Analysis of small sample size studies using nonparametric bootstrap test with pooled resampling method

A PACAP-activated network for secretion requires coordination of Ca2+ influx and Ca2+ mobilization

Chromaffin cells of the adrenal medulla transduce sympathetic nerve activity into stress hormone secretion. The two neurotransmitters principally responsible for coupling cell stimulation to secretion are acetylcholine and pituitary adenylate activating polypeptide (PACAP). In contrast to acetylcholine, PACAP evokes a persistent secretory response from chromaffin cells. However, the mechanisms by which PACAP acts are poorly understood. Here, it is shown that PACAP induces sustained increases in cytosolic Ca2+ which are disrupted when Ca2+ influx through L-type channels is blocked or internal Ca2+ stores are depleted. PACAP liberates stored Ca2+ via inositol trisphosphate receptors (IP3Rs) on the endoplasmic reticulum (ER), thereby functionally coupling Ca2+ mobilization to Ca2+ influx and supporting Ca2+-induced Ca2+-release. These Ca2+ influx and mobilization pathways are unified by an absolute dependence on phospholipase C epsilon (PLCε) activity. Thus, the persistent secretory response that is a defining feature of PACAP activity, in situ, is regulated by a signaling network that promotes sustained elevations in intracellular Ca2+ through multiple pathways.

FBLN2 is associated with Goldenhar syndrome and is essential for cranial neural crest cell development

Goldenhar syndrome, a rare craniofacial malformation, is characterized by developmental anomalies in the first and second pharyngeal arches. Its etiology is considered to be heterogenous, including both genetic and environmental factors that remain largely unknown. To further elucidate the genetic cause in a five-generation Goldenhar syndrome pedigree and exploit the whole-exome sequencing (WES) data of this pedigree, we generated collapsed haplotype pattern markers based on WES and employed rare variant nonparametric linkage analysis. FBLN2 was identified as a candidate gene via analysis of WES data across the significant linkage region. A fbln2 knockout zebrafish line was established by CRISPR/Cas9 to examine the gene's role in craniofacial cartilage development. fbln2 was expressed specifically in the mandible during the zebrafish early development, while fbln2 knockout zebrafish exhibited craniofacial malformations with abnormal chondrocyte morphologies. Functional studies revealed that fbln2 knockout caused abnormal chondrogenic differentiation, apoptosis, and proliferation of cranial neural crest cells (CNCCs), and downregulated the bone morphogenic protein (BMP) signaling pathway in the zebrafish model. This study demonstrates the role of FBLN2 in CNCC development and BMP pathway regulation, and highlights FBLN2 as a candidate gene for Goldenhar syndrome, which may have implications for the selection of potential screening targets and the development of treatments for conditions like microtia-atresia.

Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning

Purpose

Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format.

Participants and Methods

Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation.

Results

Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences.

Conclusion

Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.

Exposing kinetic disparities between inflammasome readouts using time-resolved analysis

The NLRP3 inflammasome is an intracellular multiprotein complex described to be involved in both an effective host response to infectious agents and various diseases. Investigation into the NLRP3 inflammasome has been extensive in the past two decades, and often revolves around the analysis of a few specific readouts, including ASC-speck formation, caspase-1 cleavage or activation, and cleavage and release of IL-1β and/or IL-18. Quantification of these readouts is commonly undertaken as an endpoint analysis, where the presence of each positive outcome is assessed independently of the others. In this study, we apply time-resolved analysis of a human macrophage model (differentiated THP-1-ASC-GFP cells) to commonly accessible methods. This approach yields the additional quantifiable metrics time-resolved absolute change and acceleration, allowing comparisons between readouts. Using this methodological approach, we reveal (potential) discrepancies between inflammasome-related readouts that otherwise might go undiscovered. The study highlights the importance of time-resolved data in general and may be further extended as well as incorporated into other areas of research.

Rates of diagnosis and service utilization in veterans with hoarding disorder

Hoarding Disorder (HD) is a prominent and disabling neuropsychiatric condition defined by the inability to discard objects resulting in impairing levels of clutter. The prevalence rate is 2-6 % and increases with age. The aging Veteran population is a high risk group for impairment associated with HD. Medical and psychiatric comorbidities as well as associated rates of disability and poor quality of life are very common in both HD and the related disorder of OCD. We examined rates of HD and OCD diagnoses at the VA San Diego Healthcare System. Data were obtained from medical records for all Veterans with these diagnoses over 8-years and included information on medical and psychiatric care, homelessness services, and Care Assessment Needs (CAN) scores. Rates of diagnosis for both HD and OCD were well below epidemiological estimates. Veterans with HD were older, had higher rates of medical hospital admissions with longer stays; had more cardiac, neurological, and acquired medical conditions; had more psychiatric comorbidities; had more interactions with the suicide prevent team and homelessness services; and had higher CAN scores than Veterans with OCD. The low rate of diagnosis and high services utilization of Veterans with HD demonstrates an area of unmet need.

Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage

INTRODUCTION

Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES.

METHODS

Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower).

RESULTS

Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type.

CONCLUSION

This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.

Bringing together multimodal and multilevel approaches to study the emergence of social bonds between children and improve social AI

This protocol paper outlines an innovative multimodal and multilevel approach to studying the emergence and evolution of how children build social bonds with their peers, and its potential application to improving social artificial intelligence (AI). We detail a unique hyperscanning experimental framework utilizing functional near-infrared spectroscopy (fNIRS) to observe inter-brain synchrony in child dyads during collaborative tasks and social interactions. Our proposed longitudinal study spans middle childhood, aiming to capture the dynamic development of social connections and cognitive engagement in naturalistic settings. To do so we bring together four kinds of data: the multimodal conversational behaviors that dyads of children engage in, evidence of their state of interpersonal rapport, collaborative performance on educational tasks, and inter-brain synchrony. Preliminary pilot data provide foundational support for our approach, indicating promising directions for identifying neural patterns associated with productive social interactions. The planned research will explore the neural correlates of social bond formation, informing the creation of a virtual peer learning partner in the field of Social Neuroergonomics. This protocol promises significant contributions to understanding the neural basis of social connectivity in children, while also offering a blueprint for designing empathetic and effective social AI tools, particularly for educational contexts.

A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation

BACKGROUND

There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes.

AIMS

This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming.

METHOD

This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates.

RESULTS

All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes.

CONCLUSIONS

Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.

Validation of Core Ingredients and Molecular Mechanism of Cinobufotalin Injection Against Liver Cancer

Purpose

Cinobufotalin injection has obvious curative effects on liver cancer patients with less toxicity and fewer side effects than other therapeutic approaches. However, the core ingredients and mechanism underlying these anti-liver cancer effects have not been fully clarified due to its complex composition.

Methods

Multidimensional network analysis was used to screen the core ingredients, key targets and pathways underlying the therapeutic effects of cinobufotalin injection on liver cancer, and in vitro and in vivo experiments were performed to confirm the findings.

Results

By construction of ingredient networks and integrated analysis, eight core ingredients and ten key targets were finally identified in cinobufotalin injection, and all of the core ingredients are tightly linked with the key targets, and these key targets are highly associated with the cell cycle-related pathways, supporting that both cinobufotalin injection and its core ingredients exert anti-liver cancer roles by blocking cell cycle-related pathways. Moreover, in vitro and in vivo experiments confirmed that either cinobufotalin injection or one of its core ingredients, cinobufagin, significantly inhibited cell proliferation, colony formation, cell cycle progression and xenograft tumor growth, and the key target molecules involved in the cell cycle pathway such as CDK1, CDK4, CCNB1, CHEK1 and CCNE1, exhibit consistent changes in expression after treatment with cinobufotalin injection or cinobufagin. Interestingly, some key targets CDK1, CDK4, PLK1, CHEK1, TTK were predicted to bind with multiple of core ingredients of cinobufotalin injection, and the affinity between one of the critical ingredients cinobufagin and key target CDK1 was further confirmed by SPR assay.

Conclusion

Cinobufotalin injection was confirmed to includes eight core ingredients, and they play therapeutic effects in liver cancer by blocking cell cycle-related pathways, which provides important insights for the mechanism of cinobufotalin injection antagonizing liver cancer and the development of novel small molecule anti-cancer drugs.

