User's guide to correlation coefficients

Phylogenetic clustering and rarity imply risk of local species extinction in prospective deep-sea mining areas of the Clarion-Clipperton Fracture Zone

An understanding of the forces controlling community structure in the deep sea is essential at a time when its pristineness is threatened by polymetallic nodule mining. Because abiotically defined communities are more sensitive to environmental change, we applied occurrence- and phylogeny-based metrics to determine the importance of biotic versus abiotic structuring processes in nematodes, the most abundant invertebrate taxon of the Clarion–Clipperton Fracture Zone (CCFZ), an area targeted for mining. We investigated the prevalence of rarity and the explanatory power of environmental parameters with respect to phylogenetic diversity (PD). We found evidence for aggregation and phylogenetic clustering in nematode amplicon sequence variants (ASVs) and the dominant genus Acantholaimus, indicating the influence of environmental filtering, sympatric speciation, affinity for overlapping habitats and facilitation for community structure. PD was associated with abiotic variables such as total organic carbon, chloroplastic pigments equivalents and/or mud content, explaining up to 57% of the observed variability and providing further support of the prominence of environmental structuring forces. Rarity was high throughout, ranging from 64 to 75% unique ASVs. Communities defined by environmental filtering with a prevalence of rarity in the CCFZ suggest taxa of these nodule-bearing abyssal plains will be especially vulnerable to the risk of extinction brought about by the efforts to extract them.

Absence of a Faster-X Effect in Beetles (Tribolium, Coleoptera)

The faster-X effect, namely the rapid evolution of protein-coding genes on the X chromosome, has been widely reported in metazoans. However, the prevalence of this phenomenon across diverse systems and its potential causes remain largely unresolved. Analysis of sex-biased genes may elucidate its possible mechanisms: for example, in systems with X/Y males a more pronounced faster-X effect in male-biased genes than in female-biased or unbiased genes may suggest fixation of recessive beneficial mutations rather than genetic drift. Further, theory predicts that the faster-X effect should be promoted by X chromosome dosage compensation. Here, we asked whether we could detect a faster-X effect in genes of the beetle Tribolium castaneum (and T. freemani orthologs), which has X/Y sex-determination and heterogametic males. Our comparison of protein sequence divergence (dN/dS) on the X chromosome vs. autosomes indicated a rarely observed absence of a faster-X effect in this organism. Further, analyses of sex-biased gene expression revealed that the X chromosome was particularly highly enriched for ovary-biased genes, which evolved slowly. In addition, an evaluation of male X chromosome dosage compensation in the gonads and in non-gonadal somatic tissues indicated a striking lack of compensation in the testis. This under-expression in testis may limit fixation of recessive beneficial X-linked mutations in genes transcribed in these male sex organs. Taken together, these beetles provide an example of the absence of a faster-X effect on protein evolution in a metazoan, that may result from two plausible factors, strong constraint on abundant X-linked ovary-biased genes and a lack of gonadal dosage compensation.

Galectin-3 is associated with severe heart failure and death: A hospital-based study in Chinese patients

Heart failure (HF) is a serious disease syndrome characterized by elevated pro-inflammatory cytokines and inflammatory mediators presume to have significant contribution on disease progression. Galectins are carbohydrate-binding proteins responsible of various physiological functions. Role of galectins in heart failure has been ill-defined. In the present case-controls study, 136 patients clinically diagnosed with heart failure and 125 healthy Chinese controls were recruited. Levels of galectins (Gal-1, 3 and 9) and cytokines (IFN-γ, IL-17A, IL-4 and TGF-β) were quantified by ELISA. Increased levels of galectin-1 and 3 was observed in HF patients and associated with clinical severity. In addition, pro-inflammatory cytokines such as IFN-γ and IL-17A were increased in patients whereas, anti-inflammatory TGFβ was decreased. Galectin-3 was positively correlated with IFN-γ, IL-17A and inversely with TGF-β. Furthermore, ROC curve analysis suggested galectin-3 as a promising biomarker for diagnosis and HF and clinical severity. Interestingly, a two-year follow-up indicated significant association of elevated galectin-3 with mortality due to HF. In conclusion, galectin-3 associated with HF and clinical manifestations possibly by inducing pro-inflammatory cytokines and could be a possible biomarker of HF and severe clinical conditions.

Stair negotiation behaviour of older individuals: Do step dimensions matter?

Stair falls are a major health problem for older people. Most studies on identification of stair fall risk factors are limited to staircases set in given step dimensions. However, it remains unknown whether the conclusions drawn would still apply if the dimensions had been changed to represent more challenging or easier step dimensions encountered in domestic and public buildings. The purpose was to investigate whether the self-selected biomechanical stepping behaviours are maintained when the dimensions of a staircase are altered. Sixty-eight older adults (>65 years) negotiated a seven-step staircase set in two step dimensions (shallow staircase: rise 15 cm, going 28 cm; steep staircase: rise 20 cm, going 25 cm). Six biomechanical outcome measures indicative of stair fall risk were measured. K-means clustering profiled the overall stair-negotiating behaviour and cluster profiles were calculated. A Cramer's V measured the degree of association in membership between clusters. The cluster profiles revealed that the biomechanically risky and conservative factors that characterized the overall behaviour in the clusters did not differ for the majority of older adults between staircases for ascent and descent. A strong association of membership between the clusters on the shallow staircase and the steep staircase was found for stair ascent (Cramer's V: 0.412, p < 0.001) and descent (Cramer's V: 0.380, p = 0.003). The findings indicate that manipulating the demand of the task would not affect the underpinning mechanism of a potential stair fall. Therefore, for most individuals, detection of stair fall risk might not require testing using a staircase with challenging step dimensions.

Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia

Due to inadequate human and financial resource support, the development of mental health services in Cambodia has been undertaken by various non-governmental organizations (NGOs). Schizophrenia is the most common functional psychotic disorder, causing severe and chronic symptoms, and the programs provided by the NGOs should have enhanced the quality of life (QoL) of patients and their caregivers; however, epidemiological research, which is a driving force behind the recognition of mental health as a global public health concern, is lacking for schizophrenia in Cambodia. This study therefore aimed to create QoL evaluation questionnaires available in Khmer (the Cambodian language) for patients with schizophrenia and family caregivers, and to identify the social determinants and predictors of their QoL. This cross-sectional study recruited 59 patients and 59 caregivers attending three clinics operated by two NGOs: the Transcultural Psychosocial Organization (TPO) Cambodia and the Supporters for Mental Health (SUMH) Cambodia. We conducted linguistic validation of the Schizophrenia Quality of Life Questionnaire 18-item version (S-QoL 18) and the Schizophrenia Caregiver Questionnaire (SCQ), then analyzed correlations between the QoL dimensions and socio-demographic factors. The main findings of this study were as follows: 1) the newly created Khmer versions of S-QoL 18 and SCQ are relatively good psychometric tools that are suitable for research to identify patients’ and caregivers’ needs to improve their QoL; and 2) engaging in paid work or being of the post-Khmer Rouge generation results in higher QoL for patients, but having low household economic status or being affected by chronic disease leads to lower QoL for family caregivers. These findings are useful for enabling community mental health professionals and aid organizations to create programs to lessen the patient and caregiver burden in Cambodia. Further research is necessary to develop practical projects that will improve patients’ and caregivers’ QoL in various clinical settings in Cambodia.

