Global occurrence and probabilistic environmental health hazard assessment of per- and polyfluoroalkyl substances (PFASs) in groundwater and surface waters

Per- and polyfluoroalkyl substances (PFASs) have been used in consumer and military products since the 1950s but are increasingly scrutinized worldwide because of inherent chemical properties, environmental contamination, and risks to public health and the environment. The United States Environmental Protection Agency (USEPA) identified 24 PFASs of interest for further study and possible regulation. We examined 371 peer-reviewed studies published since 2001 to understand the occurrence and distribution of 24 priority PFASs in global surface waters and groundwater. We identified 77,541 and 16,246 data points for surface waters and groundwater, respectively, with total PFAS concentrations ranging from low pg/L to low mg/L levels. Most data were from Asia, Europe, and North America with some reports from Oceania. PFAS information from other geographic regions is lacking. PFASs levels are consistently higher in rivers and streams followed by lakes and reservoirs and then coastal and marine systems. When sufficient data were available, probabilistic environmental hazard assessments (PEHAs) were performed from environmental exposure distributions (EEDs) to identify potential exceedances of available guideline values for each compound by matrix, region, and aquatic system. Specifically, exceedances of USEPA drinking water lifetime health advisory levels were up to 74% for PFOS in groundwater from Oceania and 69% for PFOA in North American groundwater. Our findings support selection of environmentally relevant experimental treatment levels for future toxicology, ecotoxicology and bioaccumulation studies, and potable source water exposure investigations, while highlighting PFASs and major geographic locations requiring additional study and inclusion in global monitoring and surveillance campaigns.

Development of Alzheimer’s Disease Biomarkers: From CSF- to Blood-Based Biomarkers

In the 115 years since the discovery of Alzheimer’s disease (AD), our knowledge, diagnosis, and therapeutics have significantly improved. Biomarkers are the primary tools for clinical research, diagnostics, and therapeutic monitoring in clinical trials. They provide much insightful information, and while they are not clinically used routinely, they help us to understand the mechanisms of this disease. This review charts the journey of AD biomarker discovery and development from cerebrospinal fluid (CSF) amyloid-beta 1-42 (Aβ42), total tau (T-tau), and phosphorylated tau (p-tau) biomarkers and imaging technologies to the next generation of biomarkers. We also discuss advanced high-sensitivity assay platforms for CSF Aβ42, T-tau, p-tau, and blood analysis. The recently proposed Aβ deposition/tau biomarker/neurodegeneration or neuronal injury (ATN) scheme might facilitate the definition of the biological status underpinning AD and offer a common language among researchers across biochemical biomarkers and imaging. Moreover, we highlight blood-based biomarkers for AD that offer a scalable alternative to CSF biomarkers through cost-saving and reduced invasiveness, and may provide an understanding of disease initiation and development. We discuss different groups of blood-based biomarker candidates, their advantages and limitations, and paths forward, from identification and analysis to clinical validation. The development of valid blood-based biomarkers may facilitate the implementation of future AD therapeutics and diagnostics.

Alteration of Neural Pathways and Its Implications in Alzheimer’s Disease

Alzheimer’s disease (AD) is a neurodegenerative disease accompanied by cognitive and behavioral symptoms. These AD-related manifestations result from the alteration of neural circuitry by aggregated forms of amyloid-β (Aβ) and hyperphosphorylated tau, which are neurotoxic. From a neuroscience perspective, identifying neural circuits that integrate various inputs and outputs to determine behaviors can provide insight into the principles of behavior. Therefore, it is crucial to understand the alterations in the neural circuits associated with AD-related behavioral and psychological symptoms. Interestingly, it is well known that the alteration of neural circuitry is prominent in the brains of patients with AD. Here, we selected specific regions in the AD brain that are associated with AD-related behavioral and psychological symptoms, and reviewed studies of healthy and altered efferent pathways to the target regions. Moreover, we propose that specific neural circuits that are altered in the AD brain can be potential targets for AD treatment. Furthermore, we provide therapeutic implications for targeting neuronal circuits through various therapeutic approaches and the appropriate timing of treatment for AD.

How do perceptions of public health measures affect experience of unmet healthcare needs among older Korean adults during COVID-19 pandemic?

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Lack of or inadequate access to needed care may deteriorate health.

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COVID-19 outbreak may prohibit access to needed care.

