Poorly controlled pediatric type 1 diabetes mellitus is a risk factor for metabolic dysfunction associated steatotic liver disease (MASLD): An observational study

OBJECTIVES

Recent studies have suggested a link between type 1 diabetes mellitus (T1D) and metabolic dysfunction associated steatotic liver disease (MASLD) in children and adolescent, but longitudinal evidence is lacking. This study aimed to investigate the potential association between poorly controlled T1D and elevated alanine aminotransferase (ALT), serving as a proxy for MASLD in children and adolescents over time.

METHODS

The study included 32,325 children aged 2-17 years with T1D from Germany, Austria, and Switzerland who had undergone at least one assessment of liver enzyme levels recorded in the Diabetes-Patienten- Verlaufsdokumentation registry. Multivariable logistic and Cox regression models were calculated to show possible associations between T1D and elevated ALT values (>26 U/L in males, >22 U/L in females) as a proxy for MASLD.

RESULTS

Children with poorly controlled T1D (HbA1c > 11%) exhibited increased odds of elevated ALT values, after adjustment for age, sex, diabetes duration and overweight (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.10-3.10; p < 0.01). This finding is substantiated by a longitudinal analysis, which reveals that inadequately controlled T1D was associated with a higher hazard ratio (HR) of elevated ALT values compared to children with controlled T1D over an observation period extending up to 5.5 (HR: 1.54; 95% CI, 1.19-2.01; p < 0.01).

CONCLUSION

In conclusion, the current study strongly links poorly controlled T1D in children and adolescents to MASLD irrespective of overweight. This association is not only present cross-sectionally but also increases over time. The study underscores the critical role of effective diabetes management in reducing the risk of MASLD in this population.

Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study

BACKGROUND

The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel.

METHODS

This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods.

RESULTS

Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation.

CONCLUSION

In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVEjob Study

This study aims to identify the distribution of the "Work-related behavior and experience patterns" (Arbeitsbezogenes Verhaltens-und Erlebnismuster, AVEM) in general practitioners and their teams by using baseline data of the IMPROVEjob study. Members of 60 general practices with 84 physicians in a leadership position, 28 employed physicians, and 254 practice assistants participated in a survey in 2019 and 2020. In this analysis, we focused on AVEM variables. Age, practice years, work experience, and working time were used as control variables in the Spearman Rho correlations and analysis of variance. The majority of the participants (72.1%) revealed a health-promoting pattern (G or S). Three of eleven AVEM dimensions were above the norm for the professional group "employed physicians". The AVEM dimensions "striving for perfection" (p < 0.001), "experience of success at work" (p < 0.001), "satisfaction with life" (p = 0.003), and "experience of social support" (p = 0.019) differed significantly between the groups' practice owners and practice assistants, with the practice owners achieving the higher values, except for experience of social support. Practice affiliation had no effect on almost all AVEM dimensions. We found a high prevalence of AVEM health-promoting patterns in our sample. Nearly half of the participants in all professional groups showed an unambitious pattern (S). Adapted interventions for the represented AVEM patterns are possible and should be utilized for maintaining mental health among general practice teams.

Directed acyclic graph for epidemiological studies in childhood food allergy: Construction, user's guide, and application

Understanding modifiable prenatal and early life causal determinants of food allergy is important for the prevention of the disease. Randomized clinical trials studying environmental and dietary determinants of food allergy may not always be feasible. Identifying risk/protective factors for early-life food allergy often relies on observational studies, which may be affected by confounding bias. The directed acyclic graph (DAG) is a causal diagram useful to guide causal inference from observational epidemiological research. To date, research on food allergy has made little use of this promising method. We performed a literature review of existing evidence with a systematic search, synthesized 32 known risk/protective factors, and constructed a comprehensive DAG for early-life food allergy development. We present an easy-to-use online tool for researchers to re-construct, amend, and modify the DAG along with a user's guide to minimize confounding bias. We estimated that adjustment strategies in 57% of previous observational studies on modifiable factors of childhood food allergy could be improved if the researchers determined their adjustment sets by DAG. Future researchers who are interested in the causal inference of food allergy development in early life can apply the DAG to identify covariates that should and should not be controlled in observational studies.

A radiation of Psylliodes flea beetles on Brassicaceae is associated with the evolution of specific detoxification enzymes

Flea beetles of the genus Psylliodes have evolved specialized interactions with plant species belonging to several distantly related families, mainly Brassicaceae, Solanaceae, and Fagaceae. This diverse host use indicates that Psylliodes flea beetles are able to cope with different chemical defense metabolites, including glucosinolates, the characteristic defense metabolites of Brassicaceae. Here we investigated the evolution of host use and the emergence of a glucosinolate-specific detoxification mechanism in Psylliodes flea beetles. In phylogenetic analyses, Psylliodes species clustered into four major clades, three of which contained mainly species specialized on either Brassicaceae, Solanaceae, or Fagaceae. Most members of the fourth clade have broader host use, including Brassicaceae and Poaceae as major host plant families. Ancestral state reconstructions suggest that Psylliodes flea beetles were initially associated with Brassicaceae and then either shifted to Solanaceae or Fagaceae, or expanded their host repertoire to Poaceae. Despite a putative ancestral association with Brassicaceae, we found evidence that the evolution of glucosinolate-specific detoxification enzymes coincides with the radiation of Psylliodes on Brassicaceae, suggesting that these are not required for using Brassicaceae as hosts but could improve the efficiency of host use by specialized Psylliodes species.

A multidomain intervention against cognitive decline in an at-risk-population in Germany: Results from the cluster-randomized AgeWell.de trial

INTRODUCTION

We investigated the effectiveness of a multidomain intervention to preserve cognitive function in older adults at risk for dementia in Germany in a cluster-randomized trial.

METHODS

Individuals with a Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk score ≥ 9 aged 60 to 77 years were recruited. After randomization of their general practitioner (GP), patients received a multidomain intervention (including optimization of nutrition and medication, and physical, social, and cognitive activity) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance (composite z score, based on domain-specific neuropsychological tests).

RESULTS

Of 1030 participants at baseline, n = 819 completed the 24-month follow-up assessment. No differences regarding global cognitive performance (average marginal effect = 0.010, 95% confidence interval: -0.113, 0.133) were found between groups at follow-up. Perceived restrictions in intervention conduct by the COVID-19 pandemic did not impact intervention effectiveness.

DISCUSSION

The intervention did not improve global cognitive performance.

HIGHLIGHTS

Overall, no intervention effects on global cognitive performance were detected. The multidomain intervention improved health-related quality of life in the total sample. In women, the multidomain intervention reduced depressive symptoms. The intervention was completed during the COVID-19 pandemic.

