(SP-1224: t. 5; 1. 40'0"; b. 13'0"; dr. 2'6"; a 6 k.; cpl. 6a. 1 1-pdr.)
Onset a wooden motor boat built by Hacketts, Bayonne, N. J. in 1888 and rebuilt in 1910, was acquired by the Navy 15 June 1917 from W. H. Steelman, Chineoteague, Va. for use on patrol in the 5th Naval District during World War I. Operating out of Norfolk, she performed patrol duties until she decommissioned and was returned to her owner 21 December 1918.
The natural history of secondary progressive multiple sclerosis
Background: The onset of secondary progression is a pivotal event in the course of relapsing-remitting (RR) multiple sclerosis (MS). Patients with secondary progressive MS (SPMS) experience continuous worsening of symptoms independent of the occurrence of relapses. Possible risk factors associated with the onset of SPMS remain under investigated in natural history studies of MS disease course.
Methods: We used Kaplan-Meier survival analyses and Cox regression models to investigate the influence of gender, onset age and onset symptoms on time to and age at SPMS in British Columbia (BC) MS patients with a RR disease onset who were not exposed to immunomodulatory drugs.
Results: Of 5778 patients in the BCMS database with definite MS, 5207 (90%) had an RR onset. Median time to SPMS was 21.4 years (95% CI 20.6 to 22.2), reached at a median age of 53.7 years (95% CI 53.1 to 54.3). Male gender and motor onset symptoms were associated with a shorter time to and a younger age at SPMS. A younger age at disease onset was associated with a longer time to SPMS but also with a younger age at secondary progression. Other onset symptoms were not associated with time to, or age at, SPMS.
Conclusions: We identified three factors influencing the onset of SPMS in untreated patients with RRMS: motor onset symptoms and male gender were associated with both a shorter time to and a younger age at SPMS. A younger age at disease onset should not be viewed as indicating a better prognosis.
What to know about adult-onset asthma
Adult-onset asthma is asthma that develops in adulthood. In most cases, people develop asthma during childhood, though it can arise at any age.
According to the American Lung Association (ALA), 1 in 12 adults has asthma.
Asthma is a chronic lung disease that leads to problems breathing. It causes narrowing and inflammation of the airways and increased mucus production.
In this article, we provide an overview of adult-onset asthma, including its possible causes, symptoms, and treatments.
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Doctors are not sure why asthma develops in some adults, but certain factors, such as exposure to chemicals or irritants in the workplace, can cause adult-onset asthma.
According to the ALA, 1 in 6 cases of adult-onset asthma occurs due to occupational exposures. Substances that cause asthma symptoms are called asthmagens.
Adults between 45 and 64 years of age have the highest rates of work-related asthma.
Another possible cause is allergies. Allergies trigger at least 30% of cases of adult asthma.
Various allergens may trigger asthma symptoms in adults. Common allergens include:
Similar to asthma that develops in childhood, symptoms of adult-onset asthma may include the following:
Childhood and adult asthma have several similarities, such as symptoms and standard treatment, but there are also differences.
The severity of symptoms can vary in both children and adults.
Asthma that develops in childhood often involves symptoms that come and go. In adult-onset asthma, symptoms are more likely to be persistent and less well controlled.
Adults that develop asthma may have faster lung-function decline that children. Adults, especially by middle age, may have stiffening of the chest wall, which can make treating asthma more difficult.
Adults are also at a higher risk of death due to asthma than children. According to the American Academy of Allergy, Asthma, and Immunology, 3,615 people died due to asthma in 2015. Almost all of these people were over 18 years old.
The reasons why adults have a higher rate of asthma-related death are not clear. It may be because symptoms tend to be less well controlled than children or because of a delay in diagnosis.
it is vital to get an accurate diagnosis of adult-onset asthma in order to develop the most effective treatment plan.
In many cases, adult-onset asthma takes longer to diagnose than asthma in childhood. This is partly due to confusion with other conditions that occur in adults but are rare in children. For example, asthma that develops in adulthood is sometimes confused with chronic obstructive pulmonary disease (COPD).
Doctors can diagnose adult-onset asthma through a physical exam, medical history, and lung-function tests. A lung-function test involves a series of breathing tests that measure how much air a person can inhale and exhale.
People can treat adult-onset asthma with a combination of lifestyle changes and medications. Everyone has their own treatment plan with asthma.
Adults are more likely than children to have other medical conditions as well, which is a consideration when developing an asthma treatment plan.
