C-36 Montreal Cognitive Assessment for Dementia Severity Rating in a Diagnostically Heterogeneous Clinical Cohort

Objective The Mini Mental State Exam (MMSE) has enjoyed widespread use as a dementia severity staging instrument (Perneczky et al., 2006). More recently, the Montreal Cognitive Assessment (MoCA; Nasreddine, 2005) has been advanced as a potentially superior measure with enhanced sensitivity to Mild Cognitive Impairment (MCI). To the authors’ knowledge, there are no published guidelines for staging dementia severity with the MoCA. The aim of this study was to evaluate the utility of the MoCA for dementia severity staging. Method Participants (N = 162) were drawn from a diagnostically heterogeneous retrospective sample of referrals to a multidisciplinary memory clinic. Participants were categorized as MCI, mild dementia, or moderate dementia using the Quick Dementia Rating System (QDRS) sum of boxes score. Receiver operating characteristics of the MoCA were calculated using MATLAB and optimal cutpoints were determined using Youden’s Index. Results The MoCA demonstrated some utility in differentiating MCI from all severity dementia as defined by the QDRS, with an optimal cutpoint of 17 (AUC = .75). Cut points of 17 and 14 best separated MCI from mild dementia (AUC = .72) and mild from moderate dementia (AUC = .66), respectively. These cutpoints were associated with modest sensitivity (.50 - .53) and reasonable specificity (.76 - .87). Average diagnostic accuracy was 69.5%. Conclusions This study suggests that the MoCA has some utility for dementia severity staging. Future work should replicate these findings in other clinical cohorts. The use of the QDRS (an informant report measure) as the severity criterion is a significant limitation of the present study.

A missing cornerstone in the Norwegian Priority Commission’s weighting scheme – Sub-treatment balancedness is a necessary property for priority setting criteria

The Norwegian government recently put in place a priority commission tasked with suggesting a set of explicit criteria for priority setting in the health care sector. The commission suggested three criteria, the first two of which equate to cost-effectiveness, where, essentially, the gain is measured in terms of Quality Adjusted Life Years (QALYs). The third criteria specifies that the number of QALYs be multiplied by a factor depending on the total health loss – also measured in QALYs – without the treatment in question.In this paper, we will show that the suggested weighting scheme creates contradictory situations in which the priority of treatment programmes will change based on arbitrary bundling (where two or more treatments are combined into one) or sub-divisions (where a treatment is split up into two or more components.)We show that these types of problems can be avoided or ameliorated if the QALY weighting scheme satisfies a property which we call sub-treatment balanced – informally, that the total weighted QALY gain is preserved when treatments are bundled or sub-divided. To our best knowledge, this property has not previously been discussed in the priority setting literature.We demonstrate that sub-treatment balance can easily be achieved in general, and in particular we show how to adapt the weighting scheme suggested by the Norwegian priority commission in order to satisfy this sub-treatment balance. Finally, we argue that any weighting scheme used in health care priority setting should be sub-treatment balanced with respect to any other attribute of a treatment which policy makers would want to take into account when making their decisions.At the time of writing, the Norwegian government has yet to conclude on a final set of criteria for prioritization, and a task-group, lead by professor Jon Magnussen, is re-evaluating the severity criterion suggested by the priority commission. However, sub-treatment balance is still relevant, as it should be required of any weighing scheme, and is crucial given that (i) the criterion results in weighting QALYs, and (ii) if the selected measure of severity is affected by the administered treatment. Published: Online November 2015. In print August 2016.

Characterization of Topside Mechanical Damage

Mechanical damage, such as gouge, is the damage to the pipe surface caused by external forces and is usually caused by third-party damage during construction and excavation. This normally results in a highly deformed, work hardened surface layer with possible metal removal. In many cases, dents are coincident with gouges. Industry standards and regulators treat this type of mechanical damage as critical and require immediate investigation. Therefore, from a pipeline operator perspective, distinguishing between plain dent and dent with gouge is a great challenge for topside dents because quite often they are caused by un-authorized third party activity and contain gouge. In a previous study[1,2], the present authors developed an approach that combines dent strain-severity criterion with MFL signal recognition to identify dent with gouge and crack. In this paper, an extension of the previous study to topside dents is presented. The enhanced approach for distinguishing between plain dents and dent with gouge/crack for topside dents is summarized. Case studies are given to demonstrate the effectiveness of the approach for identify topside dent with gouge.

The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification

Introduction: Allergic rhinitis (AR) is a common disease with major socieconomic burden and a significant impact on quality of life. Objective: The objective of the study was to assess the impact of AR severity, using the modified ARIA (m-ARIA) severity criterion in order to discriminate among moderate and severe AR, in symptoms and quality of life assessed with the questionnaire ESPRINT-15. Methods: The specific quality of life questionnaire (ESPRINT-15) was applied in over thousand untreated RA patients. Severity was evaluated by the m-ARIA classification, which categorizes AR as mild, moderate, and severe. Nasal symptoms were evaluated by using categorized (none, low, middle, and high) Total Four Symptom Score (T4SS). Results: Using the m-ARIA severity classification, significant differences in quality of life, both global score and specific domains, and categorized T4SS were found among the AR severity groups. Conclusion: Modified ARIA severity classification in mild, moderate, and severe allergic rhinitis clearly discriminates the impact of AR in all domains of quality of life and categorized symptom`s score.

The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification

Introduction: Allergic rhinitis (AR) is a common disease with major socieconomic burden and a significant impact on quality of life. Objective: The objective of the study was to assess the impact of AR severity, using the modified ARIA (m-ARIA) severity criterion in order to discriminate among moderate and severe AR, in symptoms and quality of life assessed with the questionnaire ESPRINT-15. Methods: The specific quality of life questionnaire (ESPRINT-15) was applied in over thousand untreated RA patients. Severity was evaluated by the m-ARIA classification, which categorizes AR as mild, moderate, and severe. Nasal symptoms were evaluated by using categorized (none, low, middle, and high) Total Four Symptom Score (T4SS). Results: Using the m-ARIA severity classification, significant differences in quality of life, both global score and specific domains, and categorized T4SS were found among the AR severity groups. Conclusion: Modified ARIA severity classification in mild, moderate, and severe allergic rhinitis clearly discriminates the impact of AR in all domains of quality of life and categorized symptom`s score.

Dynamic Severity Criterion for Designing Against High Cycle Fatigue

A novel approach to the interpretation of material behavior under cyclic loading is presented. In this approach a nondimensional criterion, featuring the dynamic severity of applied load, is put forward with a view to the provision of simple though confident assessment of component performance under dynamic load. The fatigue diagram based on the proposed criterion displays significant merits over previous diagrams, the presented approach thus providing an effective tool for designing against high cycle fatigue with due consideration to maximum utilization of material.