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A poor understanding of public health measures increased unmet healthcare needs.

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Trust and satisfaction of public health measures were not related to unmet healthcare needs.

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The findings suggest the importance of effective risk communication.

Increasing difficulties in the use of healthcare services after the COVID-19 outbreak is a major concern as ensuring access to healthcare services is a primary health policy goal. The aim of this study was to examine the impacts of public perceptions regarding COVID-19 related public health measures on older adults’ experience of unmet healthcare needs in Korea. A total of 1961 participants from the Korea Health Care System Performance, over the age of 65, were included in the analyses. Three different logistic regression models were used to assess the impact of public perceptions – understanding, trust and satisfaction- regarding COVID-19 public health measures on unmet healthcare needs. Our results show that a poor understanding of public health measures was associated with higher odds of unmet healthcare needs among Korean older adults (OR:2.65, 95%CI: 1.79–3.94). However, trust and satisfaction of public health measures were not related to unmet healthcare needs. Our findings suggest that the importance of effective risk communication to facilitate better understand quarantine polices rather than emphasizing trust or satisfaction over public health measure.

Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture

Background

Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures.

Methods

This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1–4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance.

Results

Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes.

Conclusions

Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

Significance of Follow-Up Ultrasonography 24 Hours Post-Reduction in Detecting Intussusception Recurrence

PURPOSE

The objective of this study was to identify the significance of 24-hour post-reduction ultrasonography (US) in pediatric patients with intussusception.

METHODS

A total of 229 patients with intussusception who were treated with saline reduction at Severance Children's Hospital between January 2014 and September 2020 were retrospectively reviewed. The 229 patients with successful saline reduction were divided into two groups: a recurrence at 24 hours group (R, n=41) and a non-recurrence group (NR, n=188). The full patient sample was divided into two groups: follow-up US (FU) or no follow-up US (NFU); the recurrence group was divided into follow-up (R-FU) and non-follow-up (R-NFU) subgroups, and stratified analyses were performed.

RESULTS

There were no significant differences in age, sex, laboratory findings, symptoms, and sonographic findings between the NR and R groups. In the R group, 24 patients underwent follow-up US, and 17 patients did not. Specific sonographic findings were statistically significant in the R-FU group compared to the R-NFU group (p=0.002). The R-FU group had fewer admissions (p=0.012) and longer mean hospitalization times (p<0.001) than the R-NFU group. The NFU group had a 12.2% recurrence rate, while the R-FU group recurrence rate was 25.8% (p=0.0099), suggesting that the omission of some recurrent events and follow-up US was a significant variable in the recurrence of intussusception. The median time to recurrence was 21 hours which supports the 24-hour follow-up protocol.

CONCLUSION

Twenty-four-hour follow-up US was shown to be valuable for detecting early recurrence of intussusception.

Anti-adhesive effect and safety of a thermosensitive adhesion barrier (Mediclore) for thyroid surgery: a double-blinded randomized controlled trial

Purpose

Methods

Results

Conclusion

Effort, success, and side of lesion determine arm choice in individuals with chronic stroke

In neurotypical individuals, arm choice in reaching movements depends on expected biomechanical effort, expected success, and a handedness bias. Following a stroke, does arm choice change to account for the decreased motor performance, or does it follow a preinjury habitual preference pattern? Participants with mild-to-moderate chronic stroke who were right-handed before stroke performed reaching movements in both spontaneous and forced-choice blocks, under no-time, medium-time, and fast-time constraint conditions designed to modulate reaching success. Mixed-effects logistic regression models of arm choice revealed that expected effort predicted choices. However, expected success only strongly predicted choice in left-hemiparetic individuals. In addition, reaction times decreased in left-hemiparetic individuals between the no-time and the fast-time constraint conditions but showed no changes in right-hemiparetic individuals. Finally, arm choice in the no-time constraint condition correlated with a clinical measure of spontaneous arm use for right-, but not for left-hemiparetic individuals. Our results are consistent with the view that right-hemiparetic individuals show a habitual pattern of arm choice for reaching movements relatively independent of failures. In contrast, left-hemiparetic individuals appear to choose their paretic left arm more optimally: that is, if a movement with the paretic arm is predicted to be not successful in the upcoming movement, the nonparetic right arm is chosen instead.NEW & NOTEWORTHY Although we are seldom aware of it, we constantly make decisions to use one arm or the other in daily activities. Here, we studied whether these decisions change following stroke. Our results show that effort, success, and side of lesion determine arm choice in a reaching task: whereas left-paretic individuals modified their arm choice in response to failures in reaching the target, right-paretic individuals showed a pattern of choice independent of failures.

