Does Literacy Moderate the Relationship between Age of Migration and Cognitive Change: Results from the Washington Heights-Inwood Community Aging Project (WHICAP)

Objective

The “healthy immigrant effect” pertains to findings that Hispanics/Latinos born outside of the US tend to be physically and emotionally healthier than individuals born in the US. However, immigrant Latino groups residing in the US have higher incidences of dementia (Tang et al., 2001). Sex/gender and years of education have been found to moderate the relationship between age of migration and cognitive functioning among immigrants born in Mexico (Garcia et al., 2017; Hill et al., 2012). While years of education has been the focus of many studies, literacy (ability to read/write) has been less frequently explored as a moderator of age of migration and cognitive change. We investigated the effect of age of migration on cognitive trajectory in a diverse Latino population and explored whether literacy influences the association between age of immigration and cognitive change. We hypothesize that literacy (ability to read/write) will buffer the effects of age of migration on cognitive (memory, language, motor speed, visuospatial) trajectory.

Participants and Method

Age at baseline, English fluency, country of birth, sex/gender, and years of education were included as time-invariant covariates and literacy was tested as a moderator via multiple group modeling.

Results

Results show that age of migration is marginally and inversely associated with baseline cognitive performance (p < .01). Thus, individuals who immigrated at an older age had lower baseline cognitive scores than their counterparts. Age of migration was not associated with cognitive change. Independent of covariates, literacy did not buffer the negative effects of later age at migration on cognitive function.

Conclusions

Results suggest that literacy confers a small advantage in premorbid cognition, but does not protect against cognitive decline over time. These findings also suggest that adults who immigrate at an older age present with lower cognitive scores at baseline, but do not experience faster rates of cognitive change.

References

Tang, M. X., Cross, P., Andrews, H., Jacobs, D. M., Small, S., Bell, K., ... & Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49-56. Garcia, M. A., Reyes, A. M., Downer, B., Saenz, J. L., Samper-Ternent, R. A., & Raji, M. (2018). Age of migration and the incidence of cognitive impairment: A cohort study of elder Mexican-Americans. Innovation in aging, 1, igx037. https://doi.org/10.1093/geroni/igx037. Hill, T. D., Angel, J. L., Balistreri, K. S., & Herrera, A. P. (2012). Immigrant Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine (1982), 75, 2076–2084. http://doi.org/10.1016/j.socscimed.2012.04.005.

A-55 Memory Complaint Inventory Cutoff Scores: Differentiating Genuine Clinical Presentation from Insufficient Effort

Objective

The current study utilized archival MCI scores in clinical (Alzheimer’s Disease, Vascular Dementia, Mild Cognitive Impairment, and Pseudodementia) and insufficient effort populations to determine clinical cutoff scores for utilization of the MCI in neuropsychological settings.

Method

Data were gathered from the archives of an outpatient neuropsychology clinic based on diagnosis, resulting in a total of 244 participants for inclusion. Participants were subsequently separated into clinical (n = 195) or insufficient effort (n = 49) groups based on diagnosis. Data were analyzed using Receiving Operator Characteristic (ROC) curve analyses, consisting of area under the curve (AUC), specificity, sensitivity, diagnostic odds ratios (DOR), and Youden’s indices.

Results

Data suggested a cutoff of 10.35 (42% endorsement) for the Overall score of the MCI to differentiate clinical populations from insufficient effort with acceptable sensitivity (55%) and specificity (90%). Further, cutoff values for each scale of the MCI were calculated, including the Plausible and Implausible imbedded validity scales.

Conclusions

The findings provided further evidence for the use of the MCI as a symptom validity measure. The identified cutoff scores can differentiate between insufficient effort and clinical populations with acceptable specificity and sensitivity to aid clinician accuracy in detecting insufficient effort and non-credible symptom endorsement.

Brain-Derived Neurotrophic Factor Val66Met Polymorphism Is Associated With a Reduced ERP Component Indexing Emotional Recollection

The Met allele of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with reduced functioning of the amygdala and hippocampus. It has been linked to major psychiatric conditions, including depression and post-traumatic stress disorder, and is associated with deficits in episodic memory. The precise mechanisms of the BDNF gene’s influence on emotional memory are not well characterized, especially its impact on recognition. Two electrophysiological experiments of emotional memory were run on two independent samples genotyped for BDNF Val66Met. Event-related potentials (ERPs) corresponding to the recognition of negative and neutral words (Experiment 1, N = 37) and negative and positive words (Experiment 2, N = 23) were recorded, and the late parietal component (LPC), typically associated with conscious recollection, was analyzed. In Experiment 1, a reduced LPC was observed in Met carriers (N = 12) compared to Val homozygotes (N = 25) in the negative condition, but the group difference was not present in the neutral condition. In Experiment 2, the reduced LPC was seen in Met carriers (N = 12) compared to Val homozygotes (N = 11) across both conditions. This study provides the first evidence of an association between the BDNF Val66Met genotype and the late parietal electrophysiological component, suggesting that the conscious experience of emotional recollection may differ according to BDNF Val66Met genotype. Further, these results suggest that this effect is likely due to emotional arousal rather than valence polarity. Results were discussed with reference to the possible mechanisms by which emotional recollection deficits may contribute to psychopathology.

