Systematic review and meta-analysis of prognostic characteristics for breast cancers in populations with digital versus film mammography indicate the transition may have increased both early detection and overdiagnosis

OBJECTIVE

Film mammography has replaced digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumour characteristics of screen-detected and interval breast cancers.

STUDY DESIGN AND SETTING

We searched seven databases from inception to 08 October 2023 for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumour characteristics and assessed risk of bias using the ROBINS-I tool. We synthesized results using meta-analyses of random effects.

RESULTS

Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumour size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumour characteristics. There were statistically significant increases in screen-detected DCIS across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1,000 screens for low, intermediate, and high grade DCIS respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades.

CONCLUSION

The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.

FUNDING

Australian National Health and Medical Research Council and the National Breast Cancer Foundation.

REGISTRATION

PROSPERO 2017:CRD42017070601.

Two cases of driver death caused by airbag rupture

OBJECTIVE

This article reports two accidents caused by defective Takata airbags ruptured, which led to the deaths of the drivers. This is the first public report on the deaths caused by Takata airbags in China.

METHODS

Determine the relationship between the driver death and airbag rupture through autopsy indings and vehicle inspection.

RESULTS

Due to defects in the design of Takata's inflator, moist air was permitted to slowly enter the inflator, resulting the PSAN slowly degraded physically. The damaged propellant burned more rapidly than intended and overpressurized the inflator's steel housing, causing fragmentation and flying debris at high speed, killing or injuring vehicle occupants.

CONCLUSIONS

To date, there are still tens of millions of defective Takata airbags that have not been recalled for repair, posing safety risks. This article suggests taking preventive measures to avoid the occurrence of similar accidents.

Idiosyncratic effects of interviewer behavior on the accuracy of children's responses

Children are interviewed to provide information about past events in various contexts (e.g., police interviews, court proceedings, therapeutic interviews). During an interview, various factors may influence the accuracy of children's responses to questions about recent events. However, behavioral research in this area is limited. Sparling et al. (2011) showed that children frequently provided inaccurate responses to questions about video clips they just watched depending on the antecedents (i.e., the way a question was asked) and consequences (i.e., the response of the interviewer to their answers). In the current study, we replicated and extended the procedures reported by Sparling et al. and found that two of five children were sensitive to the various antecedents and consequences that we manipulated. Our findings indicate a need for more research in this area to determine the relevant environmental variables that affect children's response accuracy.

Accuracy of patient-reported bowel symptoms for fecal incontinence: Historical recall versus prospective evaluation

INTRODUCTION

Fecal incontinence (FI) is characterized by both irregular and unpredictable bowel symptoms. An accurate history of symptoms is important for diagnosis and guiding management. Whether a patient's history of bowel symptoms is reliable or if there is recall bias is unknown.

AIM

To evaluate the accuracy of FI symptoms based on patient's recall compared with a prospective stool diary.

METHODS

FI (Rome IV) patients completed a bowel questionnaire that included leakage episodes and stool consistency. Subsequently they completed a one-week FI stool diary. Agreement and correlation between historical recall and stool diary were compared.

RESULTS

One hundred patients participated. On average they reported 12 bowel movements (BMs) and five FI episodes per week. Fifty-two percent had completed under-graduation, 33% high school and 15% postgraduation. Using recall, 23% of patients accurately reported the number of FI episodes, whereas 41% underestimated and 36% overestimated its prevalence compared to the FI diary. Similarly, the concordance for the number of BMs was 30%, urgency was 54%, amount of stool leakage was 16%, and stool consistency was 12.5%. The concordance for nocturnal FI events, use of pads and lack of stool awareness were 63%, 75%, and 66.6% respectively.

CONCLUSION

There is poor concordance for key bowel symptoms including the number of FI episodes as reported by FI patients, suggesting significant recall bias. Thus, historical recall of chronic FI symptoms may be less accurate. A prospective stool diary could provide more accurate information for the evaluation of FI patients.

The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults

BACKGROUND

Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults.

OBJECTIVE

We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults.

METHODS

The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work.

RESULTS

REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews.

CONCLUSIONS

REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences.

Public health risk due to contamination of Solanum nigrum in frozen green beans - collaboration effort between a poison centre, a hospital and health authorities

INTRODUCTION

We describe a rare food contamination of organically grown frozen green beans with Solanum nigrum, also called black night shade, which were widely available in supermarkets in the Netherlands.

CASE SERIES

To our knowledge, only three adults and one child were referred to the emergency department for observation after eating the contaminated green beans. Only minor symptoms were seen during observation. The remainder of the frozen green beans were obtained from the patients and sent for analysis within one day. Within two and a half days after the first case, a public safety warning and recall were launched.

DISCUSSION

Due to an increase in popularity of organic food, more incidents involving toxic weed contaminants like the one we describe in this report could happen when quality control in organic agriculture is insufficient. In this event, the critical control point obtained from the hazard analysis was insufficiently managed by the producer.

CONCLUSION

This report demonstrates the efficient collaboration between the Dutch Poisons Information Centre, treating physicians at the hospital and the Netherlands Food and Consumer Product Safety Authority in case of a possible public safety issue. Because of quick acting and collaboration between the involved parties, the product was quickly withdrawn from the market.

Reciprocal associations of posttraumatic stress symptoms and cognitive decline in community-dwelling older adults: The mediating role of depression

BACKGROUND

People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal.

OBJECTIVE

This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms.

METHOD

The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis.

RESULTS

Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures.

CONCLUSIONS

This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.

User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study

BACKGROUND

The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data.

OBJECTIVE

This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years.

METHODS

Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls).

RESULTS

Most children were able to complete FoodBear's (11/14, 79%), myBear's (10/14, 71%), and FoodCam's (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product.

CONCLUSIONS

Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children's autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children's dietary assessment and the provision of personalized dietary support.

Improving regional medical laboratory center report quality through a report recall management system

OBJECTIVES

Currently, most medical laboratories do not have a dedicated software for managing report recalls, and relying on traditional manual methods or laboratory information system (LIS) to record recall data is no longer sufficient to meet the quality management requirements in the large regional laboratory center. The purpose of this article was to describe the research process and preliminary evaluation results of integrating the Medical Laboratory Electronic Record System (electronic record system) laboratory report recall function into the iLab intelligent management system for quality indicators (iLab system), and to introduce the workflow and methods of laboratory report recall management in our laboratory.

METHODS

This study employed cluster analysis to extract commonly used recall reasons from laboratory report recall records in the electronic record system. The identified recall reasons were validated for their applicability through a survey questionnaire and then incorporated into the LIS for selecting recall reasons during report recall. The statistical functionality of the iLab system was utilized to investigate the proportion of reports using the selected recall reasons among the total number of reports, and to perform visual analysis of the recall data. Additionally, we employed P-Chart to establish quality targets and developed a "continuous improvement process" electronic flow form.

RESULTS

The reasons for the recall of laboratory reports recorded in the electronic recording system were analyzed. After considering the opinions of medical laboratory personnel, a total of 12 recall reasons were identified, covering 73.05 % (1854/2538) of the recalled laboratory reports. After removing data of mass spectra lab with significant anomalies, the coverage rate increased to 82.66 % (1849/2237). The iLab system can generate six types of statistical graphs based on user needs, including statistical time, specialty labs (or divisions), test items, reviewers, reasons for report recalls, and distribution of the recall frequency of 0-24 h reports. The control upper limit of the recall rate of P-Chart based on laboratory reports can provide quality targets suitable for each professional group at the current stage. Setting the five stages of continuous process improvement reasonably and rigorously can effectively achieve the goal of quality enhancement.