A comprehensive benchmark for COVID-19 predictive modeling using electronic health records in intensive care

The COVID-19 pandemic highlighted the need for predictive deep-learning models in health care. However, practical prediction task design, fair comparison, and model selection for clinical applications remain a challenge. To address this, we introduce and evaluate two new prediction tasks-outcome-specific length-of-stay and early-mortality prediction for COVID-19 patients in intensive care-which better reflect clinical realities. We developed evaluation metrics, model adaptation designs, and open-source data preprocessing pipelines for these tasks while also evaluating 18 predictive models, including clinical scoring methods and traditional machine-learning, basic deep-learning, and advanced deep-learning models, tailored for electronic health record (EHR) data. Benchmarking results from two real-world COVID-19 EHR datasets are provided, and all results and trained models have been released on an online platform for use by clinicians and researchers. Our efforts contribute to the advancement of deep-learning and machine-learning research in pandemic predictive modeling.

Natural mating ability is associated with gut microbiota composition and function in captive male giant pandas

The issue of poor sexual performance of some male giant pandas seriously impairs the growth and the genetic diversity of the captive population, yet there is still no clear understanding of the cause of the loss of this ability and its underlying mechanism. In this study, we analyzed the gut microbiota and its function in 72 fecal samples obtained from 20 captive male giant pandas, with an equal allocation between individuals capable and incapable of natural mating. Additionally, we investigated fecal hormone levels and behavioral differences between the two groups. A correlation analysis was then conducted among these factors to explore the influencing factors of their natural mating ability. The results showed significant differences in the composition of gut microbiota between the two groups of male pandas. The capable group had significantly higher abundance of Clostridium sensu stricto 1 (p adjusted = .0021, GLMM), which was positively correlated with fatty acid degradation and two-component system functions (Spearman, p adjusted < .05). Additionally, the capable group showed higher gene abundance in gut microbiota function including purine and pyrimidine metabolism and galactose metabolism, as well as pathways related to biological processes such as ribosome and homologous recombination (DEseq2, p adjusted < .05). We found no significant differences in fecal cortisol and testosterone levels between the two groups, and no difference was found in their behavior either. Our study provides a theoretical and practical basis for further studying the behavioral degradation mechanisms of giant pandas and other endangered mammal species.

Noninvasive spinal stimulation improves walking in chronic stroke survivors: a proof-of-concept case series

BACKGROUND

After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke.

METHODS

Eight participants with hemiparesis after a single, chronic stroke were enrolled. Each participant was assigned to either the Stim group (N = 4, gait training + tSCS) or Control group (N = 4, gait training alone). Each participant in the Stim group was matched to a participant in the Control group based on age, time since stroke, and self-selected gait speed. For the Stim group, tSCS was delivered during gait training via electrodes placed on the skin between the spinous processes of C5-C6, T11-T12, and L1-L2. Both groups received 24 sessions of gait training over 8 weeks with a physical therapist providing verbal cueing for improved gait symmetry. Gait speed (measured from 10 m walk test), endurance (measured from 6 min walk test), spatiotemporal gait symmetries (step length and swing time), as well as the neurophysiological outcomes (muscle synergy, resting motor thresholds via spinal motor evoked responses) were collected without tSCS at baseline, completion, and 3 month follow-up.

RESULTS

All four Stim participants sustained spatiotemporal symmetry improvements at the 3 month follow-up (step length: 17.7%, swing time: 10.1%) compared to the Control group (step length: 1.1%, swing time 3.6%). Additionally, 3 of 4 Stim participants showed increased number of muscle synergies and/or lowered resting motor thresholds compared to the Control group.

CONCLUSIONS

This study provides promising preliminary evidence that using tSCS as a therapeutic catalyst to gait training may increase the efficacy of gait rehabilitation in individuals with chronic stroke. Trial registration NCT03714282 (clinicaltrials.gov), registration date: 2018-10-18.

Go with the flow: Impacts of high and low flow conditions on freshwater mussel assemblages and distribution

Understanding the drivers of distribution and assemblage composition of aquatic organisms is an important aspect of management and conservation, especially in freshwater systems that are inordinately facing increasing anthropogenic pressures and decreasing biodiversity. For stream organisms, habitat conditions during high flows may be impossible to measure in the field, but can be an important factor for their distribution, especially for less mobile organisms like freshwater mussels. Hence, the objective of this study was to use a two dimensional HEC-RAS model to simulate hydraulic conditions during high and baseline flows (flows approx. 10-600 x and 0.7 x median daily flows respectively) in a 20 km segment in the San Saba River, Texas in combination with existing mussel survey data from 200 sites (collected every 100m) to 1) examine whether hydraulic conditions differed between areas of increased mussel richness and diversity (referred to as hotspots) and other sites, and 2) understand how well site occupancy and species abundance could be explained by hydraulic conditions occurring under different flow conditions. The results showed that richness and diversity hotspots occurred in deeper areas with lower shear stress, stream power, and Froude number during both high and low flows. Occupancy could be predicted with 67-79% accuracy at the site scale and 60-70% accuracy at the mesohabitat scale (∼20 to 1200 m long). In addition, hydraulic conditions across flow scenarios explained up to 55% of variation in species abundances, but predictions were less successful for species often observed to occupy micro-scale flow refuges such as bedrock crevices. The results indicate that pools may serve as important refuge for all species during both high and low flow events, which may be relatively unique to bedrock-dominated systems. Understanding hydraulic conditions that occur at extreme flows such as these is important given that the frequency and magnitude of such events are increasing due to climate change.

Exercise and hypoxia-induced hypercoagulability is counterbalanced in women in part by decreased platelet reactivity

Hypoxia plays an important role in several pathologies, e.g. chronic obstructive pulmonary disease and obstructive sleep apnea syndrome, and is linked to an increased thrombosis risk. Furthermore, oxygen deprivation is associated with hypercoagulability. In this study, we investigated the effect of gender and exercise on the coagulation potential under hypoxic conditions at high altitude by assessing thrombin generation (TG) and platelet activation. Hereto, ten healthy volunteers were included (50 % male, median age of 27.5 years). The measurements were conducted first at sea level and then twice at high altitude (3883 m), first after a passive ascent by cable car and second after an active ascent by a mountain hike. As expected, both the passive and active ascent resulted in a decreased oxygen saturation and an increased heart rate at high altitude. Acute mountain sickness symptoms were observed independently of the ascent method. After the active ascent, platelet, white blood cell and granulocyte count were increased, and lymphocytes were decreased, without a gender-related difference. FVIII and von Willebrand factor were significantly increased after the active ascent for both men and women. Platelet activation was reduced and delayed under hypobaric conditions, especially in women. TG analysis showed a prothrombotic trend at high altitude, especially after the active ascent. Women had a hypercoagulable phenotype, compared to men at all 3 timepoints, indicated by a higher peak height and endogenous thrombin potential (ETP), and shorter lag time and time-to-peak. In addition, ETP and peak inhibition by thrombomodulin was lower in women after the active ascent, compared to men. Interestingly, data normalisation for subject baseline values indicated an opposing effect of altitude-induced hypoxia on α2-macroglobulin levels and TG lag time between men and women, decreasing in men and increasing in women. We conclude that hypoxia increases TG, as well as FVIII and VWF levels in combination with exercise. In contrast, platelets lose their responsiveness at high altitude, which is most pronounced after heavy exercise. Women had a more pronounced prothrombotic phenotype compared to men, which we theorize is counterbalanced under hypobaric conditions by decreased platelet activation.

Mitofusin-2 Regulates Platelet Mitochondria and Function

BACKGROUND

Single-nucleotide polymorphisms linked with the rs1474868 T allele (MFN2 [mitofusin-2] T/T) in the human mitochondrial fusion protein MFN2 gene are associated with reduced platelet MFN2 RNA expression and platelet counts. This study investigates the impact of MFN2 on megakaryocyte and platelet biology.

METHODS

Mice with megakaryocyte/platelet deletion of Mfn2 (Mfn2-/- [Mfn2 conditional knockout]) were generated using Pf4-Cre crossed with floxed Mfn2 mice. Human megakaryocytes were generated from cord blood and platelets isolated from healthy subjects genotyped for rs1474868. Ex vivo approaches assessed mitochondrial morphology, function, and platelet activation responses. In vivo measurements included endogenous/transfused platelet life span, tail bleed time, transient middle cerebral artery occlusion, and pulmonary vascular permeability/hemorrhage following lipopolysaccharide-induced acute lung injury.