A patient-centered gout information value chain: a scoping review

OBJECTIVE

To examine and identify the scope of research addressing health information requirements for gout patients using value chain analysis.

METHODS

Five electronic databases (PubMed, CINAHL, ERIC, PsycINFO, Embase, and Scopus) and grey literature (WorldCat) were searched in accordance with a published protocol. Only English language articles were included, with no limitations for date of publication. The findings of the 33 studies included for final analysis were subsequently divided into 6 groups according to the stages of the care delivery value chain their research most closely pertained to: screening/preventing (n = 2), diagnosing (n = 1), preparing (n = 7), intervening (n = 11), recovering/rehabilitating (n = 5), and monitoring/managing (n = 13).

RESULTS

The 33 studies focused on one or more of the following information phenotypes: 1) pathophysiology; 2) medical treatment; and 3) nonpharmaceutical interventions. Long term treatment adherence was a popular topic amongst studies that focused on gout patient education.

CONCLUSION

Based on the identified studies, gout patients are being told what to do, but are not being adequately educated regarding why recommended interventions are important or how to accomplish them.

PRACTICE IMPLICATIONS

This review provides a foundation to develop and evaluate personalized education materials using value chain analysis.

Characteristics of Intraoperative Hemodynamic Instability in Postoperatively Diagnosed Pheochromocytoma and Sympathetic Paraganglioma Patients

BACKGROUND

Despite an improved understanding of pheochromocytoma and extra-adrenal sympathetic parganglioma (PPGL), including diagnosis and management, some PPGLs are postoperatively diagnosed. Clinical characteristics and intraoperative haemodynamic instability (HI) in postoperatively diagnosed PPGL patients have been poorly defined. Thus, we investigated the clinical characteristics and HI in patients with postoperatively diagnosed PPGLs compared to patients with preoperatively diagnosed PPGLs.

METHODS

We obtained clinical and haemodynamic data from the electronic medical records of 256 patients with pathologically confirmed PPGLs at our institution from January 2005 to December 2019. We assessed the intraoperative HI (systolic blood pressure [SBP]>160 mmHg (min) or mean blood pressure [MBP]<60 mmHg (min)) over time.

RESULTS

Twenty-nine patients (11.3%) were diagnosed with PPGLs postoperatively. Hypertension (34.5% vs. 63.0%, P=0.006) and pheochromocytoma (17.2% vs. 81.1%, P<0.001) case rates were lower in postoperatively diagnosed patients than in preoperatively diagnosed patients. Preoperative SBP in the ward was similar between groups, but the use of α-blockers and β-blockers was more frequent in preoperatively diagnosed patients (89.0% vs. 3.4%, P<0.001; 36.3% vs. 6.9%, P=0.003). Considering intraoperative HI, postoperatively diagnosed patients demonstrated a similar percentage of time with SBP>160 mmHg (median [IQR]; 7.9% [2.5; 11.9] % vs. 4.6% [0.0; 11.9], P=0.088) but a significantly lower percentage of time with MBP<60 mmHg (0.0% [0.0; 3.0] vs. 5.6% [0.0, 12.6], P=0.002) compared with preoperatively diagnosed patients.

CONCLUSIONS

Patients diagnosed with PPGLs postoperatively may have no further higher risk of intraoperative hypertension than those diagnosed preoperatively despite insufficient preoperative management for PPGLs. Further study will be needed to ascertain intrinsic tumour characteristics, and need for universal preoperative use of α- and β-blockers in PPGL patients postoperatively diagnosed or without typical symptoms related PPGLs.

