The Test-Retest Reliability of a Clinically-Relevant Dual-Task Assessment in Healthy College Students

Purpose

The dual-task (DT) paradigm consists of concurrent administration of motor and cognitive tasks which may demonstrate improved measurement properties of the included tasks as compared to independent administration. Our study examined the test-retest reliability of a clinically-relevant DT assessment.

Methods

Our prospective cohort study included 60 (53.3% female) healthy, recreationally active college students (Age=20.5–1.34 years; Height=171.7–9.33 cm). Participants completed the Standardized Assessment of Concussion (SAC) and timed tandem gait (TTG) test concurrently for the DT assessment at two time points separated by a two-week test-retest interval. The SAC composite score (45 points) was calculated by summing the domain scores of immediate memory (30 points) which consisted of a 10-word list, concentration (5 points), and delayed recall (10 points). The TTG composite score was calculated by summing the mean time to complete the TTG during each SAC task (3 trials for immediate memory, up to 5 trials for the digits-backwards task, and one trial for the months in reverse order and delayed recall tasks). Mixed-model intraclass correlation coefficients (ICC[3,1]) with 95% confidence intervals were calculated to evaluate test-retest reliability between time points for the SAC and TTG composite scores.

Results

Mean SAC (39.4–3.80 vs. 39.6–3.49 points) and TTG (52.1–9.44 vs. 48.2–8.33 sec) composite scores were observed at time points 1 and 2, respectively. Moderate (ICC[3,1]=0.56 [0.26, 0.74]) and good (ICC[3,1]=0.88 [0.80, 0.93]) test-retest reliability were observed for the SAC and TTG composite scores, respectively.

Conclusion

Test-retest reliability for our DT assessment aligns with previously established values for independent administration of the SAC and TTG.

First fertilizing-value typology of digestates: A decision-making tool for regulation

Defined as the residue from anaerobic digestion (AD), digestate refers to a set of materials with varied biochemical compositions. The objective of this study was to establish a digestate typology according to its fertilizing-value with data from literature and internal unpublished databases. To establish a relatively big database allowing the application of advanced statistics, usual fertilizing-value parameters were used: dry matter, volatile solids, C/N, C/Organic-N, total N (TN), total ammoniacal nitrogen (TAN), TAN/TN, total P and total K. Statistical analysis was performed on a dataset of 91 raw digestates, 34 solid fractions and 25 liquid fractions after separation. The resulting typology outlined that fertilizing-values are linked to AD feedstock and process. As case study regulations, no digestate (without any post-treatment) fulfilled French standards and the latest European Union regulation proposal on fertilizers. Options to reach regulations' product categories were discussed according to the typology. For the first time, a digestate typology was established based on fertilizing value, which can be a useful tool enhancing digestate management and policy making.

Digestate mechanical separation: Efficiency profiles based on anaerobic digestion feedstock and equipment choice

Digestate mechanical separation is present in numerous anaerobic digestion plants. In this study, data from literature and from unpublished analysis were gathered to evaluate digestate separation efficiency for different mechanical separators. For the first time, efficiency indicators allowed the definition of two mass distribution profiles. The low-performance profile was characterized by each component being mainly destined to the liquid fraction, excluding P, Mg and Ca in a few cases. Screw presses represented 68% of these separators and 78% of digestates came from mainly fibrous inputs such as cow manure and silage. In the high-performance profile, digestate compounds were effectively concentrated in the solid fraction, except nitrogen. The great majority of separators were decanting centrifuges, and the anaerobic digestion inputs were principally non-fibrous such as pig slurry, sludge and agro-industrial waste. This study represents a source for benchmarking digestate separation and opens a possibility to forecast more realistically digestate separation performance.

Transcriptional subtyping and CD8 immunohistochemistry identifies poor prognosis stage II/III colorectal cancer patients who benefit from adjuvant chemotherapy

Purpose

Transcriptomic profiling of colorectal cancer (CRC) has led to the identification of four consensus molecular subtypes (CMS1 to 4) that have prognostic value in stage II and III disease. More recently, the Colorectal Cancer Intrinsic Subtypes (CRIS) classification system has helped to define the biology specific to the epithelial component of colorectal tumors; however, the clinical value of these classification systems in the prediction of response to standard-of-care adjuvant chemotherapy remains unknown.

Patients and Methods

Using samples from four European sites, we assembled a novel cohort of patients with stage II and III CRC (n = 156 samples) and performed transcriptomic profiling and targeted sequencing and generated a tissue microarray to enable integrated multiomics analyses. We also accessed data from two published cohorts of patients with stage II and III CRC: GSE39582 and GSE14333 (n = 479 and n = 185 samples, respectively).