CONCLUSIONS

The enhanced iLab system enhances the intelligence and sustainable improvement capability of the recall management of laboratory reports, thus improving the efficiency of the recall management process and reducing the workload of laboratory personnel.

Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia

OBJECTIVE

To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD).

DESIGN

We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods.

SETTING

Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts).

PARTICIPANTS

Children aged 6-23 months: 636 in Cambodia and 608 in Zambia.

RESULTS

MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries.

CONCLUSION

The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.

Coordinating brain-distributed network activities in memory resistant to extinction

Certain memories resist extinction to continue invigorating maladaptive actions. The robustness of these memories could depend on their widely distributed implementation across populations of neurons in multiple brain regions. However, how dispersed neuronal activities are collectively organized to underpin a persistent memory-guided behavior remains unknown. To investigate this, we simultaneously monitored the prefrontal cortex, nucleus accumbens, amygdala, hippocampus, and ventral tegmental area (VTA) of the mouse brain from initial recall to post-extinction renewal of a memory involving cocaine experience. We uncover a higher-order pattern of short-lived beta-frequency (15-25 Hz) activities that are transiently coordinated across these networks during memory retrieval. The output of a divergent pathway from upstream VTA glutamatergic neurons, paced by a slower (4-Hz) oscillation, actuates this multi-network beta-band coactivation; its closed-loop phase-informed suppression prevents renewal of cocaine-biased behavior. Binding brain-distributed neural activities in this temporally structured manner may constitute an organizational principle of robust memory expression.

Recalling the severity of nausea and vomiting of pregnancy - a study using Pregnancy-Unique Quantification of Emesis Questionnaire

The accuracy of the recall of the severity of nausea and vomiting of pregnancy (NVP) with Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire has been questioned. We aimed to compare PUQE scores of women recalling the worst episode of NVP of their current pregnancy in different gestational weeks (gwks). Total of 2343 pregnant women (gwks 7-40) were recruited. Four groups were formed according to the gwks at reply: ≤16 gwks (n = 554), ≤20 gwks (n = 1209), >20 gwks (n = 1134) and ≥24 gwks (n = 495). PUQE scores were similar between the groups. Consequently, consistency of PUQE scores across the groups endorses the useability of the PUQE questionnaire in retrospective assessment of the overall severity of NVP in different gwks, regardless of passing of the peak NVP symptoms.Impact statementWhat is already known on this subject? Retrospective evaluation of the severity of nausea and vomiting of pregnancy (NVP) has been argued to be disposed to recall bias. Structured Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is a validated tool for assessing the severity of NVP.What do the results of this study add? When the women recalled the most severe NVP symptoms of their current pregnancy, no differences in the PUQE scores were found despite different gestational weeks at reply. Of distinct PUQE questions, women answering in early pregnancy reported longer duration of nausea than women answering in late pregnancy, but other questions were rated similarly.What the implications are of these findings for clinical practice and/or further research? Our aim was to compare the PUQE scores between the women who filled in the PUQE questionnaire in early or in late pregnancy, instructed to recall their worst symptoms in their current pregnancy. As there were no differences between the groups in total PUQE scores, our results support the application of PUQE questionnaire to assess the severity of NVP during pregnancy not only concurrent to the peak symptoms but also retrospectively.

Longer-term verbal and visual memory patterns in patients with temporal lobe and genetic generalized epilepsies

OBJECTIVE

To compare forgetting patterns between patients with temporal lobe (TLE) and generalized (GGE) epilepsies and to assess whether recall is associated with epileptic activity.

METHODS

Thirty-three patients with TLE (13 left, 17 right, and 3 nonlateralized TLE), 42 patients with GGE, and 57 healthy controls (HCs) were asked to recall words, verbal story material, and the Rey-Osterrieth complex figure at two delays. Accelerated long-term forgetting (ALF) was defined by group performance comparable to HCs at 30 min and worse recall than HCs after 4 weeks. ALF was assessed by comparing raw test scores in a two-way repeated measures analysis of variance (ANOVA) adjusted for the learning capacity.

RESULTS

Compared to HCs, patients with R-TLE remembered fewer items of the word list after 30 min as well as after 4 weeks. Patients with L-TLE and GGE had comparable learning-adjusted performance to HCs at the 30 min delay but scored less after 4 weeks (group by delay interaction F(3, 124) = 3.2, P = 0.026,η p 2  = 0.07). The epilepsy group (patients with TLE and GGE combined) performed as well as HCs at 30 min but worse after 4 weeks irrespective of experienced seizures during the 4-week delay or interictal bilateral (TLE) or generalized (GGE) activity before the study. We noted no statistically significant differences between patient and HC verbal story (group by delay interaction F(3, 124) = 0.7, P = 0.570,η p 2  = 0.02) or complex figure (F(3, 124) = 0.8, P = 0.488,η p 2  = 0.02) recall.

SIGNIFICANCE

Our data support verbal and visual memory impairment in both TLE and GGE with different performances between these groups in the task of word recall. We suggest the presence of ALF in patients with GGE and left TLE after adjusting for learning capacity. We could not confirm the influence of epileptic activity on long-term forgetting patterns. Future studies are required to better define domain-specific differences in memory impairment in TLE and GGE.

Cancer Diagnosis through Contour Visualization of Gene Expression Leveraging Deep Learning Techniques

Prompt diagnostics and appropriate cancer therapy necessitate the use of gene expression databases. The integration of analytical methods can enhance detection precision by capturing intricate patterns and subtle connections in the data. This study proposes a diagnostic-integrated approach combining Empirical Bayes Harmonization (EBS), Jensen-Shannon Divergence (JSD), deep learning, and contour mathematics for cancer detection using gene expression data. EBS preprocesses the gene expression data, while JSD measures the distributional differences between cancerous and non-cancerous samples, providing invaluable insights into gene expression patterns. Deep learning (DL) models are employed for automatic deep feature extraction and to discern complex patterns from the data. Contour mathematics is applied to visualize decision boundaries and regions in the high-dimensional feature space. JSD imparts significant information to the deep learning model, directing it to concentrate on pertinent features associated with cancerous samples. Contour visualization elucidates the model's decision-making process, bolstering interpretability. The amalgamation of JSD, deep learning, and contour mathematics in gene expression dataset analysis diagnostics presents a promising pathway for precise cancer detection. This method taps into the prowess of deep learning for feature extraction while employing JSD to pinpoint distributional differences and contour mathematics for visual elucidation. The outcomes underscore its potential as a formidable instrument for cancer detection, furnishing crucial insights for timely diagnostics and tailor-made treatment strategies.

Intermacs quarterly report analysis to monitor longitudinal outcomes in a centrifugal flow assist device

In June 2021, HVAD System distribution ceased due to observational data demonstrating increased mortality and neurological events compared to another commercial device, and a device malfunction with delay or failure to restart, especially in certain subpopulations. To assess ongoing risk for patients on support following subsequent device recalls, the manufacturer's Intermacs HVAD System 2022 Quarterly Reports were queried to identify mortality and adverse events trends in a contemporary cohort of 3110 primary HVAD implantations since October 2017, stratified by year-of-implant. Mean duration of support was 21 ± 16 months, with 33% alive on original device, 25% transplanted, 6% undergoing device exchange, 4% recovered, and 32% expired. Kaplan-Meier and event-per-patient-year estimates for survival, freedom from device explant, stroke, and pump thrombus were similar across year-of-implant. Following market withdrawal and recent device recalls, there appears to be no increase in mortality, stroke, pump thrombus, or explant for HVAD-supported patients. Quarterly report monitoring is ongoing.