The Effect of a Multimodal Occupational Therapy Program with Cognition-Oriented Approach on Cognitive Function and Activities of Daily Living in Patients with Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Non-pharmacological intervention, which includes a broad range of approaches, may be an alternative treatment for Alzheimer's disease (AD). Multimodal non-pharmacological intervention alleviates cognitive dysfunction and the impairment of activities of daily living (ADL) in AD patients. However, it is still unclear which combination of non-pharmacological interventions is preferred. We selected a non-pharmacological intervention combined with occupational therapy (OT). We investigated the effect of a multimodal OT program with cognition-oriented approach on cognitive dysfunction and impairments of ADL in patients with AD. Four electronic databases were searched from January 2000 to August 2020. The studies were assessed for heterogeneity, quality assessment, effect size and publication bias. A total of seven randomized controlled trials examining multimodal OT programs with cognition-oriented approach in AD patients were included in the meta-analysis. Compared with the control group, the multimodal OT program with cognition-oriented approach group was statistically beneficial for cognitive dysfunction (95% CI: 0.25-0.91). However, compared with the control group, the multimodal OT program with cognition-oriented approach group tended to be beneficial for basic ADL, and instrumental ADL. These results suggest that the multimodal OT program with cognition-oriented approach might be the optimal multimodal non-pharmacological intervention for improving cognitive dysfunction in AD patients.

Machine Learning-Based Predictive Models of Behavioral and Psychological Symptoms of Dementia

Models predicting the occurrence of specific types of behavioral and psychological symptoms of dementia (BPSD) can be highly beneficial for its early intervention and individualized care planning. Using a machine learning approach, this study developed and validated predictive models of the occurrence of BPSD, categorized into seven subsyndromes, among community-dwelling older adults with dementia in South Korea. BPSD dairy was used to measure BPSD and the state of unmet needs daily. We measured sleep and activity levels using actigraphy, and stress and fatigue using a portable heart rate variability analyzer. We developed predictive models and conducted cross-validation using training data that consisted of the first two wave dataset, and then validated the models using wave 3 test data. To deal with imbalanced datasets, we used Synthetic Minority Oversampling Technique (SMOTE), an over-sampling method. Categorical variables were pre-processed using target encoding. We then compared the machine-learning models with logistic regression. The area under the receiver operating characteristic curve (AUC) scores of the support vector machine (SVM) models for the wave 3 test data showed a similar or greater value than logistic regression models across all BPSD subsyndromes. The SVM model (AUC = 0.899) had an AUC value greater than that of the logistic regression model (AUC = 0.717), particularly for hyperactivity symptoms. Machine learning algorithms, especially SVM models, can be used to develop BPSD prediction models to help identify at-risk individuals and implement symptom-targeted individualized interventions.

Risk Factors of Sleep Disturbance in Older Adults With Dementia: An Actigraphy-Based Validation Study

Sleep disturbance is a common and significant symptom experienced by older adults with dementia. Early detection and timely treatment of sleep disturbance are critical to prevent adverse consequences including decreased quality of life for persons with dementia and increased caregiver burden. While direct observations and sleep diaries are often unreliable, actigraphy is a cost-effective method in measuring sleep problems in older adults with dementia and provides reliable and rich sleep data. Therefore, this study aimed to examine sleep disturbance objectively measured by actigraphy and its risk factors in community-dwelling older adults with dementia in Korea. This is a prospective study consisting of a two-wave dataset. The model was fitted using Wave 1 data (n=151) and then validated using Wave 2 data (n=59). Independent variables were demographics, cognitive and physical function, depressive symptoms, physical activity level, and neuropsychiatric symptoms measured by Neuropsychiatric Inventory(NPI), and clinical factors including dementia type, sedative use, and comorbidities. Sleep disturbance was defined as less than six nighttime sleep hours and sleep efficacy less than 75%. Using the Youden’s Index, the sample was dichotomized into sleep disturbance group (n=83) and sound sleep group (n=68). The results of the generalized linear mixed model showed that the risk factors for sleep disturbance included vascular dementia, age, step count, and having three neuropsychiatric symptoms (i.e., delusions, depression, and disinhibition). Individuals with dementia at risk for sleep disturbance should be identified to prioritize early prevention strategies and individualized interventions. Particularly, management of delusion, depression, disinhibition is critical in preventing disturbed sleep.

