Effect of COVID-19 prevention as part of an urban renewal programme

OBJECTIVES

To address existing inequalities, the Barcelona City Council launched a Neighbourhood Plan in 2016-2020. During the first wave of the COVID-19 pandemic, the Neighbourhood Plan interventions were intensified. This study aimed to assess the effect of the plan on the incidence of COVID-19 during the first wave of the pandemic in Barcelona.

STUDY DESIGN

We used a quasi-experimental design with 16 intervention neighbourhoods and 17 neighbourhoods in the comparison group with similar socioeconomic characteristics.

METHODS

We calculated the cumulative incidence rate (CIR) of COVID-19 per 100,000 inhabitants by sex, age groups, and neighbourhood of residence. Poisson regression models were fitted to estimate the crude relative risk and relative risk adjusted by socioeconomic status (cRR and aRR) and their 95% confidence intervals (CIs).

RESULTS

The CIR of COVID-19 was lower in the intervention neighbourhoods (CIR: 841 per 100,000 inhabitants) than in the comparison group (CIR: 973 per 100,000 inhabitants). On multivariate analysis, the aRR was 0.77 (CI: 0.70-0.83) for men and 0.89 (CI: 0.83-0.96) for women. Among men older than 75 years (aRR = 0.73; CI: 0.62-0.86), statistically significant differences were found in the intervention neighbourhoods compared to the comparison group. This pattern was not observed in women older than 75 years (aRR = 1.13; CI: 0.99-1.30).

CONCLUSION

This research finds positive short-term effect in the intervention neighbourhoods. We conclude that the COVID-19 control and prevention interventions are likely to explain the better performance in the neighbourhoods included in the Neighbourhood Plan.

Quantitative Analysis of BrainAge using Neuroimaging Data to Estimate Radiation-Induced Brain Aging and Associations with Cognitive Changes in Brain Metastases Patients

PURPOSE/OBJECTIVE(S)

Radiotherapy is critical in brain tumor management yet causes accelerated aging via irreparable damage to white matter, cortex, and subcortical areas. BrainAGE is an open-source machine learning tool that analyses morphology from raw quantitative structural MRI to generate a predictive 'BrainAge' value, enabling analyses of patients with neurodegenerative diseases. We assessed the utility of this algorithm in measuring brain age morphology in brain metastases patients on a clinical trial, analyzed differences in BrainAge and chronological age, and explored associations with cognitive performance.

MATERIALS/METHODS

We analyzed pre-SRS high-resolution T1-weighted noncontrast volumetric MRI in patients with brain metastases (n = 57, median age 63 years, range 20-87) treated on a prospective clinical trial of cognitive-sparing SRS. The BrainAGE machine learning tool processed images to derive a BrainAge; it reliably generates this value using a Gaussian Processes regression, with a robust neurotypical training cohort. We examined correlations between BrainAge and chronological age with regression. Brain-predicted age gap (Brain-Gap) was calculated, defined as the difference between a patient's BrainAge and chronological age. We assessed cognitive function at baseline pre-SRS with a comprehensive battery of validated tests across multiple domains performed by a neuropsychologist, including memory (HVLT total), executive function (COWAT category fluency), and language (COWAT letter fluency). Raw test scores were scaled to T-scores adjusting for age, sex, and education level per testing norms. We examined if Brain-Gap was associated with cognitive performance pre-SRS.

RESULTS

BrainAGE software was robust, estimating a BrainAge for all input MRI sequences. We found a strong correlation between BrainAge and chronological age (r-squared = 0.82). The Brain-Gap median value was 0.84 and the mean was -0.90, in years (range -18.30-11.36 years). Brain-Gap was not significantly associated with cognitive performance across the three tests at the pre-SRS timepoint. Among patients with impaired cognition (T<35), there was no significant difference in BrainAge relative to chronological age.

CONCLUSION

To our knowledge, this is the first study utilizing the BrainAGE model as a biomarker of neuroanatomical age for brain tumors patients. Existing publications had lesion-free cohorts. Our results show that BrainAge was reliably associated with chronologic age in brain metastases patients pre-SRS. The Brain-Gap difference was minimal at baseline, and we found no significant association with pre-SRS cognitive performance. Future studies will examine this biomarker after SRS to look for individual aging radiation effects and prediction for cognitive changes after therapy.

Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile

BACKGROUND

MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS.

OBJECTIVE

To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile.

METHODS

Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed.

RESULTS

We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05).

CONCLUSION

MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.

Evidence-Based Multivariate Normal Tissue Complication Probability (NTCP) Study of Domain-Specific Cognitive Decline after Partial Brain RT

PURPOSE/OBJECTIVE(S)

Beyond the hippocampus, there are no evidence-based dose constraints for eloquent brain structures which subserve memory and attention/processing speed. We performed a multivariate normal tissue complication probability analysis of post-RT neurocognitive decline, examining dosimetric predictors of eloquent brain regions.

