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Polar ring galaxies (PRGs) are a unique class of galaxies characterised by a ring of gas and stars orbiting nearly orthogonal to the main body. This study delves into the evolutionary trajectory of PRGs using the exemplary trio of NGC 3718, NGC 2685, and NGC 4262. We investigate the distinct features of PRGs by analysing their ring and host components to reveal their unique characteristics through spectral energy distribution (SED) fitting. Using CIGALE, we performed SED fitting to independently analyse the ring and host spatially resolved regions, marking the first decomposed SED analysis for PRGs, which examines stellar populations using high-resolution observations from AstroSat UVIT at a resolved scale. The UV-optical surface profiles provide an initial idea that distinct patterns in the galaxies, with differences in FUV and NUV, suggest three distinct stages of ring evolution in the selected galaxies. The study of resolved-scale stellar regions reveals that the ring regions are generally younger than their host galaxies, with the age disparity progressively decreasing along the evolutionary sequence from NGC 3718 to NGC 4262. Star formation rates (SFR) also exhibit a consistent pattern, with higher SFR in the ring of NGC 3718 compared to the others, and a progressive decrease through NGC 2685 and NGC 4262. Finally, the representation of the galaxies in the HI gas fraction versus the NUV–$\text r$ plane supports the idea that they are in three different evolutionary stages of PRG evolution, with NGC 3718 in the initial stage, NGC 2685 in the intermediate stage, and NGC 4262 representing the final stage. This study concludes that PRGs undergo various evolutionary stages, as evidenced by the observed features in the ring and host components. NGC 3718, NGC 2685, and NGC 4262 represent different stages of this evolution, highlighting the dynamic nature of PRGs and emphasising the importance of studying their evolutionary processes to gain insights into galactic formation and evolution.
This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.
Among participants with Alzheimer's disease (AD) we estimated the minimal clinically important difference (MCID) in apathy symptom severity on three scales.
Design:
Retrospective anchor- and distribution-based analyses of change in apathy symptom scores.
Setting:
Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2 randomized controlled trials conducted at three and ten clinics specialized in dementia care in United States and Canada, respectively.
Participants:
Two hundred and sixty participants (60 ADMET, 200 ADMET 2) with clinically significant apathy in Alzheimer’s disease.
Measurements:
The Clinical Global Impression of Change in Apathy scale was used as the anchor measure and the MCID on the Neuropsychiatric Inventory – Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) were estimated with linear mixed models across all study visits. The estimated thresholds were evaluated with performance metrics.
Results:
Among the MCID was a decrease of four points (95% CI: −4.0 to −4.8) on the NPI-A, 0.56 points (95% CI: −0.47 to −0.65) on the DAIR, and three points on the AES-I (95% CI: −0.9 to −5.4). Distribution-based analyses were largely consistent with the anchor-based analyses. The MCID across the three measures showed ∼60% accuracy. Sensitivity analyses found that MMSE scores and apathy severity at baseline influenced the estimated MCID.
Conclusions:
MCIDs for apathy on three scales will help evaluate treatment efficacy at the individual level. However, the modest correspondence between MCID and clinical impression of change suggests the need to consider other scales.
Background: The burden and outcome of stroke in indigenous populations is less well understood. This review evaluates ischemic stroke outcomes in indigenous populations as compared to the general population in the context of recent advances in ischemic stroke therapy. Methods: The OVID Medline and EMBASE databases were searched for this review. Clinical outcome was measured using standardized outcome scale (eg. mRS) at 90 days following stroke intervention in indigenous as compared to non-indigenous adult populations. Results: 897 studies were identified, with 4 studies included in the final analysis. A total of (n=68895) patients were included who underwent thrombolysis. Study populations from Australia, New Zealand, United States and Canada comprised of (n=2012) indigenous patients. Mortality was significantly higher in indigenous populations as compared to non-indigenous (Odds Ratio-1.28, 95% CI-1.12; 1.46). The odds ratios of atrial fibrillation (1.26, 95% CI-1.12;– 1.41), diabetes (1.43, 95% CI- 1.27; 1.62), hypertension (1.33, 95% CI- 1.17; 1.51) and IHD (0.71, 95% CI- 0.62; 0.81) in indigenous patients was significantly higher than in non-indigenous patients. Conclusions: Indigenous populations undergoing stroke therapy are at a significantly increased risk of mortality as compared to non-indigenous populations. Comorbidities including diabetes, atrial fibrillation and hypertension are more prevalent in indigenous populations.