Discriminative machine learning for maximal representative subsampling

Biased population samples pose a prevalent problem in the social sciences. Therefore, we present two novel methods that are based on positive-unlabeled learning to mitigate bias. Both methods leverage auxiliary information from a representative data set and train machine learning classifiers to determine the sample weights. The first method, named maximum representative subsampling (MRS), uses a classifier to iteratively remove instances, by assigning a sample weight of 0, from the biased data set until it aligns with the representative one. The second method is a variant of MRS - Soft-MRS - that iteratively adapts sample weights instead of removing samples completely. To assess the effectiveness of our approach, we induced artificial bias in a public census data set and examined the corrected estimates. We compare the performance of our methods against existing techniques, evaluating the ability of sample weights created with Soft-MRS or MRS to minimize differences and improve downstream classification tasks. Lastly, we demonstrate the applicability of the proposed methods in a real-world study of resilience research, exploring the influence of resilience on voting behavior. Through our work, we address the issue of bias in social science, amongst others, and provide a versatile methodology for bias reduction based on machine learning. Based on our experiments, we recommend to use MRS for downstream classification tasks and Soft-MRS for downstream tasks where the relative bias of the dependent variable is relevant.

Luminescent reporter cells enable the identification of broad-spectrum antivirals against emerging viruses

The emerging viruses SARS-CoV-2 and arenaviruses cause severe respiratory and hemorrhagic diseases, respectively. The production of infectious particles of both viruses and virus spread in tissues requires cleavage of surface glycoproteins (GPs) by host proprotein convertases (PCs). SARS-CoV-2 and arenaviruses rely on GP cleavage by PCs furin and subtilisin kexin isozyme-1/site-1 protease (SKI-1/S1P), respectively. We report improved luciferase-based reporter cell lines, named luminescent inducible proprotein convertase reporter cells that we employ to monitor PC activity in its authentic subcellular compartment. Using these sensor lines we screened a small compound library in high-throughput manner. We identified 23 FDA-approved small molecules, among them monensin which displayed broad activity against furin and SKI-1/S1P. Monensin inhibited arenaviruses and SARS-CoV-2 in a dose-dependent manner. We observed a strong reduction in infectious particle release upon monensin treatment with little effect on released genome copies. This was reflected by inhibition of SARS-CoV-2 spike processing suggesting the release of immature particles. In a proof of concept experiment using human precision cut lung slices, monensin potently inhibited SARS-CoV-2 infection, evidenced by reduced infectious particle release. We propose that our PC sensor pipeline is a suitable tool to identify broad-spectrum antivirals with therapeutic potential to combat current and future emerging viruses.

Molecular-Cling-Effect of Fluoroethylene Carbonate Characterized via Ethoxy(pentafluoro)cyclotriphosphazene on SiOx/C Anode Materials - A New Perspective for Formerly Sub-Sufficient SEI Forming Additive Compounds

Effective electrolyte compositions are of primary importance in raising the performance of lithium-ion batteries (LIBs). Recently, fluorinated cyclic phosphazenes in combination with fluoroethylene carbonate (FEC) have been introduced as promising electrolyte additives, which can decompose to form an effective dense, uniform, and thin protective layer on the surface of electrodes. Although the basic electrochemical aspects of cyclic fluorinated phosphazenes combined with FEC were introduced, it is still unclear how these two compounds interact constructively during operation. This study investigates the complementary effect of FEC and ethoxy(pentafluoro)cyclotriphosphazene (EtPFPN) in aprotic organic electrolyte in LiNi0.5 Co0.2 Mn0.3 O ∥ SiOx /C full cells. The formation mechanism of lithium ethyl methyl carbonate (LEMC)-EtPFPN interphasial intermediate products and the reaction mechanism of lithium alkoxide with EtPFPN are proposed and supported by Density Functional Theory calculations. A novel property of FEC is also discussed here, called molecular-cling-effect (MCE). To the best knowledge, the MCE has not been reported in the literature, although FEC belongs to one of the most investigated electrolyte additives. The beneficial MCE of FEC toward the sub-sufficient solid-electrolyte interphase forming additive compound EtPFPN is investigated via gas chromatography-mass spectrometry, gas chromatography high resolution-accurate mass spectrometry, in situ shell-isolated nanoparticle-enhanced Raman spectroscopy, and scanning electron microscopy.

Associations of Depressive Symptoms with Subjective Cognitive Decline in Elderly People-A Cross-Sectional Analysis from the AgeWell.de-Study

To develop effective dementia prevention strategies, it is necessary to understand risk factors, associated factors and early signs of dementia. Subjective cognitive decline (SCD) is the earliest form of dementia. The aim of this study is to assess depression as a factor that is significantly associated with SCD. The data of 1030 general practitioner patients from the AgeWell.de-study (60-77 years; CAIDE dementia risk score ≥ 9) were analysed. A descriptive analysis was conducted using validated instruments like the Geriatric depression scale (GDS), Lubben social network scale (LSNS-6) and education classes according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations). A multivariate regression model with the dependent variable SCD was calculated. Of the 1030 participants, 5.9% had depressive symptoms and 31.3% SCD. The group with depressive symptoms showed significantly higher body-mass-index (p = 0.005), lower education class (p = 0.022), lower LSNS-6 score (p < 0.001), higher sports activity (p < 0.001), and more sleeping problems (p = 0.026). In the regression model a higher GDS-score [Odds ratio (OR): 1.219 (p < 0.001)], more sleeping problems [OR: 1.550 (p = 0.017)] and higher education class [middle/high: OR: 1.474/1.875 (p = 0.037/0.004)] were significantly associated with SCD. This study identified depressive symptoms, sleeping problems, and higher education classes as factors associated with SCD, which can represent an early form of dementia.

German GPs' Self-Perceived Role in the COVID-19 Pandemic: Leadership, Participation in Regional Services and Preferences for Future Pandemic Preparedness

General practitioners (GPs) played a vital role during the COVID-19 pandemic. Little is known about GPs' view of their role, leadership, participation in regional services and preferences for future pandemic preparedness. This representative study of German GPs comprised a web-based survey and computer-assisted telephone interviewing (CATI). It addressed GPs' satisfaction with their role, self-perceived leadership (validated C-LEAD scale), participation in newly established health services, and preferences for future pandemic preparedness (net promotor score; NPS; range -100 to +100%). Statistical analyses were conducted using Spearman's correlation and Kruskal-Wallis tests. In total, 630 GPs completed the questionnaire and 102 GPs the CATI. In addition to their practice duties, most GPs (72.5%) participated in at least one regional health service, mainly vaccination centres/teams (52.7%). Self-perceived leadership was high with a C-LEAD score of 47.4 (max. 63; SD ± 8.5). Overall, 58.8% were not satisfied with their role which correlated with the feeling of being left alone (r = -0.349, p < 0.001). 77.5 % of respondents believed that political leaders underestimated GPs' potential contribution to pandemic control. Regarding regional pandemic services, GPs preferred COVID-19 focus practices (NPS +43.7) over diagnostic centres (NPS -31). Many GPs, though highly engaged regionally, were dissatisfied with their role but had clear preferences for future regional services. Future pandemic planning should integrate GPs' perspectives.