A comprehensive treatment plan often includes:
Treatment for most types of asthma includes bronchodilators. Different types of bronchodilators are available, including long-acting and fast-acting ones. Both types can play a role in the management of asthma.
Fast-acting bronchodilators, such as albuterol, work by relaxing the muscles of the airways. As the muscles relax, the airways widen, making breathing easier. People take fast-acting bronchodilators via an inhaler or through a nebulizer. The medications reduce sudden symptoms, such as wheezing and shortness of breath.
People can also use long-acting bronchodilators to manage adult-onset asthma. These drugs also relax the airways, but they last longer than fast-acting inhalers. Instead of treating sudden symptoms, they prevent symptoms.
In some instances, people can also use inhalers that contain corticosteroids to treat adult-onset asthma. Steroids decrease airway inflammation.
Inhalers that contain corticosteroids do not treat sudden symptoms. Instead, they decrease the frequency of symptoms.
In some cases, treatment includes oral steroids. However, oral steroids may increase blood sugar levels and possibly worsen other conditions, such as glaucoma and osteoporosis, which can occur in adulthood.
One of the most important factors that influences the severity of the disease is cigarette smoking.
A 2014 study looked at the factors affecting asthma severity in 128 adults with new onset of adult asthma.
After two years, researchers assessed changes in asthma severity, using the Global Initiative for Asthma Score. They noticed the following changes:
- asthma severity increased in 13.3% of the people
- severity decreased in 41.4% of people
- cigarette smoking predicted the worsening of symptoms
Daily prevention of asthma involves taking medications as prescribed. It is also vital to monitor symptoms every day and recognize signs of a flare-up.
Treating symptoms as soon as possible helps get asthma exacerbations under control, preventing life-threatening situations.
Decreasing exposure to lung irritants and allergens is also part of a daily asthma prevention plan.
People may benefit from keeping a daily log of the severity of their symptoms and exposures to different irritants to determine a connection. Reducing exposure to known allergens, as much as possible, helps decrease symptoms.
Certain factors may put a person at an increased chance of developing asthma as an adult:
- having asthma as a child that disappeared in early adulthood
- having allergies as an adult
- hormonal fluctuations, such as those occurring in pregnancy and menopause , which can increase severity of asthma symptoms and risk of hospitalization
The outlook for adult-onset asthma varies. Adult-onset asthma can involve more persistent symptoms than in children, which may mean a worse prognosis.
Following an asthma action plan may decrease flare-ups and help people manage the condition. An asthma treatment plan often includes medication and lifestyle changes.
Adults who develop symptoms of asthma should work closely with their healthcare provider to learn more about their condition and management strategies.
For most people with early-onset Alzheimer disease, the symptoms closely mirror those of other forms of Alzheimer disease.
Forgetting important things, particularly newly learned information or important dates
Asking for the same information again and again
Trouble solving basic problems, such as keeping track of bills or following a favorite recipe
Losing track of the date or time of year
Losing track of where you are and how you got there
Trouble with depth perception or other vision problems
Trouble joining conversations or finding the right word for something
Misplacing things and not being able to retrace your steps to find it
Increasingly poor judgment
Withdrawal from work and social situations
Changes in mood and personality
Severe mood swings and behavior changes
Deepening confusion about time, place, and life events
Suspicions about friends, family, or caregivers
Trouble speaking, swallowing, or walking
Relationship of age of onset and family history in Parkinson disease
Background: The aim of this study was to determine whether age of onset of Parkinson disease (PD) is associated with differences in PD risk and PD age of onset in parents and siblings.
Methods: Clinical and detailed family history data were available for 1,114 PD probands.
Results: Proband age of onset was not associated with differences in PD prevalence or PD age of onset in parents. Proband age of PD onset <50, compared with ≥ 50 years, was associated with significantly greater risk of PD in siblings (hazard ratio: 2.4 P=0.002 95% confidence interval: 1.4, 4.1), and proband age of onset was significantly correlated with sibling age of onset (Somer's D=0.20 P=0.018).
Conclusions: Proband age of PD onset is not associated with differences in parental PD risk. Siblings of PD patients with onset before age 50 are at increased risk of PD and are more likely to have early-onset disease.
Keywords: Parkinson disease age of onset familial aggregation family history genetics.
A family history of diabetes determines poorer glycaemic control and younger age of diabetes onset in immigrants from the Middle East compared with native Swedes
Aims: Immigrant populations from the Middle East develop diabetes earlier than indigenous European populations however, the underlying etiology is poorly understood. This study looked at the risk factors associated with early diabetes onset and, in non-diabetics, glycaemic control in immigrants from Iraq compared with native Swedes.