Spatial Dimension of the Employment Market Exposition to Digitalisation—The Case of Austria

Digitalisation, referred to as the fourth industrial revolution, is gradually becoming part of all areas of life. The progressing digitalisation inspires new business models, restructures production processes and provides new revenue and value-producing opportunities. Simultaneously jobs are becoming abdicable and livelihoods can get threatened. To analyse the spatial context of the susceptibility of regional labour markets to 4.0 technology in Austria, the occupation-based assessment of digitalisation probability was projected on the industry standard classification and linked to the statistical employee data at the municipal level. The outcomes reveal to what extent the economic sections and divisions are exposed to digitalisation. Results representing spatial distribution reveal that digitalisation risks cannot be explicitly assigned to certain spatial structures or localities. Still, it can be stated that urban areas and small towns are relatively less exposed to disappearing of existing jobs. Municipalities with the highest vulnerability to labour replaceability are located mainly in rural areas. The discussion focuses on regional resilience, social vulnerability and possible development paths for different frameworks and spatial context of consequences. The study emphasizes the importance of digitalisation processes for regional development and presents an approach of analysing their territorial dimensions.

Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren's syndrome: a cross-sectional study

BACKGROUND

Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders.

OBJECTIVE

To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity.

DESIGN AND SETTING

Analytical observational study conducted at an exercise psychobiology laboratory.

METHODS

Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics.

RESULTS

A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI.

CONCLUSION

The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

Predicting Brain Functional Connectivity Using Mobile Sensing

Brain circuit functioning and connectivity between specific regions allow us to learn, remember, recognize and think as humans. In this paper, we ask the question if mobile sensing from phones can predict brain functional connectivity. We study the brain resting-state functional connectivity (RSFC) between the ventromedial prefrontal cortex (vmPFC) and the amygdala, which has been shown by neuroscientists to be associated with mental illness such as anxiety and depression. We discuss initial results and insights from the NeuroSence study, an exploratory study of 105 first year college students using neuroimaging and mobile sensing across one semester. We observe correlations between several behavioral features from students' mobile phones and connectivity between vmPFC and amygdala, including conversation duration (r=0.365, p<0.001), sleep onset time (r=0.299, p<0.001) and the number of phone unlocks (r=0.253, p=0.029). We use a support vector classifier and 10-fold cross validation and show that we can classify whether students have higher (i.e., stronger) or lower (i.e., weaker) vmPFC-amygdala RSFC purely based on mobile sensing data with an F1 score of 0.793. To the best of our knowledge, this is the first paper to report that resting-state brain functional connectivity can be predicted using passive sensing data from mobile phones.

Depigmented Centella asiatica Extraction by Pretreated with Supercritical Carbon Dioxide Fluid for Wound Healing Application

Centella asiatica has been included in Thai traditional medicinal plants and recipes, as a well-established historical use as a vegetable and tonic. However, when applied in modern formulations, the progressive degradation of the plant pigments occurs, causing color-fading and color variation in the products. Depigmentation of the comminuted sample using supercritical carbon dioxide (scCO2) fluid extraction with a cosolvent was introduced as a pretreatment to solve the color-fading problem. The contents of compounds with known biological activities and the wound healing activities (antioxidant screening by DPPH and ABTS+ scavenging activities; cell migration assay; matrix metallopeptidase [MMP]-2 inhibition on human skin fibroblast; endothelial cell tube formation assay) of the C. asiatica leaf extracts obtained by conventional ethanolic extraction (CV) and pretreatment using scCO2 extraction, were determined. Total triterpenoids (madecassoside, asiaticoside B, asiaticoside, madecassic acid, terminolic acid and asiatic acid) and total triterpenoid glucosides (madecassoside, asiaticoside B and asiaticoside) were notably more abundant in the extract that had been pretreated using scCO2 than the extract obtained by CV. Moreover, the scCO2 pretreatment not only caused greater relative MMP-2 inhibition (58.48 ± 7.50% of the control), but also exhibited a higher cell migration (59.83 ± 1.85% of the initial) and number of vessels (18.25 ± 4.58) of angiogenesis in the wound healing process. Additionally, positive correlations were observed between the DPPH antioxidant activity and madecassoside content (r = 0.914, p < 0.01), as well as between the cell migration activity and asiaticoside content (r = 0.854, p < 0.05). It can be concluded that the scCO2 pretreatment of C. asiatica can eliminate color pigments from the extract and improve its in vitro wound healing activity.

Congruence between nurses' and patients' assessment of postoperative pain: a literature review

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.

Human B1 Cells are the Main Blood Group A-Specific B Cells That Have a Moderate Correlation With Anti-A Antibody Titer

Background

Anti-carbohydrate antibody responses, including those of anti-blood group ABO antibodies, are yet to be thoroughly studied in humans. Because anti-ABO antibody-mediated rejection is a key hurdle in ABO-incompatible transplantation, it is important to understand the cellular mechanism of anti-ABO responses. We aimed to identify the main human B cell subsets that produce anti-ABO antibodies by analyzing the correlation between B cell subsets and anti-ABO antibody titers.

Methods

Blood group A-binding B cells were analyzed in peritoneal fluid and peripheral blood samples from 43 patients undergoing peritoneal dialysis and 18 healthy volunteers with blood group B or O. The correlation between each blood group A-specific B cell subset and anti-A antibody titer was then analyzed using Pearson's correlation analysis.

Results

Blood group A-binding B cells were enriched in CD27⁺CD43⁺CD1c⁻ B1, CD5⁺ B1, CD11b⁺ B1, and CD27⁺CD43⁺CD1c⁺ marginal zone-B1 cells in peripheral blood. Blood group A-specific B1 cells (P=0.029 and R=0.356 for IgM; P=0.049 and R=0.325 for IgG) and marginal zone-B1 cells (P=0.011 and R=0.410 for IgM) were positively correlated with anti-A antibody titer. Further analysis of peritoneal B cells confirmed B1 cell enrichment in the peritoneal cavity but showed no difference in blood group A-specific B1 cell enrichment between the peritoneal cavity and peripheral blood.

Conclusions

Human B1 cells are the key blood group A-specific B cells that have a moderate correlation with anti-A antibody titer and therefore constitute a potential therapeutic target for successful ABO-incompatible transplantation.

Vitamin D nutritional status in the adult population in Colombia - An analytical cross-sectional study

Background

The key role of Vitamin D is to maintain an adequate calcium and phosphorus metabolism. Vitamin D plays an antagonistic role with the parathyroid hormone. 25 OH Vitamin D is the major circulating form and the best indicator to monitor Vitamin D levels.

Methods

A cross-sectional study was conducted in 1339 individuals ≥18 years old. The main objective was to establish the nutritional status of Vitamin D and its association with PTH and ionized calcium levels. Other objectives were to compare the levels of 25 OH Vitamin D based on sun exposure habits, and to identify the minimum cut-off point for the levels of 25 OH Vitamin D that could give rise to a concomitant increase in PTH and ionized calcium levels.

Results

14.2% of participants presented Vitamin D deficiency, and 28.8% presented insufficiency; ≥89% of the participants with deficiency or insufficiency were exposed to sunlight <30 minutes per week. A value of 25 OH Vitamin D >30 ng/mL was associated with a more stable and "flat" PTH value. The median of 25 OH Vit-D associated with hypercalcemia was <10 ng/mL.

Conclusion

In Colombia, low 25 OH Vitamin D values are highly prevalent; this may be accounted for by poor sun-exposure habits and frequent use of sunscreen. Just as in other similar trials, the lower the levels of 25 OH Vit-D, the higher the effect on PTH and ionized calcium elevation.