CNV-ClinViewer: enhancing the clinical interpretation of large copy-number variants online

MOTIVATION

Pathogenic copy-number variants (CNVs) can cause a heterogeneous spectrum of rare and severe disorders. However, most CNVs are benign and are part of natural variation in human genomes. CNV pathogenicity classification, genotype-phenotype analyses, and therapeutic target identification are challenging and time-consuming tasks that require the integration and analysis of information from multiple scattered sources by experts.

RESULTS

Here, we introduce the CNV-ClinViewer, an open-source web application for clinical evaluation and visual exploration of CNVs. The application enables real-time interactive exploration of large CNV datasets in a user-friendly designed interface and facilitates semi-automated clinical CNV interpretation following the ACMG guidelines by integrating the ClassifCNV tool. In combination with clinical judgment, the application enables clinicians and researchers to formulate novel hypotheses and guide their decision-making process. Subsequently, the CNV-ClinViewer enhances for clinical investigators' patient care and for basic scientists' translational genomic research.

AVAILABILITY AND IMPLEMENTATION

The web application is freely available at https://cnv-ClinViewer.broadinstitute.org and the open-source code can be found at https://github.com/LalResearchGroup/CNV-clinviewer.

Mediators of digital depression prevention in patients with chronic back pain: Findings from a multicenter randomized clinical trial

OBJECTIVE

The mechanisms of change in digital interventions for the prevention of depression are largely unknown. Here, we explored whether five theoretically derived intervening variables (i.e., pain intensity, pain-related disability, pain self-efficacy, quality of life [QoL], and work capacity) were mediating the effectiveness of a digital intervention specifically designed to prevent depression in patients with chronic back pain (CBP).

METHOD

This study is a secondary analysis of a pragmatic, observer-masked randomized clinical trial conducted at 82 orthopedic clinics in Germany. A total of 295 adults with a diagnosis of CBP and subclinical depressive symptoms were randomized to either the intervention group (n = 149) or treatment-as-usual (n = 146). Longitudinal mediation analyses were conducted with structural equation modeling and depression symptom severity as primary outcome (Patient Health Questionnaire-9 [PHQ-9]; 6 months after randomization) on an intention-to-treat basis.

RESULTS

Beside the effectiveness of the digital intervention in preventing depression, we found a significant causal mediation effect for QoL as measured with the complete scale of Assessment of Quality of Life (AQoL-6D; axb: -0.234), as well as for the QoL subscales mental health (axb: -0.282) and coping (axb: -0.249). All other potential intervening variables were not significant.

CONCLUSION

Our findings suggest a relevant role of QoL, including active coping, as change mechanism in the prevention of depression. Yet, more research is needed to extend and specify our knowledge on empirically supported processes in digital depression prevention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

New Perspectives for Prosthetic Valve Endocarditis: Impact of Molecular Imaging by FISHseq Diagnostics

BACKGROUND

The microbial etiology of prosthetic valve infective endocarditis (PVE) can be difficult to identify. Our aim was to investigate the benefit of molecular imaging technique fluorescence in situ hybridization (FISH) combined with 16S rRNA-gene polymerase chain reaction (PCR) and sequencing (FISHseq) for the analysis of infected prosthetic heart valves.

METHODS

We retrospectively evaluated the diagnostic outcome of 113 prosthetic valves from 105 patients with suspected PVE, treated in 2003-2013 in the Department of Cardiac Surgery, Charité University Medicine Berlin. Each prosthetic valve underwent cultural diagnostics and was routinely examined by FISH combined with 16S rRNA gene PCR and sequencing. We compared classical microbiological culture outcomes (blood and valve cultures) with FISHseq results and evaluated the diagnostic impact of the molecular imaging technique.

RESULTS

Conventional microbiological diagnostic alone turned out to be insufficient, as 67% of preoperative blood cultures were noninformative (negative, inconclusive, or not obtained) and 67% of valve cultures remained negative. FISHseq improved the conventional cultural diagnostic methods in PVE in 30% of the cases and increased diagnostic accuracy. Of the valve culture-negative PVE cases, FISHseq succeeded in identifying the causative pathogen in 35%.

CONCLUSIONS

FISHseq improves PVE diagnostics, complementing conventional cultural methods. In addition to species identification, FISH provides information about the severity of PVE and state of the pathogens (eg, stage of biofilm formation, activity, and localization on and within the prosthetic material). As a molecular imaging technique, FISHseq enables the unambiguous discrimination of skin flora as contaminant or infectious agent.

Conserved patterns across ion channels correlate with variant pathogenicity and clinical phenotypes

Clinically identified genetic variants in ion channels can be benign or cause disease by increasing or decreasing the protein function. As a consequence, therapeutic decision-making is challenging without molecular testing of each variant. Our biophysical knowledge of ion-channel structures and function is just emerging, and it is currently not well understood which amino acid residues cause disease when mutated. We sought to systematically identify biological properties associated with variant pathogenicity across all major voltage and ligand-gated ion-channel families. We collected and curated 3049 pathogenic variants from hundreds of neurodevelopmental and other disorders and 12 546 population variants for 30 ion channel or channel subunits for which a high-quality protein structure was available. Using a wide range of bioinformatics approaches, we computed 163 structural features and tested them for pathogenic variant enrichment. We developed a novel 3D spatial distance scoring approach that enables comparisons of pathogenic and population variant distribution across protein structures. We discovered and independently replicated that several pore residue properties and proximity to the pore axis were most significantly enriched for pathogenic variants compared to population variants. Using our 3D scoring approach, we showed that the strongest pathogenic variant enrichment was observed for pore-lining residues and alpha-helix residues within 5Å distance from the pore axis centre and not involved in gating. Within the subset of residues located at the pore, the hydrophobicity of the pore was the feature most strongly associated with variant pathogenicity. We also found an association between the identified properties and both clinical phenotypes and functional in vitro assays for voltage-gated sodium channels (SCN1A, SCN2A, SCN8A) and N-methyl-D-aspartate receptor (GRIN1, GRIN2A, GRIN2B) encoding genes. In an independent expert-curated dataset of 1422 neurodevelopmental disorder pathogenic patient variants and 679 electrophysiological experiments, we show that pore axis distance is associated with seizure age of onset and cognitive performance as well as differential gain versus loss-of-channel function. In summary, we identified biological properties associated with ion-channel malfunction and show that these are correlated with in vitro functional readouts and clinical phenotypes in patients with neurodevelopmental disorders. Our results suggest that clinical decision support algorithms that predict variant pathogenicity and function are feasible in the future.