RESULTS

Mitochondria was more fragmented in megakaryocytes derived from Mfn2-/- mice and from human cord blood with MFN2 T/T genotype compared with control megakaryocytes. Human resting platelets of MFN2 T/T genotype had reduced MFN2 protein, diminished mitochondrial membrane potential, and an increased rate of phosphatidylserine exposure during ex vivo culture. Platelet counts and platelet life span were reduced in Mfn2-/- mice accompanied by an increased rate of phosphatidylserine exposure in resting platelets, especially aged platelets, during ex vivo culture. Mfn2-/- also decreased platelet mitochondrial membrane potential (basal) and activated mitochondrial oxygen consumption rate, reactive oxygen species generation, calcium flux, platelet-neutrophil aggregate formation, and phosphatidylserine exposure following dual agonist activation. Ultimately, Mfn2-/- mice showed prolonged tail bleed times, decreased ischemic stroke infarct size after cerebral ischemia-reperfusion, and exacerbated pulmonary inflammatory hemorrhage following lipopolysaccharide-induced acute lung injury. Analysis of MFN2 SNPs in the iSPAAR study (Identification of SNPs Predisposing to Altered ALI Risk) identified a significant association between MFN2 and 28-day mortality in patients with acute respiratory distress syndrome.

CONCLUSIONS

Mfn2 preserves mitochondrial phenotypes in megakaryocytes and platelets and influences platelet life span, function, and outcomes of stroke and lung injury.

Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?

Background

Day admission surgery (DAS) is meant to provide a better in-hospital experience for patients and to save costs by reducing the length of stay. However, in a prospective payment system, it may also reduce the reimbursement amount, leading to unintended incentives for hospitals.

Methods

Over a 4-month period in 2021 and based on predefined clinical and logistic criteria, patients from different surgical sub-specialties were identified to follow the institutional DAS program. Revenue-analysis was performed, considering the Swiss diagnosis-related group (SwissDRG) prospective payment policy. Revenue with DAS program was compared to revenue if patients were admitted the day prior surgery (No DAS) using nonparametric pooled bootstrap t-test. All other costs considered identical, an estimation of the average cost spared due to the avoidance of pre-operative hospitalization in the DAS setting was carried out using a micro-costing approach.

Results

Overall, 105 inpatients underwent DAS over the study period, totaling a revenue of CHF 1 209 840. Among them, 25 patients (24%) were low outliers due to the day spared from the DAS program and triggering a mean (SD) financial discount of Swiss Francs (CHF) 4192 (2835), yielding a total amount of CHF 105 435. DAS revealed a mean revenue of CHF 7320 (656), compared to CHF 11 510 (1108) if patients were admitted the day before surgery (No DAS, P = .007).

Conclusion

In a PPS, anticipation of financial penalties when implementing a DAS for all-comers is key to prevent an imbalance of the hospital equation if no financial criteria are used to select eligible patients. Promptly revising workflow to maintain constant fixed costs for a greater number of patients may be a valuable hedging strategy.

A PACAP-activated network for secretion requires coordination of Ca 2+ influx and Ca 2+ mobilization

Chromaffin cells of the adrenal medulla transduce sympathetic nerve activity into stress hormone secretion. The two neurotransmitters principally responsible for coupling cell stimulation to secretion are acetylcholine and pituitary adenylate activating polypeptide (PACAP). In contrast to acetylcholine, PACAP evokes a persistent secretory response from chromaffin cells. However, the mechanisms by which PACAP acts are poorly understood. Here, it is shown that PACAP induces sustained increases in cytosolic Ca 2+ which are disrupted when Ca 2+ influx through L-type channels is blocked or internal Ca 2+ stores are depleted. PACAP liberates stored Ca 2+ via inositol trisphosphate receptors (IP3Rs) on the endoplasmic reticulum (ER), thereby functionally coupling Ca 2+ mobilization to Ca 2+ influx and supporting Ca 2+ -induced Ca 2+ -release. These Ca 2+ influx and mobilization pathways are unified by an absolute dependence on phospholipase C epsilon (PLCε) activity. Thus, the persistent secretory response that is a defining feature of PACAP activity, in situ , is regulated by a signaling network that promotes sustained elevations in intracellular Ca 2+ through multiple pathways.

Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study

Objective

The aim of the present study was to investigate trunk kinematics and spine muscle activation during walking after minimally invasive surgery in patients with L4-L5 degenerative spondylolisthesis suffering from lumbar instability (LI).

Methods

Eleven patients suffering from LI and 13 healthy controls (HC) were enrolled. Trunk kinematics and spine muscle activation patterns during walking were collected. Maximal trunk ranges of motion were also recorded from standing position. Assessments were performed pre-operatively (T0), 1 month (T1) and 3 months (T2) after MIS.

Results

We found significant improvement in spine muscle activation during walking at T2 compared to T0, mainly involving right/left symmetry at the operated level (L4-L5) and up-down synchronization from L3 to S1. Significant improvements in trunk rotation nearing to the HC group during walking were also found at T2 after surgery, though no changes were observed in the maximal range of motion of the trunk during standing. Furthermore, trunk rotation improvement correlated with a lower grade of residual disability.

Conclusions

Our findings indicate that trunk rotation improves after surgery, and impaired aspects of spine muscle activation can be improved with surgery. These biomechanical parameters could represent novel tools for monitoring the effect of surgery in LI and preventing impaired spine mobility and muscle activation.

Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants

Immunization-specific motivational interviewing (MI), a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients' doubts and concerns related to vaccines. We sought to assess the impact of an MI-training of General Practitioner (GP) interns on the psychosocial determinants of their vaccine confidence and behaviors. French GP interns participated in a virtual three-day MI-workshop in southeastern France. We used the validated Pro-VC-Be questionnaire - before and after the MI-workshop spanning over three months - to measure the evolution of these determinants. Scores before and after workshop trainings were compared in pairs. Participants' scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001), openness to patients (+18.7 ± 17.0, P < .0001), and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions, but not the score for confidence in vaccines (+1.5 ± 11.9, P = .14). The effect sizes of the four score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). This study provides evidence that certain determinants of overall vaccine confidence in HCPs, reflected respectively in the openness to patients and self-efficacy scores of the Pro-VC-Be, improve after immunization MI-training workshops. Incorporating immunization-specific MI-training in the curriculum for HCPs could improve several necessary skills to improve HCP-patient relationships and be useful for vaccination and other healthcare services.

Bioaccumulation Capacity of Onion (Allium cepa L.) Tested with Heavy Metals in Biofortification

On a worldwide scale, A. cepa is among the most commonly consumed vegetables. In Europe, the leading onion producers are Russia, the Netherlands, Spain, Poland and Germany. In this study, the bioaccumulation of heavy metals (Cr, Cu, Zn, Ni, Fe, Mn, Co, Sr, Cd and Pb) by Allium cepa L. plants was followed under hydroponic conditions. The heavy metals were applied at six concentrations (0, 25, 50, 100, 200 and 400 mg L-1) over three weeks. The quantitative analysis of selected heavy metals in plant tissues (bulbs, roots and assimilation leaves) was performed using atomic absorption spectrometry with flame atomization (F-AAS). The accumulation of metal ions was strongly dependent on their concentrations in the solution and the analyzed parts of plants. The highest accumulation of metal ions was confirmed for the roots and ranged from 8.48 to 5912.34 µg g-1 DW (dry weight). All parts of A. cepa were characterized by the high accumulation of Mn2+. The lowest accumulation was confirmed for Co2+ in the roots, Pb2+ in the assimilation leaves and Cu2+ in the bulbs of onion. Moreover, the study showed that the highest concentrations of heavy metals decreased the growth of bulbs and even caused them to die off. In contrast, lower concentrations of some elements stimulated plant development.