Hypothesis testing procedure for binary and multi-class F1 -scores in the paired design

In modern medicine, medical tests are used for various purposes including diagnosis, disease screening, prognosis, and risk prediction. To quantify the performance of the binary medical test, we often use sensitivity, specificity, and negative and positive predictive values as measures. Additionally, theF 1 $$ {F}_1 $$ -score, which is defined as the harmonic mean of precision (positive predictive value) and recall (sensitivity), has come to be used in the medical field due to its favorable characteristics. TheF 1 $$ {F}_1 $$ -score has been extended for multi-class classification, and two types ofF 1 $$ {F}_1 $$ -scores have been proposed for multi-class classification: a micro-averagedF 1 $$ {F}_1 $$ -score and a macro-averagedF 1 $$ {F}_1 $$ -score. The micro-averagedF 1 $$ {F}_1 $$ -score pools per-sample classifications across classes and then calculates the overallF 1 $$ {F}_1 $$ -score, whereas the macro-averagedF 1 $$ {F}_1 $$ -score computes an arithmetic mean of theF 1 $$ {F}_1 $$ -scores for each class. Additionally, Sokolova and Lapalme1 $$ {}^1 $$ gave an alternative definition of the macro-averagedF 1 $$ {F}_1 $$ -score as the harmonic mean of the arithmetic means of the precision and recall over classes. Although some statistical methods of inference for binary and multi-classF 1 $$ {F}_1 $$ -scores have been proposed, the methodology development of hypothesis testing procedure for them has not been fully progressing yet. Therefore, we aim to develop hypothesis testing procedure for comparing twoF 1 $$ {F}_1 $$ -scores in paired study design based on the large sample multivariate central limit theorem.

Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: An international multi-centered study

BACKGROUND

Existing patient-reported outcome measures (PROMs) for chronic rhinosinusitis (CRS) use a variety of recall periods and response scales to assess CRS symptom burden. Global perspectives of CRS patients regarding optimal recall periods and response scales for CRS PROMs are unknown.

METHODS

This was a multi-center, cross-sectional study recruiting 461 CRS patients from sites across the United States, Saudi Arabia, New Zealand, and Austria. Participants chose which CRS symptom recall period (1 day, 2 weeks, 1 month, >1 month) was most reflective of their current disease state and upon which to best base treatment recommendations (including surgery). Participants also chose which of six response scales (one visual analogue scale and five Likert scales ranging from four to eight items) was easiest to use, understand, and preferred.

RESULTS

A plurality of participants (40.0%) felt their CRS symptoms' current state was best reflected by a 1-month recall period. However, most patients (56.9%) preferred treatment recommendations to be determined by symptoms experienced over a >1 month period. The four- and five-item Likert scales were the easiest to understand (26.0% and 25.4%, respectively) and use (23.4% and 26.7%, respectively). The five-item (26.4% rating it most preferred and 70.9% rating it preferred) and four-item Likert (22.3% rating it most preferred and 56.4% rating it preferred) response scales were most preferred.

CONCLUSION

Future PROMs for CRS should consider assessment of symptoms over a 1-month period and use a four- or five-item Likert response scale to reflect global patient preferences. These findings also inform interpretation of current CRS PROMs.

Analysis of computational intelligence approaches for predicting disease severity in humans: Challenges and research guidelines

The word disease is a common word and there are many diseases like heart disease, diabetes, breast cancer, COVID-19, and kidney disease that threaten humans. Data-mining methods are proving to be increasingly beneficial in the present day, especially in the field of medical applications; through the use of machine-learning methods, that are used to extract valuable information from healthcare data, which can then be used to predict and treat diseases early, reducing the risk of human life. Machine-learning techniques are useful especially in the field of health care in extracting information from healthcare data. These data are very much helpful in predicting the disease early and treating the patients to reduce the risk of human life. For classification and decision-making, data mining is very much suitable. In this paper, a comprehensive study on several diseases and diverse machine-learning approaches that are functional to predict those diseases and also the different datasets used in prediction and making decisions are discussed in detail. The drawbacks of the models from various research papers have been observed and reveal countless computational intelligence approaches. Naïve Bayes, logistic regression (LR), SVM, and random forest are able to produce the best accuracy. With further optimization algorithms like genetic algorithm, particle swarm optimization, and ant colony optimization combined with machine learning, better performance can be achieved in terms of accuracy, specificity, precision, recall, and specificity.

Does point value structure influence measures of memory selectivity?

ABSTRACTIn reward-based learning and value-directed remembering, many different value structures for the to-be-remembered information have been used by researchers. I was interested in whether different scoring structures used in a value-directed remembering task impact measures of memory selectivity. Participants studied lists of words paired with point values and some lists included words paired with values ranging from 1 to 20, 1 to 10 (repeating twice), either a high value (10 points) or a low value (1 point), and either a high value (10 points), a medium value (5 points) or a low value (1 point). Results suggest that (1) in tests of free recall, if using a continuous value scale, the range of values matters in terms of selective memory, (2) analysing the selectivity index can yield different results than modelling item-level recall using point values (and the latter may be a preferable approach), (3) measures of selectivity using different value structures may lack construct validity when testing memory via recognition tests, and (4) the effect of value on memory is much larger on recall than recognition tests. Thus, I suggest that researchers carefully consider and justify the value structure used when examining selective memory for valuable information in list learning tasks.

Maternal infections and medications in pregnancy: how does self-report compare to medical records in childhood cancer case-control studies?

BACKGROUND

Studies examining the potential impact of mothers' health during pregnancy on the health of their offspring often rely on self-reported information gathered several years later. To assess the validity of this approach, we analysed data from a national case-control study of childhood cancer (diagnosed <15 years) that collected health information from both interviews and medical records.

METHODS

Mothers' interview reports of infections and medications in pregnancy were compared with primary care records. Taking clinical diagnoses and prescriptions as the reference, sensitivity and specificity of maternal recall along with kappa coefficients of agreement were calculated. Differences in the odd ratios estimated using logistic regression for each information source were assessed using the proportional change in the odds ratio (OR).

RESULTS

Mothers of 1624 cases and 2524 controls were interviewed ∼6 years (range 0-18 years) after their child's birth. Most drugs and infections were underreported; in general practitioner records, antibiotic prescriptions were nearly three times higher and infections >40% higher. Decreasing with increasing time since pregnancy, sensitivity was ⩽40% for most infections and all drugs except 'anti-epileptics and barbiturates' (sensitivity 80% among controls). ORs associated with individual drug/disease categories that were based on self-reported data varied from 26% lower to 26% higher than those based on medical records; reporting differences between mothers of cases and controls were not systematically in the same direction.

CONCLUSIONS

The findings highlight the scale of under-reporting and poor validity of questionnaire-based studies conducted several years after pregnancy. Future research using prospectively collected data should be encouraged to minimize measurement errors.