Delineation of functionally essential protein regions for 242 neurodevelopmental genes

Neurodevelopmental disorders (NDDs), including severe paediatric epilepsy, autism and intellectual disabilities are heterogeneous conditions in which clinical genetic testing can often identify a pathogenic variant. For many of them, genetic therapies will be tested in this or the coming years in clinical trials. In contrast to first-generation symptomatic treatments, the new disease-modifying precision medicines require a genetic test-informed diagnosis before a patient can be enrolled in a clinical trial. However, even in 2022, most identified genetic variants in NDD genes are 'variants of uncertain significance'. To safely enrol patients in precision medicine clinical trials, it is important to increase our knowledge about which regions in NDD-associated proteins can 'tolerate' missense variants and which ones are 'essential' and will cause a NDD when mutated. In addition, knowledge about functionally indispensable regions in the 3D structure context of proteins can also provide insights into the molecular mechanisms of disease variants. We developed a novel consensus approach that overlays evolutionary, and population based genomic scores to identify 3D essential sites (Essential3D) on protein structures. After extensive benchmarking of AlphaFold predicted and experimentally solved protein structures, we generated the currently largest expert curated protein structure set for 242 NDDs and identified 14 377 Essential3D sites across 189 gene disorders associated proteins. We demonstrate that the consensus annotation of Essential3D sites improves prioritization of disease mutations over single annotations. The identified Essential3D sites were enriched for functional features such as intermembrane regions or active sites and discovered key inter-molecule interactions in protein complexes that were otherwise not annotated. Using the currently largest autism, developmental disorders, and epilepsies exome sequencing studies including >360 000 NDD patients and population controls, we found that missense variants at Essential3D sites are 8-fold enriched in patients. In summary, we developed a comprehensive protein structure set for 242 NDDs and identified 14 377 Essential3D sites in these. All data are available at https://es-ndd.broadinstitute.org for interactive visual inspection to enhance variant interpretation and development of mechanistic hypotheses for 242 NDDs genes. The provided resources will enhance clinical variant interpretation and in silico drug target development for NDD-associated genes and encoded proteins.

Subgroup discovery in structural equation models

Structural equation modeling is one of the most popular statistical frameworks in the social and behavioral sciences. Often, detection of groups with distinct sets of parameters in structural equation models (SEM) are of key importance for applied researchers, for example, when investigating differential item functioning for a mental ability test or examining children with exceptional educational trajectories. In the present article, we present a new approach combining subgroup discovery-a well-established toolkit of supervised learning algorithms and techniques from the field of computer science-with structural equation models termed SubgroupSEM. We provide an overview and comparison of three approaches to modeling and detecting heterogeneous groups in structural equation models, namely, finite mixture models, SEM trees, and SubgroupSEM. We provide a step-by-step guide to applying subgroup discovery techniques for structural equation models, followed by a detailed and illustrated presentation of pruning strategies and four subgroup discovery algorithms. Finally, the SubgroupSEM approach will be illustrated on two real data examples, examining measurement invariance of a mental ability test and investigating interesting subgroups for the mediated relationship between predictors of educational outcomes and the trajectories of math competencies in 5th grade children. The illustrative examples are accompanied by examples of the R package subgroupsem, which is a viable implementation of our approach for applied researchers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tactile Robotic Telemedicine for Safe Remote Diagnostics in Times of Corona: System Design, Feasibility and Usability Study

The current crisis surrounding the COVID-19 pandemic demonstrates the amount of responsibility and the workload on our healthcare system and, above all, on the medical staff around the world. In this work, we propose a promising approach to overcome this problem using robot-assisted telediagnostics, which allows medical experts to examine patients from distance. The designed telediagnostic system consists of two robotic arms. Each robot is located at the doctor and patient sites. Such a system enables the doctor to have a direct conversation via telepresence and to examine patients through robot-assisted inspection (guided tactile and audiovisual contact). The proposed bilateral teleoperation system is redundant in terms of teleoperation control algorithms and visual feedback. Specifically, we implemented two main control modes: joint-based and displacement-based teleoperation. The joint-based mode was implemented due to its high transparency and ease of mapping between Leader and Follower whereas the displacement-based is highly flexible in terms of relative pose mapping and null-space control. Tracking tests between Leader and Follower were conducted on our system using both wired and wireless connections. Moreover, our system was tested by seven medical doctors in two experiments. User studies demonstrated the system's usability and it was successfully validated by the medical experts.

Practice-related changes in perceptual evidence accumulation correlate with changes in working memory

It has been proposed that evidence accumulation determines not only the speed and accuracy of simple perceptual decisions but also influences performance on tasks assessing higher-order cognitive abilities, such as working memory (WM). Accordingly, estimates of evidence accumulation based on diffusion decision modeling of perceptual decision-making tasks have been found to correlate with WM performance. Here we use diffusion decision modeling in combination with latent factor modeling to test the stronger prediction that practice-induced changes in evidence accumulation correlate with changes in WM performance. Analyses are based on data from the COGITO Study, in which 101 young adults practiced a battery of cognitive tasks, including three simple two-choice reaction time tasks and three WM tasks, in 100 day-to-day training sessions distributed over 6 months. In initial analyses, drift rates were found to correlate across the three choice tasks, such that latent factors of evidence accumulation could be established. These latent factors of evidence accumulation were positively correlated with latent factors of practiced and unpracticed WM tasks, both before and after practice. As predicted, individual differences in changes of evidence accumulation correlated positively with changes in WM performance. Our findings support the proposition that decision making and WM both rely on the active maintenance of task-relevant internal representations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Genotype-phenotype correlations in SCN8A-related disorders reveal prognostic and therapeutic implications