MATERIALS/METHODS

Data were analyzed from a prospective longitudinal clinical trial. Patients (n = 78) with primary brain tumors receiving fractionated RT complete a comprehensive neurocognitive evaluation and high-resolution volumetric and diffusion MRI at baseline and 6 months post-RT. Image processing using robust, validated automated segmentation parcellated individual WM tracts, cortical regions, and hippocampi. Well-validated neurocognitive tests including Delis-Kaplan Executive Function System and Wechsler Adult Intelligence Scale-IV coding (attention/processing), Boston Naming Test (language) and Hopkins Verbal Learning Test and Brief Visuospatial Memory Test (verbal/visuospatial memory) were assessed. Reliable change indices adjusted for practice effects (RCI-PE) were calculated for each patient between baseline and 6 months; a negative RCI-PE was scored as decline. Univariate logistic regression was performed with mean and max dose to structures of interest as well as clinical variables. Multivariate model building was performed using automated bootstrapped logistic regression, LASSO and random forest modeling.

RESULTS

On univariate analysis mean and max dose to multiple regions of the corpus callosum (CC) were correlated with attention/processing speed decline; most significantly in WAIS coding, including Dmax to the anterior CC (p = 0.011) and central CC (p = 0.010), and Dmax and Dmean to the mid anterior CC (p = 0.006 and 0.010). Mean dose to the left fornix was associated with decline in memory (p = 0.023, cutoff 12.9 Gy), as were increasing age and both concurrent and adjuvant chemotherapy. On multivariate analysis for attention, automated bootstrapped logistic regression showed the most frequently selected variable was mean dose to the mid anterior CC. Performance at nested cross-validation by AUC was 0.80 (0.75-0.84); LASSO model performance by AUC was 0.76 (0.72-0.81) with Dmean to the mid anterior CC being the most frequent variable. The top five most important variables in the Random Forest as ranked by mean decrease in Gini coefficient were mean dose to mid anterior CC, all white matter, combined CC and max dose to CC and posterior CC. Model performance by AUC was 0.66 (0.60-0.71).

CONCLUSION

Here, we present the first, to our knowledge, NTCP model for decline in attention/processing speed, along with dosimetric predictors of memory decline beyond the hippocampus. We found that after partial brain RT, dose to several ROIs significantly correlated with post-RT impairment. These data can guide future cognitive-sparing strategies for brain RT.

Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

The Effects of Long-term Molybdenum Exposure in Drinking Water on Molybdenum Metabolism and Production Performance of Beef Cattle Consuming a High Forage Diet

Fifty-four multiparous beef cows with calves were used to evaluate the effects of Mo source (feed or water) on reproduction, mineral status, and performance over two cow-calf production cycles (553 days). Cows were stratified by age, body weight, liver Cu, and Mo status and were then randomly assigned to one of six treatment groups. Treatments were (1) negative control (NC; basal diet with no supplemental Mo or Cu), (2) positive control (NC + Cu; 3 mg of supplemental Cu/kg DM), (3) NC + 500 µg Mo/L from Na2MoO4·2H2O supplied in drinking water, (4) NC + 1000 µg Mo/L of Na2MoO4·2H2O supplied in drinking water, (5) NC + Mo 1000-water + 3 mg of supplemental Cu/kg DM, and (6) NC + 3.0 mg of supplemental Mo/kg diet DM from Na2MoO4·2H2O. Animals were allowed ad libitum access to both harvested grass hay (DM basis: 6.6% crude protein; 0.15% S, 6.7 mg Cu/kg, 2.4 mg Mo/kg) and water throughout the experiment. Calves were weaned at approximately 6 months of age each year. Dietary Cu concentration below 10.0 mg Cu/kg DM total diet reduced liver and plasma Cu concentrations to values indicative of a marginal Cu deficiency in beef cows. However, no production parameters measured in this experiment were affected by treatment. Results suggest that Mo supplemented in water or feed at the concentrations used in this experiment had minimal impact on Cu status and overall performance.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

The association between hope and employment among individuals with multiple sclerosis: A hierarchical logistic regression model

BACKGROUND

Most people with multiple sclerosis (MS) are employed at the time of their diagnosis; however, due to the unpredictable nature of MS, most exit the workforce shortly thereafter. A plethora of research has examined factors that negatively affect employment outcomes for people with MS. However, little is known about how hope, a modifiable positive psychology factor, affects employment.

OBJECTIVE

This study examined the role of hope and its association with employment outcomes for people with MS.

METHODS

Two-hundred and fifty-five adults with MS (mean ± SD age, 45.45 years ± 10.28) completed surveys about their MS, employment, disability-related stress, and hope. A three-step hierarchical logistic regression was conducted to examine the extent to which hope explains the variance in employment, over and above demographic and disability related covariates.

RESULTS

The final model explained 28% of the variance in employment, suggesting that the model was able to distinguish people with MS who were employed versus those who were unemployed. Higher levels of hope were associated with an increased probability of being employed (OR = 4.65; 95% CI [1.98, 10.92]).

CONCLUSION

This study supports that hope is associated with favorable employment outcomes for people with MS. Persons with MS may benefit from working with rehabilitation professionals to enhance their hope, and this study provides a foundation for the development of hope-based interventions to improve employment outcomes among this population.