In the right place at the right time: tissue-resident memory T cells in immunity to cancer

Tissue-resident memory (Trm) cells have recently emerged as essential components of the immune response to cancer. Here, we highlight new studies that demonstrate how CD8+ Trm cells are ideally suited to accumulate in tumors and associated tissues, to recognize a wide range of tumor antigens (Ags), and to persist as durable memory. We discuss compelling evidence that Trm cells maintain potent recall function and serve as principal mediators of immune checkpoint blockade (ICB) therapeutic efficacy in patients. Finally, we propose that Trm and circulating memory T-cell compartments together form a formidable barrier against metastatic cancer. These studies affirm Trm cells as potent, durable, and necessary mediators of cancer immunity.

The thalamic reuniens is associated with consolidation of non-spatial memory too

The nucleus reuniens (RE) is situated in the midline thalamus and provides a key link between the hippocampus and prefrontal cortex. This anatomical relationship positions the Re as an ideal candidate to facilitate memory consolidation. However, there is no evidence that this role extends beyond spatial memory and contextual fear memory, which are both strongly associated with hippocampal function. We, therefore, trained intact male Long-Evans rats on an odor-trace-object paired-associate task where the explicit 10-s delay between paired items renders the task sensitive to hippocampal function. Neurons in the RE showed significantly increased activation of the immediate early gene (Zif268) when rats were re-tested for previous non-spatial memory 25 days after acquisition training, compared to a group tested at 5-days post-acquisition, as well as a control group tested 25 days after acquisition but with a new pair of non-spatial stimuli, and home cage controls. The remote recall group also showed relatively augmented IEG expression in the superficial layers of the medial PFC (anterior cingulate cortex and prelimbic cortex). These findings support the conclusion that the RE is preferentially engaged during remote recall in this non-spatial task and thus has a role beyond spatial memory and contextual fear memory.

Physical activity counseling during and following stem cell transplantation - patients' versus advisors' perspectives

BACKGROUND

People receiving hematopoietic stem cell transplantation (HSCT) endure long phases of therapy and immobility, which diminish their physical activity (PA) level leading to physical deconditioning. One of the reasons is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. Therefore, our study investigates reported physical activity counseling behavior of health care professionals (HCPs) and the patient perspective on this topic.

METHODS

Physicians (N = 52), nurses (N = 52) physical therapists (N = 26), and patients receiving HSCT (N = 62) participated in a nationwide cross-sectional online-survey. Patients' preferred source of information concerning PA was determined. We examined HCPs self-assessed PA counseling behavior and patients' PA recall by assessing the use of the 5As (Ask, Advice, Agree, Assist, Arrange). Analysis of survey responses was descriptive. Univariate multinomial logistic regression examined whether sociodemographic factors and patient characteristics influence the response behavior.

RESULTS

Physicians and PA specialists were patients' preferred source of information regarding PA. A large discrepancy between HCPs' perception and the degree to which HSCT patients recall advice became apparent; profound counseling steps like making referrals were less often recalled in our patient sample. Inactive patients reported to receive less basic PA counseling by physicians.

CONCLUSION

Future research should identify the requirements to increase patients' recall concerning PA counseling in the setting of HSCT. Important messages about PA need to be made more salient to those who are less active and less engaged.

False Memory Facilitation Through Semantic Overlap

This study investigated the effects of semantic overlap from multiple sources on false memories. Participants were presented with paired study lists comprising items highly associated with one nonstudied critical item. There were three types of list pairs: (1) the sharing condition, in which the words in both lists were classified into different semantic groups that converged on the same critical word (semantic overlap), (2) the repetition condition, in which the two lists comprised identical words, and (3) the single condition, in which the paired lists were attributed to different semantic groups that did not share a critical item. In Experiment 1, participants were presented with the paired study lists and responded to free recall tests and a recognition test including remember-know judgments. In Experiment 2, the participants responded to a recognition test, and the participants in Experiment 3 recalled the studied items. The results indicated that the false recall and false recognition rates in the sharing condition were higher than those in the repetition and single conditions. These results suggest that activation from multiple independent sources may have an accumulative additive effect. The findings are discussed in relation to the Activation-Monitoring theory.

Accuracy of retrospective pain measurement in patients with chronic pain

The use of pain scales that refer to a past time period is thereby based on the assumption that patients accurately remember their 'average', 'greatest' and 'least' pain. The present study addresses the validity of numerical pain rating scales that refer to a past period of time (herein, the past 7 days). Routine data from 94 patients with chronic pain were retrospectively analysed. Pain questionnaire data on the greatest, least and average pain during the past week and on current pain were compared with the mean value of entries in a pain diary from the corresponding period. The retrospectively assessed average, greatest and least pain values were consistently slightly higher than the corresponding values of daily current pain measured for the studied collective of chronic pain patients. Current pain (at the time of answering the questionnaire) better represents daily currently measured pain [intraclass correlation (ICC)=0.885] than retrospective individual measurements. The greatest correlation with averaged diary data was shown by the combination of questionnaire data on average, least and current pain (ICC=0.911). The high correlations between the questionnaire and diary data support the validity of retrospective pain surveys. However, the current status influences recall. Thus, composite retrospective pain data improve with the addition of current pain.

Reminiscence bump invariance with respect to genre, age, and country

We report a cross-cultural study investigating musical reminiscence bumps, the phenomenon whereby adults remain emotionally invested in the music they preferentially listened to in adolescence. Using a crowdsourcing service, 4,824 participants from 102 countries were each required to recall five songs (titles and artist names), resulting in a 24,120-song study. In addition, participants provided demographic information and answered questions relating to the songs they recalled, such as age first listened to, levels of nostalgia, and associated emotions. Song titles and artist names were cleaned and genre information established through fuzzy matching recalled information to songs within an open-source music encyclopedia. These data, plus participants' demographic information, allowed reminiscence bumps differentiated by age, sex, country, and genre preference to be explored. Recency-bias effects of recalled songs were also investigated. Results demonstrated that the musical reminiscence bump phenomenon is common to all age groups and both sexes, pervasive across all countries, and is not restricted to particular genres. In sum, musical reminiscence bumps appear to be biologically and culturally ubiquitous.

Does multisensory stimulation with virtual reality (VR) and smell improve learning? An educational experience in recall and creativity

Purpose

The purpose of this paper is to derive into practical recommendations from multisensory stimulation with virtual reality (VR) and scent to help educators develop effective teaching strategies geared toward aspects of the learning experience, recall, and creativity in a stereotypical learning context.

Design/methodology/approach

The paper is based on a randomized experiment in which student participants were subdivided into three treatment groups and one control group. Each group was stimulated by a different combination of visual, auditory, and olfactory stimuli (2D SMELL, VR, and VR SMELL) and the outcomes were compared against those of the control group (2D). Consistent with the Cognitive Theory of Multimedia Learning, hypotheses were constructed to study the effect of different combinations of stimuli on the learning experience and learning outcomes related to recall and creativity in a stereotypical learning context.

Findings

Traditional video content alone and bundled with a coherent olfactory stimulus prompted higher self-reported ratings of perceived quality of the sensory experience. Olfactory stimulus in combination with either VR or a traditional video prompted higher self-reported ratings on perceived immersion. In a stereotypical learning context, the highest recall scores were achieved with traditional video alone. Both VR alone and bundled with an olfactory stimulus resulted in enhanced creativity.

