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Adler C, Ahammed Z, Allgower C, Amonett J, Anderson BD, Anderson M, Averichev GS, Balewski J, Barannikova O, Barnby LS, Baudot J, Bekele S, Belaga VV, Bellwied R, Berger J, Bichsel H, Billmeier A, Bland LC, Blyth CO, Bonner BE, Boucham A, Brandin A, Bravar A, Cadman RV, Caines H, Calderón de la Barca Sánchez M, Cardenas A, Carroll J, Castillo J, Castro M, Cebra D, Chaloupka P, Chattopadhyay S, Chen Y, Chernenko SP, Cherney M, Chikanian A, Choi B, Christie W, Coffin JP, Cormier TM, Cramer JG, Crawford HJ, Csanád M, Deng WS, Derevschikov AA, Didenko L, Dietel T, Draper JE, Dunin VB, Dunlop JC, Eckardt V, Efimov LG, Emelianov V, Engelage J, Eppley G, Erazmus B, Fachini P, Faine V, Filimonov K, Finch E, Fisyak Y, Flierl D, Foley KJ, Fu J, Gagliardi CA, Gagunashvili N, Gans J, Gaudichet L, Germain M, Geurts F, Ghazikhanian V, Grachov O, Grigoriev V, Guedon M, Gushin E, Hallman TJ, Hardtke D, Harris JW, Henry TW, Heppelmann S, Herston T, Hippolyte B, Hirsch A, Hjort E, Hoffmann GW, Horsley M, Huang HZ, Humanic TJ, Igo G, Ishihara A, Ivanshin YI, Jacobs P, Jacobs WW, Janik M, Johnson I, Jones PG, Judd EG, Kaneta M, Kaplan M, Keane D, Kiryluk J, Kisiel A, Klay J, Klein SR, Klyachko A, Konstantinov AS, Kopytine M, Kotchenda L, Kovalenko AD, Kramer M, Kravtsov P, Krueger K, Kuhn C, Kulikov AI, Kunde GJ, Kunz CL, Kutuev RK, Kuznetsov AA, Lakehal-Ayat L, Lamont MAC, Landgraf JM, Lange S, Lansdell CP, Lasiuk B, Laue F, Lebedev A, Lednický R, Leontiev VM, LeVine MJ, Li Q, Lindenbaum SJ, Lisa MA, Liu F, Liu L, Liu Z, Liu QJ, Ljubicic T, Llope WJ, LoCurto G, Long H, Longacre RS, Lopez-Noriega M, Love WA, Ludlam T, Lynn D, Ma J, Ma R, Majka R, Margetis S, Markert C, Martin L, Marx J, Matis HS, Matulenko YA, McShane TS, Meissner F, Melnick Y, Meschanin A, Messer M, Miller ML, Milosevich Z, Minaev NG, Mitchell J, Moiseenko VA, Moore CF, Morozov V, de Moura MM, Munhoz MG, Nelson JM, Nevski P, Niida T, Nikitin VA, Nogach LV, Norman B, Nurushev SB, Odyniec G, Ogawa A, Okorokov V, Oldenburg M, Olson D, Paic G, Pandey SU, Panebratsev Y, Panitkin SY, Pavlinov AI, Pawlak T, Perevoztchikov V, Peryt W, Petrov VA, Planinic M, Pluta J, Porile N, Porter J, Poskanzer AM, Potrebenikova E, Prindle D, Pruneau C, Putschke J, Rai G, Rakness G, Ravel O, Ray RL, Razin SV, Reichhold D, Reid JG, Retiere F, Ridiger A, Ritter HG, Roberts JB, Rogachevski OV, Romero JL, Rose A, Roy C, Rykov V, Sakrejda I, Salur S, Sandweiss J, Saulys AC, Savin I, Schambach J, Scharenberg RP, Schmitz N, Schroeder LS, Schüttauf A, Schweda K, Seger J, Seliverstov D, Seyboth P, Shahaliev E, Shestermanov KE, Shimanskii SS, Shvetcov VS, Skoro G, Smirnov N, Snellings R, Sorensen P, Sowinski J, Spinka HM, Srivastava B, Stephenson EJ, Stock R, Stolpovsky A, Strikhanov M, Stringfellow B, Struck C, Suaide AAP, Sugarbaker E, Suire C, Šumbera M, Surrow B, Symons TJM, Szanto de Toledo A, Szarwas P, Tai A, Takahashi J, Tang AH, Thomas JH, Thompson M, Tikhomirov V, Todoroki T, Tokarev M, Tonjes MB, Trainor TA, Trentalange S, Tribble RE, Trofimov V, Tsai O, Ullrich T, Underwood DG, Van Buren G, VanderMolen AM, Vasilevski IM, Vasiliev AN, Vigdor SE, Voloshin SA, Wang F, Ward H, Watson JW, Wells R, Westfall GD, Whitten C, Wieman H, Willson R, Wissink SW, Witt R, Wood J, Xu N, Xu Z, Yakutin AE, Yamamoto E, Yang J, Yepes P, Yurevich VI, Zanevski YV, Zborovský I, Zhang H, Zhang WM, Zoulkarneev R, Zubarev AN. Erratum: Azimuthal Anisotropy of K_{S}^{0} and Λ+Λ[over ¯] Production at Midrapidity from Au+Au Collisions at sqrt[s]_{NN}=130 GeV [Phys. Rev. Lett. 89, 132301 (2002)]. PHYSICAL REVIEW LETTERS 2021; 127:089901. [PMID: 34477449 DOI: 10.1103/physrevlett.127.089901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 06/13/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.89.132301.
