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Given the rate of advancement in predictive psychiatry, there is a threat that it outpaces public and professional willingness for use in clinical care and public health. Prediction tools in psychiatry estimate the risk of future development of mental health conditions. Prediction tools used with young populations have the potential to reduce the worldwide burden of depression. However, little is known globally about adolescents’ and other stakeholders’ attitudes toward use of depression prediction tools. To address this, key informant interviews and focus group discussions were conducted in Brazil, Nepal, Nigeria and the United Kingdom with 23 adolescents, 45 parents, 47 teachers, 48 health-care practitioners and 78 other stakeholders (total sample = 241) to assess attitudes toward using a depression prediction risk calculator based on the Identifying Depression Early in Adolescence Risk Score. Three attributes were identified for an acceptable depression prediction tool: it should be understandable, confidential and actionable. Understandability includes depression literacy and differentiating between having a condition versus risk of a condition. Confidentiality concerns are disclosing risk and impeding educational and occupational opportunities. Prediction results must also be actionable through prevention services for high-risk adolescents. Six recommendations are provided to guide research on attitudes and preparedness for implementing prediction tools.
The datasets on the Italian political class provides two sets of information: (a) census data on a broad spectrum of individual-level variables on elected politicians, offering an updated mapping of the characteristics of more than 20,000 Italian representatives at all governmental levels; (b) survey data on politicians' attitudes towards elections, participation, public opinion, several national and international policy issues, and their views of political representation. Between September 2020 and January 2021, 2134 elected politicians at the local (n = 1917), regional (n = 128), national (n = 75) and European (n = 14) levels were interviewed, making this one of the largest surveys of the Italian political elites ever conducted and a valuable resource for researchers interested in the study of democratic representation.
Guided-jet waves have been shown to close resonance loops in a myriad of problems such as screech and impingement tones in jets. These discrete, upstream-travelling waves have long been identified in linear-stability models of jet flows, but in this work they are instead considered in the context of an acoustic-scattering problem. It is shown that the guided-jet mode results from total internal reflection and transmission of acoustic waves, arising from the shear layer behaving like a duct with some given wall impedance. After total reflection, only discrete streamwise wavenumbers may be supported by the flow, with these wavenumbers dictated by the fact that the standing wave formed inside of the jet must fit between the two shear layers. Close to the sonic line, the transmission of this mode to the outside is maximum, leading to a net-energy flux directed upstream, which dictates the direction of propagation of this mode, providing a clear connection to the better understood soft-duct mode (Towne et al., J. Fluid Mech., vol. 825, 2017, pp. 1113–1152). The model also indicates that these waves are generated in the core of the flow and can only be efficiently transmitted to the quiescent region under certain conditions, providing an explanation as to why screech is only observed at conditions where the discrete mode is supported by the flow. The present results explain, for the first time, the nature and characteristics of the guided-jet waves.
This article explores how populist attitudes are correlated with foreign policy postures at the public level in four European countries: France, Germany, Great Britain, and Italy. We provide first evidence adjudicating between two rivalling perspectives. One perspective focuses on the ideational core of populism and argues that it entails substantive beliefs and values that may inform foreign policy preferences – just like any other ideology. Another perspective focuses on the thin-centredness of populism and argues that no policy implications can be derived from populist ideas. Analysing original survey data, we find strong and consistent associations of populist attitudes with two foreign policy postures, militant internationalism and isolationism, and weaker and less systematic associations with two others, cooperative internationalism and global justice orientations. Importantly, these patterns are independent of host ideologies. We discuss the implications of these findings for the question of how “thick” populism is and what that may mean for the politics of (European) foreign policies in times of a continuing populist Zeitgeist.
We present an experimental study of reactive control of turbulent jets, in which we target axisymmetric coherent structures, known to play a key role in the generation of sound. We first consider a forced jet, in which coherent structures are amplified above background levels, facilitating their detection, estimation and control. We then consider the more challenging case of an unforced jet. The linear control targets coherent structures in the region just downstream of the nozzle exit plane, where linear models are known to be appropriate for description of the lowest-order azimuthal modes of the turbulence. The control law is constructed in frequency space, based on empirically determined transfer functions. And the Wiener–Hopf formalism is used to enforce causality and to provide an optimal controller, as opposed to the sub-optimal control laws provided by simpler wave-cancellation methods. Significant improvements are demonstrated in the control of both forced and unforced jets. In the former case, order-of-magnitude reductions are achieved; and in the latter, turbulence levels are reduced by up to 60 %. The results open new perspectives for the control of turbulent flow at high Reynolds number.