Research limitations/implications

The findings of this study should be interpreted in the context of adopting multisensory stimulations combined with VR technology as part of stereotypical learning contexts. Most professional educators do not have robust knowledge or experience in using build-on-purpose multisensory stimuli but are increasingly engaged in using multisensory tools such as VR, as part of their teaching practice. In relation to recall, the results are consistent with the hypothesis that in a stereotypical learning context, a multisensory experience involving VR and olfactory stimuli can be related to an undesired cognitive load for learners. There exists a possibility that the low-technical version of the VR goggles used, as well as the contents of the instructional video may have influenced the learning outcomes in terms of recall. Hence, future research should consider such aspects and focus on richer learning contexts.

Originality/value

This work offers practical recommendations for instructional design strategies aiming to create multisensory stimulations with VR and olfactory components to foster a richer learning experience and enhanced learning outcomes, under the assumptions of a stereotypical learning context.

Efficacy of the nootropic supplement Mind Lab Pro on memory in adults: Double blind, placebo-controlled study

OBJECTIVES

This study aimed to investigate the efficacy of taking Mind Lab Pro, a plant-based nootropic on memory in a group of healthy adults. Auditory, visual, visual working memory, immediate and delayed recall (DR) were assessed.

METHODS

The study employed a pseudo randomised, double blinded, placebo-controlled design. A total of 49 healthy individuals completed the study with 36 in the experimental group and 13 in the control group. Participants ranged between 20 and 68 years with a mean age of 31.4 ± 14.4 years. Pre and post taking either the Mind Lab Pro supplement or placebo for 30 days. All participants completed the Wechsler Memory Scale Fourth UK Edition (WSM-IV UK).

RESULTS

We found that the experimental group significantly improved in all memory subtests assessed (p < 0.05) whilst the control group only significantly improved in auditory memory and immediate recall (p = 0.004 and p = 0.014 respectively). A significant difference in immediate and DR was also found between the control and experimental group (p = 0.005 and 0.034 respectively).

CONCLUSION

The use of Mind Lab Pro for 4 weeks improves memory with the experimental group significantly improving in all sub areas of memory as assessed by the WSM-IV UK.

Resuscitation Preferences of Older Acutely Admitted Medical and Mentally Competent Patients with One and Six Months Follow-up

AIM

Determining patients' cardiopulmonary resuscitation (CPR) preferences in the emergency department (ED) is common practice but the stability of these preferences and their recollection by patients has been questioned. Therefore, this study assessed the stability and recall of CPR preferences of older patients at and following ED discharge.

METHODS

This survey-based cohort study was conducted between February and September 2020 at three EDs in Denmark. It consecutively asked mentally competent patients aged 65 years or older who were admitted to hospital through the ED and then one and six months later "In your current state of health, do you wish that physicians should try to intervene if your heart stops beating?" Possible responses were confined to "definitely yes", "definitely no", "uncertain", and "prefer not to answer".

RESULTS

In total, 3688 patients admitted to hospital via the ED patients were screened, 1766 were eligible and 491 (27.8%) were included: median age was 76 (IQR 71-82) years, and 257 (52.3%) were men. One third of patients who expressed definite yes or no preferences in ED had changed their preference at one month follow-up. Only 90 (27.4%) and 94 (35.7%) patients recalled their preferences at one and six months follow-up, respectively.

CONCLUSION

and Relevance In this study, one-in-three older ED patients who initially expressed definite resuscitation preferences had changed their minds at one month follow-up. Preferences were more stable at six months but only a minority were able to recall their preferences.

The Accuracy of Early Reproductive History and Physical Activity Participation Recall Across Multiple Age Ranges

Background: The ability to accurately recall specific reproductive health events is an integral aspect of medical decision making and evaluating a female's overall health and wellness across their lifespan. The Health and Reproductive Survey (HeRS) was developed to recall reproductive events and environmental influences on reproductive characteristics throughout the lifespan of a female. This study aimed to determine how reliably women recall certain events during menarche and early reproductive years. It was hypothesized that age at menarche, hormonal contraceptive use, and physical activity would be recalled reliably among all age ranges, while the recall reliability for cycle regularity and length would be more inconsistent with advancing age. Materials and Methods: A total of 144 participants (age: 32.73 ± 11.92), completed the HeRS on two occasions spaced 4 months apart to investigate recall reliability. Cohen's kappa coefficient was used to assess the consistency of categorical responses and 95% limits of agreement were used for continuous data. Results: Although physical activity changes had greater variability than anticipated (0.79), the recall reliability among the youngest (1) and oldest (0.89) age groups was high, and females were able to consistently recall the age of menarche (0.83), physical activity level (0.9), cessation of period during early reproductive years (0.91), and birth control use following menarche (0.85) and during the early reproductive years (0.9). Conclusions: The HeRS is a useful tool for reliably recalling reproductive history and physical activity participation across multiple age ranges and can be utilized to gather crucial information throughout the reproductive lifespan.

Racial and ethnic variation in the negativity bias-ideology connection: A registered report

This is a registered report for a study of racial and ethnic variation in the relationship between negativity bias and political attitudes. Pioneering work on the psychological and biological roots of political orientation has suggested that political conservatism is driven in large part by enhanced negativity bias. This work has been criticized on several theoretical fronts, and recent replication attempts have failed. To dig deeper into the contours of when (and among whom) negativity bias predicts conservatism, we investigate a surprisingly overlooked factor in existing literature: race and ethnicity. We propose that political issues represent threat or disgust in different ways depending on one's race and ethnicity. We recruited 174 White, Latinx, and Asian American individuals (in equal numbers) to examine how the relationship between negativity bias and political orientation varies by race/ethnicity across four domains: policing/criminal justice, immigration, economic redistribution, and religious social conservatism.

Aging and Mixed Emotions: A Word-Suffix Approach in Free Recall

The current study investigated mixed-emotional memories in groups of young, young-old, and old-old participants. We used a "word-suffix approach" to simulate the co-occurrence of positive and negative emotions. The participants engaged in a free-recall task for valenced words and mixed-emotional words (valenced words coupled with pejorative or endearment suffixes). Our results showed that the groups of older adults recalled higher numbers of suffixed words compared to their younger counterparts. Our findings highlighted older adults' tendency to perceive and remember emotionally ambivalent words to a greater extent than younger adults and showed that the young-old participants were particularly good at solving ambivalence by focusing on positive-dominant ambivalent words.

Risk of Recall for Total Joint Arthroplasty Devices Over 10 Years

BACKGROUND

Orthopaedic devices comprise nearly 20% of devices on the market and 12% to 20% of these devices undergo a recall within 10 years. More than 95% of these devices are approved without supporting clinical data through the Food and Drug Administration's 510(k) pathway. The risk of recall of orthopaedic arthroplasty devices approved through the 510(k) pathway has not been previously studied.

METHODS

The FDA 510(k) database was queried for orthopaedic devices approved between January 01, 2008 and December 31, 2018 and subsequently codified to hip and knee arthroplasty devices using product codes. The database included 904 arthroplasty devices during the study period, with hip and knee making up 53.7% (485) and 46.3% (419) of devices, respectively. Information regarding numbers, dates, and reasons for recall were recorded. Cumulative incidence function was conducted to compare the risk of recall between hip and knee arthroplasty.