Tumor segmentation analysis at different post-contrast time points: A possible source of variability of quantitative DCE-MRI parameters in locally advanced breast cancer

PURPOSE

to assess if tumor segmentation analysis performed at different post-contrast time points (TPs) on dynamic images could influence the extraction of dynamic contrast enhanced (DCE)-MRI parameters in locally advanced breast cancer (LABC), and potentially represent a source of variability.

METHOD

forty patients with forty-two LABC lesions were prospectively enrolled and underwent breast DCE-MRI examination at 3 T. On post-processed dynamic images, enhancing tumor lesions were manually segmented at four different TPs: at the first post-contrast dynamic image in which the lesion was appreciable (TP 1) and at 1, 5 and 10 min after contrast-agent administration (TPs 2, 3 and 4, respectively) and corresponding DCE-MRI parameters were extracted. Friedman's test followed by Bonferroni-adjusted Wilcoxon signed rank test for post-hoc analysis was used to compare DCE-MRI parameters. Intra- and inter-observer reliability of DCE-MRI parameters measurements was assessed using the Intraclass Correlation Coefficient (ICC) analysis.

RESULTS

Ktrans, Kep and iAUC were significantly higher when extracted from ROIs placed at TP1 and progressively decreased from TP 2-4. The intra-observer reliability ranged from good to excellent (ICC's: 0.894 to 0.990). The inter-observer reliability varied from moderate to excellent (0.770 to 0.942). The inter-observer reliability was significantly higher for Ktrans and Kep extracted at TPs1 and 2 as compared to TPs 3 and 4.

CONCLUSIONS

A significant variability of DCE-MRI quantitative parameters occurs when tumor segmentation is performed at different TPs. We suggest to performing tumor delineation at an established TP, preferably the earliest, in order to extract reliable and comparable DCE-MRI data.

Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017

OBJECTIVE

To describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using data from the Global Burden of Disease Study 2017.

DESIGN

Systematic analysis.

DATA SOURCE

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017.

METHODS

Mortality and DALYs from chronic respiratory diseases were estimated from the Global Burden of Disease Study 2017 using DisMod-MR 2.1, a Bayesian meta-regression tool. The estimated annual percentage change of the age standardised mortality rate was calculated using a generalised linear model with a Gaussian distribution. Mortality and DALYs were stratified according to the Socio-demographic index. The strength and direction of the association between the Socio-demographic index and mortality rate were measured using the Spearman rank order correlation. Risk factors for chronic respiratory diseases were analysed from exposure data.

RESULTS

Between 1990 and 2017, the total number of deaths due to chronic respiratorydiseases increased by 18.0%, from 3.32 (95% uncertainty interval 3.01 to 3.43) million in 1990 to 3.91 (3.79 to 4.04) million in 2017. The age standardised mortality rate of chronic respiratory diseases decreased by an average of 2.41% (2.28% to 2.55%) annually. During the 27 years, the annual decline in mortality rates of chronic obstructive pulmonary disease (COPD; 2.36%, uncertainty interval 2.21% to 2.50%) and pneumoconiosis (2.56%, 2.44% to 2.68%) has been slow, whereas the mortality rate for interstitial lung disease and pulmonary sarcoidosis (0.97%, 0.92% to 1.03%) has increased. Reductions in DALYs for asthma and pneumoconiosis have been seen, but DALYs due to COPD, and interstitial lung disease and pulmonary sarcoidosis have increased. Mortality and the annual change in mortality rate due to chronic respiratory diseases varied considerably across 195 countries. Assessment of the factors responsible for regional variations in mortality and DALYs and the unequal distribution of improvements during the 27 years showed negative correlations between the Socio-demographic index and the mortality rates of COPD, pneumoconiosis, and asthma. Regions with a low Socio-demographic index had the highest mortality and DALYs. Smoking remained the major risk factor for mortality due to COPD and asthma. Pollution from particulate matter was the major contributor to deaths from COPD in regions with a low Socio-demographic index. Since 2013, a high body mass index has become the principal risk factor for asthma.

CONCLUSIONS

Regions with a low Socio-demographic index had the greatest burden of disease. The estimated contribution of risk factors (such as smoking, environmental pollution, and a high body mass index) to mortality and DALYs supports the need for urgent efforts to reduce exposure to them.

SEMA3A Exon 9 Expression Is a Potential Prognostic Marker of Unfavorable Recurrence-Free Survival in Patients with Tongue Squamous Cell Carcinoma

This study tried to assess the prognostic value of semaphorin (SEMA) family genes in patients with tongue squamous cell carcinoma (TSCC) and the potential epigenetic alterations of the genes. The part of third-level TSCC data in The Cancer Genome Atlas-Head and Neck Squamous Cell Carcinoma (TCGA-HNSC) was extracted using the UCSC Xena browser for analysis. Among 20 SEMA genes examined, 7 were markedly upregulated, while 8 were substantially decreased in TSCC tissues compared with adjacent normal tissues. SEMA3A was the only gene with independent prognostic value in terms of recurrence-free survival (RFS) in multivariate analysis (hazard ratio [HR]: 1.697, 95% CI: 1.228-2.345, p = 0.001). Among the individual exons of SEMA3A, the exon 9 had a better prognostic value in terms of recurrence than total SEMA3A expression and its expression also independently predicted shorter RFS (HR: 2.193, 95% CI: 1.463-3.290, p < 0.001). The methylation levels of two CpG sites (cg06144675 and cg13988052) were moderately correlated with SEMA3A expression. Interestingly, cg06144675, which locates at the promoter region, showed a negative correlation with SEMA3A expression, whereas cg13988052, which is in the intron of SEMA3A gene body showed a positive correlation with SEMA3A expression. In conclusion, SEMA3A expression is aberrantly upregulated in TSCC tissues. Its exon 9 expression is a potentially valuable prognostic marker of unfavorable RFS in TSCC patients. Both promoter hypomethylation and gene body hypermethylation might contribute to the dysregulation.

Effects of MRI image normalization techniques in prostate cancer radiomics

The variance in intensities of MRI scans is a fundamental impediment for quantitative MRI analysis. Intensity values are not only highly dependent on acquisition parameters, but also on the subject and body region being scanned. This warrants the need for image normalization techniques to ensure that intensity values are consistent within tissues across different subjects and visits. Many intensity normalization methods have been developed and proven successful for the analysis of brain pathologies, but evaluation of these methods for images of the prostate region is lagging. In this paper, we compare four different normalization methods on 49 T2-w scans of prostate cancer patients: 1) the well-established histogram normalization, 2) the generalized scale normalization, 3) an extension of generalized scale normalization called generalized ball-scale normalization, and 4) a custom normalization based on healthy prostate tissue intensities. The methods are compared qualitatively and quantitatively in terms of behaviors of intensity distributions as well as impact on radiomic features. Our findings suggest that normalization based on prior knowledge of the healthy prostate tissue intensities may be the most effective way of acquiring the desired properties of normalized images. In addition, the histogram normalization method outperform the generalized scale and generalized ball-scale methods which have proven superior for other body regions.

Relationship between the sectional area of the rectus capitis posterior minor and the to be named ligament from 3D MR imaging

Background

To evaluate the maximal sectional area (SA) of the rectus capitis posterior minor (RCPmi) muscle and its potential correlation with to be named ligament (TBNL) in the suboccipital area using 3D MR imaging.