Intraoperative TOE guided management of newly diagnosed severe tricuspid regurgitation and pulmonary hypertension during orthotopic liver transplantation: a case report demonstrating the importance of reversibility as a favorable prognostic factor

Background

Tricuspid regurgitation (TR) and pulmonary hypertension (PHT) are highly dynamic cardiovascular lesions that may progress rapidly, particularly in the orthotopic liver transplantation (OLT) waitlist population. Severe TR and PHT are associated with poor outcomes in these patients, however it is rare for the two to be newly diagnosed intraoperatively at the time of OLT. Without preoperative information on pulmonary vascular and right heart function, the potential for reversibility of severe TR and PHT is unclear, making the decision to proceed to transplant fraught with difficulty.

Case presentation

We present a case of successful orthotopic liver transplantation (OLT) in a 48 year old female with severe (PHT) (mean pulmonary arterial pressure > 55 mmHg) and severe TR diagnosed post induction of anaesthesia. The degree of TR was associated with systemic venous pressures of > 100 mmHg resulting in massive haemorrhage during surgery and difficulty in distinguishing venous from arterial placement of vascular access devices. Intraoperative transoesophageal echocardiography (TOE) proved crucial in diagnosing functional TR due to tricuspid annular and right ventricular (RV) dilatation, and dynamically monitoring response to treatment. In response to positioning, judicious volatile anaesthesia administration, pulmonary vasodilator therapy and permissive hypovolemia during surgery we noted substantial improvement of the TR and pulmonary arterial pressures, confirming the reversibility of the TR and associated PHT.

Conclusion

TR and PHT are co-dependent, dynamic, load sensitive right heart conditions that are interdependent with chronic liver disease, and may progress rapidly in patients waitlisted for OLT. Use of intraoperative TOE and pulmonary artery catheterisation on the day of surgery will detect previously undiagnosed severe TR and PHT, enable rapid assessment of the cause and the potential for reversibility. These dynamic monitors permit real-time assessment of the response to interventions or events affecting right ventricular (RV) preload and afterload, providing critical information for prognosis and management. Furthermore, we suggest that TR and PHT should be specifically sought when waitlisted OLT patients present with hepatic decompensation.

Electronic supplementary material

The online version of this article (10.1186/s12871-019-0795-6) contains supplementary material, which is available to authorized users.

Tests of General Relativity with GW170817

The recent discovery by Advanced LIGO and Advanced Virgo of a gravitational wave signal from a binary neutron star inspiral has enabled tests of general relativity (GR) with this new type of source. This source, for the first time, permits tests of strong-field dynamics of compact binaries in the presence of matter. In this Letter, we place constraints on the dipole radiation and possible deviations from GR in the post-Newtonian coefficients that govern the inspiral regime. Bounds on modified dispersion of gravitational waves are obtained; in combination with information from the observed electromagnetic counterpart we can also constrain effects due to large extra dimensions. Finally, the polarization content of the gravitational wave signal is studied. The results of all tests performed here show good agreement with GR.

Automated data extraction and report analysis in computer-aided radiology audit: practice implications from post-mortem paediatric imaging

AIM

To determine local departmental adherence to the paediatric post-mortem magnetic resonance imaging (MRI) protocols, using a customised automated computational approach.

MATERIALS AND METHODS

A retrospective review of 460 whole-body post-mortem MRI examinations performed at Great Ormond Street Hospital for Children over a 5.5-year period was assessed for adherence to a full or abbreviated imaging sequence protocol. A simple computer program was developed to batch process DICOM (digital imaging and communications in medicine) files, extracting imaging sequence details, followed by natural language processing (NLP) of authorised reports to automate information extraction of diagnostic image quality.