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Adams J, Adler C, Aggarwal MM, Ahammed Z, Amonett J, Anderson BD, Anderson M, Arkhipkin D, Averichev GS, Badyal SK, Balewski J, Barannikova O, Barnby LS, Baudot J, Bekele S, Belaga VV, Bellwied R, Berger J, Bezverkhny BI, Bhardwaj S, Bhaskar P, Bhati AK, Bichsel H, Billmeier A, Bland LC, Blyth CO, Bonner BE, Botje M, Boucham A, Brandin A, Bravar A, Cadman RV, Cai XZ, Caines H, Calderón de la Barca Sánchez M, Carroll J, Castillo J, Castro M, Cebra D, Chaloupka P, Chattopadhyay S, Chen HF, Chen Y, Chernenko SP, Cherney M, Chikanian A, Choi B, Christie W, Coffin JP, Cormier TM, Cramer JG, Crawford HJ, Csanád M, Das D, Das S, Derevschikov AA, Didenko L, Dietel T, Dong WJ, Dong X, Draper JE, Du F, Dubey AK, Dunin VB, Dunlop JC, Dutta Majumdar MR, Eckardt V, Efimov LG, Emelianov V, Engelage J, Eppley G, Erazmus B, Estienne M, Fachini P, Faine V, Faivre J, Fatemi R, Filimonov K, Filip P, Finch E, Fisyak Y, Flierl D, Foley KJ, Fu J, Gagliardi CA, Gagunashvili N, Gans J, Ganti MS, Gaudichet L, Germain M, Geurts F, Ghazikhanian V, Ghosh P, Gonzalez JE, Grachov O, Grigoriev V, Gronstal S, Grosnick D, Guedon M, Guertin SM, Gupta A, Gushin E, Gutierrez TD, Hallman TJ, Hardtke D, Harris JW, Heinz M, Henry TW, Heppelmann S, Herston T, Hippolyte B, Hirsch A, Hjort E, Hoffmann GW, Horsley M, Huang HZ, Huang SL, Humanic TJ, Igo G, Ishihara A, Jacobs P, Jacobs WW, Janik M, Jiang H, Johnson I, Jones PG, Judd EG, Kabana S, Kaneta M, Kaplan M, Keane D, Khodyrev VY, Kiryluk J, Kisiel A, Klay J, Klein SR, Klyachko A, Koetke DD, Kollegger T, Kopytine M, Kotchenda L, Kovalenko AD, Kramer M, Kravtsov P, Kravtsov VI, Krueger K, Kuhn C, Kulikov AI, Kumar A, Kunde GJ, Kunz CL, Kutuev RK, Kuznetsov AA, Lamont MAC, Landgraf JM, Lange S, Lansdell CP, Lasiuk B, Laue F, Lauret J, Lebedev A, Lednický R, LeVine MJ, Li C, Li Q, Lindenbaum SJ, Lisa MA, Liu F, Liu L, Liu Z, Liu QJ, Ljubicic T, Llope WJ, Long H, Longacre RS, Lopez-Noriega M, Love WA, Ludlam T, Lynn D, Ma J, Ma R, Ma YG, Magestro D, Mahajan S, Mangotra LK, Mahapatra DP, Majka R, Manweiler R, Margetis S, Markert C, Martin L, Marx J, Matis HS, Matulenko YA, McShane TS, Meissner F, Melnick Y, Meschanin A, Messer M, Miller ML, Milosevich Z, Minaev NG, Mironov C, Mishra D, Mitchell J, Mohanty B, Molnar L, Moore CF, Mora-Corral MJ, Morozov DA, Morozov V, de Moura MM, Munhoz MG, Nandi BK, Nayak SK, Nayak TK, Nelson JM, Nevski P, Niida T, Nikitin VA, Nogach LV, Norman B, Nurushev SB, Odyniec G, Ogawa A, Okorokov V, Oldenburg M, Olson D, Paic G, Pandey SU, Pal SK, Panebratsev Y, Panitkin SY, Pavlinov AI, Pawlak T, Perevoztchikov V, Perkins C, Peryt W, Petrov VA, Phatak SC, Picha R, Planinic M, Pluta J, Porile N, Porter J, Poskanzer AM, Potekhin M, Potrebenikova E, Potukuchi BVKS, Prindle D, Pruneau C, Putschke J, Rai G, Rakness G, Raniwala R, Raniwala S, Ravel O, Ray RL, Razin SV, Reichhold D, Reid JG, Renault G, Retiere F, Ridiger A, Ritter HG, Roberts JB, Rogachevski OV, Romero JL, Rose A, Roy C, Ruan LJ, Sahoo R, Sakrejda I, Salur S, Sandweiss J, Savin I, Schambach J, Scharenberg RP, Schmitz N, Schroeder LS, Schweda K, Seger J, Seliverstov D, Seyboth P, Shahaliev E, Shao M, Sharma M, Shestermanov KE, Shimanskii SS, Singaraju RN, Simon F, Skoro G, Smirnov N, Snellings R, Sood G, Sorensen P, Sowinski J, Spinka HM, Srivastava B, Stanislaus S, Stock R, Stolpovsky A, Strikhanov M, Stringfellow B, Struck C, Suaide AAP, Sugarbaker E, Suire C, Šumbera M, Surrow B, Symons TJM, Szanto de Toledo A, Szarwas P, Tai A, Takahashi J, Tang AH, Thein D, Thomas JH, Tikhomirov V, Todoroki T, Tokarev M, Tonjes MB, Trainor TA, Trentalange S, Tribble RE, Trivedi MD, Trofimov V, Tsai O, Ullrich T, Underwood DG, Van Buren G, VanderMolen AM, Vasiliev AN, Vasiliev M, Vigdor SE, Viyogi YP, Voloshin SA, Waggoner W, Wang F, Wang G, Wang XL, Wang ZM, Ward H, Watson JW, Wells R, Westfall GD, Whitten C, Wieman H, Willson R, Wissink SW, Witt R, Wood J, Wu J, Xu N, Xu Z, Xu ZZ, Yamamoto E, Yepes P, Yurevich VI, Zanevski YV, Zborovský I, Zhang H, Zhang WM, Zhang ZP, Żołnierczuk PA, Zoulkarneev R, Zoulkarneeva J, Zubarev AN. Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]. PHYSICAL REVIEW LETTERS 2021; 127:069901. [PMID: 34420354 DOI: 10.1103/physrevlett.127.069901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 06/13/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.92.062301.
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Anderson M, Dahllöf G, Warnqvist A, Grindefjord M. Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden. Eur Arch Paediatr Dent 2021; 22:947-957. [PMID: 34106458 PMCID: PMC8526475 DOI: 10.1007/s40368-021-00642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Purpose To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs. Methods We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0. Results Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years. Conclusions For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.
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Thomson T, Anderson M, Fikes K, Medina B, Wagner A, Girard I, Suagee-Bedore J. 92 Effects of a novel blend of citrus botanical oils on cortisol concentrations during a trailering test. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Peedell C, Aynsley E, Wood A, Kumar G, Masinghe S, Reynolds J, Huntley C, Blower A, Green J, Bradley J, Veeratterapillay J, Hassani A, Anderson M, Greenhalgh A, Daniel J, Swingler A, Turnbull M, Burke K. PO-0988: Is there a learning curve for SABR that affects overall survival outcomes in early stage NSCLC? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Enenkel M, Brown ME, Vogt JV, McCarty JL, Reid Bell A, Guha-Sapir D, Dorigo W, Vasilaky K, Svoboda M, Bonifacio R, Anderson M, Funk C, Osgood D, Hain C, Vinck P. Why predict climate hazards if we need to understand impacts? Putting humans back into the drought equation. CLIMATIC CHANGE 2020; 162:1161-1176. [PMID: 33071396 PMCID: PMC7545810 DOI: 10.1007/s10584-020-02878-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2020] [Indexed: 06/01/2023]
Abstract
Virtually all climate monitoring and forecasting efforts concentrate on hazards rather than on impacts, while the latter are a priority for planning emergency activities and for the evaluation of mitigation strategies. Effective disaster risk management strategies need to consider the prevailing "human terrain" to predict who is at risk and how communities will be affected. There has been little effort to align the spatiotemporal granularity of socioeconomic assessments with the granularity of weather or climate monitoring. The lack of a high-resolution socioeconomic baseline leaves methodical approaches like machine learning virtually untapped for pattern recognition of extreme climate impacts on livelihood conditions. While the request for "better" socioeconomic data is not new, we highlight the need to collect and analyze environmental and socioeconomic data together and discuss novel strategies for coordinated data collection via mobile technologies from a drought risk management perspective. A better temporal, spatial, and contextual understanding of socioeconomic impacts of extreme climate conditions will help to establish complex causal pathways and quantitative proof about climate-attributable livelihood impacts. Such considerations are particularly important in the context of the latest big data-driven initiatives, such as the World Bank's Famine Action Mechanism (FAM).