Anxiety disorders are one of the most common mental illnesses, and a consistent increase was observed after the COVID-19 pandemic. Mindfulness refers to a process that leads to a mental state characterized by nonjudgmental awareness of the present experience. Mindfulness can be considered both a skill and a practice. The stronger is the ability to adopt a mindful state, the less suffering one will experience. While Mindfulness-based Psychotherapies have shown efficacy in their treatment, they have not yet been thoroughly studied in Italian public mental health services. In Detached Mindfulness, negative thoughts are acknowledged and avoided by turning them into actions using a standardized, time-limited, metacognitive intervention.
Objectives
The purpose of this study is to examine the efficacy and cost-effectiveness of Detachment Mindfulness for twelve patients with Generalized Anxiety Disorder (GAD) not being treated pharmacologically.
Methods
We enrolled 12 patients diagnosed with GAD according to DSM-V in an 8-session program of Detached Mindfulness Psychotherapy (once a week). The Generalized Anxiety Disorder - 7 Scale (GAD-7) and the Kellner Symptom Questionnaire (SQ) were used to assess anxiety symptoms at baseline (T0), after 4 sessions (T1), and at the end of treatment (T2). The Client Satisfaction Questionnaire (CSQ-8) was used to assess treatment satisfaction.
Results
The GAD-7 score showed consistent reductions in generalized anxiety symptoms after Detached Mindfulness treatment (mean decrease of -42% at the end of the program). As measured by SQ, patients also reported improvement in physical well-being, relaxation, and somatic symptoms significantly respect to baseline. As for treatment satisfaction, ten out of twelve patients rated their treatment as satisfactory. As reported by patients, mindfulness can become a powerful and effective means to relate to one’s own internal experiences such as anxiety or fear, learning to recognize them, staying with them and avoiding their consequences.
Conclusions
These results showed that detached mindfulness was an effective and cost-effective intervention for GAD, given the short amount of time it requires and the ease with which it can be implemented. For its extensive use in the public mental health system to be further supported, studies on larger populations are needed.
Persistent depressive episodes and subsyndromic depressive symptoms frequently characterize mood alterations in bipolar disorder (BD) and negatively influence quality of life and suicide risk. BD patients with predominant depressive episodes generally show significantly higher treatment resistance rates. Although not specifically approved in Italy for bipolar depression, recently published observational data suggest that the cariprazine add-on may be a potential effective short-term treatment for resistant bipolar depression. Nevertheless data on long-term cariprazine treatment are lacking.
Objectives
This study evaluated the efficacy and safety of long-term cariprazine augmentation in patients suffering from treatment-resistant bipolar depression.
Methods
30 resistant bipolar depressed patients, whose resistance was defined according to The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder, were treated with cariprazine 1,5 -3 mg flexible dose for 4 weeks, added to previous mood stabilizing and/or antidepressant treatment. Psychopathology at time 0 and at 4, 8, 12, 16, 20, 24 weeks of treatment was evaluated using the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Young Mania Rating Scale (YMRS) and the Bipolar Depression Rating Scale (BDRS); safety and tolerability was measured by the UKU Side Effect Rating Scale. The drop-out rate was assessed throughout the study duration.
Results
Cariprazine add-on was effective in the study sample but only during the first 4 weeks of treatment. Improvement in depression scores started from the first week, reaching about 40% mean HDRS score reduction at T4; a moderate ulterior decrease (-15%) was reached at T24 but was accompanied by a significant drop-out rate; anxiety symptoms improved (mean HARS score reduction 37% at T4) mainly during the first 4 weeks. The treatment was generally well tolerated. From week 4 to 24 we observed a near 70% drop-out rate (18 total drop-outs) with maximum drop-outs between weeks 4-8 (n=7) and 18-24 (n=7). Discontinuation causes were inefficacy (5/18); clinical worsening (10/18); side effects (3/18); hypomanic shift (2/18).