RESULTS

The program was able to extract study parameters from the entire dataset (approximately 80 GB of data) in a few hours, and retrieve information on diagnostic image quality using NLP with an overall diagnostic accuracy for data extraction of 96.7% (445/460, 95% confidence interval [CI]: 94.7-98%). The full imaging protocol was adhered to in 305/460 (66.3%) cases, and an abbreviated protocol in 140/460 (30.4%) cases. Overall, 423/460 (91.9%) of studies were of diagnostic quality. These included 298/305 (97.7%) of the full protocol, 111/140 (79.3%) of the abbreviated protocol. In only five cases were the examinations non-diagnostic for all body systems, all of whom weighed <100 g (24.7-72 g) and imaged using the abbreviated protocol.

CONCLUSION

The present study demonstrated a successful application of an automated approach for data collection for audit and quality assessment purposes using paediatric post-mortem imaging as a specific example. Re-audit of these data following change implementation will be straightforward now that the automated workflow is clearly established.

State and trait neural correlates of the balance between work and nonwork roles

Difficulty managing the demands of work and nonwork roles (often referred to in terms of managing balance) can be detrimental to psychological wellbeing and contribute to occupational burnout. The current study investigated the neural correlates of perceived satisfaction with this balance using both trait and state EEG alpha measures. EEG was recorded from 14 participants in full time employment (12 females, aged 35.1 ± 10.1 years) during a resting state and performance of an auditory oddball task; e-mail and messaging alert sounds were used as target stimuli. It was predicted that dissatisfaction with the balance between work and nonwork roles would be associated with increased resting alpha power, consistent with studies of burnout, and diminished alpha response to oddball distractors, consistent with difficulty suppressing automatic responses to work-related stimuli. Significant correlations between self-reported measures of work/nonwork balance and both resting, and task-related alpha responses, supported our predictions. Furthermore, an exploratory partial correlation between work and nonwork balance and resting EEG, controlling for task-related alpha response, suggested that the three variables were interrelated. We propose that dissatisfaction with work/nonwork balance is associated with a state hypervigilance to work-related cues, and a trait neural marker of fatigue, both symptomatic of lowered cognitive capacity.

A systems-based assessment of Palestine's current and future infrastructure requirements

The occupied Palestinian territories of West Bank and Gaza Strip are currently experiencing many challenges in the provision of infrastructure services for their inhabitants. This includes an undersupply of infrastructure services across multiple sectors - an issue exacerbated by population growth, increasing urbanisation, economic growth and climate change. We address this challenge by providing a systems-based assessment of Palestine's infrastructure requirements and identifying broad strategies for how those needs might be met. This assessment involved four key components including: 1) defining and assessing the current system and planned infrastructure investments; 2) assessing potential future demand for infrastructure services; 3) identifying alternative strategies for future infrastructure provision beyond planned investments; and 4) analysing the performance of each strategy against a series of key performance indicators. Results from the assessment highlight the magnitude of the current and future need for urgent infrastructure investment in Palestine. The most immediate need is to alleviate the water crises in Gaza Strip, which will require at least twice as much water infrastructure investment over the coming decade than is currently in the pipeline, even if the goal is only to achieve the most basic World Health Organisation water availability requirements. To move beyond this protracted state of crises will then require a doubling of investments across all sectors to bring Palestine up to the standards of services already enjoyed by its neighbours. Such investments can have even greater impact on delivery of infrastructure services through the strategic use of interdependencies between infrastructure sectors, such as water re-use and energy-from-waste. In the pursuit of global sustainable development, the systems-based approach presented here provides an important first step in the assessment of infrastructure needs and opportunities for any country. It is particularly important for states like Palestine where key resources, such as water and energy, are so acutely constrained.

Abstract PD1-07: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Howell SJ, Waters S, Twelves C, Joffe J, Moon S, Bale C, Venkitaraman R, Bezecny P, Casbard A, Wilhelm-Benartzi C, Carucci M, Butler R, Alchami F, Jones R. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD1-07.