Methods: This cross-sectional population-based study comprised 1398 Iraqi immigrants and 757 Swedes (ages 30-75years) residing in the same area of Malmö, Sweden. Outcomes were age at diabetes onset and glycaemic control (HbA1c) as assessed by Cox proportional hazards and linear regression, respectively.
Results: In Iraqis vs Swedes, clustering in the family history (in two or more relatives) was more prevalent (23.2% vs 3.6%, P<0.001) and diabetes onset occurred earlier (47.6years vs 53.4years, P=0.001). Having an Iraqi background independently raised the hazard ratio (HR) for diabetes onset. Diabetes risk due to family history was augmented by obesity, with the highest HRs observed in obese participants with clustering in the family history (HR: 5.1, 95% CI: 3.2-8.2) after adjusting for country of birth and gender. In participants without previously diagnosed diabetes (Iraqis: n=1270 Swedes: n=728), HbA1c levels were slightly higher in Iraqis than in Swedes (4.5% vs 4.4%, P=0.038). This difference was explained primarily by clustering in the family history rather than age, obesity, lifestyle or socioeconomic status.
Conclusion: The study shows that the greater predisposition to diabetes in Middle Eastern immigrants may be explained by a more extensive family history of the disorder clinical interventions tailored to Middle Eastern immigrants with such a family history are thus warranted.
Keywords: Diabetes onset Heredity Hyperglycaemia Immigrant Middle East.
Large study explores age of onset of frontotemporal dementia by genetics, family history
Frontotemporal disorders — a family of diseases that can affect thinking, behavior and language — are the most common cause of dementia in people younger than 60. There is a strong genetic component to frontotemporal dementias (FTDs). One-third of FTD cases are inherited, meaning family members with the genetic mutation will also develop the disease. But there’s large variation in when symptoms first appear.
Scientists recently combined data from multiple observational studies in the U.S., Europe, Canada and Australia to explore how genetics and family history relate to age of onset and disease duration in frontotemporal dementia. The findings were published in Lancet Neurology.
The study analyzed data from 3,403 individuals, from almost 1,500 families, who had genetic mutations in one of three main genes associated with genetic frontotemporal dementia (FTD): MAPT, GRN and C9orf72. Data were collected from published papers and from the Frontotemporal Dementia Prevention Initiative, which connects several natural history cohort studies of people with FTD, including the ALLFTD study, which is jointly supported by NIA and the National Institute of Neurological Disorders and Stroke (NINDS).
The researchers looked at age of onset and death, disease duration and relationship with parental age of onset among the three different sets of mutations.
|MAPT (791 people)||GRN (1,179 people)||C9orf72 (1,433 people)|
|Age at symptom onset (mean)||49.5 years||61.3 years||58.2 years|
|Age at death (mean)||58.5 years||68.8 years||65.3 years|
|Disease duration (mean)||9.3 years||7.1 years||6.4 years|
Results showed that people with MAPT mutations were younger at symptom onset and death than people in the GRN and C9orf72 groups. However, age of onset ranged from 17 years to the 80s for people with MAPT mutations and from the 20s to the 90s for the other two groups, providing evidence that FTD can occur throughout adulthood, the researchers noted.
They further investigated the impact of individual mutations within the genes. For example, within the MAPT gene, 67 different mutations were included in the study, and the researchers found that one of those mutations (Asn279Lys) was associated with a significantly lower age at symptom onset (43.8 years old) than other MAPT mutations.
Across all genetic mutation groups, age at symptom onset and at death were linked to both parental and mean family ages, but these associations were strongest in the MAPT group.
Understanding the causes of variation in age of onset could provide important clues about what causes FTD. The data also could help inform efforts to test interventions early, before symptoms appear, and to track people as they transition from asymptomatic to symptomatic. But more research is needed on the factors affecting age of onset and disease duration before such findings could be applied to individuals.
Of note, the analysis did not include information on people with genetic FTD who did not have symptoms. Future research might investigate long-living asymptomatic individuals with mutations to better understand modifiers of age at symptom onset.
This research was supported in part by grants from NIA and NINDS (U01AG045390 and U19AG063911).
These activities relate to NIA’s AD+ADRD Research Implementation Milestone 1.M. “Understand phenotypic heterogeneity and natural history.”
If your asthma symptoms are caused by allergies, take steps to control known or potential triggers in your environment.
• Allergy-proof your house for dust, mold, cockroaches, and other common indoor allergens to which you are allergic.