We report detailed functional analyses and genotype-phenotype correlations in 392 individuals carrying disease-causing variants in SCN8A, encoding the voltage-gated Na+ channel Nav1.6, with the aim of describing clinical phenotypes related to functional effects. Six different clinical subgroups were identified: Group 1, benign familial infantile epilepsy (n = 15, normal cognition, treatable seizures); Group 2, intermediate epilepsy (n = 33, mild intellectual disability, partially pharmaco-responsive); Group 3, developmental and epileptic encephalopathy (n = 177, severe intellectual disability, majority pharmaco-resistant); Group 4, generalized epilepsy (n = 20, mild to moderate intellectual disability, frequently with absence seizures); Group 5, unclassifiable epilepsy (n = 127); and Group 6, neurodevelopmental disorder without epilepsy (n = 20, mild to moderate intellectual disability). Those in Groups 1-3 presented with focal or multifocal seizures (median age of onset: 4 months) and focal epileptiform discharges, whereas the onset of seizures in patients with generalized epilepsy was later (median: 42 months) with generalized epileptiform discharges. We performed functional studies expressing missense variants in ND7/23 neuroblastoma cells and primary neuronal cultures using recombinant tetrodotoxin-insensitive human Nav1.6 channels and whole-cell patch-clamping. Two variants causing developmental and epileptic encephalopathy showed a strong gain-of-function (hyperpolarizing shift of steady-state activation, strongly increased neuronal firing rate) and one variant causing benign familial infantile epilepsy or intermediate epilepsy showed a mild gain-of-function (defective fast inactivation, less increased firing). In contrast, all three variants causing generalized epilepsy induced a loss-of-function (reduced current amplitudes, depolarizing shift of steady-state activation, reduced neuronal firing). Functional effects were known for 170 individuals. All 136 individuals carrying a functionally tested gain-of-function variant had either focal (n = 97, Groups 1-3) or unclassifiable (n = 39) epilepsy, whereas 34 individuals with a loss-of-function variant had either generalized (n = 14), no (n = 11) or unclassifiable (n = 6) epilepsy; only three had developmental and epileptic encephalopathy. Computational modelling in the gain-of-function group revealed a significant correlation between the severity of the electrophysiological and clinical phenotypes. Gain-of-function variant carriers responded significantly better to sodium channel blockers than to other anti-seizure medications, and the same applied for all individuals in Groups 1-3. In conclusion, our data reveal clear genotype-phenotype correlations between age at seizure onset, type of epilepsy and gain- or loss-of-function effects of SCN8A variants. Generalized epilepsy with absence seizures is the main epilepsy phenotype of loss-of-function variant carriers and the extent of the electrophysiological dysfunction of the gain-of-function variants is a main determinant of the severity of the clinical phenotype in focal epilepsies. Our pharmacological data indicate that sodium channel blockers present a treatment option in SCN8A-related focal epilepsy with onset in the first year of life.

Bacteroides muris sp. nov. isolated from the cecum of wild-derived house mice

Two bacterial strains, KH365_2^T and KH569_7, were isolated from the cecum contents of wild-derived house mice. The strains were characterized as Gram-negative, rod-shaped, strictly anaerobic, and non-motile. Phylogenetic analysis based on 16S rRNA gene sequences revealed that both strains were most closely related to Bacteroides uniformis ATCC 8492^T. Whole genome sequences of KH365_2^T and KH569_7 strains have a DNA G + C content of 46.02% and 46.03% mol, respectively. Most morphological and biochemical characteristics did not differ between the newly isolated strains and classified Bacteroides strains. However, the average nucleotide identity (ANI) and dDNA–DNA hybridization (dDDH) values clearly distinguished the two strains from described members of the genus Bacteroides. Here, we present the phylogeny, morphology, and physiology of a novel species of the genus Bacteroides and propose the name Bacteroides muris sp. nov., with KH365_2^T (DSM 114231^T = CCUG 76277^T) as type strain.

Causal effect analysis in nonrandomized data with latent variables and categorical indicators: The implementation and benefits of EffectLiteR

Instead of using manifest proxies for a latent outcome or latent covariates in a causal effect analysis, the R package EffectLiteR facilitates a direct integration of latent variables based on structural equation models (SEM). The corresponding framework considers latent interactions and provides various effect estimates for evaluating the differential effectiveness of treatments. In addition, a user-friendly graphical interface customizes the implementation of the complex models. We aim to enable applications of EffectLiteR in more contexts, and therefore generalize the framework for incorporating latent variables measured with categorical indicators. This refers, for instance, to achievement tests in educational large-scale assessments (LSAs), which are typically constructed in the tradition of item response theory (IRT). We review different modeling strategies for incorporating latent variables from IRT models in an effect analysis (i.e., individual score estimates, plausible values, SEM for categorical indicators). The strategies differ in the handling of measurement error and, thus, have different implications for the accuracy and efficiency of causal effect estimates. We describe our extensions of EffectLiteR based on SEM for categorical indicators and illustrate the model specification step-by-step. In addition, we present a hands-on example, where we apply EffectLiteR in LSA data. The practical benefit of using latent variables in comparison to proficiency scores is of special interest in the application and discussion. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The hen's egg test for micronucleus induction (HET-MN): validation data set

The classical in vitro genotoxicity test battery is known to be sensitive for indicating genotoxicity. However, a high rate of 'misleading positives' was reported when three assays were combined as required by several legislations. Despite the recent optimisations of the standard in vitro tests, two gaps could hardly be addressed with assays based on 2D monolayer cell cultures: the route of exposure and a relevant intrinsic metabolic capacity to transform pro-mutagens into reactive metabolites. Following these considerations, fertilised chicken eggs have been introduced into genotoxicity testing and were combined with a classical read-out parameter, the micronucleus frequency in circulating erythrocytes, to develop the hen's egg test for micronucleus induction (HET-MN). As a major advantage, the test mirrors the systemic availability of compounds after oral exposure by reflecting certain steps of Absorption, Distribution, Metabolism, Excretion (ADME) without being considered as an animal experiment. The assay is supposed to add to a toolbox of assays to follow up on positive findings from initial testing with classical in vitro assays. We here report on a validation exercise, in which >30 chemicals were tested double-blinded in three laboratories. The specificity and sensitivity of the HET-MN were calculated to be 98 and 84%, respectively, corresponding to an overall accuracy of 91%. A detailed protocol, which includes a picture atlas detailing the cell and micronuclei analysis, is published in parallel (Maul et al. Validation of the hen's egg test for micronucleus induction (HET-MN): detailed protocol including scoring atlas, historical control data and statistical analysis).

B-Cell NHL Subtype Risk Associated with Autoimmune Conditions and PRS

BACKGROUND

A previous International Lymphoma Epidemiology (InterLymph) Consortium evaluation of joint associations between five immune gene variants and autoimmune conditions reported interactions between B-cell response-mediated autoimmune conditions and the rs1800629 genotype on risk of B-cell non-Hodgkin lymphoma (NHL) subtypes. Here, we extend that evaluation using NHL subtype-specific polygenic risk scores (PRS) constructed from loci identified in genome-wide association studies of three common B-cell NHL subtypes.