Results

The epithelial-rich CMS2 subtype of CRC benefitted significantly from treatment with adjuvant chemotherapy in both stage II and III disease (P = .02 and P < .001, respectively), whereas the CMS3 subtype significantly benefitted in stage III only (P = .001). After CRIS substratification of CMS2, we observed that only the CRIS-C subtype significantly benefitted from treatment with adjuvant chemotherapy in stage II and III disease (P = .0081 and P < .001, respectively), whereas the CRIS-D subtype significantly benefitted in stage III only (P = .0034). We also observed that CRIS-C patients with low levels of CD8⁺ tumor-infiltrating lymphocytes were most at risk for relapse in both stage II and III disease (log-rank P = .0031; hazard ratio, 12.18 [95% CI, 1.51 to 98.58]).

Conclusion

Patient stratification using a combination of transcriptional subtyping and CD8 immunohistochemistry analyses is capable of identifying patients with poor prognostic stage II and III disease who benefit from adjuvant standard-of-care chemotherapy. These findings are particularly relevant for patients with stage II disease, where the overall benefit of adjuvant chemotherapy is marginal.

Characterization and prediction of organic nitrogen biodegradability during anaerobic digestion: A bioaccessibility approach

Prediction of organic nitrogen mineralization into ammonium during anaerobic digestion is required for optimizing substitution of mineral fertilizer by digestates. The aim of this study was to understand organic nitrogen biodegradability and to investigate how it can be predicted from carbon biodegradability, and nitrogen bioaccessibility, respectively. Bioaccessibility was assessed using fractionation methods based on sequential extractions. Results showed that organic nitrogen was present in fractions whose bioaccessibility levels differed. Organic nitrogen and carbon biodegradability were also determined and compared. Results highlighted two groups of substrates: the first with an initial NH₄⁺/TKN < 30%, whose carbon and nitrogen biodegradability are similar; the second with an initial NH₄⁺/TKN > 30%, whose carbon and nitrogen biodegradability differ significantly. To enable prediction on all substrates, partial least square (PLS) regressions were carried out to link organic nitrogen bioaccessibility indicators to biodegradability. The models successfully predicted organic nitrogen biodegradability with a maximum prediction error of 10%.

Barriers to the treatment of childhood tuberculous infection and tuberculosis disease: a qualitative study

SETTING

In 2012, Peru's National TB Program (NTP) reported approximately 2400 incident cases of tuberculosis (TB) disease in children aged <15 years. Peru's TB burden is concentrated in the Lima metropolitan area, particularly in poor districts such as El Agustino and La Victoria, where this study was conducted.

OBJECTIVE

To identify barriers to the treatment of childhood tuberculous infection and TB disease in Lima from the perspective of front-line providers and patients' families.

DESIGN

We conducted 10 semi-structured focus groups with 53 purposefully sampled primary care providers, community health workers, and parents/guardians of pediatric TB patients. We also completed nine in-depth interviews with National TB Program administrators and pulmonologists specializing in TB. Two authors performed inductive thematic analysis and identified emerging themes.

RESULTS

Four main treatment barriers emerged from the data: 1) dosing errors, 2) time- and labor-intensive preparation and administration of medications, 3) provider concern that isoniazid preventive therapy (IPT) generates isoniazid resistance, and 4) poor adherence to IPT.

CONCLUSION

Our findings highlight the urgent need for child-friendly formulations, provider and parent/guardian education about IPT, and strategies to promote adherence to IPT, including support and supervision by health workers and/or regimens with fewer doses.

The structural basis of alpha-tropomyosin linked (Asp230Asn) familial dilated cardiomyopathy

Recently, linkage analysis of two large unrelated multigenerational families identified a novel dilated cardiomyopathy (DCM)-linked mutation in the gene coding for alpha-tropomyosin (TPM1) resulting in the substitution of an aspartic acid for an asparagine (at residue 230). To determine how a single amino acid mutation in α-tropomyosin (Tm) can lead to a highly penetrant DCM we generated a novel transgenic mouse model carrying the D230N mutation. The resultant mouse model strongly phenocopied the early onset of cardiomyopathic remodeling observed in patients as significant systolic dysfunction was observed by 2months of age. To determine the precise cellular mechanism(s) leading to the observed cardiac pathology we examined the effect of the mutation on Ca²⁺ handling in isolated myocytes and myofilament activation in vitro. D230N-Tm filaments exhibited a reduced Ca²⁺ sensitivity of sliding velocity. This decrease in sensitivity was coupled to increase in the peak amplitude of Ca²⁺ transients. While significant, and consistent with other DCMs, these measurements are comprised of complex inputs and did not provide sufficient experimental resolution. We then assessed the primary structural effects of D230N-Tm. Measurements of the thermal unfolding of D230N-Tm vs WT-Tm revealed an increase in stability primarily affecting the C-terminus of the Tm coiled-coil. We conclude that the D230N-Tm mutation induces a decrease in flexibility of the C-terminus via propagation through the helical structure of the protein, thus decreasing the flexibility of the Tm overlap and impairing its ability to regulate contraction. Understanding this unique structural mechanism could provide novel targets for eventual therapeutic interventions in patients with Tm-linked cardiomyopathies.