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Haque R, Lentz S, Skates S, Armstrong M, Anderson M, Alvarado M, Chillemi G, Shaw S, Kushi L, Powell C. Patient acceptability and compliance for ovarian cancer surveillance: Comparing strategies among women with BRCA mutations. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lentz S, Powell C, Haque R, Armstrong M, Anderson M, Chillemi G, Shaw S, Alvarado M, Kushi L, Skates S. Development of a longitudinal combined biomarker algorithm for early detection of ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Anderson M, Schulze K, Cassini A, Plauchoras D, Mossialos E. Strengthening implementation of antimicrobial resistance national action plans. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Antimicrobial resistance is one of the major challenges of our time. Countries use national action plans as a mechanism to build engagement among stakeholders and coordinate a range of actions across human, animal, and environmental health. However, implementation of recommended policies such as stewardship of antimicrobials, infection prevention and control, and stimulating research and development of novel antimicrobials and alternatives remains inconsistent. Improving the quality of governance within antimicrobial resistance national action plans is an essential step to improving implementation. To date, no systematic approach to governance of national action plans on AMR exists. To address this issue, we aimed to develop the first governance framework to offer guidance for both the development and assessment of national action plans on AMR. We reviewed health system governance framework reviews to inform the basic structure of our framework, international guidance documents from WHO, the Food and Agriculture Organization, the World Organisation for Animal Health, and the European Commission, and sought the input of 25 experts from international organisations, government ministries, policy institutes, and academic institutions to develop and refine our framework. The framework consists of 18 domains with 52 indicators that are contained within three governance areas: policy design, implementation tools, and monitoring and evaluation. Countries must engage with a cyclical process of continuous design, implementation, monitoring and evaluation to achieve these aims.
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Angelopoulos V, Tsai E, Bingley L, Shaffer C, Turner DL, Runov A, Li W, Liu J, Artemyev AV, Zhang XJ, Strangeway RJ, Wirz RE, Shprits YY, Sergeev VA, Caron RP, Chung M, Cruce P, Greer W, Grimes E, Hector K, Lawson MJ, Leneman D, Masongsong EV, Russell CL, Wilkins C, Hinkley D, Blake JB, Adair N, Allen M, Anderson M, Arreola-Zamora M, Artinger J, Asher J, Branchevsky D, Capitelli MR, Castro R, Chao G, Chung N, Cliffe M, Colton K, Costello C, Depe D, Domae BW, Eldin S, Fitzgibbon L, Flemming A, Fox I, Frederick DM, Gilbert A, Gildemeister A, Gonzalez A, Hesford B, Jha S, Kang N, King J, Krieger R, Lian K, Mao J, McKinney E, Miller JP, Norris A, Nuesca M, Palla A, Park ESY, Pedersen CE, Qu Z, Rozario R, Rye E, Seaton R, Subramanian A, Sundin SR, Tan A, Turner W, Villegas AJ, Wasden M, Wing G, Wong C, Xie E, Yamamoto S, Yap R, Zarifian A, Zhang GY. The ELFIN Mission. SPACE SCIENCE REVIEWS 2020; 216:103. [PMID: 32831412 PMCID: PMC7413588 DOI: 10.1007/s11214-020-00721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The Electron Loss and Fields Investigation with a Spatio-Temporal Ambiguity-Resolving option (ELFIN-STAR, or heretoforth simply: ELFIN) mission comprises two identical 3-Unit (3U) CubeSats on a polar (∼93∘ inclination), nearly circular, low-Earth (∼450 km altitude) orbit. Launched on September 15, 2018, ELFIN is expected to have a >2.5 year lifetime. Its primary science objective is to resolve the mechanism of storm-time relativistic electron precipitation, for which electromagnetic ion cyclotron (EMIC) waves are a prime candidate. From its ionospheric vantage point, ELFIN uses its unique pitch-angle-resolving capability to determine whether measured relativistic electron pitch-angle and energy spectra within the loss cone bear the characteristic signatures of scattering by EMIC waves or whether such scattering may be due to other processes. Pairing identical ELFIN satellites with slowly-variable along-track separation allows disambiguation of spatial and temporal evolution of the precipitation over minutes-to-tens-of-minutes timescales, faster than the orbit period of a single low-altitude satellite (Torbit ∼ 90 min). Each satellite carries an energetic particle detector for electrons (EPDE) that measures 50 keV to 5 MeV electrons with Δ E/E < 40% and a fluxgate magnetometer (FGM) on a ∼72 cm boom that measures magnetic field waves (e.g., EMIC waves) in the range from DC to 5 Hz Nyquist (nominally) with <0.3 nT/sqrt(Hz) noise at 1 Hz. The spinning satellites (Tspin ∼ 3 s) are equipped with magnetorquers (air coils) that permit spin-up or -down and reorientation maneuvers. Using those, the spin axis is placed normal to the orbit plane (nominally), allowing full pitch-angle resolution twice per spin. An energetic particle detector for ions (EPDI) measures 250 keV - 5 MeV ions, addressing secondary science. Funded initially by CalSpace and the University Nanosat Program, ELFIN was selected for flight with joint support from NSF and