Background: Sex differences in treatment response to intravenous thrombolysis (IVT) are poorly characterized. We compared sex-disaggregated outcomes in patients receiving IVT for acute ischemic stroke in the Alteplase compared to Tenecteplase (AcT) trial, a Canadian multicentre, randomised trial. Methods: In this post-hoc analysis, the primary outcome was excellent functional outcome (modified Rankin Score [mRS] 0-1) at 90 days. Secondary and safety outcomes included return to baseline function, successful reperfusion (eTICI≥2b), death and symptomatic intracerebral hemorrhage. Results: Of 1577 patients, there were 755 women and 822 men (median age 77 [68-86]; 70 [59-79]). There were no differences in rates of mRS 0-1 (aRR 0.95 [0.86-1.06]), return to baseline function (aRR 0.94 [0.84-1.06]), reperfusion (aRR 0.98 [0.80-1.19]) and death (aRR 0.91 [0.79-1.18]). There was no effect modification by treatment type on the association between sex and outcomes. The probability of excellent functional outcome decreased with increasing onset-to-needle time. This relation did not vary by sex (pinteraction 0.42). Conclusions: The AcT trial demonstrated comparable functional, safety and angiographic outcomes by sex. This effect did not differ between alteplase and tenecteplase. The pragmatic enrolment and broad national participation in AcT provide reassurance that there do not appear to be sex differences in outcomes amongst Canadians receiving IVT.
Himalayan glaciers have been shrinking and losing mass rapidly since 1970s with an enhanced rate after 2000. The shrinkage is, however, quite heterogeneous and it is important to document individual glacier characteristics and their changes at the basin scale. We present an updated glacier inventory of the Upper Alaknanda Basin (UAB), Central Himalaya for the year 2020 and report area, debris cover and length changes for the periods 1994–2006 and 2006–2020 based on remote-sensing data. We identified 198 glaciers, comprising an area of 354.6 ± 8.5 km2, and classified them according to their size and morphology. The glaciers of the basin lost 4.2 ± 2.9% (0.16 ± 0.11% a−1) of their frontal area (from 368.6 ± 9.2 to 353.0 ± 5.3 km2) from 1994 to 2020. The average retreat rate was higher in the period 2006–2020 (13.3 ± 1.8 m a−1) in comparison to 1994–2006 (9.3 ± 1.9 m a−1). However, the area change rate was similar for the two periods (0.14 ± 0.27% a−1 for 1994–2006 and 0.16 ± 0.19% a−1 for 2006–2020). The debris-covered area has increased by 13.4 ± 4.4% from 1994 to 2020. A comparison with previous studies in UAB indicates consistent area loss of ~0.15% a−1 since the 1960s.
Background: The coronavirus disease 2019 (COVID-19) pandemic has led the implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 6 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=150 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.