Methods

A total of 365 subjects underwent sagittal 3D T₂WI MR imaging of the RCPmi and TBNL. Among them, 45 subjects were excluded due to a particular clinical history or poor image quality. Finally, 320 subjects met the inclusion criteria, including 138 men and 182 women. The 624 RCPmi muscles were classified into positive and negative groups according to their attachment to the TBNL. Two experienced radiologists manually measured the maximum SA of the RCPmi muscle on the parasagittal image with a 30° deviation from the median sagittal plane. The correlations between the SA and the subject’s age, height, BMI, gender, handedness, and age-related disc degeneration were tested by Spearman analysis. The SA differences between different groups were compared using independent samples t-test.

Results

A total of 123 RCPmi-TBNL attachments were identified in the positive group, while 501 RCPmi muscles were identified in the negative group. The SA of the 624 RCPmi muscles was 62.71 ± 28.72 mm² and was poorly correlated with the subject’s age, BMI, or handedness, with no correlation with age-related disc degeneration. A fair correlation was found between the SA and the body height in the whole group, and poor correlation in each male/female group. The SA of the RCPmi muscle in males was significantly bigger than that in women ([75.54 ± 29.17] vs. [52.74 ± 24.07] mm²). The SA of RCPmi muscle in the positive group was significantly smaller than that in the negative group ([55.95 ± 26.76] mm² vs. [64.37 ± 28.97] mm²).

Conclusions

Our results revealed a significantly smaller SA of the RCPmi in subjects with RCPmi-TBNL attachment. Besides, a larger SA of the RCPmi was correlated with the male gender. These findings suggest that the SA of the RCPmi ought to be interpreted with care for each patient since there could be considerable variations.

The Correlations Between Disease Specific Quality of Life, Short Form-36 and Clinical Variables in Patients With Ankylosing Spondylitis

Objectives

This study aims to assess the correlations between disease specific quality of life (QoL), general health status and clinical variables in patients with ankylosing spondylitis (AS), and also to determine a cutoff value for the disease specific QoL questionnaire.

Patients and methods

A total of 124 patients (80 males, 44 females; mean age 40.6±11.1 years; range, 20 to 65 years) who fulfilled the modified New York criteria for AS were included in this cross-sectional study. All patients received a comprehensive rheumatologic assessment including disease specific instruments for disease activity, functional status, spinal mobility and QoL. Furthermore, short form-36 (SF-36) was used to determine general health status. Pain levels of the patients were assessed with visual analog scale (VAS). Pearson’s analysis was used to assess correlation among variables, with moderate, strong, or very strong correlations if the value was between 0.40-0.69, 0.70-0.89, and 0.90-0.99, respectively. To determine a cutoff value for the ankylosing spondylitis quality of life (ASQoL) score, the area under the receiver operating characteristic curve (AUC) was computed according to clinical parameters which have the strongest correlations with ASQoL.

Results

The mean ASQoL score was 8.8±4.9. There was a significantly positive correlation between ASQoL and disease activity, functional status, spinal mobility and pain VAS whereas there was a significantly negative correlation between ASQoL and the SF-36 subscale scores except for mental health and emotional role (p<0.001). The strongest positive correlation was found between ASQoL and the Bath Ankylosing Spondylitis Disease Activity Index (r=0.721, p<0.001) whereas the strongest negative correlation was found between ASQoL and the first question of SF-36 (r=-0.844, p<0.001). A cutoff value of eight in ASQoL showed good discriminative properties for impaired QoL where sensitivity and specificity were simultaneously maximized according to disease activity (AUC=0.84 [95% confidence interval (CI): 0.770-0.908, p<0.001]) and the patients’ global health status (AUC=0.85 [95% CI: 0.782-0.923, p<0.001]) in patients with AS.

Conclusion

There was a strong correlation between ASQoL and disease activity as well as the patients’ global health status in patients with AS. A cutoff value of eight in ASQoL could be used with good discriminative properties for impaired QoL in AS.

Serum C-Reactive Protein/Albumin Ratio in Rheumatoid Arthritis and its Relationship With Disease Activity, Physical Function, and Quality of Life

Objectives

This study aims to evaluate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and disease activity, quality of life (QoL), and physical function in rheumatoid arthritis (RA).

Patients and methods

A total of 121 RA patients (22 males, 99 females; mean age 57.6±11.2 years; range, 32 to 85 years) applying to Ankara University School of Medicine Rheumatology Outpatient Clinic between January 2019 and February 2019 were included in this cross-sectional study. The inclusion criteria were fulfilling the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, being over 18 years and accepting to participate in the study. Demographic and clinical parameters including serum erythrocyte sedimentation rate (ESR), CRP and albumin levels were recorded. Disease activity was measured using Disease Activity Score 28 (DAS28)-ESR. General health, fatigue, and pain were questioned by means of a 100 mm visual analog scale (VAS). The QoL was assessed with the Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire. The functional status was determined using the Health Assessment Questionnaire (HAQ).

Results

Rheumatoid factor (RF) was positive in 56.2% of the patients. The median ESR was 19.0 mm/hour [interquartile range (IQR): 19.5] and median CRP was 5.6 (IQR: 9) mg/L. The median CAR was 1.3 (IQR: 2.1) and median DAS 28-ESR was 3.6 (IQR: 1.5). There was a significant but weak correlation between CAR and DAS28-ESR [p<0.001, Spearman's correlation coefficient (rs)=0.327]. Moreover, CAR was positively correlated with ESR, CRP, and VAS physician's global assessment (p<0.001, rs=0.497; p<0.001, rs=0.987, p<0.001, rs=0.401, respectively). However, no correlation was observed between CAR, HAQ, and RAQoL. In the RF positive group, there was a significant but weak correlation between CAR and RF titers (p=0.016, rs=0.292).

Conclusion

We observed a positive but weak correlation between CAR and DAS28-ESR, ESR, and the RF titer. Further studies are warranted to investigate the role of CAR in RA.

Evaluation of body composition as a potential biomarker in spinal muscular atrophy

INTRODUCTION

We aimed to investigate the correlation between body composition (BC) and spinal muscular atrophy (SMA)-specific motor function assessments.

METHODS

Patients with SMA types I or II, aged 1 to 10 years, were recruited in this cross-sectional study. The protocol included anthropometric measurements, and dual-energy X-ray absoprtiometry to assess fat mass (FM), lean mass (LM), fat-free mass (FFM), FM and FFM indexes (FMI, FFMI), and motor function assessments (Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders scale for SMAI, and Hammersmith Functional Motor Scale-Expanded for SMAII).

RESULTS

Eighty-eight children were included. All had a higher FM percentage than reference values. Motor function was moderately correlated with body mass index (BMI), FFMI, and LMI in SMAI, and weakly correlated with FFMI, LMI, and LM:FM ratio in SMAII.

DISCUSSION

BC shows promise as a potential biomarker for SMA, but further studies are needed.

A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study

Background

Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population.

Objective

The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research.

Methods

A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study.

Results

We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR.

Conclusions

ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.

