Prediction of Autonomy Loss in Alzheimer’s Disease

The evolution of functional autonomy loss leads to institutionalization of people affected by Alzheimer’s disease (AD), to an alteration of their quality of life and that of their caregivers. To predict loss of functional autonomy could optimize prevention strategies, aids and cost of care. The aim of this study was to develop and to cross-validate a model to predict loss of functional autonomy as assessed by Instrumental Activities of Daily Living (IADL) score. Outpatients with probable AD and with 2 or more visits to the Clinical and Research Memory Centre of the University Hospital were included. Four Tree-Augmented Naïve bayesian networks (6, 12, 18 and 24 months of follow-up) were built. Variables included in the model were demographic data, IADL score, MMSE score, comorbidities, drug prescription (psychotropics and AD-specific drugs). A 10-fold cross-validation was conducted to evaluate robustness of models. The study initially included 485 patients in the prospective cohort. The best performance after 10-fold cross-validation was obtained with the model able to predict loss of functional autonomy at 18 months (area under the curve of the receiving operator characteristic curve = 0.741, 27% of patients misclassified, positive predictive value = 77% and negative predictive value = 73%). The 13 variables used explain 41.6% of the evolution of functional autonomy at 18 months. A high-performing predictive model of AD evolution of functional autonomy was obtained. An external validation is needed to use the model in clinical routine so as to optimize the patient care.

Comparison of Different Approaches to Operationalize Fried’s Phenotypic Frailty in the NuAge Cohort

Many operationalization approaches were proposed to identify frailty in older adults. The common use of Fried’s original criteria or other cut-offs based on cohort distribution may not apply in every cohort leading to potential bias in the identification of frail individuals. We thus aimed to apply different Fried’s phenotypic frailty operationalization approaches in the Quebec NuAge cohort of generally healthy community-dwelling older adults (n=1,753; aged 67-84 years), and longitudinally compare prevalence, incidence and predictive strength on outcomes, such as functional autonomy, falls, hospitalization and mortality. Significant variability in prevalence, classification agreement and predictive strengths were observed between approaches, notably using different types of distribution cut-offs, variables, or ways to handle missing data. This strategy helped us to prioritize a specific Fried’s phenotypic frailty operationalization in NuAge, which could then be used in secondary research projects aiming to study determinants of Fried’s phenotypic frailty and its role in health outcomes.

Psychological Correlates of (Non)Use of Formal Resources by Family Caregivers of People With Dementia

Caring for a relative with dementia is a stressful task characterized by a high number of demands extended in time. Therefore, caregivers frequently report the need for assistance to cope with the situation. However, formal resources use is low among that population. The objective of this study was to explore the correlates of (non)use of formal resources (day care center and home care) by family caregivers of people with dementia. Participants were 225 dementia family caregivers that were individually assessed in a) use of formal resources, b) sociodemographic variables, c) stressors (frequency and reaction to behavioral problems), and d) psychological variables (depression, anxiety, and dysfunctional thoughts about caregiving). A logistic regression was done comparing those who used formal resources with those who did not use them. Caregivers who did not use formal resources were younger (OR = .95; 95% CI [.92 - .98]), devoted more daily hours to caring (OR = 1.07; 95% CI [1.02 - 1.11]), reported higher levels of dysfunctional thoughts about caregiving (OR = 1.07; 95% CI [1.04 – 1.10]) and higher anxiety levels (OR = 1.07; 95% CI [1.00- 1.13]), and their care-recipient had a higher functional autonomy (OR = 1.04; 95% CI [1.02 – 1.05]). Higher levels of anxiety and dysfunctional thoughts in caregivers may be act as barriers to seek for formal support. Targeting these variables may help to increase the use of formal resources by family caregivers of people with dementia.

Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses

Background Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. Methods A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. Results The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features—with implications towards prosthesis design tradeoffs. Conclusions This study’s findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.