A supraglacial debris layer controls energy transfer to the ice surface and moderates ice ablation on debris-covered glaciers. Measurements of vertical temperature profiles within the debris enables the estimation of thermal diffusivities and sub-debris ablation rates. We have measured the debris-layer temperature profiles at 16 locations on Satopanth Glacier (central Himalaya) during the ablation seasons of 2016 and 2017. Debris temperature profile data are typically analysed using a finite-difference method, assuming that the debris layer is a homogeneous one-dimensional thermal conductor. We introduce three more methods for analysing such data that approximate the debris layer as either a single or a two-layered conductor. We analyse the performance of all four methods using synthetic experiments and by comparing the estimated ablation rates with in situ glaciological observations. Our analysis shows that the temperature measurements obtained at equispaced sensors and analysed with a two-layered model improve the accuracy of the estimated thermal diffusivity and sub-debris ablation rate. The accuracy of the ablation rate estimates is comparable to that of the in situ observations. We argue that measuring the temperature profile is a convenient and reliable method to estimate seasonal to sub-seasonal variations of ablation rates in the thickly debris-covered parts of glaciers.
Background: The coronavirus disease 2019 (COVID-19) pandemic has led an implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 9 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=144 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during the pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.
We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The index case had a travel history and spent 24 days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only four individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.
To investigate the relative contributions of cerebral cortex and basal ganglia to movement stopping, we tested the optimum combination Stop Signal Reaction Time (ocSSRT) and median visual reaction time (RT) in patients with Alzheimer’s disease (AD) and Parkinson’s disease (PD) and compared values with data from healthy controls.
Methods:
Thirty-five PD patients, 22 AD patients, and 29 healthy controls were recruited to this study. RT and ocSSRT were measured using a hand-held battery-operated electronic box through a stop signal paradigm.
Result:
The mean ocSSRT was found to be 309 ms, 368 ms, and 265 ms in AD, PD, and healthy controls, respectively, and significantly prolonged in PD compared to healthy controls (p = 0.001). The ocSSRT but not RT could separate AD from PD patients (p = 0.022).
Conclusion:
Our data suggest that subcortical networks encompassing dopaminergic pathways in the basal ganglia play a more important role than cortical networks in movement-stopping. Combining ocSSRT with other putative indices or biomarkers of AD (and other dementias) could increase the accuracy of early diagnosis.
Field experiments were conducted to standardize protocols for site-specific fertilizer nitrogen (N) management in Bt cotton using Soil Plant Analysis Development (SPAD) chlorophyll meter. Performance of different SPAD-based site-specific N management scenarios was evaluated vis-à-vis blanket fertilizer N recommendation. The N treatments comprised a no-N (control), four fixed-time and fixed N doses (60, 90, 120, and 150 kg N ha-1) including the recommended dose (150 kg ha-1), and eight fixed-time and adjustable N doses based on critical SPAD readings of 45 and 41 at first flowering and boll formation stages, respectively. The results revealed that by applying 45 or 60 kg N ha-1 at thinning stage of the crop and critical SPAD value-guided dose of 45 or 30 kg N ha-1 at first flowering stage resulted in yields similar to that recorded by applying the recommended dose of 150 kg N ha-1. However, significantly higher N use efficiency as well as 30–40% less total fertilizer N use was recorded with site-specific N management. Applying 30 kg N ha-1 at thinning and SPAD meter-guided 45 kg N ha-1 at first flowering were not enough and required additional SPAD meter-guided 45 kg N ha-1 at boll formation for sustaining yield levels equivalent to those observed by following blanket recommendation but resulted in 20% less fertilizer N application. Our data revealed that SPAD meter-based site-specific N management in Bt cotton results in optimum yield with dynamic adjustment of fertilizer N doses at first flowering and boll formation stages. The total amount of N fertilizer following site-specific management strategies was substantially less than the blanket recommendation of 150 kg N ha-1, but the extent may vary in different fields.
Using an anonymised case study (with written consent), we describe a process aiming to understand the impact a patient's learning disability, personality disorder and bipolar affective disorder each had upon her capacity to make decisions and to ascertain in which areas of her life the patient had the ability to take responsibility. This information was then used to plan an effective management strategy.
We have developed an approach to care planning in which we analyse management areas by defining which diagnosis is relevant and so deciding if the patient has capacity for that specific area of life. in this way we can be clear with patients when they have capacity and encourage greater responsibility and independence in their lives.