Conclusions
Despite the relatively small population examined and the observational design, our results suggest that cariprazine may represent an effective and safe short-term enhancement strategy in resistant bipolar depression. Long-term treatment, in this sample, did not lead to significant improvements and was burdened by a high drop-out rate, mainly due to inefficacy/clinical worsening. Further studies on larger samples are needed to confirm these preliminary findings, both in short-term and in longer observations.
Manipulation of host behaviour by parasites to enhance transmission to the next host is a fascinating phenomenon that has interested scientists since the 1970s. It has been proposed that infection with the cestode Echinococcus multilocularis produces an impairment of the antipredatory behaviour in the rodent intermediate host common vole, Microtus arvalis, which may facilitate transmission of the tapeworm to the canid final host. In this study, we observed the behaviour of infected common voles at 12 weeks post-infection, when protoscoleces production and maturation commonly occurs, in order to assess behavioural changes compared to uninfected controls, that might ease predation in the wild. Infected and uninfected voles were monitored for 24 h to observe their spontaneous activity. In addition, the next day, both infected and uninfected voles were subjected to 4 different behavioural tests: open field test, barrier test, platform test and air-puff test in a running wheel. No significant difference between uninfected and infected voles emerged during the behavioural tests. However, observation of spontaneous activity revealed that infected voles increased their feeding frequency and spent significantly more time above bedding even when not eating, compared to the uninfected controls. In the wild, these behavioural changes increase the animals exposure to predators, raising their chance of becoming prey. These findings are the first direct evidence consistent with behavioural manipulation by E. multilocularis on common voles.
To enable the circular economy paradigm, it is important to design easy-to-disassemble products. A new method, known as Design for Circular Disassembly (DfCD), has been proposed to enhance product disassembly performances toward circularity. The method was tested on a small-sized product, showing promising results. However, its applicability to medium-sized products remains unclear. The goal of this article is to assess the effectiveness of DfCD on medium-sized products, particularly washing machines. Results showed DfCD can be extended to medium-sized products, increasing model complexity.
The experimental microcirculatory analysis of treating anemia by blood transfusion shows that it minimally increases oxygen (O2) delivery by the capillary circulation, where O2 pressure (pO2), hematocrit (Hct) and capillary hydraulic pressure (pC) are normally 1/5 of systemic, and further depressed by anemia. The concomitant decrease of functional capillary density becomes lethal when falling below a specific threshold due to the decrease in pC, and requires re-pressurizing the microcirculation without increasing the heart’s work load. These effects are achieved by increasing plasma blood viscosity using a viscous plasma expander. This approach significantly elevates capillary blood viscosity and shear stress, increasing the production of the vasodilator NO, becoming significantbecause of the large capillary endothelial surface area, and because increased NO tends to lower O2 consumption. We show that using hyperviscous plasma expanders increases FCD, blood flow velocity and the rate of RBC delivery to the tissues. They could ultimately justify transfusing blood when DO2 falls to ¼ of normal, which is 4 times the normal organism metabolic requirement at rest.
OBJECTIVES/GOALS: To determine the impact of regional anesthesia (RA) on rates of breast cancer recurrence, breast cancer specific mortality, post mastectomy pain syndrome, and chronic opioid use among patients who received regional anesthesia during primary breast cancer surgery. METHODS/STUDY POPULATION: Study population: Patients who underwent primary breast cancer surgery at Emory University and among a national patient cohort. Methods: This is a retrospective analysis of patients who underwent primary breast cancer surgery. Invasive breast cancer specific survival & breast cancer-specific survival will be estimated using Kaplan-Meier method and compared among patient groups. Cox proportional hazards will be utilized to estimate the unadjusted & adjusted risk of breast cancer recurrence and breast cancer-specific mortality between the two groups. RESULTS/ANTICIPATED RESULTS: We will present on our work comparing rates of breast cancer recurrence among patients who received regional anesthesia compared to patients who did not. DISCUSSION/SIGNIFICANCE: This study aims to establish the effect of regional anesthesia on breast cancer recurrence,breast cancer specific mortality, post mastectomy pain syndrome, and chronic opioid use following primary breast cancer surgery.