• Reduce your outdoor activities when the pollen count or ozone level is high.
• Choose foods that don’t contribute to your asthma or allergy symptoms.
• Evaluate your workplace for possible allergens and take the necessary steps to reduce your exposure to them.
In order to determine relevant triggers, you may want to seek consultation with an allergist who can further define these triggers.
In addition, anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their internist about getting a pneumonia vaccination.
Abnormalities in chromosome 6q24 as a cause of early-onset, non-obese, non-autoimmune diabetes mellitus without history of neonatal diabetes
Aims: Abnormalities in the imprinted locus on chromosome 6q24 are the most common causes of transient neonatal diabetes mellitus (6q24-related transient neonatal diabetes). 6q24-Related transient neonatal diabetes is characterized by the patient being small-for-gestational age, diabetes mellitus at birth, spontaneous remission within the first few months and frequent recurrence of diabetes after childhood. However, it is not clear whether individuals with 6q24 abnormalities invariably develop transient neonatal diabetes. This study explored the possibility that 6q24 abnormalities might cause early-onset, non-autoimmune diabetes without transient neonatal diabetes.
Methods: The 6q24 imprinted locus was screened for abnormalities in 113 Japanese patients with early-onset, non-obese, non-autoimmune diabetes mellitus who tested negative for mutations in the common maturation-onset diabetes of the young (MODY) genes and without a history of transient neonatal diabetes. Positive patients were further analysed by combined loss of heterozygosity / comparative genomic hybridization analysis and by microsatellite analysis. Detailed clinical data were collected through the medical records of the treating hospitals.
Results: Three patients with paternal uniparental isodisomy of chromosome 6q24 were identified. None presented with hyperglycaemia in the neonatal period. Characteristically, these patients were born small-for-gestational age, representing 27.2% of the 11 patients whose birth weight standard deviation score (SDS) for gestational age was below -2.0.
Conclusions: Abnormalities in the imprinted locus on chromosome 6q24 do not necessarily cause transient neonatal diabetes. Non-penetrant 6q24-related diabetes could be an underestimated cause of early-onset, non-autoimmune diabetes in patients who are not obese and born small-for-gestational age.
Problems of the state of research
These explanations each leave certain problems open:
A. Schellenberg and Šarčević have to claim a true legal state concept, which the National Socialist use of the same word misses. This means that their position is merely a mirror image of the National Socialist position, which rejects the liberal constitutional state as a constitutional state and claims for itself to have the true understanding of the rule of law.
1. In order to counter this mere juxtaposition of assertion and counter-assertion, Schellenberger refers to the shaping that the concept of the rule of law experienced in the "early liberal movement of constitutionalism".
But this still leaves three difficulties: a) No word is immune from suffering shifts in meaning in the course of time. The original meaning is ultimately not a suitable critique. b) Schellenberger ignores the co-shaping that the concept of the rule of law was also influenced by conservative authors in the 19th century. c) Schellenberger avoids the question of how liberal German early and (later) national liberalism were.
2. Šarčević avoids these problems by making a logical argument instead: A meaningful concept of the rule of law should have a narrower meaning than the state.
This is undoubtedly true, but the NS position was not: 'All states are constitutional states', but 'Nazi Germany is a constitutional state and, for example, the Weimar Republic was not a constitutional state.' The sense of this National Socialist claim may be criticized, but it did not mean a pointless use of the word “constitutional state”.
The connection that, according to Šarčević, exists between the National Socialist understanding of the rule of law, which he himself describes as “material”, and a “monistic” conception of “state and law [as] identical phenomena” is not entirely clear. Šarčević writes: "His [the National Socialist constitutional state] is made up of the people as a whole" - in contrast to the people of the liberal state, which is fragmented into individuals - "and the leader as the only, concrete embodiment of the people's will and the only source of reason and law." (P. 214) This shows how fatal it is when the law is made dependent only on the vuluntas (on the will) of the legislature and is not also permeated by ratio (reason). (P. 217 f.)
It remains unclear how the appeal to reason is supposed to offer a solution if - as Šarčević himself writes - reason was also claimed for the National Socialist leader. In addition, it is an accurate description that in the National Socialist reality the concretization of the “material” legal (state) content depended on the will of the Führer. But this points to the dilemma of all natural law theories that - contrary to their claim to pure reason, divine revelation or natural evidence - they cannot do without a human authority that enforces the respective definition of the supposedly natural, reasonable, divine etc. law.