Genomic and immune signatures predict clinical outcome in newly diagnosed multiple myeloma treated with immunotherapy regimens

Despite improving outcomes, 40% of patients with newly diagnosed multiple myeloma treated with regimens containing daratumumab, a CD38-targeted monoclonal antibody, progress prematurely. By integrating tumor whole-genome and microenvironment single-cell RNA sequencing from upfront phase 2 trials using carfilzomib, lenalidomide and dexamethasone with daratumumab ( NCT03290950 ), we show how distinct genomic drivers including high APOBEC mutational activity, IKZF3 and RPL5 deletions and 8q gain affect clinical outcomes. Furthermore, evaluation of paired bone marrow profiles, taken before and after eight cycles of carfilzomib, lenalidomide and dexamethasone with daratumumab, shows that numbers of natural killer cells before treatment, high T cell receptor diversity before treatment, the disappearance of sustained immune activation (that is, B cells and T cells) and monocyte expansion over time are all predictive of sustained minimal residual disease negativity. Overall, this study provides strong evidence of a complex interplay between tumor cells and the immune microenvironment that is predictive of clinical outcome and depth of treatment response in patients with newly diagnosed multiple myeloma treated with highly effective combinations containing anti-CD38 antibodies.

SLC4A10 mutation causes a neurological disorder associated with impaired GABAergic transmission

SLC4A10 is a plasma-membrane bound transporter that utilizes the Na+ gradient to drive cellular HCO3- uptake, thus mediating acid extrusion. In the mammalian brain, SLC4A10 is expressed in principal neurons and interneurons, as well as in epithelial cells of the choroid plexus, the organ regulating the production of CSF. Using next generation sequencing on samples from five unrelated families encompassing nine affected individuals, we show that biallelic SLC4A10 loss-of-function variants cause a clinically recognizable neurodevelopmental disorder in humans. The cardinal clinical features of the condition include hypotonia in infancy, delayed psychomotor development across all domains and intellectual impairment. Affected individuals commonly display traits associated with autistic spectrum disorder including anxiety, hyperactivity and stereotyped movements. In two cases isolated episodes of seizures were reported in the first few years of life, and a further affected child displayed bitemporal epileptogenic discharges on EEG without overt clinical seizures. While occipitofrontal circumference was reported to be normal at birth, progressive postnatal microcephaly evolved in 7 out of 10 affected individuals. Neuroradiological features included a relative preservation of brain volume compared to occipitofrontal circumference, characteristic narrow sometimes 'slit-like' lateral ventricles and corpus callosum abnormalities. Slc4a10 -/- mice, deficient for SLC4A10, also display small lateral brain ventricles and mild behavioural abnormalities including delayed habituation and alterations in the two-object novel object recognition task. Collapsed brain ventricles in both Slc4a10-/- mice and affected individuals suggest an important role of SLC4A10 in the production of the CSF. However, it is notable that despite diverse roles of the CSF in the developing and adult brain, the cortex of Slc4a10-/- mice appears grossly intact. Co-staining with synaptic markers revealed that in neurons, SLC4A10 localizes to inhibitory, but not excitatory, presynapses. These findings are supported by our functional studies, which show the release of the inhibitory neurotransmitter GABA is compromised in Slc4a10-/- mice, while the release of the excitatory neurotransmitter glutamate is preserved. Manipulation of intracellular pH partially rescues GABA release. Together our studies define a novel neurodevelopmental disorder associated with biallelic pathogenic variants in SLC4A10 and highlight the importance of further analyses of the consequences of SLC4A10 loss-of-function for brain development, synaptic transmission and network properties.

Phospholipase C-ε defines a PACAP-stimulated pathway for secretion in the chromaffin cell

Adrenomedullary chromaffin cells respond to splanchnic (sympathetic) nerve stimulation by releasing stress hormones into the circulation. The signal for hormone secretion is encoded in the neurotransmitters - especially acetylcholine (ACh) and pituitary adenylate cyclase activating polypeptide (PACAP) - that are released into the splanchnic-chromaffin cell synapse. However, functional differences in the effects of ACh and PACAP on the chromaffin cell secretory response are not well defined. Here, selective agonists of PACAP receptors or nicotinic and muscarinic acetylcholine receptors were applied to chromaffin cells. The major differences in the effects of these agents were not on exocytosis, per se, but rather on the steps upstream of exocytosis. In almost every respect, the properties of individual fusion events triggered by PACAP and cholinergic agonists were similar. On the other hand, the properties of the Ca2+ transients evoked by PACAP differed in several ways from those evoked by muscarinic and nicotinic receptor stimulation. A defining feature of the PACAP-stimulated secretory pathway was its dependence on signaling through exchange protein directly activated by cAMP (Epac) and PLCε. However, the absence of PLCε did not disrupt Ca2+ transients evoked by cholinergic agonists. Accordingly, inhibition of Epac activity did not disrupt secretion triggered by acetylcholine or specific agonists of muscarinic and nicotinic receptors. Thus, PACAP and acetylcholine stimulate chromaffin cell secretion via separate and independent pathways. This feature of stimulus-secretion coupling may be important for sustaining hormone release from the adrenal medulla under conditions associated with the sympathetic stress response.

Trapezius activity during personal computer work with progressive addition lenses for general purpose and for computer work in neophytes

INTRODUCTION

This study analysed the impact of general purpose progressive addition lenses (GP-PALs) and computer progressive addition lenses (PC-PALs) on the activity of the trapezius muscle during computer operation.

METHODS

In this randomised, single-blinded, crossover study, surface electromyography (SEMG) signals were recorded bilaterally from the trapezius muscle during a 30-min computer task performed wearing different presbyopic corrections. The amplitude probability distribution function and its percentiles, gap frequency, muscular rest time and sustained low-level muscle activity periods were analysed in 32 subjects with artificially induced presbyopia. Subjectively perceived differences in vision and postural load between lenses were evaluated using a seven-item questionnaire (non-standardised, visual analogue scale ranged from 1 [bad] to 100 [good]).

RESULTS

Considering the SEMG data, no significant difference in the muscular activity of the trapezius muscle was observed when using GP-PALs or PC-PALs for computer operation. However, PC-PALs showed statistically and clinically significantly higher results for subjectively perceived visual quality (78.4-31.3; p < 0.001), spontaneous tolerance (79.2-31.3; p < 0.001) and field of view (75.9-23.5; p < 0.001) compared with GP-PALs.

CONCLUSIONS

Even though the electromyographic approach did not show a significant differentiation between the lenses, the subjective evaluation was clearly in favour of PC-PALs. Eye care practitioners should always take an occupational history of presbyopes, ask about the workplace situation and consider the use of PC-PALs.

Distribution, abundance, and ecogenomics of the Palauibacterales, a new cosmopolitan thiamine-producing order within the Gemmatimonadota phylum

The phylum Gemmatimonadota comprises mainly uncultured microorganisms that inhabit different environments such as soils, freshwater lakes, marine sediments, sponges, or corals. Based on 16S rRNA gene studies, the group PAUC43f is one of the most frequently retrieved Gemmatimonadota in marine samples. However, its physiology and ecological roles are completely unknown since, to date, not a single PAUC43f isolate or metagenome-assembled genome (MAG) has been characterized. Here, we carried out a broad study of the distribution, abundance, ecotaxonomy, and metabolism of PAUC43f, for which we propose the name of Palauibacterales. This group was detected in 4,965 16S rRNA gene amplicon datasets, mainly from marine sediments, sponges, corals, soils, and lakes, reaching up to 34.3% relative abundance, which highlights its cosmopolitan character, mainly salt-related. The potential metabolic capabilities inferred from 52 Palauibacterales MAGs recovered from marine sediments, sponges, and saline soils suggested a facultative aerobic and chemoorganotrophic metabolism, although some members may also oxidize hydrogen. Some Palauibacterales species might also play an environmental role as N2O consumers as well as suppliers of serine and thiamine. When compared to the rest of the Gemmatimonadota phylum, the biosynthesis of thiamine was one of the key features of the Palauibacterales. Finally, we show that polysaccharide utilization loci (PUL) are widely distributed within the Gemmatimonadota so that they are not restricted to Bacteroidetes, as previously thought. Our results expand the knowledge about this cryptic phylum and provide new insights into the ecological roles of the Gemmatimonadota in the environment. IMPORTANCE Despite advances in molecular and sequencing techniques, there is still a plethora of unknown microorganisms with a relevant ecological role. In the last years, the mostly uncultured Gemmatimonadota phylum is attracting scientific interest because of its widespread distribution and abundance, but very little is known about its ecological role in the marine ecosystem. Here we analyze the global distribution and potential metabolism of the marine Gemmatimonadota group PAUC43f, for which we propose the name of Palauibacterales order. This group presents a saline-related character and a chemoorganoheterotrophic and facultatively aerobic metabolism, although some species might oxidize H2. Given that Palauibacterales is potentially able to synthesize thiamine, whose auxotrophy is the second most common in the marine environment, we propose Palauibacterales as a key thiamine supplier to the marine communities. This finding suggests that Gemmatimonadota could have a more relevant role in the marine environment than previously thought.