Genomic organization of the autonomous regulatory domain of eyeless locus in Drosophila melanogaster

In Drosophila, expression of eyeless (ey) gene is restricted to the developing eyes and central nervous system. However, the flanking genes, myoglianin (myo), and bent (bt) have different temporal and spatial expression patterns as compared to the ey. How distinct regulation of ey is maintained is mostly unknown. Earlier, we have identified a boundary element intervening myo and ey genes (ME boundary) that prevents the crosstalk between the cis-regulatory elements of myo and ey genes. In the present study, we further searched for the cis-elements that define the domain of ey and maintain its expression pattern. We identify another boundary element between ey and bt, the EB boundary. The EB boundary separates the regulatory landscapes of ey and bt genes. The two boundaries, ME and EB, show a long-range interaction as well as interact with the nuclear architecture. This suggests functional autonomy of the ey locus and its insulation from differentially regulated flanking regions. We also identify a new Polycomb Response Element, the ey-PRE, within the ey domain. The expression state of the ey gene, once established during early development is likely to be maintained with the help of ey-PRE. Our study proposes a general regulatory mechanism by which a gene can be maintained in a functionally independent chromatin domain in gene-rich euchromatin.

Essential Characteristics of a Primary School Teacher as a Subject of Creative Pedagogical Activity

The article describes and analyzes three key aspects of the personality of a primary school teacher as a subject of creative pedagogical activity - Requirements for the personality of a modern primary school teacher, subjectivity of a primary school teacher in scientific discourse and activity components as a basis of professional subjectivity of a primary school teacher. The purpose of the article is to summarize the experience of Western and Eastern European scholars on the modern view of the components and activities of the subjectivity of the teacher of this profession in order to increase its didactic and educational effectiveness. It’s proved that the subjectivity of the primary school teacher is defined as a complex functional autonomy of the system, which is formed, developed, built and transformed by him in the process of life, acquisition of pedagogical education and experience of pedagogical activity. Such subject-oriented manifestations of the teacher's personality as activity (ability to conscious self-determination of creative pedagogical activity) are described; productivity (its complex ability, on the one hand, to transform the educational reality in the classroom into a humane educational environment and the student in the subject of creative learning, and on the other - to constant subjective, professional and professional self-development and self-improvement in teaching, improving the results of their activities and themselves as a subject of pedagogical activity.

The SEEKING Drive and Its Fixation: A Neuro-Psycho-Evolutionary Approach to the Pathology of Addiction

Neuro-ethological studies conducted by Panksepp and his colleagues have provided an understanding of how the activity of the mesolimbic dopaminergic (ML DA) system leads to the emotional disposition to SEEK/Explore, which is involved in all appetitive motivated behavior and mental activity. In pathological addiction phenomena, this emotional disposition “fixes” itself on certain obsessive-compulsive habits, losing its versatility and its natural predisposition to spontaneous and unconditioned activation. Overall, the result is a consistent disinterest in everything that is not the object of addiction. From a neuro-psycho-evolutionary point of view, the predisposition to develop addictive behavior can be attributed to a loss of “functional autonomy” of the SEEKING/Explorative disposition. Indeed, as shown by animal and human studies, the tendency to be conditioned by situations and contexts that provide an immediate reward can be closely related to a deficit in the tonic endogenous activity of the ML DA-SEEKING system.

„Underwater Reefs” of Democracy

The aim of the article is to discuss the problems of transition from autocraty to democracy. The author analyzing so called “underwater reefs” of democracy marks our internal and extremal dilemmas: oligarchy, self-elimination, “cycling” in politics, functional autonomy, interdependence. The article especially underlines and describes those terma which define the weakness of democracy in the process of transformation: Avolding difficult decisions by politicians due to pressure from interest groups or fear of losing the election Exercising the freedom gained by democracy by interest groups, lobbyists who seek to raise more funds through tax or budget subsidies manipulating very impotant problems for the country as a tool of political struggle failure to keep promises, especially during elections dividing democracy into common and local spheres competent, application structure of the state administration. It also confirms the idea that to elaborate and to carry out of effective political course is available only on the basis of serious empirical research of those problems discussed in the article and the results of these researches.