RESULTS

In total, 94 (19.4%) hip and 85 (20.3%) knee devices were recalled. The hazard of recall by 10 years for hip and knee arthroplasty devices was approximately 24%, with no statistical differences between each region. The most common causes of recall were process control and device design, accounting for 29.6% and 26.3% of recalls, respectively, with no significant difference between study groups.

CONCLUSION

The risk of recall for arthroplasty devices is more than that previously understood. Improved postmarket surveillance strategies along with increased physician participation in detecting and reporting device safety issues are necessary to strengthen patient safety.

Neuropsychological markers of antidepressant action: a secondary analysis of the ANTLER randomised controlled trial

BACKGROUND

Antidepressants have been proposed to act via their influence on emotional processing. We investigated the effect of discontinuing maintenance antidepressant treatment on positive and negative self-referential recall and the association between self-referential recall and risk of relapse.

METHODS

The ANTLER trial was a large (N = 478) pragmatic double-blind trial investigating the clinical effectiveness of long-term antidepressant treatment for preventing relapse in primary care patients. Participants were randomised to continue their maintenance antidepressants or discontinue via a taper to placebo. We analysed memory for positive and negative personality descriptors, assessed at baseline, 12- and 52-week follow-up.

RESULTS

The recall task was completed by 437 participants. There was no evidence of an effect of discontinuation on self-referential recall at 12 [positive recall ratio 1.00, 95% CI (0.90-1.11), p = 0.93; negative recall ratio 1.00 (0.87-1.14), p = 0.87] or 52 weeks [positive recall ratio 1.03 (0.91-1.17), p = 0.62; negative recall ratio 1.00 (0.86-1.15), p = 0.96; ratios larger than one indicate higher recall in the discontinuation group], and no evidence of an association between recall at baseline or 12 weeks and later relapse [baseline, positive hazard ratio (HR) 1.02 (0.93-1.12), p = 0.74; negative HR 1.01 (0.90-1.13), p = 0.87; 12 weeks, positive HR 0.99 (0.89-1.09), p = 0.81; negative HR 0.98 (0.84-1.14), p = 0.78; ratios larger than one indicate a higher frequency of relapse in those with higher recall].

CONCLUSIONS

We found no evidence that discontinuing long-term antidepressants altered self-referential recall or that self-referential recall was associated with risk of relapse. These findings suggest that self-referential recall is not a neuropsychological marker of antidepressant action.

A novel Home Exercise Assessment Tool (HEAT) to assess recall and performance: A reliability study

BACKGROUND

A reliable and valid tool to measure short-term recall does not exist.

OBJECTIVE

The purpose of this study was o assess the reliability of a novel tool designed to evaluate the immediate recall and performance of prescribed exercises. This reliability study was secondary from a parent randomized controlled trial.

METHODS

Patients ages 18 to 65 with low back or unilateral knee pain longer than 6 weeks, reporting to a primary care or physical therapy clinic at one large military hospital. Participants were randomized into one of four groups based on number of exercises and type of instruction. The Home Exercise Assessment Tool (HEAT) is scored along an ordinal scale, (zero = low; three = high performance), with 2+ equal to meeting the intent of the exercise. Reliability of testing was assessed using a pool of four raters.

RESULTS

The interrater reliability of the HEAT performed on 30 participants (9 females, and 21males, mean age 36.7 (SD = 11.7)) and eight participants during pilot testing demonstrated moderate to good reliability (ICC = 0.66-0.77). Intrarater reliability during pilot testing was excellent (ICC = 0.93-0.96).

CONCLUSION

The HEAT demonstrated moderate to good interrater and excellent intrarater reliability. This tool is unique in that it assesses both recall and adherence, and merits further testing in other settings.

Prescription changes in patients with gastrointestinal disorders after withdrawal of ranitidine: a nationwide population-based cohort study

OBJECTIVE

Ranitidine products contain unacceptable levels of N-nitrosodimethylamine. This study aimed to investigate changes in the treatment regimen and their influencing factors after the ranitidine recall.

METHODS

This retrospective study used data from nationwide Korean claims from 2019. Patients with gastrointestinal disorders treated with ranitidine for at least a month on 25 September 2019, were selected for this study. Other histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), potassium-competitive acid blockers (PCABs), and prostaglandin E1 analogs were administered as alternatives to ranitidine. Kaplan-Meier survival and Cox proportional hazards regression analyses were performed to gauge the time until switching to alternative drugs and assess the influencing factors.

RESULTS

In total, 7502 patients were included in this study, among which 5164 (68.8%) switched from ranitidine to an alternative drug. The most prescribed alternative drugs were H2RAs, followed by PPIs, PCABs, and prostaglandin E1 analogs. Increasing age; Medical Aid insurance (MedAid); and a history of hypertension, diabetes mellitus, asthma, and osteoarthritis were associated with a higher probability of switching treatments. Patients with concomitant gastroesophageal reflux disease and peptic ulcers were more likely to switch to alternative drugs than patients with gastritis.

CONCLUSIONS

Approximately two-thirds of patients with gastrointestinal disorders switched from ranitidine to alternative drugs within 3 months after ranitidine withdrawal. The Cox regression analysis showed that age (>55 years); insurance type (MedAid); comorbidities, such as hypertension, diabetes mellitus, asthma, and osteoarthritis, and gastrointestinal disorder severity influenced the switch from ranitidine to alternative drugs.

Connected consciousness after tracheal intubation in young adults: an international multicentre cohort study

BACKGROUND

Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18-40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes.

METHODS

This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation.

RESULTS

Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [ORadjusted]=2.7; 95% confidence interval [CI], 1.1-7.6; P=0.022) and was decreased with continuous anaesthesia before laryngoscopy (ORadjusted=0.43; 95% CI, 0.20-0.96; P=0.041). Responses were more likely to occur after a command to respond (and not to nonsense, 13 subjects) than after a nonsense statement (and not to command, four subjects, P=0.049).

CONCLUSIONS

Connected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to reduce the incidence of connected consciousness. Further research is required to understand sex-related differences in the risk of connected consciousness.

Effects of familiar music exposure on deliberate retrieval of remote episodic and semantic memories in healthy aging adults

Familiar music facilitates memory retrieval in adults with dementia. However, mechanisms behind this effect, and its generality, are unclear because of a lack of parallel work in healthy aging. Exposure to familiar music enhances spontaneous recall of memories directly cued by the music, but it is unknown whether such effects extend to deliberate recall more generally - e.g., to memories not directly linked to the music being played. It is also unclear whether familiar music boosts recall of specific episodes versus more generalised semantic memories, or whether effects are driven by domain-general mechanisms (e.g., improved mood). In a registered report study, we examined effects of familiar music on deliberate recall in healthy adults ages 65-80 years (N = 75) by presenting familiar music from earlier in life, unfamiliar music, and non-musical audio clips across three sessions. After each clip, we assessed free recall of remote memories for pre-selected events. Contrary to our hypotheses, we found no effects of music exposure on recall of prompted events, though familiar music evoked spontaneous memories most often. These results suggest that effects of familiar music on recall may be limited to memories specifically evoked in response to the music (Preprint and registered report protocol at https://osf.io/kjnwd/).

Substandard and falsified medical product recalls in Zambia from 2018 to 2021 and implications on the quality surveillance systems

Background

Substandard and falsified (SF) medical products are removed from circulation through a process called 'product recall' by medicines regulatory agencies. In Zambia, the Zambia Medicines Regulatory Authority (ZAMRA) is responsible for recalling SF medical products from the Zambian market through passive and active surveillance methods. This study aimed to describe the prevalence of recalls of SF medical products and to analyse the frequently recalled therapeutic categories, dosage forms, categories of defects that led to the recalls and their sources with respect to the country of the marketing authorisation holder (MAH) or manufacturer.