DS with aging is associated with greatly increased risk of developing dementia similar to Alzheimer's. Anti-dementia drug discontinuation is recommended when clinical benefit is not determined. In DS it is more complex as medication ill effects of stopping needs to be weighed in balance to extraneous processes such as environment changes, sensory impediments and physical ill health and natural progression of dementia.
Aim
Can identified risk factors extracted from a comprehensive literature review be developed into an evidence based check list to support risk minimized person centered withdrawal of anti-dementia drugs when considered not to be efficacious in DS?
Method
A detailed literature review using Medline, PsychInfo, Cinahl and Embase with relevant search terms in various permutations and combinations without any date limit enquiring current evidence base on anti-dementia medication withdrawal was conducted. The review also looked to extract the common risk factors in stopping medication. All risk factors were collated, reviewed by a focus group of experts, developed into a checklist.
Results
Thirty abstracts were obtained following the search. Six papers were short-listed. No papers identified a structured approach to medication reduction. An 18-factor checklist was applied prospectively to 30 cases. The checklist was sensitive to identify change to guide clinical decision-making.
Conclusions
Currently, decision to peg medication withdrawal risk is arbitrary and clinical in dementia especially in DS dementia. The evidenced based developed checklist is useful to support and structure clinical decisions. It helps clinicians and patients to focus on promoting safety, reduce harm and guide treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Clinician-patient communication is a major factor in influencing outcomes of healthcare. Complexity increases if an individual has multiple health needs requiring support of different clinicians or agencies.
Aim
To develop and evidence a simple dynamic computerised tool to capture and communicate outcomes of intervention or alteration in clinical need in patients with multiple chronic health needs.
Method
A MS Excel algorithm was designed for swift capture of clinical information discussed in an appointment using pre-designed set of evidenced based domains. An instant personalized single screen visual is produced to facilitate information sharing and decision-making. The display is responsive to compare changes across time. A prototype was conceptually tested in an epilepsy clinic for people with Intellectual disability (ID) due to the unique challenges posed in this population.
Results
Evidence across 300 patients with ID and epilepsy showed the tool works by enhancing reflective communication, compliance and therapeutic relationship. Medication and appointment compliance was 95% and patient satisfaction over 90%.
Conclusion
To discuss all influencing health factors in a consultation is a communication challenge esp. if the patient has multiple health needs. A picture equals 1000 words and helps address the cognitive complexity of verbal information. The radar offers an evidenced based common framework to host care plans of different health conditions. It provides individualised easy view person centred care plans to allow patients to gain insight on how the different conditions impact on their overall well being and be active participants. The tool will be practically demonstrated.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Epilepsy is the second most common cause of premorbid mortality in the ID population. Rates of SUDEP are considered up to 9 times higher in the ID population. Cornwall UK (population 600.000 i.e. 1% of UK) runs a specialist ID epilepsy community service for adults with ID. It delivers reasonable adjustments and person centered care to this population. We measured how service outcomes on SUDEP compared to regional and national averages.
Methods
Data of all Cornwall epilepsy deaths 2004–2015 using the Cornwall Coroner's database and the Public Health Cornwall was reviewed systemically. We identified patients with and without ID.
Results
There were 113 epilepsy deaths of which 57 were SUDEPs of which 3 were identified to have a clinical diagnosis of ID. In another 2 cases it was not evident if they had an ID or not. None of the 5 was known to the ID Epilepsy service. Mean and 95% confidence intervals were calculated using a binomial calculation, making no prior assumptions about the population distribution.
Conclusion
Cornwall's specialist ID epilepsy service is a rarity in the UK. A recent study using the Leicestershire ID Register revealed 26 people with ID of the total deaths of 83 SUDEP. This contrasts greatly with Cornwall only 5.26% of SUDEP deaths had ID compared to 23.4% in Leicestershire and similarly when compared to neighboring Plymouth (population 300.000) which had 26% ID deaths in its SUDEPs between 2004–2012. It is possible that having an ID dedicated epilepsy service saves lives.