Thus, the reference to the Führer principle is an accurate description of National Socialist legal reality, but not an accurate description (and therefore also not a sound basis for criticism) of National Socialist legal theory . Because material rule of law theories in the anti-positivist sense meant by Šarčević represent by definition a dualistic view of state and law: there is a right before and above the state - and so also in the case of the National Socialist constitutional state.
As for all natural law activists, what should be law for the Nazis was not the result of a voluntaristic decision by a legislature
- "The law is not an earthly thing that can be experienced from human laws, but the eternal order of life that is only brought into shape by the law the law should always be in harmony with the moral law in the stars and our breasts." (Nicolai)
- “The law is the soul of every state. The legislation raises it to the light of consciousness . "(Frank)
- “We are rooted in legal life, the law is our element of life. [. ] We know how to separate right and wrong and have no Byzantine or state-absolutist tendencies. Above all, we can differentiate between law and arbitrariness, an empty power ruling from a legal ruling. "(Schmitt)
- “The law [. ] does not arise from the state. [. ]. The law […] is rooted as the people's way of life in the people, is an outflow and expression of the people's spirit . [. ]. The Führer is therefore above all and above all under the duty of loyalty, under the right. "(Lange)
According to Schmitt, Freisler, Lange, Ipsen, the National Socialist constitutional state should not be a legal or legislative state and in Carl Schmitt's notorious essay on the murder of Röhm and others , the Führer does not justify the law, but rather: "The Führer protects the law". In this way, Otto conceptualized by Schweinichen the "leaders will as [. ] will to determine reduction -" and, not - " By reduction of legal"
According to this, it remains unclear how the National Socialist understanding of the relationship between state and law should be described (and rejected) as monistic if it is recognized at the same time that the National Socialist understanding of the rule of law was "material" ( substantialist ).
B. Stolleis avoids the difficulty of having to assert a true concept of the rule of law, but restricts himself to the accusation that the National Socialist actors did not take their “tactical” appeal to the rule of law seriously. With the exception of Carl Schmitt, however, this accusation cannot be substantiated on the basis of the source texts Stolleis himself does not quote any quotes for this either.
C. The position that the National Socialists rightly claimed a substantive understanding of the rule of law is a mirror image of the same problem as Schellenberg: it may be shown that the National Socialist understanding of the rule of law is objectively - mutatis mutandis - in line with earlier and later material understandings of the rule of law . Subjectively, the National Socialist authors - apart from Schmitt's reference to Gneist and Stein and Tatarin-Tarnheyden's to Gierke - claimed that their concept of the rule of law was novelty, not only in relation to its racial theoretical foundation, but also generally not only in relation to the Weimar Republic, but also compared to the 19th century, which was generally subsumed under an undifferentiated term of “liberal”.
- It is scientifically inadequate to accept the National Socialist characterization of the 19th century as liberal and on this basis to assert a qualitative difference between the National Socialist and the pre-Weimar rule of law.
- But it would also be insufficient to simply equate both of the constitutional-monarchical and the National Socialist rule of law because of the non-democratic-parliamentary character. The specific claim to modernity, especially of “conservative revolutionaries” like Carl Schmitt (but also original National Socialists), both in relation to their own present and their retrospective criticism of the 19th century, should be included in a comprehensive analysis of their use of the concept of the rule of law.
Such a comprehensive, historically comparative analysis was not claimed by Hilger, who instead, by declaring, limited himself “to a primarily descriptive approach from which the [National Socialist] views on the concept of the rule of law are to be presented in detail”.
D. Finally, unanswered and not even asked in this clarity is the question of how Carl Schmitt's tendentious change of strategy from a substantialist appropriation of the concept of the rule of law to considering its task can be explained. This is due to the fact that some see Schmitt as a critic of “the” constitutional state par excellence, the second think that Schmitt did not represent a material but a formal concept of the constitutional state before and after National Socialism (according to Schuller), and the third, the Schmitts materially oriented Work out the strategy of appropriation most clearly, overlooked his vacillations in 1935. Ule alone suspects that the change in strategy "was supported by the investigations of his [Schmitt's] pupil Krauss". Hilger, on the other hand, suspects that Schmitt "used Krauss [. ] as a mouthpiece" - but less because of the rule of law itself than in intrigues with Koellreutter. Both assumptions are not supported by sources. Hilger's hypothesis also suffers from the fact that it can explain Krauss's positioning, but does not provide an answer to the underlying question about Schmitt's (re) positioning. -
In the essays by Ule and Schuller, on the other hand, the - each different - apologetic function is particularly striking .