While many investor-state dispute settlement (ISDS) proceedings based on international investment agreements have dealt, directly or incidentally, with environmental issues, state measures relating to the mitigation and adaptation to climate change have been subject to a small number of reported cases. This article demonstrates that there is a significant gap between the number of investor-state disputes having a direct relevance with climate change, on the one hand, and the number of such cases that have actually raised climate change as a material legal or factual issue. In addition, arbitral tribunals faced with disputes related to measures or sectors that are of direct relevance to climate action have, to date, virtually never engaged in any sort of substantial analysis of international climate change treaties and related instruments, rules, or practices. Against this backdrop, this article will explore ways for arbitrators and parties to ISDS proceedings to better consider the climate regime — in particular, the Paris Agreement and instruments arising therefrom — in ISDS proceedings beyond its current limited role as an element of context. While the literature has mostly focused on integrating climate change concerns in ISDS, this article goes further by exploring how states’ international climate obligations could play a greater role in the adjudication of investor-state disputes, including by providing states with a justification for implementing more ambitious regulations as well as tribunals with guidance for interpreting substantive obligations in investment treaties.
There is currently considerable interest in the guided-jet mode, as a result of recent works demonstrating it being the upstream component of various resonant systems in high-speed flows. For given jet operating conditions, the mode is known to exist over only a finite-frequency range that, for a twin-jet system, has been observed to vary with both jet separation and solution symmetry. Vortex-sheet and finite-thickness linear stability models are here employed to consider the behaviour of the guided-jet mode as the two jets are brought together, for both a planar and round twin-jet system. It is demonstrated that in both cases as the twin-jet system merges it forms a higher-order mode of an equivalent single-jet geometry. This then imposes a constraint on the guided-jet mode as the finite-frequency range must change to meet that of the equivalent geometry the system merges to, explaining the previously observed dependence on jet separation.
Formation of authigenic trioctahedral Mg-rich smectite is common in evaporative lake sediments, but was not described previously in modern marine evaporative environments. This study documents formation of authigenic K-rich, Mg-smectite during very early diagenesis in the dominantly siliciclastic Salina Ometepec (Baja California), a large supratidal evaporative sabkha complex near the mouth of the Colorado River. Here, sediment pore waters are exceptionally Mg2+-rich relative to other marine evaporative environments due to suppressed sulfate reduction which limits production of carbonate alkalinity and, hence, carbonate (particularly dolomite) precipitation. Sediment cores were obtained along a five km transect seaward across the hypersaline mud flat to evaluate how these atypical geochemical conditions would affect the clay mineral compositions.
Scanning transmission electron microscopy (STEM) observations show that the smectite from the marine Inlet, near the sediment source, consists of grains of irregular shape that give selected area diffraction (SAED) patterns reflecting dominant turbostratic stacking. Analytical electron microscopy (AEM) analyses indicate that K+ is the dominant interlayer cation; the mean composition is approximately K0.7(Al3.3Fe(III)0.3Mg0.5)(Al0.5Si7.5)O20(OH)4. Such smectite is implied to be detrital in part because it is similar to smectite known to be deposited by the Colorado River.
Smectite from the hypersaline mud flat occurs as aggregates of small subhedral pseudohexagonal plate or lath-shaped crystals ≤250 nm in diameter, with thicknesses varying between three and ten layers. The SAED patterns reflect substantial turbostratic stacking, but with a greater frequency of interlayer coherency as compared with detrital smectite. Crystals from greater sediment depths are larger and more nearly euhedral. This smectite is dominantly trioctahedral, with mean composition approximately K0.7(Al0.7Fe(III)0.5Mg4.45)(Al1.2Si6.8)O20(OH)4 (saponitic). This smectite is inferred to be dominantly authigenic in origin.
The X-ray diffraction (XRD) and STEM/AEM data collectively imply that detrital aluminous dioctahedral smectite reacts to form authigenic Mg-rich trioctahedral smectite, driven in part by the high Mg2+/ Ca2+ ratio of pore waters. Such early-formed Mg-rich smectite may be the precursor for the trioctahedral mixed-layer smectite, corrensite, and chlorite assemblages found in ancient marine evaporative sequences. These results also add to the accumulating evidence that interlayer K+ in marine smectite is fixed during the earliest stages of marine diagenesis near the sediment water interface.