A preliminary examination of the contextual interference effect on trained trick retention in domestic dogs

This study sought to enhance current dog training practices by determining whether a finding from human motor skill learning research, the contextual interference (CI) effect, could be replicated in a trick-training paradigm with companion dogs. In humans, research shows that practicing skills in random order, as compared with blocked order, improves learning of those skills. To test this question in dogs, we randomly allocated 17 dogs to blocked training (low CI) or random training (high CI). The dogs performed three behaviors of varying difficulty. After training, we conducted a retention test in which half of the dogs in each group performed the tasks in blocked order and the other half in random order. We scored each trick, measured duration, and measured whether dogs required one or two tries to perform a behavior. We found no significant differences between dogs who practiced three tricks in random or in blocked order during training and during a retention test. This study is the first to apply the CI effect to dog trick training. Although no evidence of the CI effect was found, the current research provides a preliminary framework for future studies with potential implications for increasing retention of trained skills.

An Evaluation of Local Implementing Partner Performance During the First 2 Years of the USAID/PEPFAR Transition

INTRODUCTION

Locally led and owned development is considered the best practice for international aid. As an implementing agency for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID) supported the goal of transitioning 70% of its portfolio funding directly to local organizations by 2020, including partner country governments. However, limited evidence or evaluation exists on how such a transition can help achieve HIV-related health outcomes.

METHODS

We evaluated monitoring, evaluation, and reporting performance; calculated indicators; and quality of service across the HIV/AIDS treatment cascade for local and international partners in the USAID/PEPFAR portfolio implementing similar programs during the U.S. Government fiscal years (FY) 2019 to 2020 (October 1, 2018-September 30, 2020). We compared results aggregated globally, by country, and across individual partners.

RESULTS

Globally, local partners met a lower proportion of their treatment targets than international partners and did not meet targets for pre-exposure prophylaxis or voluntary medical male circumcision in FY2020. However, local partners exceeded targets in programs supporting orphans, vulnerable children, and key populations affected by HIV/AIDS. Local partners also had testing positivity, linkage rates, and viral load suppression that were equivalent to or higher than that of international partners. Based on available assessments, local partners displayed quality of service delivery comparable to international partners.

CONCLUSION

Local partners faced challenges, including unfamiliarity with USAID funding, increasing targets across several indicators, and the syndemics of HIV/AIDS and COVID-19. A higher percentage of targets and funding led South African local partners to yield an outsized effect on global percent target achievement. While these findings should be interpreted cautiously due to limited sample size and short time horizon, they are a key first step in evaluating the local partner transition support of the long-term goal of sustained epidemic control of HIV/AIDS.

Quantitative plasma profiling by 1H NMR-based metabolomics: impact of sample treatment

Introduction: There is evidence that sample treatment of blood-based biosamples may affect integral signals in nuclear magnetic resonance-based metabolomics. The presence of macromolecules in plasma/serum samples makes investigating low-molecular-weight metabolites challenging. It is particularly relevant in the targeted approach, in which absolute concentrations of selected metabolites are often quantified based on the area of integral signals. Since there are a few treatments of plasma/serum samples for quantitative analysis without a universally accepted method, this topic remains of interest for future research. Methods: In this work, targeted metabolomic profiling of 43 metabolites was performed on pooled plasma to compare four methodologies consisting of Carr-Purcell-Meiboom-Gill (CPMG) editing, ultrafiltration, protein precipitation with methanol, and glycerophospholipid solid-phase extraction (g-SPE) for phospholipid removal; prior to NMR metabolomics analysis. The effect of the sample treatments on the metabolite concentrations was evaluated using a permutation test of multiclass and pairwise Fisher scores. Results: Results showed that methanol precipitation and ultrafiltration had a higher number of metabolites with coefficient of variation (CV) values above 20%. G-SPE and CPMG editing demonstrated better precision for most of the metabolites analyzed. However, differential quantification performance between procedures were metabolite-dependent. For example, pairwise comparisons showed that methanol precipitation and CPMG editing were suitable for quantifying citrate, while g-SPE showed better results for 2-hydroxybutyrate and tryptophan. Discussion: There are alterations in the absolute concentration of various metabolites that are dependent on the procedure. Considering these alterations is essential before proceeding with the quantification of treatment-sensitive metabolites in biological samples for improving biomarker discovery and biological interpretations. The study demonstrated that g-SPE and CPMG editing are effective methods for removing proteins and phospholipids from plasma samples for quantitative NMR analysis of metabolites. However, careful consideration should be given to the specific metabolites of interest and their susceptibility to the sample treatment procedures. These findings contribute to the development of optimized sample preparation protocols for metabolomics studies using NMR spectroscopy.

Impact of Sumadhur intervention on fertility and family planning decision-making norms: a mixed methods study

BACKGROUND

Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making.

METHODS

In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically.

RESULTS

Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges.

CONCLUSIONS

Entrenched social norms surrounding fertility and family planning contrasted with participants' personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

PACAP and acetylcholine cause distinct Ca2+ signals and secretory responses in chromaffin cells

The adrenomedullary chromaffin cell transduces chemical messages into outputs that regulate end organ function throughout the periphery. At least two important neurotransmitters are released by innervating preganglionic neurons to stimulate exocytosis in the chromaffin cell-acetylcholine (ACh) and pituitary adenylate cyclase activating polypeptide (PACAP). Although PACAP is widely acknowledged as an important secretagogue in this system, the pathway coupling PACAP stimulation to chromaffin cell secretion is poorly understood. The goal of this study is to address this knowledge gap. Here, it is shown that PACAP activates a Gαs-coupled pathway that must signal through phospholipase C ε (PLCε) to drive Ca2+ entry and exocytosis. PACAP stimulation causes a complex pattern of Ca2+ signals in chromaffin cells, leading to a sustained secretory response that is kinetically distinct from the form stimulated by ACh. Exocytosis caused by PACAP is associated with slower release of peptide cargo than exocytosis stimulated by ACh. Importantly, only the secretory response to PACAP, not ACh, is eliminated in cells lacking PLCε expression. The data show that ACh and PACAP, acting through distinct signaling pathways, enable nuanced and variable secretory outputs from chromaffin cells.

Cross-sectional and longitudinal assessment of the association between DDR1 variants and processing speed in patients with early psychosis and healthy controls

Recent evidence indicates that DDR1 participates in myelination and that variants of DDR1 are associated with decreased cognitive processing speed (PS) in schizophrenia (SZ). Here, we explored whether DDR1 variants were associated with PS in subjects diagnosed with an early psychosis (EP), a condition often preceding SZ. Data from two Spanish independent samples (from Reus and Santander) including patients with EP (n = 75 and n = 312, respectively) and healthy controls (HCs; n = 57 and n = 160) were analyzed. The Trail Making Test part A was used to evaluate PS. Participants underwent genotyping to identify DDR1 variants rs1264323 and rs2267641. Cross-sectional data were analyzed with general linear models and longitudinal data were analyzed using mixed models. We examined the combined rs1264323AA-rs2267641AC/CC genotypes (an SZ-risk combination) on PS. The SZ-risk combined genotypes were associated with increased PS in EP patients but not in HCs in the cross-sectional analysis. In the longitudinal analysis, the SZ-risk combined genotypes were significantly associated with increased PS in both HCs and EP patients throughout the 10-year follow-up but no genotype × time interaction was observed. These results provide further evidence that DDR1 is involved in cognition and should be replicated with other samples.