Ultrafast laser diode thermal desorption method for analysis of representative pharmaceuticals in soil leachate samples

We developed and evaluated a novel analytical method combining ambient ionization technique - laser diode thermal desorption with chemical ionization (LDTD-APCI) and tandem mass spectrometry detection. The LDTD/APCI-MS/MS method was developed for determination of representative pharmaceuticals from different classes (carbamazepine, sulfamethoxazole, irbesartan, fexofenadine) in leachate samples from soil sorption experimentation. We then optimized laser pattern, laser energy and spiked sample volume, which are crucial parameters for this LDTD/APCI-MS/MS method. We further identified utility of a chelating agent (Na₂-EDTA) to obtain the highest achievable and reproducible signal of target analytes. Achieved method performance parameters (LODs, LOQs, trueness and precision) were comparable with those obtained from LC-MS/MS. However, application of this novel LDTD/APCI-MS/MS method reduced analysis time by two orders of magnitude (to 12 s), compared to more conventional LC-MS/MS approaches, without use of organic solvents. We expect this novel method will reduce costs and increase throughput for future analyses of pharmaceuticals in the environment while advancing a timely principle of green chemistry.

Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy

Objective: This study aimed to determine the validity and reliability of Inertial Measurement Units (IMUs) for the assessment of craniocervical range of motion (ROM) in patients with cerebral palsy (CP). Methods: twenty-three subjects with CP and 23 controls, aged between 4 and 14 years, were evaluated on two occasions, separated by 3 to 5 days. An IMU and a Cervical Range of Motion device (CROM) were used to assess craniocervical ROM in the three spatial planes. Validity was assessed by comparing IMU and CROM data using the Pearson correlation coefficient, the paired t-test and Bland–Altman plots. Intra-day and inter-day relative reliability were determined using the Intraclass Correlation Coefficient (ICC). The Standard Error of Measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC₉₀) were obtained for absolute reliability. Results: High correlations were detected between methods in both groups on the sagittal and frontal planes (r > 0.9), although this was reduced in the case of the transverse plane. Bland–Altman plots indicated bias below 5º, although for the range of cervical rotation in the CP group, this was 8.2º. The distance between the limits of agreement was over 23.5º in both groups, except for the range of flexion-extension in the control group. ICCs were higher than 0.8 for both comparisons and groups, except for inter-day comparisons of rotational range in the CP group. Absolute reliability showed high variability, with most SEM below 8.5º, although with worse inter-day results, mainly in CP subjects, with the MDC₉₀ of rotational range achieving more than 20º. Conclusions: IMU application is highly correlated with CROM for the assessment of craniocervical movement in CP and healthy subjects; however, both methods are not interchangeable. The IMU error of measurement can be considered clinically acceptable; however, caution should be taken when this is used as a reference measure for interventions.

Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction

PURPOSE

To assess the rate of return to sport (RTS) following revision Anterior Cruciate Ligament Reconstruction (ACLR) in a rehabilitation-based cohort of patients. A secondary goal of the study was to evaluate the association between compliance in post-operative rehabilitation and RTS rate.

METHODS

The study cohort included 79 sport-active patients (62 males, 17 females, 30.0 ± 10.2 years old) who underwent revision ACLR surgery and followed the same functional-oriented rehabilitation protocol. Patients were evaluated using a RTS survey: return to any kind of sport participation, return to the same pre-injury sport, return to the same sport at the same pre-injury level. With regards to compliance in post-operative rehabilitation, patients were then grouped in (1) Fully Compliant (FC), (2) Moderately Compliant (MC), (3) Scarcely Compliant (SC), and (4) Non-Compliant (NC).

RESULTS

At an average follow-up of 29 ± 12 months, 86% of the patients returned to some kind of sport activity, 62% returned to the same pre-injury sport activity and 59% returned to the same pre-injury level of sport activity. While no surgical aspects were correlated with RTS, higher BMI was found to have a negative influence (p = 0.033). Regardless of the type of sport, compliance significantly affected RTS at the same pre-injury level (p = 0.006): 86% in FC, 67% in MC, 50% in SC, and 45% in NC. For each compliance goal achieved, the probability of RTS increased by 68% (OR = 1.68; p = 0.027).

CONCLUSION

RTS at the same pre-injury level after revision ACLR is challenging. A higher compliance in rehabilitation significantly increases the chances of RTS.

LEVEL OF EVIDENCE

IV.

Predicting adequacy of free quadriceps tendon autograft, for primary and revision ACL reconstruction, from patients' physical parameters

PURPOSE

Free quadriceps tendon autograft (QTA) has gained popularity for both primary and revision ACL reconstruction. The aim of this study is to measure the dimensions of quadriceps tendon and determine its correlation with patient's height, weight and BMI. This is to provide a guide for patients and surgeons in predicting the suitability of QTA for ACL reconstructions.

METHODS

A cross-sectional study in which the length and thickness of the quadriceps tendon was measured in 51 Caucasian patients who underwent primary total knee arthroplasty. Exclusion criteria include non-Caucasians and previous tendon pathology. Patients were selected from routine elective total knee arthroplasty list. Tendon length is taken from musculotendinous junction to its insertion. Thickness was measured at midpoint and at distal insertion. Patients' height, weight and BMI were recorded. The correlation between patient physical parameters and tendon dimensions were determined.

RESULTS

Subjects' median age was 65 years (range 44-87), with 34 females and 17 males. Median length of the tendon was 9 mm (range 70-110), and median insertional thickness was 9 mm (7-10 mm). Median thickness at midpoint was 7 mm (range 4-10 mm). There was moderately positive correlation between subjects' height and tendon length (correlation coefficient 0.50), and also between weight and tendon length (correlation coefficient 0.47). There was no significant correlation between subjects' BMI and the tendon length. There was also no significant correlation between tendon thickness and subject's physical parameters.

CONCLUSION

This study has shown that most patients could provide adequate QTA for ACL reconstruction. It also points to the fact that no investigation is required to predict the adequacy of QTA. Though further studies with larger sample size are required to confirm this, clinician can rely on analysing patients' physical parameter in predicting the adequacy of QTA for ACL reconstruction.

LEVEL OF EVIDENCE

II.

Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists

BACKGROUND

Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance.

METHODS

We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with χ² and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research.

RESULTS

The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4-11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001).

CONCLUSIONS

Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.

REAL-Time Smartphone Activity Classification Using Inertial Sensors-Recognition of Scrolling, Typing, and Watching Videos While Sitting or Walking

By developing awareness of smartphone activities that the user is performing on their smartphone, such as scrolling feeds, typing and watching videos, we can develop application features that are beneficial to the users, such as personalization. It is currently not possible to access real-time smartphone activities directly, due to standard smartphone privileges and if internal movement sensors can detect them, there may be implications for access policies. Our research seeks to understand whether the sensor data from existing smartphone inertial measurement unit (IMU) sensors (triaxial accelerometers, gyroscopes and magnetometers) can be used to classify typical human smartphone activities. We designed and conducted a study with human participants which uses an Android app to collect motion data during scrolling, typing and watching videos, while walking or seated and the baseline of smartphone non-use, while sitting and walking. We then trained a machine learning (ML) model to perform real-time activity recognition of those eight states. We investigated various algorithms and parameters for the best accuracy. Our optimal solution achieved an accuracy of 78.6% with the Extremely Randomized Trees algorithm, data sampled at 50 Hz and 5-s windows. We conclude by discussing the viability of using IMU sensors to recognize common smartphone activities.

Automatic assessment of the myoclonus severity from videos recorded according to standardized Unified Myoclonus Rating Scale protocol and using human pose and body movement analysis

PURPOSE

Myoclonus in progressive myoclonus epilepsy type 1 (EPM1) patients shows marked variability, which presents a substantial challenge in devising treatment and conducting clinical trials. Consequently, fast and objective myoclonus quantification methods are needed.