For several decades, many efforts have been dedicated to enhancing the accuracy of mortar radiocarbon dating and evaluating the reliability of the results concerning the typology of the examined specimens. Several assumptions that are fundamental for the application of the method may be in many cases not fulfilled, such as (a) complete primary limestone dissociation during calcination, (b) efficient separation of geogenic carbon contained in calcareous aggregates, (c) short carbonation time, and (d) absence of secondary calcite. Many laboratories all over the world have proposed different methods to select suitable fractions of mortar.
The first intercomparison attempt, involving eight international laboratories, was organized in 2016 aiming at comparing and statistically treating the results obtained on the same materials by different laboratories with their own characterization and pre-treatment methods (Hajdas et al. 2017; Hayen et al. 2017). Following this first step, a new intercomparison experiment was proposed and set up in 2018 during the Mortar Dating International Meeting (Bordeaux, FR). A new set of three mortar samples was chosen, taking care of the selection of standardized materials (homogeneity, known mineralogical composition, absence of exogenous inclusions, known expected age).
This work describes the results of two research teams involved in the intercomparison. The samples were characterized, selected, and dated depending on each laboratory strategy. The results stress the importance of the characterization of the raw material is to better understand the mineralogical and petrographical composition of the samples. Such information can support the choice of the most appropriate strategy for the extraction of CO2 and then for data interpretation.
We conduct sensory analysis and assess consumer preferences and willingness to pay (WTP) for beef steaks from cattle fed hydroponically produced barley fodder (B-F) relative to those fed conventional mixed rations (CON). Results suggest consumers do not differentiate between B-F and CON when evaluating sensory attributes and possess similar WTP for both treatments. Preference toward the B-F treatment is demonstrated for sustainability-conscientious consumers informed about the potential sustainability benefits of the B-F treatment. Producers feeding hydroponically produced barley fodder should not expect premiums above beef-fed conventional feedstuff, yet establishing credence value around the sustainability of the B-F treatment may increase marketability.
After an intercomparison age experiment carried out in the framework of the first MODIS (MOrtar Dating Inter-comparison Study) project, the results showed general agreement both between optically stimulated luminescence (OSL) dating laboratories and with radiocarbon (14C) dating results. As the needs for the selection of samples convenient for an inter-comparison are not the same between 14C and OSL, for the second running, it has been decided to choose two different sample sets, one to share between the radiocarbon labs and one for the OSL dating ones. The results obtained by applying different experimental protocols (multigrain and single grain techniques) and different statistical models (weighted mean, central age mode, average dose model, minimum age model and exponential exposure dose) are discussed in this work.
Aggregation of phosphorylated tau (pTau) is a hallmark feature of Alzheimer’s disease (AD). Novel assays now allow pTau to be measured in plasma. Elevated plasma pTau predicts subsequent development of AD, cortical atrophy and AD-related pathologies in the brain. We aimed to determine whether elevated pTau is associated with cognitive functioning in older adults prior to the development of dementia.
Participants and Methods:
Independently living older adults (N = 48, mean age = 70.0 years; SD = 7.7; age range 55-88 years; 35.4% male) free of dementia or clinical stroke were recruited from the community and underwent blood draw and neuropsychological assessment. Plasma was assayed using the Quanterix Simoa® pTau-181 V2 Advantage Kit to quantify pTau-181 levels and APOE genotyping was conducted on the blood cell pellet fraction obtained from plasma separation. Global cognition was assessed using the Dementia Rating Scale-2 (DRS-2) and executive function was assessed using the Stroop, D-KEFS-2 Fluency, and Trails Making Test. Diagnosis of mild cognitive impairment (MCI) was determined based on overall neuropsychological performance. Participants were diagnosed as MCI if they scored >1 SD below norm-referenced values on 2 or more tests within a domain (language, executive, memory) or on 3 tests across domains.