Predictors of Behavioral and Psychological Symptoms in Community-Dwelling Older Adults With Dementia

Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, the current understanding is limited as it considers BPSD as a homogenous construct, not accounting for its heterogeneity. Therefore, this study explored the predictors of BPSD subsyndromes, and built prediction models for these subsyndromes in community-dwelling older adults with dementia in Korea. This prospective study consisted of a two-wave dataset. We fit the generalized linear mixed models using Wave 1 data (N = 145) and then validated them using Wave 2 data (N = 59). BPSD and their proximal factors were assessed on a daily basis using diaries written by family caregivers. Sleep and activity levels were objectively measured using actigraphy. The amount of nighttime sleep hours was significantly associated with next-day sleep and nighttime behaviors (OR = 0.87; p = 0.005), with the amounts of energy expenditure showing significant association with euphoria/elation (OR = 0.02; p = 0.019). All subsyndromes except euphoria/elation were found to be significantly associated with either hunger, thirst, urination, or bowl movement; with all BPSD showing a significant association with environmental changes. We also found several background factors, including premorbid personality and taking sedatives as predictors for specific subsyndromes. The area under the receiver operating characteristic curve scores for the data were greater than 0.9 and 0.8 in Waves 1 and 2, respectively, across all subsyndromes. Prediction models for BPSD will help in the development of symptom-targeted, individualized interventions.

Genetic Analysis of the Measles Virus From the Outbreaks in South Korea, 2019

Three genotypes (B3, D8, and H1) of the measles virus (MeV) have recently caused global outbreaks. In Korea, four measles outbreaks were reported during 2018–2019 and most patients were infants and health care workers in their 20s and 30s. To investigate the genetic characteristics and molecular epidemiology of the outbreaks, we analyzed the sequence of MeVs by targeting the N-450, MF-NCR, and/or H gene regions. Considering their phylogenetic relationships, besides the N-450 and MF-NCR sequences that are commonly used for genotyping MeVs, the MF-NCR-H sequence was related to the dynamics for identifying the transmission of MeVs. Phylogenetic clustering patterns reconstructed from the MF-NCR-H sequence set revealed that genotype D8 caused three of the four outbreaks, while B3 seemed to have induced the fourth outbreak. These results suggest that the MF-NCR-H sequence is useful for rapid confirmation of measles outbreaks and to identify the epidemiological routes of MeVs.

Gram-negative bacteria and their lipopolysaccharides in Alzheimer's disease: pathologic roles and therapeutic implications

Alzheimer's disease (AD) is the most serious age-related neurodegenerative disease and causes destructive and irreversible cognitive decline. Failures in the development of therapeutics targeting amyloid-β (Aβ) and tau, principal proteins inducing pathology in AD, suggest a paradigm shift towards the development of new therapeutic targets. The gram-negative bacteria and lipopolysaccharides (LPS) are attractive new targets for AD treatment. Surprisingly, an altered distribution of gram-negative bacteria and their LPS has been reported in AD patients. Moreover, gram-negative bacteria and their LPS have been shown to affect a variety of AD-related pathologies, such as Aβ homeostasis, tau pathology, neuroinflammation, and neurodegeneration. Moreover, therapeutic approaches targeting gram-negative bacteria or gram-negative bacterial molecules have significantly alleviated AD-related pathology and cognitive dysfunction. Despite multiple evidence showing that the gram-negative bacteria and their LPS play a crucial role in AD pathogenesis, the pathogenic mechanisms of gram-negative bacteria and their LPS have not been clarified. Here, we summarize the roles and pathomechanisms of gram-negative bacteria and LPS in AD. Furthermore, we discuss the possibility of using gram-negative bacteria and gram-negative bacterial molecules as novel therapeutic targets and new pathological characteristics for AD.

Clinical and Molecular Characteristics of PRKACA L206R Mutant Cortisol-Producing Adenomas in Korean Patients

BACKGROUND

An activating mutation (c.617A>C/p.Lys206Arg, L206R) in protein kinase cAMP-activated catalytic subunit alpha (PRKACA) has been reported in 35% to 65% of cases of cortisol-producing adenomas (CPAs). We aimed to compare the clinical characteristics and transcriptome analysis between PRKACA L206R mutants and wild-type CPAs in Korea.

METHODS

We included 57 subjects with CPAs who underwent adrenalectomy at Seoul National University Hospital. Sanger sequencing for PRKACA was conducted in 57 CPA tumor tissues. RNA sequencing was performed in 13 fresh-frozen tumor tissues.