NASA between 2014 and 2018 and launched by the ELaNa XVIII program on a Delta II rocket (with IceSatII as the primary). Mission operations are currently funded by NASA. Working under experienced UCLA mentors, with advice from The Aerospace Corporation and NASA personnel, more than 250 undergraduates have matured the ELFIN implementation strategy; developed the instruments, satellite, and ground systems and operate the two satellites. ELFIN's already high potential for cutting-edge science return is compounded by concurrent equatorial Heliophysics missions (THEMIS, Arase, Van Allen Probes, MMS) and ground stations. ELFIN's integrated data analysis approach, rapid dissemination strategies via the SPace Environment Data Analysis System (SPEDAS), and data coordination with the Heliophysics/Geospace System Observatory (H/GSO) optimize science yield, enabling the widest community benefits. Several storm-time events have already been captured and are presented herein to demonstrate ELFIN's data analysis methods and potential. These form the basis of on-going studies to resolve the primary mission science objective. Broad energy precipitation events, precipitation bands, and microbursts, clearly seen both at dawn and dusk, extend from tens of keV to >1 MeV. This broad energy range of precipitation indicates that multiple waves are providing scattering concurrently. Many observed events show significant backscattered fluxes, which in the past were hard to resolve by equatorial spacecraft or non-pitch-angle-resolving ionospheric missions. These observations suggest that the ionosphere plays a significant role in modifying magnetospheric electron fluxes and wave-particle interactions. Routine data captures starting in February 2020 and lasting for at least another year, approximately the remainder of the mission lifetime, are expected to provide a very rich dataset to address questions even beyond the primary mission science objective.
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Petit KM, Zynda AJ, Anderson M, Tomczyk CP, Covassin T. A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion.
Method
Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05.
Results
Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86).
Conclusions
Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.
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Zynda AJ, Petit KM, Anderson M, Tomczyk CP, Covassin T. A-49 To Nap or Not to Nap? The Influence of Napping on Recovery Outcomes Following Concussion. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To determine the influence of nap frequency on daily symptom severity and recovery time following concussion in college students.
Method
A prospective study of college students within 72 hours of a diagnosed concussion was performed. Participants reported nap occurrence (yes/no) and daily concussion symptoms using the Post-Concussion Symptom Scale (PCSS) for six days. Participants were categorized into frequent (>2 naps) and infrequent (<3 naps) nap groups. Recovery time was defined as total days from injury to unrestricted medical clearance. A mixed between-within ANOVA evaluated changes in daily symptom severity between nap groups, while Spearman’s Rank Correlation assessed the relationship between the number of days napping and recovery time.
Results
Thirty-four participants (23 female, 11 male; age = 19.91 ± 1.38 years) were included, with 22 in the infrequent nap group and 12 in the frequent nap group. Average recovery time for the infrequent nap group was 13.85 days compared to 18.8 days in the frequent nap group. There was no significant group x time interaction for daily symptom severity (Wilks’ λ = 0.85, F(5,24) = 0.85, p = 0.53, η2 = 0.15). There was a significant main effect for time, with daily symptom severity improving following concussion (Wilks’ λ = 0.31, F(5,24) = 10.66, p < 0.001, η2 = 0.69), but there was no significant group effect (F(1,28) = 0.79, p = 0.38, η2 = 0.03). Overall, the more naps taken, the longer the recovery time (Rs = 0.46, p = 0.01).
Conclusions
Findings from the present study suggest that frequent napping does not affect symptom severity following concussion. Further research is needed to elucidate the association between the number of naps and recovery time.
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Anderson M, Zynda AJ, Petit KM, Tomczyk CP, Covassin T. A-01 Comparing State Anxiety Between Concussed Athletes with and without a History of Sport Related Concussion. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To compare state anxiety between concussed athletes with and without a history of sport related concussion (SRC).
Method
This study utilized a cross-sectional design. The State Trait Anxiety Inventory (STAI) was administered to athletes within 72 hours of SRC diagnosis. The STAI is a subjective, 40-item inventory that assesses state and trait anxiety; however, this study only examined the state anxiety component. Participants reported how they were feeling at the moment of testing on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much so). State anxiety scores range from 20–80, with higher scores indicating higher levels of state anxiety. An independent samples t-test was used to compare state anxiety between concussed athletes with and without a history of SRC. Statistical significance was set at p < .05.