METHODS

Ten video-recorded unified myoclonus rating scale (UMRS) myoclonus with action tests were performed on EPM1 patients who were selected for the development and testing of the automatic myoclonus quantification method. Human pose and body movement analyses of the videos were used to identify body keypoints and further analyze movement smoothness and speed. The automatic myoclonus rating scale (ARMS) was developed. It included the jerk count during movement score and the log dimensionless jerk (LDLJ) score to evaluate changes in the smoothness of movement.

RESULTS

The scores obtained with the automatic analyses showed moderate to strong significant correlation with the UMRS myoclonus with action scores. The jerk count of the primary keypoints and the LDLJ scores were effective in the evaluation of the myoclonic jerks during hand movements. They also correlated moderately to strongly with the total UMRS test panel scores (r2 = 0,77, P = 0,009 for the jerk count score and r2 = 0,88, P = 0,001 for the LDLJ score). The automatic analyses was weaker in quantification of the neck, trunk, and leg myoclonus.

CONCLUSION

Automatic quantification of myoclonic jerks using human pose and body movement analysis of patients' videos is feasible and was found to be quite consistent with the accepted clinical gold standard quantification method. Based on the results of this study, the automatic analytical method should be further developed and validated to improve myoclonus severity follow-up for EPM1 patients.

Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia in hypertrophic cardiomyopathy (HCM) and is associated with adverse outcomes in HCM patients. Although the left atrial (LA) diameter has consistently been identified as a strong predictor of AF in HCM patients, the relationship between LA dysfunction and AF still remains unclear. The aim of this study is to evaluate the LA function in patients with non-obstructive HCM (NOHCM) utilizing cardiovascular magnetic resonance feature tracking (CMR-FT).

METHODS

Thirty-three patients with NOHCM and 28 healthy controls were studied. The global and regional LA function and left ventricular (LV) function were compared between the two groups. The following LA global functional parameters were quantitively analyzed: reservoir function (total ejection fraction [LA total EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive ejection fraction [LA passive EF], passive strain [εe], peak early-negative SR [SRe]), and booster pump function (active ejection fraction [LA active EF], active strain [εa], peak late-negative SR [SRa]). The LA wall was automatically divided into 6 segments: anterior, antero-roof, inferior, septal, septal-roof and lateral. Three LA strain parameters (εs, εe, εa) and their corresponding strain rate parameters (SRs, SRe, SRa) during the reservoir, conduit and booster pump LA phases were segmentally measured and analyzed.

RESULTS

The LA reservoir (LA total EF: 57.6 ± 8.2% vs. 63.9 ± 6.4%, p < 0.01; εs: 35.0 ± 12.0% vs. 41.5 ± 11.2%, p = 0.03; SRs: 1.3 ± 0.4 s- 1 vs. 1.5 ± 0.4 s- 1, p = 0.02) and conduit function (LA passive EF: 28.7 ± 9.1% vs. 37.1 ± 10.0%, p < 0.01; εe: 18.7 ± 7.9% vs. 25.9 ± 10.0%, p < 0.01; SRe: - 0.8 ± 0.3 s- 1 vs. -1.1 ± 0.4 s- 1, p < 0.01) were all impaired in patients with NOHCM when compared with healthy controls, while LA booster pump function was preserved. The LA segmental strain and strain rate analysis demonstrated that the εs, εe, SRe of inferior, SRs, SRe of septal-roof, and SRa of antero-roof walls (all p < 0.05) were all decreased in the NOHCM cohort. Correlations between LA functional parameters and LV conventional function and LA functional parameters and baseline parameters (age, body surface area and NYHA classification) were weak. The two strongest relations were between εs and LA total EF(r = 0.84, p < 0.01), εa and LA active EF (r = 0.83, p < 0.01).

CONCLUSIONS

Compared with healthy controls, patients with NOHCM have LA reservoir and conduit dysfunction, and regional LA deformation before LA enlargement. CMR-FT identifies LA dysfunction and deformation at an early stage.

Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes among People Living with HIV: A Randomized Controlled Pilot Trial

The purpose of this pilot randomized controlled trial is to assess the feasibility and impact of a triweekly 12-week yoga intervention among people living with HIV (PLWH). Additional objectives included evaluating cognition, physical function, medication adherence, health-related quality of life (HRQoL), and mental health among yoga participants versus controls using blinded assessors. We recruited 22 medically stable PLWH aged ≥35 years. A priori feasibility criteria were ≥70% yoga session attendance and ≥70% of participants satisfied with the intervention using a postparticipation questionnaire. Two participants withdrew from the yoga group. Mean yoga class attendance was 82%, with 100% satisfaction. Intention-to-treat analyses (yoga n = 11, control n = 11) showed no within- or between-group differences in cognitive and physical function. The yoga group improved over time in HRQoL cognition (P = .047) with trends toward improvements in HRQoL health transition (P =.063) and depression (P = .055). This pilot study provides preliminary evidence of feasibility and benefits of yoga for PLWH.

Psychological Symptoms and Behavioral Changes in Children and Adolescents During the Early Phase of COVID-19 Quarantine in Three European Countries

The coronavirus disease (COVID-19) pandemic forced the home confinement of the majority of population around the world, including a significant number of children and adolescents, for several weeks in 2020. Negative psychological effects have been identified in adults, but research about the impact of this type of social distancing measure on children and adolescents is scarce. The present study aimed to describe and compare the immediate psychological and behavioral symptoms associated with COVID-19 quarantine in children and adolescents from three southern European countries with different levels of restrictions (Italy, Spain, and Portugal). Parents of 1,480 children and adolescents (52.8% boys) between 3 and 18 years old (M = 9.15, SD = 4.27) participated in the study. An online survey using snowball sampling techniques was conducted during 15 days between March and April 2020, representing the early phase of the quarantine associated with COVID-19 outbreak. Parents answered questionnaires about sociodemographic data, housing conditions, immediate psychological responses during quarantine (e.g., anxiety, mood, sleep, and behavioral alterations), patterns of use of screens, daily physical activity, and sleep hours before and during the quarantine. The results revealed an increase in children's psychological and behavioral symptoms, increased screen-time, reduced physical activity, and more sleep hours/night. Italian children presented less psychological and behavioral symptoms compared with Portuguese and Spanish children. In general, hierarchical multiple regressions revealed that having an outdoor exit in the house (e.g., garden, terrace) contributed to lower levels of psychological and behavioral symptomatology. Future studies are needed to identify family and individual variables that can better predict children and adolescents' well-being during and after quarantine. Recommendations for families and implications for practice are discussed.

Psychopathology, Body Image and Quality of Life in Female Children and Adolescents With Anorexia Nervosa: A Pilot Study on the Acceptability of a Pilates Program

Background: Anorexia nervosa (AN) is a psychiatric illness that without early effective treatment becomes chronic with high physical, psychological and social morbidity and high mortality. Pilates exercises can improve quality of life and increase body awareness in different clinical and healthy populations. The aim of this pilot study was to examine the acceptability of a Pilates program in a sample of female children and adolescents with AN by evaluating the psychopathological status, alterations in the perception of body image and health-related quality of life after 10 weeks. Methods: A total of 12 female patients (age: 14.6 ± 1.7 years) completed the 10-week Pilates program. Psychopathology (EDI-3), body image disturbance (CDRS) and quality of life (KIDSCREEN-27) were evaluated before and after the intervention. A satisfaction questionnaire was also provided. Results: Regarding psychopathology, although there were standardized reductions in seven parameters of those that form EDI-3, none of them reached significance. In relation to body image, significant, moderately standardized and substantial decreases were observed in the body dissatisfaction (p = 0.046, Cohen's d = -0.69). There were significant, large standardized and substantial increases in physical well-being (p = 0.008, Cohen's d = 1.37) and significant, moderately standardized and substantial decreases in autonomy and parent relation (p = 0.021, Cohen's d = -0.60). Satisfaction data was positive. Conclusion: A Pilates program could help to improve perceived health outcomes by decreasing body dissatisfaction and increasing physical well-being in female children and adolescents with AN, so Pilates seems to be a beneficial complementary treatment in children and adolescents with AN. These findings from our pilot study are encouraging for future research with a substantially larger sample size, representing the first phase of a longer process.