RESULTS

The prevalence of the PRKACA L206R mutation was 51% (29/57). The mean age of the study subjects was 42±12 years, and 87.7% (50/57) of the patients were female. Subjects with PRKACA L206R mutant CPAs showed smaller adenoma size (3.3±0.7 cm vs. 3.8±1.2 cm, P=0.059) and lower dehydroepiandrosterone sulfate levels (218±180 ng/mL vs. 1,511±3,307 ng/mL, P=0.001) than those with PRKACA wild-type CPAs. Transcriptome profiling identified 244 differentially expressed genes (DEGs) between PRKACA L206R mutant (n=8) and wild-type CPAs (n=5), including five upregulated and 239 downregulated genes in PRKACA L206R mutant CPAs (|fold change| ≥2, P<0.05). Among the upstream regulators of DEGs, CTNNB1 was the most significant transcription regulator. In several pathway analyses, the Wnt signaling pathway was downregulated and the steroid biosynthesis pathway was upregulated in PRKACA mutants. Protein-protein interaction analysis also showed that PRKACA downregulates Wnt signaling and upregulates steroid biosynthesis.

CONCLUSION

The PRKACA L206R mutation in CPAs causes high hormonal activity with a limited proliferative capacity, as supported by transcriptome profiling.

Accounting conservatism and firm performance during the COVID‐19 pandemic

We explore whether firms with more conditionally conservative accounting practices have higher stock returns than other firms during the Covid‐19 outbreak. We find evidence that Chinese firms listed on the Shanghai and Shenzhen Stock Exchanges applying more conditionally conservative reporting have lower declines in stock return performance during the Covid‐19 outbreak relative to other firms. We also find that the beneficial role of conditional conservatism is higher when firms have greater information asymmetry following the Covid‐19 pandemic. Our results are robust to various model specifications with four different measures of conservatism and an alternative return window.

A Fibroma of Tendon Sheath Causing Carpal Tunnel Syndrome: A Case Report of an Atypical Clinical Presentation

Fibroma of the tendon sheath is a benign slow-growing fibrous tumor. Although rare, cases occurring in the upper extremities usually involve the fingers. It appears as a well-defined, roundor oval-shaped mass originating from the flexor tendon. Abundant fibrous stroma makes fibromas appear as a low intensity mass in all MRI sequences. Most of the fibromas manifest as painless soft tissue masses. Herein, we report a case of fibroma of the tendon sheath with an unusual clinical presentation, triggering carpal tunnel syndrome during wrist movement.

Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy

BACKGROUND

Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors-circadian rhythm-related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states-on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures.

OBJECTIVE

The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model.

METHODS

A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing.

RESULTS

Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day's sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes.

CONCLUSIONS

BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.

The nasal symbiont Staphylococcus species restricts the transcription of SARS-CoV-2 entry factors in human nasal epithelium

Emerging evidence indicates that severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) is transmitted through the human nasal mucosa via the principal entry factors angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), which are highly expressed in the nasal epithelium. Therefore, the biologics targeting host entry factors on human nasal mucosa will be necessary for complete control of SARS-CoV-2. Our data reveal that ACE2 was more abundant in human nasal mucosa than lung tissue. Both ACE2 and TMPRSS2 transcriptions significantly decreased in nasal epithelium in response to S. epidermidis and were relatively lower in human nasal mucus with large numbers of S. epidermidis. ACE2 transcription was also reduced in nasal epithelium in response to nasal symbiont S. aureus. This study proposes that Staphylococcus species nasal commensals might potentially restrict SARS-CoV-2 entry to the nasal epithelium via down regulation of cellular receptors coupled with reduction of principal host protease.

Characteristics and outcomes of emergency department patients with a foreign body that entered through the ear, nose or mouth: a 10-year retrospective analysis

BACKGROUND

Foreign bodies in the ear, nose and throat commonly necessitate emergency department visits.

METHOD

This retrospective study was conducted on emergency department visits from January 2010 to December 2019 to determine characteristics and clinical prognoses of ENT patients. Patients were divided into three groups according to foreign-body entry route; patient characteristics and clinical findings were compared between groups.

RESULTS

Of 676 142 emergency department visits, 10 454 were because of ENT-related foreign bodies. The mean (± standard deviation) age of subjects was 24.0 (± 23.4) years, and 5176 patients were male (49.5 per cent). The most common entry route was the mouth (74.5 per cent). Most patients (97.1 per cent) were discharged after emergency treatment. Intensive care and in-hospital mortality occurred only in the mouth group.

CONCLUSION

Clinical findings differ depending on foreign-body entry route. After emergency treatment, most patients were discharged; some cases presented serious complications.

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

OBJECTIVE

More attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting.

METHODS

Data were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only.

RESULTS

Of 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195).

CONCLUSION

For optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.