Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy.

Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. OBJECTIVE: This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. METHODS: To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). RESULTS: Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. CONCLUSIONS: Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.

Queixas de memória são frequentes em pessoas adultas com epilepsia (PCEs). Entretanto, os aspectos clínicos associados ainda não são totalmente compreendidos. OBJETIVO: Relacionar a ocorrência de queixas de memória em PCEs com aspectos clínicos e a autoestima. MÉTODOS: Relacionar os dados do Memory Complaint Questionnaire (MAC-Q) com aspectos clínicos, a Roserberg Self-esteem Scale (SES), o MEEM e a BCB-Edu de 71 PCEs. Os dados foram comparados aos de 55 indivíduos normais (GC). RESULTADOS: Queixa de memória (MAC-Q≥25) foi significativamente maior nos PCEs quando comparada a do GC [35 (49,3%) vs. 15 (27,2%); teste t de Student; p=0,012]. O desempenho cognitivo objetivo foi inferior nas PWEs. As queixas de memória foram associadas à menor escolaridade, presença de depressão e à SES, o MEEM, à memória incidental e o clock-drawing test nas PCEs. CONCLUSÕES: As queixas de memória foi mais frequente nas PCEs do que no GC, e houve relação com o déficit cognitivo, a escolaridade, a depressão e a baixa autoestima.

Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy / Queixa de memória, aspectos clínicos e a autoestima em pessoas adultas com epilepsia

ABSTRACT Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. Objective: This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. Methods: To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). Results: Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. Conclusions: Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.

RESUMO Queixas de memória são frequentes em pessoas adultas com epilepsia (PCEs). Entretanto, os aspectos clínicos associados ainda não são totalmente compreendidos. Objetivo: Relacionar a ocorrência de queixas de memória em PCEs com aspectos clínicos e a autoestima. Métodos: Relacionar os dados do Memory Complaint Questionnaire (MAC-Q) com aspectos clínicos, a Roserberg Self-esteem Scale (SES), o MEEM e a BCB-Edu de 71 PCEs. Os dados foram comparados aos de 55 indivíduos normais (GC). Resultados: Queixa de memória (MAC-Q≥25) foi significativamente maior nos PCEs quando comparada a do GC [35 (49,3%) vs. 15 (27,2%); teste t de Student; p=0,012]. O desempenho cognitivo objetivo foi inferior nas PWEs. As queixas de memória foram associadas à menor escolaridade, presença de depressão e à SES, o MEEM, à memória incidental e o clock-drawing test nas PCEs. Conclusões: As queixas de memória foi mais frequente nas PCEs do que no GC, e houve relação com o déficit cognitivo, a escolaridade, a depressão e a baixa autoestima.

[High-cost patients in Germany: General description of utilization and costs]. / Hochkostenversicherte in Deutschland: Leistungs- und Kostenprofile.

BACKGROUND: Studies from different countries have shown that a small number of insured persons (high-cost patients) are responsible for a large portion of health care spending. At the same time, it is assumed that some of these costs could be saved by a better management of this group of people. The aim of this article is to analyze the performance and cost profiles of high-cost patients, to put them in an international comparison, and to derive a better management approach. METHODS: Retrospective observation study based on statutory health insurance data from two statutory health insurances for the year 2013. STUDY POPULATION: top 5 %, as well as top 1 % of the most expensive insured persons. Identification of characteristics of high-cost patients and international comparison with the Netherlands, the USA, Canada, Spain, England and Japan. RESULTS: 5 % of insured persons account for almost half of the total costs and the most expensive 1 % of 22 %. These high-cost patients in Germany are, on average, 20 years older than the general population. Almost every person of the high-cost population was prescribed at least one medication during the study period (99.2 %), and 85.8 % had at least one hospital stay. Hospital care accounts for the biggest part of total costs: 75 % together with drugs. The average per capita costs caused by one of the 5 % most expensive insured persons in the year under review are 20 times higher than that of the other 95 % of insured persons. High-cost patients are generally more multimorbid and have higher mortality rates. The most common diagnoses of these patients are hypertension, lipoprotein metabolism disorder and back pain. CONCLUSION: Similar to other developed countries, Germany faces the challenge to develop and implement adequate intervention approaches addressing the special requirements of high-cost insured persons. This paper provides a first basis. The analogies of high-cost patients in Germany and other countries illustrate the need for transnational research and intervention approaches on this specific issue. More in-depth work is needed to investigate the potentials of Predictive Modelling and integrated care approaches to the management of this group of insured persons.

A large-scale resource for tissue-specific CRISPR mutagenesis in Drosophila.

Genetic screens are powerful tools for the functional annotation of genomes. In the context of multicellular organisms, interrogation of gene function is greatly facilitated by methods that allow spatial and temporal control of gene abrogation. Here, we describe a large-scale transgenic short guide (sg) RNA library for efficient CRISPR-based disruption of specific target genes in a constitutive or conditional manner. The library consists currently of more than 2600 plasmids and 1700 fly lines with a focus on targeting kinases, phosphatases and transcription factors, each expressing two sgRNAs under control of the Gal4/UAS system. We show that conditional CRISPR mutagenesis is robust across many target genes and can be efficiently employed in various somatic tissues, as well as the germline. In order to prevent artefacts commonly associated with excessive amounts of Cas9 protein, we have developed a series of novel UAS-Cas9 transgenes, which allow fine tuning of Cas9 expression to achieve high gene editing activity without detectable toxicity. Functional assays, as well as direct sequencing of genomic sgRNA target sites, indicates that the vast majority of transgenic sgRNA lines mediate efficient gene disruption. Furthermore, we conducted the so far largest fully transgenic CRISPR screen in any metazoan organism, which further supported the high efficiency and accuracy of our library and revealed many so far uncharacterized genes essential for development.