Results
A total of 104 (18.12 ± 2.5 years; male = 65, female = 39) high school (n = 36) and collegiate (n = 68) athletes completed the STAI within 72 hours of SRC. Fifty-nine (56.7%) concussed athletes had no history of SRC and 45 (43.3%) athletes had a history of one or more SRCs. There was no significant difference in state anxiety between concussed athletes with (37.64 ± 9.22) and without (38.47 ± 9.44) a history of SRC (p = .65).
Conclusions
This study suggests that concussion history does not affect state anxiety after SRC. However, clinicians should continue to assess emotional changes after SRC in order to best manage and treat SRC.
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Bond-Smith D, Seth R, de Klerk N, Nedkoff L, Anderson M, Hung J, Cannon J, Griffiths K, Katzenellenbogen JM. Development and Evaluation of a Prediction Model for Ascertaining Rheumatic Heart Disease Status in Administrative Data. Clin Epidemiol 2020; 12:717-730. [PMID: 32753974 PMCID: PMC7358074 DOI: 10.2147/clep.s241588] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/16/2020] [Indexed: 01/23/2023] Open
Abstract
Background Previous research has raised substantial concerns regarding the validity of the International Statistical Classification of Diseases and Related Health Problems (ICD) codes (ICD-10 I05-I09) for rheumatic heart disease (RHD) due to likely misclassification of non-rheumatic valvular disease (non-rheumatic VHD) as RHD. There is currently no validated, quantitative approach for reliable case ascertainment of RHD in administrative hospital data. Methods A comprehensive dataset of validated Australian RHD cases was compiled and linked to inpatient hospital records with an RHD ICD code (2000-2018, n=7555). A prediction model was developed based on a generalized linear mixed model structure considering an extensive range of demographic and clinical variables. It was validated internally using randomly selected cross-validation samples and externally. Conditional optimal probability cutpoints were calculated, maximising discrimination separately for high-risk versus low-risk populations. Results The proposed model reduced the false-positive rate (FPR) from acute rheumatic fever (ARF) cases misclassified as RHD from 0.59 to 0.27; similarly for non-rheumatic VHD from 0.77 to 0.22. Overall, the model achieved strong discriminant capacity (AUC: 0.93) and maintained a similar robust performance during external validation (AUC: 0.88). It can also be used when only basic demographic and diagnosis data are available. Conclusion This paper is the first to show that not only misclassification of non-rheumatic VHD but also of ARF as RHD yields substantial FPRs. Both sources of bias can be successfully addressed with the proposed model which provides an effective solution for reliable RHD case ascertainment from hospital data for epidemiological disease monitoring and policy evaluation.
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Quandt Z, Young A, Anderson M. Immune checkpoint inhibitor diabetes mellitus: a novel form of autoimmune diabetes. Clin Exp Immunol 2020; 200:131-140. [PMID: 32027018 PMCID: PMC7160652 DOI: 10.1111/cei.13424] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/17/2022] Open
Abstract
Autoimmune diabetes mellitus is a rare but significant side effect of treatment with immune checkpoint inhibitors. Immune checkpoint inhibitor-induced diabetes mellitus (CPI-DM) is characterized by acute onset of dramatic hyperglycemia with severe insulin deficiency and occurrence following exposure to programmed cell death-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors rather than cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors. As a growing number of patients undergo immunotherapy, further understanding of the characteristics of CPI-DM patients is needed for improved prognostic and diagnostic application in order to reduce overall morbidity for this already at-risk population. Additionally, understanding of the features and mechanisms of CPI-DM may contribute to understanding mechanisms of spontaneous type I diabetes mellitus (T1DM). Here, we summarize the clinical features of CPI-DM and interrogate the genetic and cellular mechanisms that may contribute to the disease, as well as the clinical challenges for predicting and treating these patients as increasing cancer immunotherapies reach clinical utility.