Methods

We conducted a descriptive cross-sectional review of the product recalls issued by ZAMRA between January 2018 and December 2021. A search for all medical product alerts and recalls issued by ZAMRA was carried out by reviewing the internal post-marketing surveillance database kept at ZAMRA headquarters. Data were extracted using a structured Excel database and analysed using Microsoft Excel.

Results

A total of 119 alerts were received during the review period, of which 83 (69.7%) were product recalls. Oral solid dosage forms were the most recalled dosage form (53%). Furthermore, the number of recalls increased in 2020 (44.6%) and 2021 (22.9%), with the majority (20.5%) of the recalled products being substandard products classified as antiseptics and disinfectants and were attributed to the high demand during the COVID-19 pandemic. Manufacturing laboratory control issues were the reason for product recall in almost half (47.4%) of the cases. Most of the products recalled originated from India (38.6%), followed by Zambia (25.3%). Only one suspected falsified product was recalled between 2018 and 2021. A total of 66 recalls of the 83 products were initiated by ZAMRA, with only 17 voluntarily by foreign MAHs. No product recall was initiated by the local representatives of foreign manufacturers or MAH.

Conclusion

The majority of the pharmaceutical product recalls in Zambia were substandard products. Manufacturing laboratory control issues lead to most recalls and require investigation of the root causes, preventive action, and strict compliance with the good manufacturing practices guidelines by manufacturers.

On the effect of hippocampal c-Jun N-terminal kinase inhibition on object recognition memory

c-Jun N-terminal kinase (JNK) phosphorylates the transcription factor c-Jun in response to stress stimuli and contributes to both hippocampal synaptic plasticity and memory processing in mammals. Object recognition memory (ORM) is essential for remembering facts and events. In rodents, ORM consolidation and reconsolidation require a functional hippocampus. However, the possible involvement of hippocampal JNK on ORM processing has not yet been studied. Here we show that when injected into dorsal CA1 5 min, but not 6 h, after training adult male rats in the novel object recognition learning task, the JNK inhibitor SP600125 impaired ORM for at least 7 days without affecting exploratory activity, short-term ORM retention, or the functional integrity of the hippocampus. SP600125 did not hinder ORM retention when given in CA1 after a memory reactivation session carried out 24 h post-training in the presence of the same two objects presented during the training session, but caused time-dependent amnesia when one of the objects presented at training was replaced by a different but behaviorally equivalent novel one. Taken together, our results indicate that hippocampal JNK activity is necessary for ORM consolidation and reconsolidation but not for ORM recall or short-term retention.

Advanced Bionics HiRes Ultra and Ultra 3D Series Cochlear Implant Recall: Time Course of Anomalies

OBJECTIVES

To estimate median survival time until the appearance of anomalies indicating a potential implant failure associated with fluid ingress in implanted cochlear implant (CI) devices of the initial version of Advanced Bionics HiRes Ultra and HiRes Ultra 3D series.

STUDY DESIGN

Retrospective review.

METHODS

Cochlear implantation was performed in a standard fashion. Implant integrity was tested at follow-up visits by measuring impedance and electrically evoked compound action potential (ECAP). Additional tests such as electrical field imaging (EFI) were conducted by the manufacturer. Based on these tests, the presence or absence of an anomaly was classified.

RESULTS

Of the 349 devices implanted at this institution, 181 showed anomalies in accordance with the special failure mode and for this reason, 120 implants were already explanted. The median survival time without anomalies was 1062 days. So far, the suspicion of device failures has been confirmed in all cases in which a post-implantation analysis was already available.

CONCLUSIONS

Regular tests at the follow-up visits are necessary to monitor the integrity of CIs.

LEVEL OF EVIDENCE

3 Laryngoscope, 132:2484-2490, 2022.

Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms

This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.

Comparison of Outcomes for One-View Asymmetries Recalled From Digital Breast Tomosynthesis Versus Full-Field Digital Mammography Screening Examinations

BACKGROUND. Recall rates are lower for digital breast tomosynthesis (DBT) than for full-field digital mammography (FFDM). This difference could have important implications with respect to one-view asymmetries given that missed cancers are often visible on one view. OBJECTIVE. The purpose of this study is to compare the outcomes of one-view asymmetries recalled from DBT versus FFDM screening examinations and to determine predictors of malignancy among recalled asymmetries. METHODS. This retrospective study first determined recall rates associated with one-view asymmetries for screening mammography performed using DBT and FFDM from July 14, 2016, through July 14, 2020. Further analyses included patients recalled for a one-view asymmetry who completed subsequent diagnostic workup and all recommended follow-up. Patient and cancer characteristics were extracted from the electronic health record. RESULTS. The recall rate associated with asymmetries was lower for DBT screening (2.5% [3169/128,755]) than for FFDM screening (3.4% [815/23,898]) (p < .001). Further analyses of patients who completed diagnostic workup and subsequent follow-up included 3119 patients (mean age, 57 years) for DBT screening and 811 patients (mean age, 56 years) for FFDM screening. Distribution of final BI-RADS categories from subsequent diagnostic workup was not different between the two modalities (p > .99). The frequency of malignancy was not different between asymmetries recalled from DBT (1.7% [54/3119]) and FFDM (1.7% [14/811]) (p > .99). Malignant asymmetries identified on FFDM versus DBT were more frequently associated with architectural distortion on diagnostic workup (35.7% [5/14] vs 9.3% [5/54]) (p < .001) and were more commonly invasive ductal carcinoma (92.9% vs 57.4%) and less commonly invasive lobular carcinoma (0.0% vs 24.1%) (p = .05). In multivariable analysis, independent predictors of malignancy among recalled asymmetries from DBT were age (for 55-69 years, odds ratio [OR] = 2.40 [p = .04]; for ≥ 70 years, OR = 7.93 [p < .001]; reference, < 55 years) and breast density (not dense, OR = 2.47 [p = .001]; reference, dense breasts). CONCLUSION. Recalled asymmetries were less frequent for DBT than for FFDM. The malignancy rate was low for both modalities (1.7%). Age 55 years old and older and lower breast density predicted malignancy for DBT-recalled asymmetries. CLINICAL IMPACT. Our results support the use of DBT to reduce unnecessary recalls without altering PPV for asymmetry-associated malignancies. Patient factors should be considered when assessing whether a potential asymmetry on DBT screening represents overlapping fibroglandular tissue or a suspicious finding that requires diagnostic workup.

The effect of sertraline on emotional processing: secondary analyses of the PANDA randomised controlled trial

BACKGROUND

According to the cognitive neuropsychological model, antidepressants reduce symptoms of depression and anxiety by increasing positive relative to negative information processing. Most studies of whether antidepressants alter emotional processing use small samples of healthy individuals, which lead to low statistical power and selection bias and are difficult to generalise to clinical practice. We tested whether the selective serotonin reuptake inhibitor (SSRI) sertraline altered recall of positive and negative information in a large randomised controlled trial (RCT) of patients with depressive symptoms recruited from primary care.