Twenty years after the release of the sequence of the human genome, the role of many genes is still unknown. This is partly because some of these genes may only be active in specific types of cells or for short periods of time, which makes them difficult to study. A powerful way to gather information about human genes is to examine their equivalents in 'model' animals such as fruit flies. Researchers can use genetic methods to create strains of insects where genes are deactivated; evaluating the impact of these manipulations on the animals helps to understand the roles of the defunct genes. However, the current methods struggle to easily delete target genes, especially only in certain cells, or at precise times. Here, Port et al. genetically engineered flies that carry CRISPR-Cas9, a biological system that can be programmed to 'cut' and mutate precise genetic sequences. The insects were also manipulated in such a way that the CRISPR elements could be switched on at will, and their quantity finely tuned. This work resulted in a collection of more than 1,700 fruit fly strains in which specific genes could be deactivated on demand in precise cells. Further experiments confirmed that this CRISPR system could mutate target genes in different parts of the fly, including in the eyes, gut and wings. Port et al. have made their collection of genetically engineered fruit flies publically available, so that other researchers can use the strains in their experiments. The CRISPR technology they refined and developed may also lay the foundation for similar collections in other model organisms.

A challenge to all. A primer on inter-country differences of high-need, high-cost patients.

BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Differences in the way that health systems are structured likely explains some of this variation, which suggests the potential of cross-system learning opportunities. Our findings highlight the need for further studies including comparable performance metrics and institutional analysis.

Evidence-based practice guidelines for prescribing home modifications for clients with bariatric care needs.

BACKGROUND/AIM: Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process. METHODS: The study included two phases. Phase 1 conducted a cross-sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits. RESULTS: Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) 'never' or 'rarely' knew rail load capacity. Therapists' knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post-implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers. CONCLUSION: There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing practices to maximise occupational performance for clients with bariatric care needs.

Functionalization of cotton fiber by partial etherification and self-assembly of polyoxometalate encapsulated in Cu3(BTC)2 metal-organic framework.

A combination of a Keggin-type polyoxometalate (POM), [CuPW11O39](5-), with a Cu3(BTC)2 metal-organic framework (MOF-199/HKUST-1; where BTC is benzene-1,3,5-tricarboxylate), was successfully self-assembled on a cellulose substrate (cotton) with a room-temperature process. Cotton fibers were functionalized by partial etherification. Cu3(BTC)2 metal-organic framework and polyoxometalate encapsulated in Cu3(BTC)2 metal-organic framework were self-assembled on the carboxymethylate ion sites initiated with copper nitrate using ethanol and water as solvents. Octahedral crystals were observed on both MOF-cotton and POM-MOF-cotton; both contained copper while the POM-MOF-cotton also contained tungsten. Occupancy of POM in MOF cages was calculated to be about 13%. Moisture content remained at 3 to 4 wt % similar to that of untreated cotton. Reactivity to both hydrogen sulfide and methyl parathion was higher for POM-MOF-cotton due to the Keggin polyoxometalate and the extra-framework cations Cu(2+) ions compensating the charges of the encapsulated Keggins. The POM-MOF material was found to effectively remove 0.089 mg of methyl parathion per mg of MOF from a hexane solution while MOF-cotton removed only 0.054 mg of methyl parathion per mg of MOF.

Effect of plasma etching on destructive adsorption properties of polypropylene fibers containing magnesium oxide nanoparticles.

Dermal absorption of pesticides poses a danger for agricultural workers. Use of personal protection equipment (PPE) is required to provide protection; some of the current PPE involves impermeable barriers. In these barrier materials, the same mechanism that prevents the penetration of toxic chemicals also blocks the passage of water vapor and air from flowing through the material, making the garments uncomfortable. Fibers that degrade organophosphate pesticides, such as methyl parathion, were developed by incorporating metal oxides. These modified fibers can be incorporated into conventional fabric structures that allow water vapor to pass through, thereby maintaining comfort. Fibers with self-decontamination functionality were developed by incorporating magnesium oxide (MgO) nanoparticles into a polypropylene (PP) melt-extruded fiber. These fibers were then treated with plasma etching to expose increased surface area of the MgO nanoparticles. Three steps were involved in this research project: (1) determining the reactivity of MgO and methyl parathion, (2) making melt-spun MgO/PP fibers, and (3) testing the reactivity of MgO/PP composite fibers and methyl parathion. It was confirmed that MgO stoichiometrically degrades methyl parathion by way of destructive adsorption. The etching of the PP fibers containing MgO nanoparticles increased the chemical accessibility of MgO reactive sites, therefore making them more effective in degrading methyl parathion. These fibers can enhance the protection provided by PPE to agricultural and horticultural workers and military personnel.

Metal ion-mediated nitric oxide generation from polyurethanes via covalently linked copper(II)-cyclen moieties.

Polyurethanes are widely used in the manufacturing of biomedical catheters and other blood-contacting devices; however, thrombus formation still occurs, which renders these catheters ineffective unless systemic anticlotting agents are used. Nitric oxide (NO) is a well-known inhibitor of platelet activity. In the current study, two commercially available medical polyurethanes (Pellethane and Tecophilic) were derivatized to possess NO-generating Cu(II)-cyclen moieties pendant to the polymer backbone. A new three-step synthetic approach is used, that is simpler than a recently reported method to prepare Cu(II)-cyclen-polyurethane materials. Both derivatized polyurethanes were found to produce NO at levels at or above those of endothelial cells. A comparison between the modified commercial polyurethanes (hydrophobic vs. hydrophilic) is presented, including the synthetic scheme, extensive characterization, and coating application. These derivatized polymers may serve as useful coatings to prevent clotting on the surface of catheters and other blood-contacting biomedical devices.