Only 25% of people who die by suicide see mental health services. Suicide is not just a health issue. Its causation and consequences lie within all of society. Many erroneously believe that suicide is inevitable and not preventable, because its causation is too complex. Underlying associations with suicide are largely social. There are programmes in the USA, which have combined interventions to reduce suicides. The 2014 UK suicide rate per 100,000 was 10.8 but 11.1 in South West (SW) England (pop: 5 million). A whole system approach is necessary. Zero Suicides SW is a project to address this.
Aim
(1) To develop a regional strategy to reduce and prevent suicide. (2) To make whole populations suicide risk aware. (3) Reduce regional suicide rates.
Method
A collaborative involving national and local 60 organisations including charities and voluntary sector was formed. Five collaborative meetings used narratives of suicide survivors, national experts led themed workshops, etc. to come up with a regional strategy. Quality Improvement (QI) Methodology was used to develop and examine the success of all projects.
Outputs
Initiatives such as using local radio stations for mental health promotion, collaboration via a poster campaign with local breweries and pubs to make men more self-aware of risk, suicide risk counselling for relatives/carers of patients admitted to psychiatric care, improving scrutiny to access to medication for recently discharged psychiatric patients have developed from the project. The QI model demonstrated how localised changes at person and organisation level could combine and have a powerful role in suicide prevention.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Nilgiri tahr Nilgiritragus hylocrius is an Endangered species of mountain ungulate endemic to the Western Ghats of India, a biodiversity hotspot. Habitat fragmentation, hunting and a restricted range are the major threats to this species. Although several surveys have assessed the species’ status, a population estimate based on a scientifically robust method is needed. We used the double-observer method to estimate the population of the Nilgiri tahr in the Anamalai Tiger Reserve, a protected area in the Western Ghats. We walked 257 km of transects across the Reserve, covering 36 grassland blocks (i.e. clusters of montane grasslands that were relatively separate from each other). We counted a minimum of 422 individuals in 28 groups, and estimated the tahr population in the study area to be 510 individuals (95% CI 300–858) in 35 groups. The male:female ratio was 0.71 and the young:female ratio was 0.56. Comparing our estimate with previous surveys suggests that the Nilgiri tahr population in Anamalai Tiger Reserve is stable. We found the double-observer survey method to be appropriate for population estimation and long-term monitoring of this species, and make recommendations for improved field protocols to facilitate the implementation of the method in the tropical mountains of the Western Ghats. Our findings suggest that the Reserve harbours 20–25% of the global population of the Nilgiri tahr, highlighting the area's importance for the conservation of this species.
Glaciological ablation is computed from point-scale data at a few ablation stakes that are usually regressed as a function of elevation and averaged over the area-elevation distribution of a glacier. This method is contingent on a tight control of elevation on local ablation. However, in debris-covered glaciers, systematic and random spatial variations of debris thickness modify the ablation rates. We propose and test a method to compute sub-debris ablation where stake data are interpolated as a function of debris-thickness alone and averaged over the debris-thickness distribution at different parts of the glacier. We apply this method on Satopanth Glacier located in Central Himalaya utilising ~1000 ablation measurements obtained from a network of up to 56 stakes during 2015–2017. The estimated mean sub-debris ablation ranges between 1.5±0.2 to 1.7±0.3 cm d−1. We show that the debris-thickness-dependent regression describes the spatial variability of the sub-debris ablation better than the elevation dependent regression. The uncertainties in ablation estimates due to the corresponding uncertainties in the measurement of ablation and debris-thickness distribution, and those due to interpolation procedures are estimated using Monte Carlo methods. Possible biases due to a finite number of stakes used are also investigated.
Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.
Methods
We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.
Results
Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.
Conclusions
Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.