Long-term changes in cortical representation through perceptual learning of spectrally degraded speech

Listeners can adapt to acoustically degraded speech with perceptual training. The learning processes for long periods underlies the rehabilitation of patients with hearing aids or cochlear implants. Perceptual learning of acoustically degraded speech has been associated with the frontotemporal cortices. However, neural processes during and after long-term perceptual learning remain unclear. Here we conducted perceptual training of noise-vocoded speech sounds (NVSS), which is spectrally degraded signals, and measured the cortical activity for seven days and the follow up testing (approximately 1 year later) to investigate changes in neural activation patterns using functional magnetic resonance imaging. We demonstrated that young adult participants (n = 5) improved their performance across seven experimental days, and the gains were maintained after 10 months or more. Representational similarity analysis showed that the neural activation patterns of NVSS relative to clear speech in the left posterior superior temporal sulcus (pSTS) were significantly different across seven training days, accompanying neural changes in frontal cortices. In addition, the distinct activation patterns to NVSS in the frontotemporal cortices were also observed 10-13 months after the training. We, therefore, propose that perceptual training can induce plastic changes and long-term effects on neural representations of the trained degraded speech in the frontotemporal cortices. These behavioral improvements and neural changes induced by the perceptual learning of degraded speech will provide insights into cortical mechanisms underlying adaptive processes in difficult listening situations and long-term rehabilitation of auditory disorders.

Can You Do That Again? Time Series Consolidation as a Robust Method of Tailoring Gesture Recognition to Individual Users

Robust inter-session modeling of gestures is still an open learning challenge. A sleeve equipped with capacitive strap sensors was used to capture two gesture data sets from a convenience sample of eight subjects. Two pipelines were explored. In FILT a novel two-stage algorithm was introduced which uses an unsupervised learning algorithm to find samples representing gesture transitions and discards them prior to training and validating conventional models. In TSC a confusion matrix was used to automatically consolidate commonly confused class labels, resulting in a set of gestures tailored to an individual subject's abilities. The inter-session testing accuracy using the Time Series Consolidation (TSC) method increased from a baseline inter-session average of 42.47 ± 3.83% to 93.02% ± 4.97% while retaining an average of 5.29 ± 0.46 out of the 11 possible gesture categories. These pipelines used classic machine learning algorithms which require relatively small amounts of data and computational power compared to deep learning solutions. These methods may also offer more flexibility in interface design for users suffering from handicaps limiting their manual dexterity or ability to reliably make gestures, and be possible to implement on edge devices with low computational power.

Role of progression of training volume on intramuscular adaptations in patients with chronic obstructive pulmonary disease

Introduction: Quadriceps dysfunction is a common systemic manifestation of chronic obstructive pulmonary disease (COPD), for which treatment using resistance training is highly recommended. Even though training volume is suggested to be a key explanatory factor for intramuscular adaptation to resistance training in healthy older adults, knowledge is scarce on the role of progression of training volume for intramuscular adaptations in COPD.

Methods: This study was a sub-analysis of a parallel-group randomized controlled trial. Thirteen patients with severe to very severe COPD (median 66 yrs, forced expiratory volume in 1 s 44% predicted) performed 8 weeks of low-load resistance training. In a post hoc analysis, they were divided into two groups according to their training volume progression. Those in whom training volume continued to increase after the first 4 weeks of training outlined the continued progression group (n = 9), while those with limited increase (<5%) or even reduction in training volume after the initial 4 weeks composed the discontinued progression group (n = 4). Fiber-type distribution and oxidative muscle protein levels, i.e., citrate synthase (CS), hydroxyacyl-coenzyme A dehydrogenase (HADH), mitochondrial transcription factor A (TfAM) as well as quadriceps endurance measures (total work from elastic band and isokinetic knee extension tests), were assessed before and after the intervention period.

Results: The continued progression group sustained their training volume progression during weeks 5–8 compared to weeks 1–4 (median +25%), while the discontinued progression group did not (median -2%) (p = 0.007 between groups). Compared with baseline values, significant between-group differences in fiber type distribution and TfAM muscle protein levels (range ± 17–62%, p < 0.05) and in individual responses to change in Type I and Type IIa fiber type proportion, CS, HADH, and TfAM muscle protein levels outcomes (median 89 vs. 50%, p = 0.001) were seen in favor of the continued progression group. Moreover, only the continued progression group had a significant increase in HADH muscle protein levels (+24%, p = 0.004), elastic band (+56%, p = 0.004) and isokinetic (+7%, p = 0.004) quadriceps endurance, but the between-group differences did not reach statistical significance (range 14–29%, p = 0.330–1.000).

Discussion: The novel findings of the current study were that patients with COPD who had a continued progression of training volume across the 8-weeks intervention had an increased proportion of Type I fibers, and TfAM muscle protein levels and decreased proportion of Type II fibers compared to those that did not continue to progress their training volume after the initial weeks. Additionally, HADH muscle protein levels and quadriceps endurance measurements only improved in the continued progression group, although no significant between-group differences were seen. These findings highlight the importance of continued progression of training volume during resistive training to counteract quadriceps dysfunction within the COPD population. Still, considering the small sample size and the post hoc nature of our analyses, these results should be interpreted cautiously, and further research is necessary.

Recent deterioration of coral reefs in the South China Sea due to multiple disturbances

More frequent global warming events, biological disasters, and anthropogenic activities have caused extensive damage to coral reefs around the world. Coral reefs in the Xisha Islands (also known as the Paracel Islands) have been damaged following rounds of heatwaves and crown-of-thorns starfish (CoTS) outbreaks over recent decades. Based on a comprehensive community survey in 2020, we determined a diagnosis for the present state of six coral regions in the Xisha Islands. The findings suggested that these regions had a total of 213 species of scleractinian corals belonging to 43 genera and 16 families. Living coral coverage across sites was widely divergent and ranged from 0.40% (IQR: 7.74-0.27%) in Panshi Yu to 38.20% (IQR: 43.00-35.90%) in Bei Jiao. Coral bleaching prevalence was 23.90% (IQR: 41.60-13.30%) overall and topped out at 49.30% (IQR: 50.60-48.10%) in Bei Jiao. Five of the coral regions (all but Yongxing Dao) were under threat of CoTS outbreaks. High mortality combined with excellent recruitment rates suggested potential rehabilitation after recent deterioration. We employed a quantifiable Deterioration Index (DI) to evaluate the intensity of deterioration of coral reefs in the Xisha Islands. The results showed that Yongxing Dao and Langhua Jiao had low recent deterioration (DIrecent = 0.05, IQR: 0.07-0.02 and 0.04, IQR: 0.11-0.01, respectively), while Bei Jiao, Yongle Atoll, Yuzhuo Jiao, and Panshi Yu had high recent deterioration (DIrecent > 0.16). Different monitoring sites within the same coral region were heterogeneous with regards to all above indexes. Moreover, we reviewed and discussed potential disturbances that threaten the health of the Xisha Islands' corals. It is crucial to identify severely afflicted areas and find successful methods to better manage coral reef health in this region.

Reproducible Inter-Personal Brain Coupling Measurements in Hyperscanning Settings With functional Near Infra-Red Spectroscopy

Despite a huge advancement in neuroimaging techniques and growing importance of inter-personal brain research, few studies assess the most appropriate computational methods to measure brain-brain coupling. Here, we focus on the signal processing methods to detect brain-coupling in dyads. From a public dataset of functional Near Infra-Red Spectroscopy signals (N=24 dyads), we derived a synthetic control condition by randomization, we investigated the effectiveness of four most used signal similarity metrics: Cross Correlation, Mutual Information, Wavelet Coherence and Dynamic Time Warping. We also accounted for temporal variations between signals by allowing for misalignments up to a maximum lag. Starting from the observed effect sizes, computed in terms of Cohen's d, the power analysis indicated that a high sample size ([Formula: see text]) would be required to detect significant brain-coupling. We therefore discuss the need for specialized statistical approaches and propose bootstrap as an alternative method to avoid over-penalizing the results. In our settings, and based on bootstrap analyses, Cross Correlation and Dynamic Time Warping outperform Mutual Information and Wavelet Coherence for all considered maximum lags, with reproducible results. These results highlight the need to set specific guidelines as the high degree of customization of the signal processing procedures prevents the comparability between studies, their reproducibility and, ultimately, undermines the possibility of extracting new knowledge.