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Furfaro D, Aversa M, Shah L, Robbins H, Anderson M, Sonett J, D'Ovidio F, Stanifer B, Kim H, Costa J, Arcasoy S, Benvenuto L. Low Lung Allocation Score Predicts Poor Waitlist Outcomes for Patients on Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cantu E, Bermudez C, Cevasco M, Suzuki Y, Buckley T, Galati V, Majeti N, Benvenuto L, Anderson M, Wille K, Weinacker A, Dhillon G, Orens J, Shah P, Lama V, McDyer J, Snyder L, Palmer S, Hartwig M, Hage C, Singer J, Calfee C, Kukreja J, Greenland J, Ware L, Hsu J, Gallop R, Diamond J, Christie J. Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Elmamoun M, Eraso M, Anderson M, Maharaj A, Coates L, Chandran V, Abogamal A, Adebajo AO, Ajibade A, Ayanlowo O, Azevedo V, Bautista-Molano W, Carneiro S, Goldenstein-Schainberg C, Hernandez-Velasco F, Ima-Edomwonyi U, Lima A, Medina-Rosas J, Mody GM, Narang T, Ortega-Loayza AG, Ranza R, Sharma A, Toloza S, Vega-Espinoza L, Vega-Hinojosa O. International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings. Clin Rheumatol 2020; 39:1839-1850. [PMID: 31950441 PMCID: PMC7237392 DOI: 10.1007/s10067-020-04934-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/26/2019] [Accepted: 01/06/2020] [Indexed: 01/17/2023]
Abstract
Background Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). Process The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). Result ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. Conclusion The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points • The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings. • The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa. • The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-04934-7) contains supplementary material, which is available to authorized users.
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Schwartzberg DM, Anderson M, Esen E, Kirat HT, Remzi FH. Uses of indocyanine green fluorescence imaging technology in complex inflammatory bowel disease surgery - a video vignette. Colorectal Dis 2019; 21:1457-1458. [PMID: 31398270 DOI: 10.1111/codi.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
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Abstract
Objective To determine the challenges, coping strategies and needs of urban and rural Jamaican caregivers of adolescents with diabetes, and suggest ways to assist coping. Methods This qualitative study comprised four focus groups (two urban and two rural) with a total of nineteen caregivers of adolescents with diabetes. Thematic analysis was conducted on the data. Results The main challenges caregivers faced were keeping their children healthy, managing conflict with their children, and financial concerns. They met these challenges with problem-focused and emotion-focused coping strategies. Caregivers used the problem-focused strategies of vigilance, advocacy, minimising their children’s negative emotions, coercion, education, and seeking support, and the emotion-focused strategies of relying on their identity as parents and turning to their faith. Caregivers wanted assistance acquiring medication and equipment, increased diabetes education, and support groups. Discussion More resources should be channelled toward provision of diabetes supplies. Diabetes education is necessary in schools and for the general public. Healthcare practitioners should explore issues beyond diabetes management, such as caregivers’ coping and the caregiver-child relationship. Support groups are needed to facilitate learning. Special attention must be paid to rural areas: rural residents appeared to be in greater need than their urban counterparts.
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Harrington M, Ashton J, Sankarasubramanian S, Anderson M, Cairney S. Losing control: sleep deprivation impairs the suppression of unwanted thoughts. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choga WT, Anderson M, Phinius BB, Mbangiwa T, Bell TG, Seatla KK, Musonda RM, Moyo S, Blackard JT, Gaseitsiwe S. A25 Impact of polymorphism in the hepatitis B surface gene on human leukocyte antigen (HLA) class II. Virus Evol 2019. [PMCID: PMC6735833 DOI: 10.1093/ve/vez002.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
There is still no cure for chronic hepatitis B virus infection (CHBV), a major cause of liver cancers and related malignancies. Elucidating the role of CD4+ T-helper cells in activating immunological responses that clear antigenic peptides during primary HBV infection holds a potential strategy for developing potent vaccines. Since the strength of CD4+ T cell responses is dictated by binding of viral epitopes to class-II human leukocyte antigens (HLAs), we hypothesize that the quality of immunological responses in CHBV patients is influenced by host genetics and HBV genotypes. Here, ninety-two non-recombinant complete HBV surface-gene proteins (PreS1/S) from Botswana were sequenced (genotype A 44(47.8%); D 48(52.2%)) and 15-mer binding epitopes restricted to nine HLA-class II molecules (DRB5/1) were mapped in silico. The HLAs used have high population coverage in Botswana. The total predicted epitopes per HLA were 94-(genotype A) and 105-(genotype D) for PreS1, 42 (A and D) for PreS2, and 105 (A and D) for S. Epitope densities (binding peptides to total epitopes) were 3 per cent and 6 per cent (PreS1A&D), 4 per cent and 2 per cent (PreS2A&D), and 23 per cent and 22 per cent (S1A&D). SA&D proteins had most polytopes: CPGYRWMCLRRFII66-81, PGYRWMCLRRFIIF67-82, GYRWMCLRRFIIFL68-83, and YRWMCLRRFIIFLF69-84 binding to 5 (55.6%) HLAs (DRB1*0101/0701/1101/1501 and DRB5*0101) used. HLA-DRB*0101 bound the most epitopes, and the least were bound by HLA-DRB*0302/0701/0401 for both genotypes. PreS1D polytope: PAFRANTANPDWDFN32-46 binds to DRB1*0101/0401/1302 and PreS2 polytopes: TAFHQALQDPRVRG6-19 and AFHQALQDPRVRGL7-20 bind to DRB1*010/1501 alleles. Non-synonymous mutations impair peptide-HLA binding when assessed as combinations of > 2. The least active HLAs may be associated with CHBV and vice-versa for HBV clearance, thus the algorithm may be used to predict HBV prognosis for different haplotypes. The results favor the use of epitopes from S protein as broad genotype vaccine. This study highlights the need to explore further the mechanisms of PreS1 and its effect on the immune system.