Constraining the p-Mode-g-Mode Tidal Instability with GW170817

We analyze the impact of a proposed tidal instability coupling p modes and g modes within neutron stars on GW170817. This nonresonant instability transfers energy from the orbit of the binary to internal modes of the stars, accelerating the gravitational-wave driven inspiral. We model the impact of this instability on the phasing of the gravitational wave signal using three parameters per star: an overall amplitude, a saturation frequency, and a spectral index. Incorporating these additional parameters, we compute the Bayes factor (lnB_{!pg}^{pg}) comparing our p-g model to a standard one. We find that the observed signal is consistent with waveform models that neglect p-g effects, with lnB_{!pg}^{pg}=0.03_{-0.58}^{+0.70} (maximum a posteriori and 90% credible region). By injecting simulated signals that do not include p-g effects and recovering them with the p-g model, we show that there is a ≃50% probability of obtaining similar lnB_{!pg}^{pg} even when p-g effects are absent. We find that the p-g amplitude for 1.4  M_{⊙} neutron stars is constrained to less than a few tenths of the theoretical maximum, with maxima a posteriori near one-tenth this maximum and p-g saturation frequency ∼70  Hz. This suggests that there are less than a few hundred excited modes, assuming they all saturate by wave breaking. For comparison, theoretical upper bounds suggest ≲10^{3} modes saturate by wave breaking. Thus, the measured constraints only rule out extreme values of the p-g parameters. They also imply that the instability dissipates ≲10^{51}  erg over the entire inspiral, i.e., less than a few percent of the energy radiated as gravitational waves.

A machine learning approach to predict perceptual decisions: an insight into face pareidolia

The perception of an external stimulus not only depends upon the characteristics of the stimulus but is also influenced by the ongoing brain activity prior to its presentation. In this work, we directly tested whether spontaneous electrical brain activities in prestimulus period could predict perceptual outcome in face pareidolia (visualizing face in noise images) on a trial-by-trial basis. Participants were presented with only noise images but with the prior information that some faces would be hidden in these images, while their electrical brain activities were recorded; participants reported their perceptual decision, face or no-face, on each trial. Using differential hemispheric asymmetry features based on large-scale neural oscillations in a machine learning classifier, we demonstrated that prestimulus brain activities could achieve a classification accuracy, discriminating face from no-face perception, of 75% across trials. The time–frequency features representing hemispheric asymmetry yielded the best classification performance, and prestimulus alpha oscillations were found to be mostly involved in predicting perceptual decision. These findings suggest a mechanism of how prior expectations in the prestimulus period may affect post-stimulus decision making.

The conventional gait model, an open-source implementation that reproduces the past but prepares for the future

BACKGROUND

The Conventional Gait Model (CGM), known by a variety of different names, is widely used in clinical gait analysis. We present pyCGM2, an open-source implementation of the CGM with two versions. The first, CGM1.0, is a clone of Vicon Plug In Gait (PiG) with all its variants. CGM1.0 provides a platform to test the effect of modifications to the CGM on data collected and processed retrospectively or to provide backward compatibility. The second version, CGM1.1, offers some practical modifications and includes three well documented improvements.

RESEARCH QUESTION

How do improvements of the conventional gait model affect joint kinematics and kinetics?

METHOD

The practical modifications include the possibility to use a medial knee epicondyle marker, during static calibration only, to define the medio-lateral axis of the femur in place of the knee alignment device. The three improvements correspond to the change of pelvis angle decomposition sequence, the adoption of a single tibia coordinate system, and the default decomposition of the joint moments in the joint coordinate system. We validated the outputs of version CGM1.0 against Vicon-PiG, and estimated the effect of the modifications included in version CGM1.1 using gait data collected in 16 healthy participants.

RESULTS

Kinematics and kinetics of CGM1.0 were superimposed with that of Vicon-PiG, with root mean square differences less than 0.04° for kinematics and less than 0.05 N.m.kg-1 for kinetics.

SIGNIFICANCE

The differences between the CGM1.1 and CGM1.0 were minimal in the healthy participant cohort but we discussed the expected difference in participants with different gait pathologies. We hope that the pyCGM2 will facilitate the systematic testing and the use of improved processing methods for the conventional gait model.

An Introductory Guide to Survey Research in Anaesthesia

Surveys allow convenient and inexpensive research. Surveys include mail-out questionnaires, email questionnaires, telephone interviews, and personal interviews. Despite a widespread perception that surveys are easy to conduct, good surveys need rigorous design, implementation and analysis. This requires substantial planning, time and effort. The most important step in designing a survey is to clearly define the question (s) the survey aims to answer. The target population, measured variables and types of associations being investigated should be specific and unambiguous. Investigators should concentrate on what they ‘need to know’ rather than what would be ‘nice to know’. During development surveys should be piloted to identify problems. The main goal when implementing a survey is to maximize the response rate to avoid misleading results. Evidence-based strategies, including brief personalized surveys with stamped return envelopes, can be used to maximize the response rate. A poorly conducted survey can lead to misleading or invalid conclusions and may undermine participation in subsequent surveys by the target population.