Associative Analysis of Inefficiencies and Station Activity Levels in Emergency Response

Emergency medical services (EMS) around the world face the challenging task of allocating resources to efficiently respond to medical emergencies within a geographical area. While several studies have been done to improve various aspects of EMS, such as ambulance dispatch planning and station placement optimization, few works have focused on the assessment of existing rich real-world emergency response data to systematically identify areas of improvement. In this paper, we propose DAPI (data-driven analysis of potential response inefficiencies), a general tool for analyzing inefficiencies in emergency response datasets. DAPI efficiently identifies potential response bottlenecks based on spatial distributions of ambulance responses and statistically assesses them with respect to inferred activity levels of relevant dispatch stations to aid causality analysis. DAPI is applied on a dataset containing all medical emergency responses in mainland Portugal, in which we find statistical evidence that inefficiencies are correlated with high levels of activity of stations closer to an emergency location. We present these findings, along with the associated patterns and geographical clusters, serving as a valuable decision support tool to aid EMS in improving their operations.

Validation Study on Automated Sleep Stage Scoring Using a Deep Learning Algorithm

Background and Objectives: Polysomnography is manually scored by sleep experts. However, manual scoring is a time-consuming and labor-intensive task. The goal of this study was to verify the accuracy of automated sleep-stage scoring based on a deep learning algorithm compared to manual sleep-stage scoring. Materials and Methods: A total of 602 polysomnography datasets from subjects (Male:Female = 397:205) aged 19 to 65 years (mean age, 43.8, standard deviation = 12.2) were included in the study. The performance of the proposed model was evaluated based on kappa value and bootstrapped point-estimate of median percent agreement with a 95% bootstrap confidence interval and R = 1000. The proposed model was trained using 482 datasets and validated using 48 datasets. For testing, 72 datasets were selected randomly. Results: The proposed model exhibited good concordance rates with manual scoring for stages W (94%), N1 (83.9%), N2 (89%), N3 (92%), and R (93%). The average kappa value was 0.84. For the bootstrap method, high overall agreement between the automated deep learning algorithm and manual scoring was observed in stages W (98%), N1 (94%), N2 (92%), N3 (99%), and R (98%) and total (96%). Conclusions: Automated sleep-stage scoring using the proposed model may be a reliable method for sleep-stage classification.

Post-acute health care needs of people with head and neck cancer: Mapping health care services, experiences, and the impact of rurality

BACKGROUND

People with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post-discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas.

METHODS

Health care appointments and services accessed by people with HNC were collated for 6-month post-treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery.

RESULTS

The 6-month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs.

CONCLUSIONS

Multiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post-treatment recovery of people with HNC in rural areas.

Identification of research priorities of radiography science: A modified Delphi study in Europe

Radiography science is a new discipline among health sciences. It is a discipline that investigates phenomena in medical imaging, radiation therapy, and nuclear medicine. It has merged from the need to provide research evidence to support these services. The domain of the discipline needs clarification and more research should be focused on its paradigmatic issues. Radiography research priorities have been previously charted on a national level in different countries but the viewpoint has been that of the needs of the profession, not of the discipline. This study aimed to identify the priorities of the discipline. The method chosen was a modified version of the Delphi technique with two rounds. The expert panel consisted of 24 European radiography researchers with long professional experience. This study shows that the research priorities in radiography science are related to the phenomena of radiographers' profession, clinical practices, and the safe and high-quality use of radiation and technology for medical imaging, radiotherapy, and nuclear medicine. Identifying these priorities can help focus research onto most important topics and clarify disciplinary perspective.

Quantile-Zone Based Approach to Normality Testing

Normality testing remains an important issue for researchers, despite many solutions that have been published and in use for a long time. There is a need for testing normality in many areas of research and application, among them in Quality control, or more precisely, in the investigation of Shewhart-type control charts. We modified some of our previous results concerning control charts by using the empirical distribution function, proper choice of quantiles and a zone function that quantifies the discrepancy from a normal distribution. That was our approach in constructing a new normality test that we present in this paper. Our results show that our test is more powerful than any other known normality test, even in the case of alternatives with small departures from normality and for small sample sizes. Additionally, many test statistics are sensitive to outliers when testing normality, but that is not the case with our test statistic. We provide a detailed distribution of the test statistic for the presented test and comparable power analysis with highly illustrative graphics. The discussion covers both the cases for known and for estimated parameters.

Neural Indices of Emotion Regulatory Implementation Correlate With Behavioral Regulatory Selection: Proof-of-Concept Investigation

“Do what you do best” conveys an intuition about the association between ability and preference. In the field of emotion regulation, ability and preference are manifested in two central stages, namely, implementation and selection of regulatory strategies, which to date have been mainly studied separately. Accordingly, the present proof-of-concept study wished to provide preliminary evidence for an association between neural indices of implementation ability and behavioral selection preferences. In this pilot study, participants performed a classic neuroimaging regulatory implementation task that examined their ability (neurally reflected in the degree of amygdala modulation) to execute two central regulatory strategies, namely, attentional distraction and cognitive reappraisal while viewing negative images. Then participants performed a separate, classic behavioral selection task that examined their choice preferences for using distraction and reappraisal while viewing negative images. Confirming our conceptual framework, we found that exclusively for distraction, which has been associated with robust amygdala modulation, a decrease in amygdala activity during implementation (i.e., enhanced ability) was associated with enhanced preference to behaviorally select distraction [r(15) = −0.69, p = 0.004]. These preliminary findings link between two central emotion regulatory stages, suggesting a clue of the adaptive association between neural ability and behavioral preference for particular regulatory strategies.

Protection motivation theory and smoking quitting intention: findings based on structural equation modelling and mediation analysis

OBJECTIVE

Although many smoking cessation strategies have been implemented, only a few strategies at the population level are grounded in theory. Even in those interventions based on specific theories, most studies have focused only on the outcome. The main objective of this study was to demonstrate the utility of protection motivation theory (PMT) in explaining smoking quitting behaviour among adults, with the goal of providing valuable evidence for further intervention strategies.

METHOD

This was a cross-sectional study. Participants were randomly selected on the street from 26 provinces in mainland China. Data were collected via face-to-face interviews. Cronbach's alpha coefficient and the interclass correlation coefficient (ICC) were used to assess the reliability of the individual PMT constructs. We applied structural equation modelling (SEM) to test how well the PMT constructs predicted intention. A bootstrap test was performed to test the potential mediators.

RESULTS

The Cronbach's alpha coefficients of all the subscales ranged from 0.71 to 0.74. Greater intentions were significantly associated with higher threat appraisal (Coef. = 0.18, P < 0.01) and coping appraisal (Coef. = 0.24, P < 0.01). Threat appraisal was significantly associated with higher perceived severity and vulnerability but inversely associated with extrinsic rewards and intrinsic rewards. Coping appraisal was significantly associated with higher self-efficacy and response efficacy but inversely associated with response cost. The R² of quitting intention was 0.12, which means that 12% of quitting intention was predicted by PMT constructs. For threat appraisal, approximately 19.8% of the effects on lower threat appraisal were mediated by higher extrinsic rewards. For coping appraisal, approximately 42.8% of the effects on higher coping appraisal were mediated by higher response efficacy.

CONCLUSION

This study finds that PMT is a sound theoretical framework for predicting smoking quitting intention among adults. Coping appraisal has a stronger effect than threat appraisal for predicting quitting intention. Mediation analyses confirmed that extrinsic rewards and response efficacy mediated the relationship between PMT constructs and quitting intention. Our findings are essential for understanding quitting behaviour among adults and support more effective smoking cessation activities.

Divergent Cortical Tau Positron Emission Tomography Patterns Among Patients With Preclinical Alzheimer Disease

Importance

Characterization of early tau deposition in individuals with preclinical Alzheimer disease (AD) is critical for prevention trials that aim to select individuals at risk for AD and halt the progression of disease.

Objective

To evaluate the prevalence of cortical tau positron emission tomography (PET) heterogeneity in a large cohort of clinically unimpaired older adults with elevated β-amyloid (A+).

Design, Setting, and Participants

This cross-sectional study examined prerandomized tau PET, amyloid PET, structural magnetic resonance imaging, demographic, and cognitive data from the Anti-Amyloid Treatment in Asymptomatic AD (A4) Study from April 2014 to December 2017. Follow-up analyses used observational tau PET data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Harvard Aging Brain Study (HABS), and the Wisconsin Registry for Alzheimer's Prevention and the Wisconsin Alzheimer's Disease Research Center (together hereinafter referred to as Wisconsin) to evaluate consistency. Participants were clinically unimpaired at the study visit closest to the tau PET scan and had available amyloid and tau PET data (A4 Study, n = 447; ADNI, n = 433; HABS, n = 190; and Wisconsin, n = 328). No participants who met eligibility criteria were excluded. Data were analyzed from May 11, 2021, to January 25, 2022.