METHODS

In a pooled analysis of NHL cases and controls of Caucasian descent from 14 participating InterLymph studies, we evaluated joint associations between B-cell-mediated autoimmune conditions and tertile (T) of PRS for risk of diffuse large B-cell lymphoma (DLBCL; n = 1,914), follicular lymphoma (n = 1,733), and marginal zone lymphoma (MZL; n = 407), using unconditional logistic regression.

RESULTS

We demonstrated a positive association of DLBCL PRS with DLBCL risk [T2 vs. T1: OR = 1.24; 95% confidence interval (CI), 1.08-1.43; T3 vs. T1: OR = 1.81; 95% CI, 1.59-2.07; P-trend (Ptrend) < 0.0001]. DLBCL risk also increased with increasing PRS tertile among those with an autoimmune condition, being highest for those with a B-cell-mediated autoimmune condition and a T3 PRS [OR = 6.46 vs. no autoimmune condition and a T1 PRS, Ptrend < 0.0001, P-interaction (Pinteraction) = 0.49]. Follicular lymphoma and MZL risk demonstrated no evidence of joint associations or significant Pinteraction.

CONCLUSIONS

Our results suggest that PRS constructed from currently known subtype-specific loci may not necessarily capture biological pathways shared with autoimmune conditions.

IMPACT

Targeted genetic (PRS) screening among population subsets with autoimmune conditions may offer opportunities for identifying those at highest risk for (and early detection from) DLBCL.

A domain-differentiated approach to everyday emotion regulation from adolescence to older age

Flexibly using different emotion-regulation (ER) strategies in different situational contexts, such as domains, has been argued to promote effective emotion regulation. Additionally, emotion regulation processes may change with age as narrowing time horizons shift emotion-regulation preferences. The purpose of the present study was to examine the occurrence and effectiveness of flexible emotion regulation in response to daily hassles from different domains within the age range from adolescence to old age. Participants, ranging from 14 to 88 years old (N = 325), completed an experience-sampling study of approximately 9 days over a 3-week period. At each momentary assessment, participants reported on their hassles, emotion-regulation strategies, and affect. As expected, strategy use varied across individuals and domains. For example, emotion expression and suppression were typical responses to interpersonal hassles, whereas social sharing was often used in response to work/school hassles. In situations wherein hassles included multiple life domains, participants reported the use of more emotion-regulation strategies than for single-domain hassles. Although flexible emotion regulation was evident in participants' responses to hassles, the expectation that it would be associated with lower hassle reactivity was not confirmed. These patterns were, for the most part, consistent across ages. This study contributes new insights into situational characteristics that are associated with emotion-regulation flexibility, showing that hassles domains are important for strategy selection, and that this holds from adolescence to old age. It also suggests that such defined emotion-regulation flexibility is not as strongly linked to emotion-regulation effectiveness as has been previously suggested. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tracking changes between preprint posting and journal publication during a pandemic

Amid the Coronavirus Disease 2019 (COVID-19) pandemic, preprints in the biomedical sciences are being posted and accessed at unprecedented rates, drawing widespread attention from the general public, press, and policymakers for the first time. This phenomenon has sharpened long-standing questions about the reliability of information shared prior to journal peer review. Does the information shared in preprints typically withstand the scrutiny of peer review, or are conclusions likely to change in the version of record? We assessed preprints from bioRxiv and medRxiv that had been posted and subsequently published in a journal through April 30, 2020, representing the initial phase of the pandemic response. We utilised a combination of automatic and manual annotations to quantify how an article changed between the preprinted and published version. We found that the total number of figure panels and tables changed little between preprint and published articles. Moreover, the conclusions of 7.2% of non-COVID-19-related and 17.2% of COVID-19-related abstracts undergo a discrete change by the time of publication, but the majority of these changes do not qualitatively change the conclusions of the paper.

Evaluation of community readiness for change prior to a participatory physical activity intervention in Germany

A lack of communities' readiness for change is reported as a major barrier toward an effective implementation of health promoting interventions in community settings. Adding an alternative readiness assessment approach to existing research practice, this study aimed to investigate how a selected community could be evaluated in-depth regarding its readiness for change based on multiple key informant perspectives, with the intention of using this knowledge for the preparation of improved local physical activity (PA) interventions for men above 50 years of age. We conducted semi-structured face-to-face key informant interviews with stakeholders and relevant persons from a local German community (N = 15). The interview guide was based on a comprehensive summary of community readiness dimensions. After verbatim transcription, we conducted thematic analysis to synthesize the complex results regarding community readiness related to PA. The data supported that the community disposed of a variety of resources regarding PA and showed signs of readiness for change. However, a certain degree of saturation regarding PA programs existed. The need for health enhancing PA interventions for men was only partly recognized. The local authority considered PA to be particularly important in the context of mobility and traffic safety. Including multiple stakeholders contributed to a balanced and in-depth assessment of community readiness and was helpful for determining starting points for tailored PA interventions due to the detection of complex relationships and structures. The study delivers preliminary evidence that a qualitative multi-perspective community readiness assessment adds value to quantified single-perspective readiness assessment research practice.

Area Oversizing of Lithium Metal Electrodes in Solid-State Batteries: Relevance for Overvoltage and thus Performance?

Systematic and systemic research and development of solid electrolytes for lithium batteries requires a reliable and reproducible benchmark cell system. Therefore, factors relevant for performance, such as temperature, voltage operation range, or specific current, should be defined and reported. However, performance can also be sensitive to apparently inconspicuous and overlooked factors, such as area oversizing of the lithium electrode and the solid electrolyte membrane (relative to the cathode area). In this study, area oversizing is found to diminish polarization and improves the performance in LiNi0.6 Mn0.2 Co0.2 O2 (NMC622)||Li cells, with a more pronounced effect under kinetically harsh conditions (e. g., low temperature and/or high current density). For validity reasons, the polarization behavior is also investigated in Li||Li symmetric cells. Given the mathematical conformity of the characteristic overvoltage behavior with the Sand's equation, the beneficial effect is attributed to lower depletion of Li ions at the electrode/electrolyte interface. In this regard, the highest possible effect of area oversizing on the performance is discussed, that is when the accompanied decrease in current density and overvoltage overcomes the Sand's threshold limit. This scenario entirely prevents the capacity decay attributable to Li+ depletion and is in line with the mathematically predicted values.

