risks, and benefits of testing.

A novel route for preparation of chemically activated carbon from pistachio wood for highly efficient Pb(II) sorption

Pistachio wood-derived activated carbon prepared by a two-stage process (PWAC-2), conducting two consecutive chemical activation processes with NH₄NO₃ and NaOH, respectively. The results showed that explosive characteristic of NH₄NO₃ can primarily be employed to produce a char, with a large surface area and a highly-ordered pore structure, which can be subjected to a second activation process with NaOH to prepare a more suitable activated carbon, with a highly porous structure and useful functional groups, for removal of lead ions from aqueous media. An L₂₅ Taguchi experimental design was used by varying impregnation ratio, activation time and temperature in both pre- and post-activation stages, and the results showed that, in both stages, a small activating agent/precursor and a proportional low activation time suffice for preparation of an advantageous activated carbon for Pb(II) adsorption. A comprehensive study was performed on the equilibrium, kinetic and thermodynamic aspects of Pb(II) adsorption by the new activated carbon. The results exhibited that, having had a high lead adsorption capacity (190.2 mg g^-1), a high adsorption rapidness, and thermodynamic favorability, PWAC-2 is a beneficial alternative for utilization in full-scale plants of lead removal from waters and wastewaters.

Efficient mercury removal from wastewater by pistachio wood wastes-derived activated carbon prepared by chemical activation using a novel activating agent

Ammonium nitrate (NH₄NO₃) with explosive characteristics at high temperatures was used as a novel activating reagent to prepare a surface-engineered activated carbon derived from pistachio wood wastes (PWAC). PWAC was characterized and compared with commercial activated carbon (CAC) by textural and morphological properties, surface chemistry, crystal structure, and surface elemental composition. The results indicated that the optimal conditions of PWAC preparation to obtain the highest mercury adsorption capacity were pyrolysis temperature (800 °C), pyrolysis time (2 h), and impregnation ratio (5%). PWAC was of highly regular-shaped and well-developed pores and possessed a large surface area (1448 m²/g) and high total pore volume (0.901 cm³/g). The batch experiments indicated that the adsorption process of Hg(II) was strongly dependent on the solution pH and reached fast equilibrium at approximately 30 min. PWAC (202 mg/g) exhibited a significantly higher maximum adsorption capacity than commercial activated carbon (66.5 mg/g). Adsorbent-adsorbate dispersion interaction plays a major role in the adsorption mechanism, compared to the minor role played by pore filling and reduction mechanism. Overall, ammonium nitrate can be considered a newer activating reagent to prepare promising and low-cost PWAC for effectively Hg(II) removal from water media.

Can MRI Visual Assessment Differentiate the Variants of Primary-Progressive Aphasia?

BACKGROUND AND PURPOSE

Primary-progressive aphasia is a clinically and pathologically heterogeneous condition. Nonfluent, semantic, and logopenic are the currently recognized clinical variants. The recommendations for the classification of primary-progressive aphasia have advocated variant-specific patterns of atrophy. The aims of the present study were to evaluate the sensitivity and specificity of the proposed imaging criteria and to assess the intra- and interrater reporting agreements.

MATERIALS AND METHODS

The cohort comprised 51 patients with a root diagnosis of primary-progressive aphasia, 25 patients with typical Alzheimer disease, and 26 matched control participants. Group-level analysis (voxel-based morphometry) confirmed the proposed atrophy patterns for the 3 syndromes. The individual T1-weighted anatomic images were reported by 3 senior neuroradiologists.

RESULTS

We observed a dichotomized pattern of high sensitivity (92%) and specificity (93%) for the proposed atrophy pattern of semantic-variant primary-progressive aphasia and low sensitivity (21% for nonfluent-variant primary-progressive aphasia and 43% for logopenic-variant primary-progressive aphasia) but high specificity (91% for nonfluent-variant primary-progressive aphasia and 95% for logopenic-variant primary-progressive aphasia) in other primary-progressive aphasia variants and Alzheimer disease (sensitivity 43%, specificity 92%). MR imaging was least sensitive for the diagnosis of nonfluent-variant primary-progressive aphasia. Intrarater agreement analysis showed mean κ values above the widely accepted threshold of 0.6 (mean, 0.63 ± 0.16). Pair-wise interobserver agreement outcomes, however, were well below this threshold in 5 of the 6 possible interrater contrasts (mean, 0.41 ± 0.09).

CONCLUSIONS

While the group-level results were in precise agreement with the recommendations, semantic-variant primary-progressive aphasia was the only subtype for which the proposed recommendations were both sensitive and specific at an individual level.