METHODS

The PANDA trial was a pragmatic multicentre double-blind RCT comparing sertraline with placebo. Memory for personality descriptors was tested at baseline and 2 and 6 weeks after randomisation using a computerised emotional categorisation task followed by a free recall. We measured the number of positive and negative words correctly recalled (hits). Poisson mixed models were used to analyse longitudinal associations between treatment allocation and hits.

RESULTS

A total of 576 participants (88% of those randomised) completed the recall task at 2 and 6 weeks. We found no evidence that positive or negative hits differed according to treatment allocation at 2 or 6 weeks (adjusted positive hits ratio = 0.97, 95% CI 0.90-1.05, p = 0.52; adjusted negative hits ratio = 0.99, 95% CI 0.90-1.08, p = 0.76).

CONCLUSIONS

In the largest individual placebo-controlled trial of an antidepressant not funded by the pharmaceutical industry, we found no evidence that sertraline altered positive or negative recall early in treatment. These findings challenge some assumptions of the cognitive neuropsychological model of antidepressant action.

Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study

Background

Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring.

Objective

This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD.

Methods

The “Amyloid Prediction in Early Stage Alzheimer’s disease” (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants’ personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer’s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire.

Results

Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)—78 cognitively unimpaired (CU) and 73 MCI or mild AD—engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests.

Conclusions

The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring.

The reciprocal relationship between episodic memory and future thinking: How the outcome of predictions is subsequently remembered

Evidence suggests that memory is involved in making simulations and predictions about the future (i.e., future thinking), but less work has examined how the outcome of those predictions (whether events play out as predicted or expected) subsequently affects episodic memory. In this investigation, we examine whether memory is better for outcomes that are consistent with predictions, or whether memory is enhanced for outcomes that are inconsistent with predictions, after the predicted event occurs. In this experiment, participants learned a core trait associated with social targets (e.g., high in extroversion), before making predictions about behaviors targets would perform. Participants then were shown behaviors the social targets actually performed (i.e., prediction outcome), which was either consistent or inconsistent with predictions. After that, participants completed a memory test (recognition; recall) for the prediction outcomes. For recognition, the results revealed better memory for outcomes that were consistent with traits associated with targets (i.e., trait-consistent outcomes), compared to outcomes that were inconsistent (i.e., trait-inconsistent outcomes). Finding a memory advantage for trait-consistent outcomes suggests that outcomes that are in line with the contents of memory (e.g., what one knows; schemas) are more readily remembered than those that are inconsistent with memory, which may reflect an adaptive memory process. For recall, memory did not differ between trait-consistent and trait-inconsistent outcomes. Altogether, the results of this experiment advance understanding of the reciprocal relationship between episodic memory and future thinking and show that outcome of predictions has an influence on subsequent episodic memory, at least as measured by recognition.

Value-directed remembering in first-episode schizophrenia

OBJECTIVE

Memory deficits in individuals with schizophrenia are well-established, but less is known about how schizophrenia affects metacognitive processes such as metamemory. We investigated metamemory ability using the value-directed remembering task, which assesses the degree to which participants use value cues to guide their learning of a list of items (i.e., their memory selectivity).

METHOD

Participants were patients undergoing treatment following a recent first episode of schizophrenia (n = 20) and demographically comparable healthy controls (n = 18). Participants viewed six lists of 24 words where each word was paired with either a low value (1-3 points) or a high value (10-12 points), and they were instructed to maximize their score on free recall tests given after each list. After the final free recall test, participants completed a recognition test where they gave remember/know judgments.

RESULTS

On tests of free recall, patients showed reduced memory selectivity relative to healthy controls. On the recognition test, patients failed to show an effect of value on recognition of nonrecalled words, in contrast to healthy controls, who showed a significant value effect that was characterized by greater "remember" judgments. Patients initially overestimated their memory capacity but were able to adjust their estimates to be more accurate based on task experience. Patients' self-reports of memory selectivity were unrelated to their actual memory selectivity.

CONCLUSIONS

Patients with first-episode schizophrenia had substantial impairments on the value-directed remembering task, but areas of preserved metamemory ability were also observed. These findings have potential implications for cognitive training interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Childhood Cancer Survivors' Adherence to Healthcare Recommendations Made Through a Distance-Delivered Survivorship Program

Purpose

Ongoing survivorship care allows childhood cancer survivors the opportunity to address treatment-related health problems and improve their quality of life. However, many survivors do not adhere to their healthcare professionals’ recommendations and the factors supporting their adherence remain unclear.

Patients and Methods

Long-term childhood cancer survivors completed the “Re-engage” program, which assessed survivors’ heath needs and provided individualised recommendations for health interventions and surveillance developed by an expert multi-disciplinary team (MDT). We measured survivors’ recall of, and adherence to, their individualised healthcare recommendations at one and six months post-intervention. We conducted a series of univariate negative binomial regressions to investigate factors associated with the total number of recommendations that were correctly recalled and adhered to.

Results

We analysed the data of 25 childhood cancer survivors who participated in Re-engage (mean age = 31.9 years). On average, survivors were provided with 6.6 recommendations (range = 1–11). Survivors accurately recalled receiving 3.0 recommendations at one month post-intervention and 1.9 at six months. Survivors had adhered to an average of 1.3 recommendations by six-month follow-up. In total, 56% of participants reported that they did not adhere to any recommendations. By six-month follow-up, greater adherence to MDT recommendations was associated with having a history of a second cancer (B = 1.391; 95% confidence interval [CI], 0.686 to 2.097; p < 0.001) and reporting a greater level of worry about late effects (B = 1.381; 95% CI, 0.494 to 2.269; p = 0.002).

Conclusion

Survivors reported sub-optimal levels of adherence and demonstrated limited recall of their healthcare recommendations. Effective communication of recommendations and clear discussion of barriers limiting adherence, coupled with late effects education, may be critical to ensure that survivors engage with their recommendations, to improve their quality of life and health outcomes.

Trial Registration Number

ACTRN12618000194268.

Improving comprehension, recall and attention using multimedia-informed assent among pediatric oncology patients: A comparative randomized controlled trial

BACKGROUND

Assent should be obtained in all children involved in research in keeping with their level of maturity. Traditional assent forms contain too much information and are difficult to read. The study aimed to identify an effective tool to enhance children's comprehension during the assent process and focused on those with cancer who are likely more engaged in research involving greater than minimal risk.

METHODS

In all, 116 children with cancer were randomized to receive either a paper-based assent document or a multimedia-based assent document. Open-ended and multiple-choice questions were used to assess comprehension and recall. Time spent on the documents and children's behavior during the assent process was recorded to determine their attention and satisfaction.

RESULTS

Children randomized to a multimedia-based assent document achieved significant higher comprehension and recall assessment scores (p-values <.001). The high score achievement significantly correlated with the child's age with adjusted odds ratio (OR) of 1.90 (p-value <.001; 95% confidence interval [CI]: 1.35-2.66) for comprehension assessment and 1.59 (p-value .001; 95% CI: 1.20-2.12) for recall assessment. Children randomized to a multimedia-based assent document had significant longer time spent on the document (p-value .001) with less numbers of inattention (p-value <.001) and expressed more signs of enjoyment during the assent process (p-values <.001).

CONCLUSION

Multimedia-based assent document successfully enhanced comprehension, recall, and attention with more satisfaction compared with a traditional paper-based document among children with cancer. This approach may be considered as an alternative format for children engaging in research involving greater than minimal risk.