Results:
Multiple linear regression analysis revealed a significant negative association between plasma pTau-181 levels and DRS-2 (B = -2.57, 95% CI (-3.68, -1.47), p <.001), Stroop Color-Word score (B = -2.64, 95% CI (-4.56, - 0.71), p = .009) and Fruits and Vegetables Fluency (B = -1.67, 95% CI (-2.84, -0.49), p = .007), adjusting for age, sex, education and APOE4 status. MCI diagnosis was determined for 43 participants, of which 8 (18.6%) met criteria. Logistic regression analysis revealed that pTau-181 levels are associated with increased odds of MCI diagnosis (OR = 2.18, 95% CI (1.01, 4.68), p = .046), after accounting for age, sex, education and APOE4 status.
Conclusions:
Elevated plasma pTau-181 is associated with worse cognition, particularly executive function, and predicts MCI diagnosis in older adults. Higher plasma pTau-181 was associated with increased odds of MCI diagnosis. Detection of pTau-181 in plasma allows a novel, non-invasive method to detect burden of one form of AD pathology. These findings lend support to the use of plasma pTau-181 as a valuable marker in detecting even early cognitive changes prior to the development of AD. Additional longitudinal studies are warranted to explore the prognostic value of plasma pTau-181 over time.
The locus coeruleus (LC) innervates the cerebrovasculature and plays a crucial role in optimal regulation of cerebral blood flow. However, no human studies to date have examined links between these systems with widely available neuroimaging methods. We quantified associations between LC structural integrity and regional cortical perfusion and probed whether varying levels of plasma Alzheimer’s disease (AD) biomarkers (Aß42/40 ratio and ptau181) moderated these relationships.
Participants and Methods:
64 dementia-free community-dwelling older adults (ages 55-87) recruited across two studies underwent structural and functional neuroimaging on the same MRI scanner. 3D-pCASL MRI measured regional cerebral blood flow in limbic and frontal cortical regions, while T1-FSE MRI quantified rostral LC-MRI contrast, a well-established proxy measure of LC structural integrity. A subset of participants underwent fasting blood draw to measure plasma AD biomarker concentrations (Aß42/40 ratio and ptau181). Multiple linear regression models examined associations between perfusion and LC integrity, with rostral LC-MRI contrast as predictor, regional CBF as outcome, and age and study as covariates. Moderation analyses included additional terms for plasma AD biomarker concentration and plasma x LC interaction.
Results:
Greater rostral LC-MRI contrast was linked to lower regional perfusion in limbic regions, such as the amygdala (ß = -0.25, p = 0.049) and entorhinal cortex (ß = -0.20, p = 0.042), but was linked to higher regional perfusion in frontal cortical regions, such as the lateral (ß = 0.28, p = 0.003) and medial (ß = 0.24, p = 0.05) orbitofrontal (OFC) cortices. Plasma amyloid levels moderated the relationship between rostral LC and amygdala CBF (Aß42/40 ratio x rostral LC interaction term ß = -0.31, p = 0.021), such that as plasma Aß42/40 ratio decreased (i.e., greater pathology), the strength of the negative relationship between rostral LC integrity and amygdala perfusion decreased. Plasma ptau181levels moderated the relationship between rostral LC and entorhinal CBF (ptau181 x rostral LC interaction term ß = 0.64, p = 0.001), such that as ptau181 increased (i.e., greater pathology), the strength of the negative relationship between rostral LC integrity and entorhinal perfusion decreased. For frontal cortical regions, ptau181 levels moderated the relationship between rostral LC and lateral OFC perfusion (ptau181 x rostral LC interaction term ß = -0.54, p = .004), as well as between rostral LC and medial OFC perfusion (ptau181 x rostral LC interaction term ß = -0.53, p = .005), such that as ptau181 increased (i.e., greater pathology), the strength of the positive relationship between rostral LC integrity and frontal perfusion decreased.
Conclusions:
LC integrity is linked to regional cortical perfusion in non-demented older adults, and these relationships are moderated by plasma AD biomarker concentrations. Variable directionality of the associations between the LC and frontal versus limbic perfusion, as well as the differential moderating effects of plasma AD biomarkers, may signify a compensatory mechanism and a shifting pattern of hyperemia in the presence of aggregating AD pathology. Linking LC integrity and cerebrovascular regulation may represent an important understudied pathway of dementia risk and may help to bridge competing theories of dementia progression in preclinical AD studies.