Primary progressive aphasia: a tale of two syndromes and the rest

OBJECTIVE

Primary progressive aphasia (PPA) has been proposed to comprise 3 discrete clinical subtypes: semantic, agrammatic/nonfluent, and logopenic. Recent consensus recommendations suggest a diagnostic framework based primarily on clinical and neuropsychological findings to classify these variants. Our objective was to evaluate the extent to which patients with PPA would conform to the proposed tripartite system and whether the clustering pattern of elements of the linguistic profile suggests discrete clinical syndromes.

METHODS

A total of 46 patients with PPA were prospectively recruited to the Cambridge Longitudinal Study of PPA. Sufficient data were collected to assess all consensus-proposed diagnostic domains. By comparing patients' performances against those of 30 age- and education-matched healthy volunteers, z scores were calculated, and values of 1.5 SDs outside control participants' means were considered abnormal. Raw test scores were used to undertake a principal factor analysis to identify the clustering pattern of individual measures.

RESULTS

Of the patients, 28.3%, 26.1%, and 4.3% fitted semantic, nonfluent/agrammatic, and logopenic categories respectively, and 41.3% did not fulfill the diagnostic recommendations for any of the 3 proposed variants. There was no significant between-group difference in age, education, or disease duration. Furthermore, the outcome of the factor analysis was in keeping with discrete semantic and nonfluent/agrammatic syndromes but did not support a logopenic variant.

CONCLUSION

Taken together, the results of this prospective data-driven study suggest that although a substantial proportion of patients with PPA have neither the semantic nor the nonfluent variants, they do not necessarily conform to a discrete logopenic variant.

Respiratory Hospital Admissions before and after Closure of a Major Industry in the Lower Hunter Region, Australia

BACKGROUND

Many epidemiological studies reported significant associations between air pollution and respiratory hospital admissions. Proximity of industries to the residential areas may have considerable impacts on air quality and subsequently public health. This paper describes the indirect impacts of closing a large steel industry, Broken Hill Proprietary (BHP), in the Lower Hunter region, Australia.

METHODS

The number of hospital admissions for a group of respiratory diseases including all respiratory disease, Chronic Obstructive Pulmonary Disease (COPD) and asthma were incorporated in this study. The study location comprised the entire Lower Hunter, Newcastle, as the closest location, and Port Stephens, as the most distant area to the industry. Two series of data set for 3.5 years before and after industry closure allowed a comparison of daily hospital admissions. Mixed Model was employed to calculate significant changes in the time series by month.

RESULTS

While the rest of the disease categories decreased, COPD 65+ increased after BHP closure. All-age asthma in Newcastle showed the highest decrease whereas the least difference was observed for respiratory disease in Port Stephens. The decrease of admission rates was generally more significant in Newcastle, where the industry was operating, than in the other areas.

CONCLUSION

Inconsistent results challenged the publically viewed significant role of BHP closure on public health. The study expected consistent decreases of respiratory admissions after industry closure; however, the district results suggested some impacts on community health. Incompatible findings could be attributable to other factors that dominated the possible impacts of BHP closure.

Isolation of acanthamoeba spp. From drinking waters in several hospitals of iran

BACKGROUND

Acanthamoeba is an opportunistic amphizoic protozoan found in different water sources including swimming pool as well as in sewage. The aim of this study was to investigate the prevalence of Acanthamoeba in tap-water samples in Iran.

METHOD

In this descriptive cross-sectional study, 94 samples of cold and warm tap-water were collected from different wards of hospitals in 13 cities of Iran in 2007-2008. Free residual chlorine, pH, and temperature of samples were measured. After filtration through multipore nylon membrane, samples were cultured on non-nutrient agar. Then we investigated existence of Acanthamoeba by reverse contrast phase microscope.

RESULTS

Acanthamoeba was found in 45 samples (48%). Thirty-four and 11 positive samples were collected from cold and warm tap water, respectively. The samples belonged to the category of 20-30°C temperature with 0-2 ppm free residual chlorine and pH 6-7.4 showed the most coincidence to the positive cases. The greatest proportion of positive samples was obtained from Mashhad hospitals, while all samples collected from Arak and Semnan hospitals were negative.

CONCLUSION

considering the results of this study and the pathogenic role of this protozoan on patients with immunodeficiency, as well as capability of this microorganism in carrying other pathogens such as Legionella, further studies are needed. What is more important, potable water in hospitals should follow the procedure of treatment and sanitation, in order to prevent the relevant nosocomial infections.