Therapeutic glucocorticoids prevent bone loss but drive muscle wasting when administered in chronic polyarthritis

BACKGROUND

Patients with rheumatoid arthritis (RA) experience extra-articular manifestations including osteoporosis and muscle wasting, which closely associate with severity of disease. Whilst therapeutic glucocorticoids (GCs) reduce inflammation in RA, their actions on muscle and bone metabolism in the context of chronic inflammation remain unclear. We utilised the TNF-tg model of chronic polyarthritis to ascertain the impact of therapeutic GCs on bone and muscle homeostasis in the context of systemic inflammation.

METHODS

TNF-tg and wild-type (WT) animals received either vehicle or the GC corticosterone (100 μg/ml) in drinking water at onset of arthritis. Arthritis severity and clinical parameters were measured, serum collected for ELISA and muscle and bone biopsies collected for μCT, histology and mRNA analysis. In vivo findings were examined in primary cultures of osteoblasts, osteoclasts and myotubes.

RESULTS

TNF-tg mice receiving GCs showed protection from inflammatory bone loss, characterised by a reduction in serum markers of bone resorption, osteoclast numbers and osteoclast activity. In contrast, muscle wasting was markedly increased in WT and TNF-tg animals receiving GCs, independently of inflammation. This was characterised by a reduction in muscle weight and fibre size, and an induction in anti-anabolic and catabolic signalling.

CONCLUSIONS

This study demonstrates that when given in early onset chronic polyarthritis, oral GCs partially protect against inflammatory bone loss, but induce marked muscle wasting. These results suggest that in patients with inflammatory arthritis receiving GCs, the development of interventions to manage deleterious side effects in muscle should be prioritised.

5 Gene expression analysis and DNA methylation patterns of porcine somatic cell nuclear transfer blastocysts with high and low incidence of apoptosis

Somatic cell NT (SCNT) efficiency remains poor, preventing the technology from being regularly used in the agricultural industry. It is believed that faulty epigenetic reprogramming of SCNT embryos leads to the low overall success. A clear apoptotic signature is associated with inappropriate gene expression and epigenomic aberrancies in many experimental cell culture systems, and we hypothesised that an apoptosis biomarker could be used to effectively separate properly reprogrammed porcine SCNT embryos from those that are destined to fail due to incomplete reprogramming. Therefore, our objective was to evaluate global gene expression and DNA methylation patterns in high- and low-apoptosis individual embryos in an effort to characterise the extent of genomic reprogramming that had taken place. Porcine SCNT blastocysts on Day 6 of development were stained with a nontoxic, noninvasive caspase activity reporter, and the top and bottom 20% of detected caspase activity were classified as high and low apoptosis, respectively (3 replicate cloning sessions; n=13 embryos per group). Genomic DNA and total RNA were isolated from each individual blastocyst. The RNA sequencing libraries were prepared using the Ovation SoLo RNA-Seq system (NuGen, San Carlos, CA, USA). Reduced representation bisulfite sequencing libraries were prepared for DNA methylation analysis using a modification of the single-cell reduced representation bisulfite sequencing global DNA methylation analysis approach detailed by Guo et al. (2015 Nat. Protoc. 10, 645-59). The RNA sequencing analysis using EdgeR (https://bioconductor.org/packages/release/bioc/html/edgeR.html) revealed 175 total differentially expressed genes (fold change ≥1.5; false discovery rate ≤0.05) between the high- and low-apoptosis SCNT embryos. This list of differentially expressed genes was used to perform enrichment analysis to identify overrepresented Gene Ontology (GO) terms or Kyoto Encyclopedia of Genes and Genomes pathways (DAVID Ease version 6.8 (https://david.ncifcrf.gov/) against the Sus scrofa background genome). However, no significantly enriched GO terms or pathways were identified (false discovery rate P&gt;0.05). Analysis of global DNA methylation patterns between high- and low-apoptosis SCNT embryos using MethylKit (Akalin et al. 2012Genome Biol. 13, R87) revealed 335 differentially methylated 100-bp regions with at least 25% difference in methylation (adjusted P ≤ 0.01). Gene transcription start sites associated with these regions were used for enrichment analysis; again, no significant enrichment of GO terms or Kyoto Encyclopedia of Genes and Genomes pathways was identified. Principal component analysis of CpG methylation showed the low-apoptosis embryos clustering more tightly than the high-apoptosis embryos, which were highly scattered. Ongoing comparisons of high- and low-apoptosis cloned embryos with naturally fertilized embryos produced invivo may provide more information about which embryos were properly reprogrammed. Although we are still pursuing a link between reprogramming and gene expression in high- and low-apoptosis embryos, we conclude that these data support a model of stochastic epigenetic reprogramming following SCNT and reinforce the necessity of identifying embryos most likely to be successful due to proper epigenetic reprogramming in order to increase SCNT efficiency.