Relationship between Substance Use and Socioeconomic Variables in Pennsylvania Adolescents: 2009-2017

Purpose: The goal of the current study is to analyze the substance use trends in Generation Z youth (in both middle and high school environments) and to determine if any correlation exists between substance use behaviors and demographic variables. Methods: Analysis is based on substance use data collected through the Pennsylvania Youth Survey (PAYS) from 2009 to 2017 and the 2016 US census data. Results: Our results suggest that substance use in Gen Z adolescents is mainly linked to alcohol, marijuana, cigarettes, smokeless tobacco, vaping, and narcotic prescription drugs. Alcohol is the most prevalent high-risk substance used by 12th grade students with 69.8% of students having consumed alcohol over their lifetime. Vaping is the next highly used substance with 28.9% of students in 12th grade having vaped 30 day prior to the survey. There is a significant correlation among adolescents between smoking cigarettes and using smokeless tobacco. A student using either alcohol, cigarettes or smokeless tobacco is highly likely to use the other two substances as well. Adolescents from counties with a high Caucasian population were at high risk for cigarette and smokeless tobacco use, while the opposite held true for counties with a high number of foreign-born persons or higher Asian or Hispanic populations. Higher median household incomes and higher adult education levels in a county were both protective factors against smokeless tobacco use. Conclusions: Results of the study suggest that students start experimenting with high-risk substance use in early grades and to combat the prevalence, we suggest the importance of educating adolescents of the dangers of drug use in early grades.

Serum B-Cell Maturation Antigen (BCMA) Levels Differentiate Primary Antibody Deficiencies

BACKGROUND

Primary antibody deficiencies (PADs) are the most prevalent primary immunodeficiencies. More severe forms of PADs-common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA)-require immunoglobulin replacement therapy (IRT) and may have serious complications. Differentiating severe PAD from milder hypogammaglobulinemia not requiring IRT can involve prolonged evaluations and treatment discontinuation. Severe PAD is defined by plasma cell deficiency, but this requires a biopsy to establish. Serum B-cell maturation antigen (sBCMA) is elevated in multiple myeloma, but levels are reduced among patients with myeloma in remission who have hypogammaglobulinemia.

OBJECTIVE

To measure the sBCMA level in 165 subjects to determine whether it differentiates severe PAD-CVID and XLA-from less severe forms not requiring IRT and those without PAD.

METHODS

sBCMA, B cells, and tissue plasma cells were measured among subjects with and without PAD, and correlated to clinical and laboratory data.

RESULTS

Subjects with an IgG level of less than 600 mg/dL had reduced sBCMA levels compared with subjects with PAD with IgG levels of greater than or equal to 600 mg/dL and controls without PAD. sBCMA level was lower in patients with CVID and XLA compared with patients with IgA or IgG deficiency and controls. sBCMA level correlated with gastrointestinal plasma cells. sBCMA level of less than 15 ng/mL had 97% positive predictive value for CVID or XLA, whereas 25 ng/mL or more had an 88% negative predictive value.

CONCLUSIONS

sBCMA level is profoundly reduced in patients with severe PAD, including those with CVID and XLA and those with IgG levels of less than 600 mg/dL. sBCMA level measurement has potential to augment clinical evaluation of PAD. Prospective studies are needed to evaluate sBCMA for new PAD diagnosis and determine the necessity of IRT.

Laws and Policies Related to the Health of US Immigrants: A Policy Scan

Objectives

We conducted a policy scan of state and local laws and policies across the United States related to social determinants of health among immigrants.

Methods

We collected all state and municipal laws and policies in 10 domains that had potential to affect immigrant health from all 50 U.S. states and the 30 most populous U.S. metropolitan statistical areas. We coded these laws and policies and created an index of restrictiveness and supportiveness of immigrants.

Results

We identified 539 state and 322 municipal laws and policies. The most common restrictive state laws and policies were in the domains of identification requirements and driver's license access. The most common supportive state laws and policies were in the domains of health services and higher education access. The most common restrictive municipal laws and policies were in the domains of identification requirements and immigration policy enforcement. The most common supportive municipal laws and policies were in the domains of immigration policy enforcement and health services access.

Conclusions

Most states had index scores reflecting policy environments that were primarily restrictive of immigrants, indicating potential negative impacts on social determinants of health. Further research examining the impact of these on health behaviors is warranted.

Gender inequality and gender-based poverty in Mexico

The objective of a country's government is to increase the well-being of its population. For this reason, a precise measure of inequality and poverty contributes to better development of economic and public policies to reduce the former and latter, respectively. Therefore, in recent years, various indexes have been developed to measure and compare inequality and poverty. In the case of Mexico, the Gini and Theil indexes are used to measure both problems. However, they are criticized for the overvaluation that they generate on specific population segments. For a better measurement, this paper calculates and investigates the relationship between the Palma index (inequality) and the Foster, Greer, and Thorbecke index (poverty). In addition to reducing the overvaluation problem, the indexes mentioned allow us to perform an analysis by gender and employment type (salaried and self-employed). The main results do not diverge from those already found through traditional measures. In general, a high level of inequality exists. However, our paper contributes to the literature by identifying both problems by gender. Men present greater inequality than women, whereas women present greater poverty than men. Finally, a positive, albeit weak, correlation exists between both problems, which means that poverty can be combated by combating inequality.

Comparison of Patient and Proxy Assessment of Patient-Centeredness in the Care of Coronary Heart Disease: A Cross Sectional Survey Using the PACIC-S11.1

INTRODUCTION

When making medical care more patient-centered, surveys on patients' and their relatives' experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients' assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients' and their proxies' assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire.

METHODS

In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists' offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests.

RESULTS

In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients' and their proxies' item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did.

CONCLUSION

The study shows that, on the individual level, proxies' ratings do not necessarily reflect the patients' assessment of PCC. On the group level, the assessments of relatives regarding PCC are similar to those of the patients.

TRIAL REGISTRATION

German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: DRKS00012434 (URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012434).

Immediate Psychological Effects of the COVID-19 Quarantine in Youth From Italy and Spain

The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide, but to date, no study has been developed within Western countries to examine the psychological impact on their lives. The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the countries most affected by COVID-19. Participants were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. Results show that 85.7% of the parents perceived changes in their children's emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children. The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with problems as early as possible to improve their psychological well-being.

The Capacities of Primary Health Care in Hungary: A Problem Statement

In the establishment, development, and provision of equal access to the health care system, the operation of adequate primary health care is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary health care, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary health care system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary health care—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary Health Care Department of the National Health Care Services Centre. In Hungary, the fundamentals of primary health care are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to health care, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.

No clear choice between Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies to assess methodological quality in cross-sectional studies of health-related quality of life and breast cancer

OBJECTIVES

The aim of the study was to compare the inter-rater reliability, concurrent validity, completion time, and ease of use of two methodological quality (MQ) assessment tools for cross-sectional studies: an adapted Newcastle-Ottawa Scale (NOS) and the Appraisal Tool for Cross-Sectional Studies (AXIS).