Main Outcomes and Measures

Individuals with preclinical AD with heterogeneous cortical tau PET patterns (A+T cortical+) were identified by examining asymmetrical cortical tau signal and disproportionate cortical tau signal relative to medial temporal lobe (MTL) tau. Voxelwise tau patterns, amyloid, neurodegeneration, cognition, and demographic characteristics were examined.

Results

The 447 A4 participants (A+ group, 392; and normal β-amyloid group, 55), with a mean (SD) age of 71.8 (4.8) years, included 239 women (54%). A total of 36 individuals in the A+ group (9% of the A+ group) exhibited heterogeneous cortical tau patterns and were further categorized into 3 subtypes: asymmetrical left, precuneus dominant, and asymmetrical right. A total of 116 individuals in the A+ group (30% of the A+ group) showed elevated MTL tau (A+T MTL+). Individuals in the A+T cortical+ group were younger than those in the A+T MTL+ group (t61.867 = -2.597; P = .03). Across the A+T cortical+ and A+T MTL+ groups, increased regional tau was associated with reduced hippocampal volume and MTL thickness but not with cortical thickness. Memory scores were comparable between the A+T cortical+ and A+T MTL+ groups, whereas executive functioning scores were lower for the A+T cortical+ group than for the A+T MTL+ group. The prevalence of the A+T cortical+ group and tau patterns within the A+T cortical+ group were consistent in ADNI, HABS, and Wisconsin.

Conclusions and Relevance

This study suggests that early tau deposition may follow multiple trajectories during preclinical AD and may involve several cortical regions. Staging procedures, especially those based on neuropathology, that assume a uniform trajectory across individuals are insufficient for disease monitoring with tau imaging.

A Review on Differential Abundance Analysis Methods for Mass Spectrometry-Based Metabolomic Data

This review presents an overview of the statistical methods on differential abundance (DA) analysis for mass spectrometry (MS)-based metabolomic data. MS has been widely used for metabolomic abundance profiling in biological samples. The high-throughput data produced by MS often contain a large fraction of zero values caused by the absence of certain metabolites and the technical detection limits of MS. Various statistical methods have been developed to characterize the zero-inflated metabolomic data and perform DA analysis, ranging from simple tests to more complex models including parametric, semi-parametric, and non-parametric approaches. In this article, we discuss and compare DA analysis methods regarding their assumptions and statistical modeling techniques.

Multimodal investigation of the association between shift work and the brain in a population-based sample of older adults

Neuropsychological studies reported that shift workers show reduced cognitive performance and circadian dysfunctions which may impact structural and functional brain networks. Here we tested the hypothesis whether night shift work is associated with resting-state functional connectivity (RSFC), cortical thickness and gray matter volume in participants of the 1000BRAINS study for whom information on night shift work and imaging data were available. 13 PRESENT and 89 FORMER night shift workers as well as 430 control participants who had never worked in shift (NEVER) met these criteria and were included in our study. No associations between night shift work, three graph-theoretical measures of RSFC of 7 functional brain networks and brain morphology were found after multiple comparison correction. Preceding multiple comparison correction, our results hinted at an association between more years of shift work and higher segregation of the visual network in PRESENT shift workers and between shift work experience and lower gray matter volume of the left thalamus. Extensive neuropsychological investigations supplementing objective imaging methodology did not reveal an association between night shift work and cognition after multiple comparison correction. Our pilot study suggests that night shift work does not elicit general alterations in brain networks and affects the brain only to a limited extent. These results now need to be corroborated in studies with larger numbers of participants.

Functional clinical endpoints and their correlations in eyes with AMD with and without subretinal drusenoid deposits-a pilot study

PURPOSE

To evaluate functional clinical endpoints and their structural correlations in AMD, with a focus on subretinal drusenoid deposits (SDD).

METHODS

This prospective study enroled 50 participants (11 controls, 17 intermediate AMD (iAMD) with no SDD, 11 iAMD with SDD and 11 non-foveal atrophic AMD). Participants underwent best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA), low luminance questionnaire (LLQ), scotopic thresholds, rod-intercept time (RIT), photopic flicker electroretinograms and multimodal imaging. Functional and structural relationships were assessed.

RESULTS

Compared with healthy participants, BCVA, LLVA, scotopic thresholds were depressed, and RIT prolonged in iAMD patients with SDD (p = 0.028, p = 0.045, p = 0.014 and p < 0.0001 respectively). Patients with SDD also had reduced scotopic function and delayed RIT compared to iAMD without SDD (p = 0.005 and p < 0.0001). Eyes with SDD and non-foveal atrophy did not differ functionally. Nor did healthy subjects compared with iAMD without SDD. Functional parameters were significantly associated with scotopic thresholds (r = 0.39-0.64). BCVA, LLVA and scotopic thresholds correlated well with ONL volume, ONL thickness and choroidal thickness (r = 0.34-0.61).

CONCLUSION

Eyes with SDD are surrogate markers of photoreceptor abnormalities comparable with non-central atrophy and should be sub-analysed in clinical trials evaluating potential prophylactic agents to decrease the progression of AMD and may even require different therapeutic interventions.

Assessment of liver stiffness measurement and ultrasound findings change during inotuzumab ozogamicin cycles for relapsed or refractory acute lymphoblastic leukemia

In adult patients, acute lymphoblastic leukemia (ALL) is a rare hematological cancer with a cure rate below 50% and frequent relapses. With traditional therapies, patients with relapsed or refractory (R/R) ALL have a survival that may be measured in months; in these patients, inotuzumab ozogamicin (IO) is an effective therapy. IO was linked to increased risk of veno-occlusive disease/sinusoid obstruction syndrome (VOD/SOS), liver injury, and various grade of liver-related complications during clinical trials and real-life settings; however, hepatologic monitoring protocol is not established in this population. In our institution, 21 patients who received IO (median of 6 doses of IO administered) for R/R ALL were prospectively followed for hepatologic surveillance, including clinical evaluation, ultrasonography, and liver stiffness measurement (LSM) biochemistry. After a median follow-up of 17.2 months, two SOS events were reported (both after allogeneic transplant) as IO potentially related clinically relevant adverse event. Mild alterations were reported in almost the totality of patients and moderate-severe liver biochemical alterations in a quarter of patients. Within biochemicals value, AST and ALP showed an augment related to IO administration. LSM linearly augmented for each IO course administered. Baseline LSM was related to liver-related changes, especially with the severity of portal hypertension (PH)-related complications. Pre-transplant LSM was higher in patients receiving IO when compared with a control cohort. PH-related complications were discovered in nearly 77% of patients, with clinically significant PH occurrence and development of ascites in 38% and 14%, respectively. This prospective experience constitutes the rationale to design a hepatologic monitoring program in patients receiving IO. LSM may be of pivotal importance in this program, constituting a rapid and effective screening that quantitatively correlates with liver alterations.

Hoehn and Yahr Stage and Striatal Dat-SPECT Uptake Are Predictors of Parkinson's Disease Motor Progression

Currently, no treatments available for Parkinson's disease (PD) can slow PD progression. At the early stage of the disease, only a subset of individuals with PD progress quickly, while the majority have a slowly progressive form of the disease. In developing treatments that aim to slow PD progression, clinical trials aim to include individuals who are likely to progress faster, such that a treatment effect, if one exists, can be identified easier and earlier. The aim of the present study was to identify baseline predictors of clinical progression in early PD. We analyzed 12-month data acquired from the PASADENA trial Part 1 (NCT03100149, n = 76 participants who were allocated to the placebo arm and did not start symptomatic therapy) and the Parkinson's Progression Markers Initiative (PPMI) study (n = 139 demographically and clinically matched participants). By using ridge regression models including clinical characteristics, imaging, and non-imaging biomarkers, we found that Hoehn and Yahr stage and dopamine transporter single-photon emission computed tomography specific binding ratios (Dat-SPECT SBR) in putamen ipsilateral to the side of motor symptom onset predicted PD progression at the early stage of the disease. Further studies are needed to confirm the validity of these predictors to identify with high accuracy individuals with early PD with a faster progression phenotype.