Oscillatory EEG Signatures of Affective Processes during Interaction with Adaptive Computer Systems

Affect monitoring is being discussed as a novel strategy to make adaptive systems more user-oriented. Basic knowledge about oscillatory processes and functional connectivity underlying affect during naturalistic human-computer interactions (HCI) is, however, scarce. This study assessed local oscillatory power entrainment and distributed functional connectivity in a close-to-naturalistic HCI-paradigm. Sixteen participants interacted with a simulated assistance system which deliberately evoked positive (supporting goal-achievement) and negative (impeding goal-achievement) affective reactions. Electroencephalography (EEG) was used to examine the reactivity of the cortical system during the interaction by studying both event-related (de-)synchronization (ERD/ERS) and event-related functional coupling of cortical networks towards system-initiated assistance. Significantly higher α-band and β-band ERD in centro-parietal and parieto-occipital regions and β-band ERD in bi-lateral fronto-central regions were observed during impeding system behavior. Supportive system behavior activated significantly higher γ-band ERS in bi-hemispheric parietal-occipital regions. This was accompanied by functional coupling of remote β-band and γ-band activity in the medial frontal, left fronto-central and parietal regions, respectively. Our findings identify oscillatory signatures of positive and negative affective processes as reactions to system-initiated assistance. The findings contribute to the development of EEG-based neuroadaptive assistance loops by suggesting a non-obtrusive method for monitoring affect in HCI.

A C. elegans model for neurodegeneration in Cockayne syndrome

Cockayne syndrome (CS) is a congenital syndrome characterized by growth and mental retardation, and premature ageing. The complexity of CS and mammalian models warrants simpler metazoan models that display CS-like phenotypes that could be studied in the context of a live organism. Here, we provide a characterization of neuronal and mitochondrial aberrations caused by a mutation in the csb-1 gene in Caenorhabditis elegans. We report a progressive neurodegeneration in adult animals that is enhanced upon UV-induced DNA damage. The csb-1 mutants show dysfunctional hyperfused mitochondria that degrade upon DNA damage, resulting in diminished respiratory activity. Our data support the role of endogenous DNA damage as a driving factor of CS-related neuropathology and underline the role of mitochondrial dysfunction in the disease.

Differential Effects of Day/Night Cues and the Circadian Clock on the Barley Transcriptome

The circadian clock is a complex transcriptional network that regulates gene expression in anticipation of the day/night cycle and controls agronomic traits in plants. However, in crops, how the internal clock and day/night cues affect the transcriptome remains poorly understood. We analyzed the diel and circadian leaf transcriptomes in the barley (Hordeum vulgare) cultivar 'Bowman' and derived introgression lines harboring mutations in EARLY FLOWERING3 (ELF3), LUX ARRHYTHMO1 (LUX1), and EARLY MATURITY7 (EAM7). The elf3 and lux1 mutants exhibited abolished circadian transcriptome oscillations under constant conditions, whereas eam7 maintained oscillations of ≈30% of the circadian transcriptome. However, day/night cues fully restored transcript oscillations in all three mutants and thus compensated for a disrupted oscillator in the arrhythmic barley clock mutants elf3 and lux1 Nevertheless, elf3, but not lux1, affected the phase of the diel oscillating transcriptome and thus the integration of external cues into the clock. Using dynamical modeling, we predicted a structure of the barley circadian oscillator and interactions of its individual components with day/night cues. Our findings provide a valuable resource for exploring the function and output targets of the circadian clock and for further investigations into the diel and circadian control of the barley transcriptome.

Same old, same old? Age differences in the diversity of daily life

Some research suggests that compared with younger adults, older adults have more homogeneous, less diverse daily life experiences because everyday situations and activities become increasingly stable and routine. However, strong empirical tests of this assumption are scarce. In two complementary studies, we examined whether older age is associated with less diversity in daily life experiences (e.g., regarding social interaction partners, activities, and places across and within days) and, if so, to what extent health limitations account for these age differences. In Study 1, we used daily diaries to investigate diversity across days among younger (N = 246; Mage = 21.8 years, SD = 2.5) and older adults (N = 119; Mage = 67.7 years, SD = 5.3). In Study 2, we investigated diversity within days employing experience sampling methods over three weeks in an adult life span sample (N = 365; range = 14-88 years). Results showed that across and within days, the daily lives of older adults were less diverse regarding their social interaction partners. Yet, older adults reported more diversity in activities within days and across days in the afternoons, whereas younger adults reported less diverse activities partly due to working or studying more often. Age differences remained statistically significant when controlling for health limitations. We conclude that age differences in the diversity of daily life are nuanced, depending on the domain and the level of analysis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Inhibition of replication of hepatitis B virus using transcriptional repressors that target the viral DNA

BACKGROUND

Chronic infection with hepatitis B virus (HBV) is a serious global health problem. Persistence of the virus occurs as a result of stability of the replication intermediate comprising covalently closed circular DNA (cccDNA). Development of drugs that are capable of disabling this cccDNA is vital.

METHODS

To investigate an epigenetic approach to inactivating viral DNA, we engineered transcriptional repressors that comprise an HBV DNA-binding domain of transcription activator like effectors (TALEs) and a fused Krüppel Associated Box (KRAB). These repressor TALEs (rTALEs) targeted the viral surface open reading frame and were placed under transcription control of constitutively active or liver-specific promoters.

RESULTS

Evaluation in cultured cells and following hydrodynamic injection of mice revealed that the rTALEs significantly inhibited production of markers of HBV replication without evidence of hepatotoxicity. Increased methylation of HBV DNA at CpG island II showed that the rTALEs caused intended epigenetic modification.

CONCLUSIONS

Epigenetic modification of HBV DNA is a new and effective means of inactivating the virus in vivo. The approach has therapeutic potential and avoids potentially problematic unintended mutagenesis of gene editing.

Health-related preferences of older patients with multimorbidity: the protocol for an evidence map

INTRODUCTION

Interaction of conditions and treatments, complicated care needs and substantial treatment burden make patient-physician encounters involving multimorbid older patients highly complex. To optimally integrate patients' preferences, define and prioritise realistic treatment goals and individualise care, a patient-centred approach is recommended. However, the preferences of older patients, who are especially vulnerable and frequently multimorbid, have not been systematically investigated with regard to their health status. The purpose of this evidence map is to explore current research addressing health-related preferences of older patients with multimorbidity, and to identify the knowledge clusters and research gaps.

METHODS AND ANALYSIS

To identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library from their inception. We will check reference lists of relevant articles and carry out cited reference research (forward citation tracking). Two independent reviewers will screen titles and abstracts, check full texts for eligibility and extract the data. Any disagreement will be resolved and consensus reached with the help of a third reviewer. We will include both qualitative and quantitative studies, and address preferences from the patients' perspectives in a multimorbid population of 60 years or older. There will be no restrictions on the publication language. Data extraction tables will present study and patient characteristics, aim of study, methods used to identify preferences and outcomes (ie, type of preferences). We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe clusters and gaps.

ETHICS AND DISSEMINATION

Due to the nature of the proposed evidence map, ethics approval will not be required. Results from our research will be disseminated by means of specifically prepared materials for patients, at relevant (inter)national conferences and via publication in peer-reviewed journals.