STUDY DESIGN AND SETTING

Two raters applied the NOS and AXIS to 63 cross-sectional studies of health-related quality of life and breast cancer.

RESULTS

AXIS demonstrated poor inter-rater reliability (intraclass correlation coefficient [ICC] = 0.49) and required more than double the amount of time to complete compared with the NOS, which demonstrated moderate reliability (ICC = 0.73). For concurrent validity, weak and moderate positive relationships existed between NOS and AXIS (rater 1: r = 0.26; rater 2: r = 0.45). Ease of using the tools was affected by the indirectness of MQ assessments, perceived thoroughness of the tools' content, and user experience.

CONCLUSION

This study was the first to assess the psychometric properties of a cross-sectional NOS and AXIS. The results did not support a clear choice between selecting either tool for evaluating MQ in cross-sectional studies.

Disorganization of spleen compartments and dermatitis in canine visceral leishmaniasis

Canine visceral leishmaniasis is associated with splenic changes that may interfere with the surveillance of blood borne antigens. Dogs with terminal visceral leishmaniasis present with a variety of skin lesions that may reflect a failure of the immune system to cope with infection. In this study, we compare the frequency of dermatitis in dogs from an endemic area of visceral leishmaniasis and take account of the following parameters: presence/absence of laboratory markers of infection and susceptibility to visceral leishmaniasis, and presence/absence of splenic structural changes associated with severe forms of the disease. Dermatitis was present in 48 of 64 (75%) of the animals. Dermatitis was more frequent in animals with positive splenic culture and negative leishmanin skin test (14/15, 93%) than in non-infected controls (P = 0.01). Diffuse dermatitis was present only in animals with evidence of Leishmania infection. Diffuse dermatitis was also more frequent in animals with positive (9/27, 33%) as opposed to negative (3/34, 9%) serology against Leishmania (P = 0.01). Presence of dermatitis correlated with both perisplenitis (P = 0.03) and with an increase in plasma cell density in the splenic tissue (P = 0.02). Diffuse dermatitis also correlated with splenic lymphoid tissue disorganization (P = 0.03) and germinal center atrophy (P < 0.01). The relationship between chronic dermatitis and spleen disorganization suggests an impairment of immune response to deal with skin aggressions in dogs with severe forms of visceral leishmaniasis. It also suggest that skin biopsy can be used in a model to define severity of canine visceral leishmaniasis.

A collective tracking method for preliminary sperm analysis

Background

Total motile sperm count (TMSC) and curvilinear velocity (VCL) are two important parameters in preliminary semen analysis for male infertility. Traditionally, both parameters are evaluated manually by embryologists or automatically using an expensive computer-assisted sperm analysis (CASA) instrument. The latter applies a point-tracking method using an image processing technique to detect, recognize and classify each of the target objects, individually, which is complicated. However, as semen is dense, manual counting is exhausting while CASA suffers from severe overlapping and heavy computation.

Methods

We proposed a simple frame-differencing method that tracks motile sperms collectively and treats their overlapping with a statistical occupation probability without heavy computation. The proposed method leads to an overall image of all of the differential footprint trajectories (DFTs) of all motile sperms and thus the overall area of the DFTs in a real-time manner. Accordingly, a theoretical DFT model was also developed to formulate the overall DFT area of a group of moving beads as a function of time as well as the total number and average speed of the beads. Then, using the least square fitting method, we obtained the optimal values of the TMSC and the average VCL that yielded the best fit for the theoretical DFT area to the measured DFT area.

Results

The proposed method was used to evaluate the TMSC and the VCL of 20 semen samples. The maximum TMSC evaluated using the method is more than 980 sperms per video frame. The Pearson correlation coefficient (PCC) between the two series of TMSC obtained using the method and the CASA instrument is 0.946. The PCC between the two series of VCL obtained using the method and CASA is 0.771. As a consequence, the proposed method is as accurate as the CASA method in TMSC and VCL evaluations.

Conclusion

In comparison with the individual point-tracking techniques, the collective DFT tracking method is relatively simple in computation without complicated image processing. Therefore, incorporating the proposed method into a cell phone equipped with a microscopic lens can facilitate the design of a simple sperm analyzer for clinical or household use without advance dilution.

The association between collagen and bone biomarkers and radiographic osteoarthritis in the distal tarsal joints of horses

BACKGROUND

Osteoarthritis (OA) of the distal intertarsal (DIT) and tarsometatarsal (TMT) joints occurs commonly. Synovial fluid (SF) biomarkers of collagen and bone turnover have potential clinical value.

OBJECTIVES

To measure SF biomarker concentrations from DIT and TMT joints in adult horses and determine if they correlate with radiographic OA severity and are higher in joints with radiographic OA compared to controls.

STUDY DESIGN

Cross-sectional.

METHODS

Radiographic OA of DIT and TMT joints was evaluated from adult horses (5-35 years old). Overall radiographic scores divided horses into those with mild or moderate radiographic OA (16 joints from 9 horses) or controls (13 joints from 9 horses). Direct biomarkers of OA (Carboxypropeptide of type II collagen = CPII, carboxy-neoepitope of type II collagen exposed after collagenase-cleavage = C2C, Bone alkaline phosphatase = BAP and Chondroitin sulfate epitope = CS846) were measured via ELISA and CPII/C2C was calculated. Biomarkers were correlated with radiographic findings and concentrations from those with radiographic OA to control joints and were compared.

RESULTS

Concentrations of CPII (R = 0.84, P<0.001), C2C (R = 0.69, P<0.001) and BAP (R = 0.41, P = 0.03) as well as CPII/C2C (R = 0.69, P<0.001) values positively correlated with overall radiographic scores. Adjusted means ± s.d., after controlling for age, for CPII (P<0.001), C2C (P<0.001), CPII/C2C (P = 0.004) and BAP (P = 0.05) were significantly higher in DIT and TMT joints with radiographic OA (CPII: 2174.45 ± 1064.01; C2C: 233.52 ± 51.187; CPII/C2C: 9.01 ± 4.09; BAP: 21.98 ± 15.34) compared to controls (CPII: 594.53 ± 463.05; C2C: 153.12 ± 48.95; CPII/C2C: 3.96 ± 2.38; BAP: 12.76 ± 3.61). CPII (P<0.001), C2C (P = 0.001) and CPII/C2C (P = 0.001) were significantly higher with moderate radiographic OA (CPII: 2444.61 ± 772.78; C2C: 248.90 ± 44.94; CPII/C2C: 9.47 ± 2.97) compared to controls (CPII: 658.38 ± 417.36; C2C: 156.49 ± 47.61; CPII/C2C: 4.15 ± 2.04), with CPII also showing significantly higher concentrations (P = 0.04) with mild radiographic OA compared (1515.00 ± 584.95) to controls (658.38 ± 417.36). There were no differences in CS846 concentrations between radiographic OA and control joints. Age positively correlated with CPII (R = 0.48, P = 0.01) and C2C (R = 0.44, P = 0.02) concentrations.

MAIN LIMITATIONS

Radiographic OA was assessed, not clinical lameness. Controls were not age-matched to those with spontaneous radiographic OA.

CONCLUSIONS

There is an association between collagen (CPII, C2C and CPII/C2C) and bone (BAP) biomarkers and radiographic OA in the distal tarsal joints of horses.