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Luvai A, Johnston L, Curtis A, Potter A, Musson S, Pattman S, Kamarrudin S, Weaver J, Arutchevelam V, Anderson M, Burns M, Hopper N, McAnulty C, Sutton R, Neely R, Carey P. High Polygenic Snp Scores Do Not Exclude Monogenic Familial Hypercholesterolaemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bretzin AC, Beidler E, Anderson M, Schmitt A, Covassin T. Sources of Acquired Concussion Information Reported by Parents of Youth Athletes. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Examining the relationships between demographics (sex, geographic location) and sources of acquired concussion information, and where parents would take their child for concussion evaluation.
Methods
A cross-sectional survey collecting demographics and concussion knowledge of parents (male: n=136/359, 38%; female: n=22/359, 62%) of youth athletes (i.e., football, ice hockey, lacrosse, soccer) in Michigan (n=131/359, 36.5%) and Pennsylvania (n=228/359, 62%). Separate Chi-square tests for independence examined the relationship between demographics (sex, geographic location) and sources of acquired concussion information, and where parents would take their child for concussion evaluation.
Results
Overall, parents recognized common concussion signs and symptoms and had general knowledge of concussion. There was a significant association between sex and acquiring information from sports medicine physicians (male: 31.6%, female: 18.9%; χ2 (1, n=358)=6.83, p=.009), and sports news outlets (male: 32.4%, female: 18.9%; χ2 (1, n=358)=7.62, p=.006). There was a significant association between geographic location and acquiring information from a coach (Michigan: 72.5%, Pennsylvania: 40.4%; χ2 (1, n=359)=32.22, p<.001), recreational league officials/league mandated paperwork (Michigan: 50.4%, Pennsylvania: 26.3%; χ2 (1, n=359)=20.11, p<.001), and youth sport state concussion laws (Michigan: 38.2%, Pennsylvania: 10.5%; χ2 (1, n=359)=37.18, p<.001). There was a significant association between geographic location and where parents would take their child for concussion evaluation (χ2 (3, n=338)=19.76, p<.001).
Conclusion
Sex and geographic location may influence where parents of youth athletes acquire concussion information and where they may seek medical attention.
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Anderson M, Bretzin AC, Petit KM, Tomczyk CP, Savage JL, Covassin T. Examining Changes in Sleep Between Concussed and Healthy Individuals Across Recovery. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
To examine changes and the relationship between Pittsburgh Sleep Quality Index (PSQI) scores and the Sport Concussion Assessment Tool–5th Edition (SCAT5) sleep symptom across recovery between concussed and healthy individuals.
Methods
Sixty-eight (18.12±2.6 years; male:n=47, female:n=21; concussed:n=38, healthy:n=30) individuals completed the PSQI and SCAT5 at three times across recovery (≤72 hours of injury, return-to-play (RTP), >one-month after RTP). Two mixed between-within subjects analysis of variance (ANOVAs) evaluated changes in PSQI scores and SCAT5 sleep symptom across recovery between concussed and healthy individuals. Spearman’s rho correlations were used to examine the relationships between the two sleep measures. Significance was set at p≤.05.
Results
There was no significant groupXtime interaction for PSQI scores (Wilks λ=.96, F(2,65)=1.50, p=.23, η2=.04) or SCAT5 sleep symptom (Wilks λ=.93, F(2,65)=2.42, p=.10, η2=.07). There was a significant main effect for time for PSQI scores (Wilks λ=.65, F(2,65)=17.2, p<.001, η2=.35) and SCAT5 sleep symptom (Wilks λ=.88, F(2,65)=4.25, p=.02, η2=.12) with PSQI scores and SCAT5 sleep symptom improving over time. For the SCAT5 sleep symptom there was a significant main effect for group (F(1,66)=13.41, p<.001, η2=.17), with concussed individuals reporting higher SCAT5 sleep symptom (M=0.59, SE=0.1) than healthy controls (M=0.09, SE=0.1). There was no significant correlation between PSQI scores and SCAT5 sleep symptom ≤72 hours (r=.15, p=.36), but there were significant correlations at RTP (r=.38, p=.02) and >one-month (r=.43, p=.01).
Conclusion
Global sleep quality changes throughout recovery and may influence post-concussion outcomes. Utilizing a specialized sleep measure along with sleep-related symptoms may be beneficial to healthcare professionals, specifically during acute concussion management.
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