The importance of sediments in ecological quality assessment of stream headwaters: embryotoxicity along the Nidda River and its tributaries in Central Hesse, Germany

BACKGROUND

Although the crucial importance of sediments in aquatic systems is well-known, sediments are often neglected as a factor in the evaluation of water quality assessment. To support and extend previous work in that field, this study was conducted to assess the impact of surface water and sediment on fish embryos in the case of a highly anthropogenically influenced river catchment in Central Hesse, Germany.

RESULTS

The results of 96 h post fertilisation fish embryo toxicity test with Danio rerio (according to OECD Guideline 236) revealed that river samples comprising both water and sediment exert pivotal effects in embryos, whereas surface water alone did not. The most prominent reactions were developmental delays and, to some extent, malformations of embryos. Developmental delays occurred at rates up to 100% in single runs. Malformation rates ranged mainly below 10% and never exceeded 25%.

CONCLUSION

A clear relationship between anthropogenic point sources and detected effects could not be established. However, the study illustrates the critical condition of the entire river system with respect to embryotoxic potentials present even at the most upstream test sites. In addition, the study stresses the necessity to take into account sediments for the evaluation of ecosystem health in industrialised areas.

Early improvement of executive test performance during antidepressant treatment predicts treatment outcome in patients with Major Depressive Disorder

Executive dysfunctions frequently occur in patients with Major Depressive Disorder and have been shown to improve during effective antidepressant treatment. However, the time course of improvement and its relationship to treatment outcome is unknown. The aim of the study was to assess the test performance and clinical outcome by repetitive assessments of executive test procedures during antidepressant treatment. Executive test performance was assessed in 209 –patients with Major Depressive Disorder (mean age 39.3 ± 11.4 years) and 84 healthy controls five times in biweekly intervals from baseline to week 8. Patients were treated by a defined treatment algorithm within the early medication change study (EMC trial; ClinicalTrials.gov NCT00974155), controls did not receive any intervention. Cognitive domains were processing speed, cognitive flexibility, phonemic and semantic verbal fluency. Intelligence was assessed at baseline. Depression severity was tested once a week by the Hamilton Depression Rating Scale (HAMD₁₇). 130 patients (62%) showed executive dysfunctions in at least one of four tests at baseline. Linear mixed regression models revealed that the course of depression severity was associated to the course of cognitive flexibility (p = 0.004) and semantic verbal fluency (p = 0.020). Cognitive flexibility and semantic verbal fluency may be candidates easily to apply for therapy response prediction in clinical routine, which should be tested in further prospective studies.

Trial registration: ClinicalTrials.gov NCT00974155

EudraCT: 2008-008280-96

Can facts trump unconditional trust? Evidence-based information halves the influence of physicians' non-evidence-based cancer screening recommendations

Informed decision making in medicine, defined as basing one’s decision on the best current medical evidence, requires both informed physicians and informed patients. In cancer screening, however, studies document that these prerequisites are not yet met. Many physicians do not know or understand the medical evidence behind screening tests, do not adequately counsel (asymptomatic) people on screening, and make recommendations that conflict with existing guidelines on informed choice. Consistent with this situation, nation-wide studies showed that the general public misperceives the contribution of cancer screening but that understanding considerably improves when evidence-based information is provided. However, can evidence-based patient information about cancer screening make people also less likely to simply follow a physician’s non-evidence-based advice? A national sample of 897 German citizens, surveyed in face-to-face computer-assisted personal interviews, received either evidence-based (e.g., absolute risks on benefits and harms; n = 451) or non-evidence-based (e.g., relative risks on benefits only; n = 446) patient information about a cancer screening test and were then asked to make their initial cancer screening choice. Thereafter, participants received a hypothetical physician’s recommendation, which was non-evidence-based in terms of existing guidelines on informed decision making (i.e., reporting either benefits or harms but not both; no provision of numbers). When provided with non-evidence-based patient information (n = 446), a mean of 33.1% of 235 participants whose initial screening choice contradicted the hypothetical physician's non-evidence-based recommendation adjusted their choice in deference to that recommendation (95% CI: 27.4 to 39.4%), whereas with evidence-based patient information (n = 451), only half as many, a mean of 16.0% of 225 (95% CI: 11.8 to 21.4%), modified their choice. Thus, evidence-based patient information makes people less likely to simply follow non-evidence-based recommendations of physicians and supports people in making evidence-based decisions even when not adequately counseled on cancer screening.

Pedigree based DNA sequencing pipeline for germline genomes of cancer families

BACKGROUND

In the course of our whole-genome sequencing efforts, we have developed a pipeline for analyzing germline genomes from Mendelian types of cancer pedigrees (familial cancer variant prioritization pipeline, FCVPP).

RESULTS

The variant calling step distinguishes two types of genomic variants: single nucleotide variants (SNVs) and indels, which undergo technical quality control. Mendelian types of variants are assumed to be rare and variants with frequencies higher that 0.1 % are screened out using human 1000 Genomes (Phase 3) and non-TCGA ExAC population data. Segregation in the pedigree allows variants to be present in affected family members and not in old, unaffected ones. The effectiveness of variant segregation depends on the number and relatedness of the family members: if over 5 third-degree (or more distant) relatives are available, the experience has shown that the number of likely variants is reduced from many hundreds to a few tens. These are then subjected to bioinformatics analysis, starting with the combined annotation dependent depletion (CADD) tool, which predicts the likelihood of the variant being deleterious. Different sets of individual tools are used for further evaluation of the deleteriousness of coding variants, 5' and 3' untranslated regions (UTRs), and intergenic variants.

CONLUSIONS

The likelihood of success of the present genomic pipeline in finding novel high- or medium-penetrant genes depends on many steps but first and foremost, the pedigree needs to be reasonably large and the assignments and diagnoses among the members need to be correct.

Validity of Willingness to Pay Measures under Preference Uncertainty

Recent studies in the marketing literature developed a new method for eliciting willingness to pay (WTP) with an open-ended elicitation format: the Range-WTP method. In contrast to the traditional approach of eliciting WTP as a single value (Point-WTP), Range-WTP explicitly allows for preference uncertainty in responses. The aim of this paper is to apply Range-WTP to the domain of contingent valuation and to test for its theoretical validity and robustness in comparison to the Point-WTP. Using data from two novel large-scale surveys on the perception of solar radiation management (SRM), a little-known technique for counteracting climate change, we compare the performance of both methods in the field. In addition to the theoretical validity (i.e. the degree to which WTP values are consistent with theoretical expectations), we analyse the test-retest reliability and stability of our results over time. Our evidence suggests that the Range-WTP method clearly outperforms the Point-WTP method.