Associations between mental health and job loss among middle‐ and low‐income veterans and civilians during the COVID‐19 pandemic: An exploratory study

This study examined the relationship between job loss and mental health during the pandemic among a nationally representative sample of middle- and low-income military veterans and civilians. Participants were recruited from Amazon Mechanical Turk in May-June 2020. Our sample was comparable to the U.S. population with respect to key demographics (i.e., sex, race, ethnicity, and geographic region). More veterans were male (36.9% civilians vs. 74.1% veterans), and on average they were older than civilians (M_civilians  = 47.86 vs. M_veterans  = 52.64). After controlling for sociodemographic factors, probable anxiety (adjusted odds ratio for veterans = 1.96, 95% [1.22-3.15]) was significantly associated with job loss among veterans, whereas among civilians, probable anxiety (adjusted odds ratio for civilians [AOR_c ] = 1.48, 95% [1.21-1.81]), probable COVID-19 era-related stress (AOR_c  = 1.73, 95% [1.45-2.07]), and loneliness (AOR_c  = 1.09, 95% [1.04-1.13]) were associated with job loss. Results demonstrated that veteran sample's effect sizes were larger than civilian sample's effect sizes; however, our moderation analyses results revealed that veteran status did not moderate the relationships between mental health and job loss. The findings in this study support a relationship between job loss and poorer mental health, suggesting that increased mental health services may be important to address ongoing effects of the COVID-19 pandemic.

Proximal balloon-guided catheter with flow inversion vs. distal filter protection during the carotid stent placement, a seven years experience in a Colombian reference center

BACKGROUND AND PURPOSE

The carotid stent placement as a therapeutic option for carotid stenosis has been increasing among years; therefore, studies are required to evaluate the security and efficacy of its materials. The purpose of this study was to evaluate the distal filter and the proximal balloon-guided catheter with flow inversion as protection devices during carotid angioplasty and stenting.

METHODS

This is a retrospective, observational study of patients diagnosed with carotid stenosis treated with angioplasty between January 1, 2014, and June 30, 2020; we analyzed a radiology service database to compare the distal filter and the proximal balloon-guided catheter as protection devices during angioplasty.

RESULTS

One hundred seventy-five angioplasties were performed, the distal filter was the most prevalent embolic protection device used (66%), patients baseline characteristics did not differ between groups with different embolic protection devices, except for history of dyslipidemia (p < 0.000). As well, we did not find any significant differences between the groups in the device related complications, intervention time (p = 0.140), unrelated complications (p = 0.693) and functional independence at 90 days (p = 0.096).

CONCLUSIONS

In our study the proximal balloon-guided catheter and the distal filter protection device as protection devices during the carotid stenting didn't show significant differences regarding complications related to the system.

The Intermediary Role of Optimism and Mental Health in the Relationship Between Disability-Related Stress and Life Satisfaction: A Serial Mediation Model

Although research has examined the relationship between stress and life satisfaction for individuals with multiple sclerosis (MS), less is known about the mechanism through which disability-related stress affects life satisfaction. The purpose of the study was to examine the intermediary role of optimism and mental health in the relationship between disability-related stress and life satisfaction in people with MS. In this cross-sectional study, the sample consisted of 373 adults with MS (mean age = 47.77 years; SD = 11.70). Descriptive statistics, correlation analyses, and a serial mediation analysis were conducted in this study. Our findings suggested that disability-related stress was inversely associated with optimism, mental health, and life satisfaction. Optimism was positively associated with mental health and life satisfaction. Mental health was positively associated with life satisfaction. The serial mediation analysis results suggested that disability-related stress was negatively associated with life satisfaction through optimism and mental health. Our findings provided implications for clinicians to facilitate optimism and mental health promotion for people with MS.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Development and validation of the social motivation scale in people with disabilities

OBJECTIVE

Social effectiveness is key to success in the labor market. For decades, social motivation has been empirically studied as both a presumed cause and consequence of social effectiveness. Yet, few direct measures of social motivation exist, and even fewer have been validated with a disability population. This study provides the measurement structure and psychometric properties of a newly created measure of social motivation tested with a general disability population.

RESEARCH DESIGN

Participants included 1,013 US adults with disabilities. Exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were implemented to validate the measure.

RESULTS

Results of the EFA suggest that a reduced 26-item inventory exhibits a 5-factor structure in a general population of people with disabilities. These results were confirmed with the CFA. Concurrent validity analysis revealed that most factors were significantly associated with relevant psychosocial variables in the expected directions.

CONCLUSIONS

The Social Motivation Inventory provides a useful tool for enhancing understanding of social motivation in rehabilitation psychology and rehabilitation counseling research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Production of rhamnolipids by the Thermoanaerobacter sp. CM-CNRG TB177 strain isolated from an oil well in Mexico

This study aimed to produce and characterize biosurfactants using the Thermoanaerobacter sp. CM-CNRG TB177 strain isolated from an oil field in Mexico, as well as assessing the influence of different carbon and nitrogen sources on the capacity of the produced surfactant to reduce the surface tension of water. The thin-layer chromatography (TLC) revealed that the obtained extract corresponds to a mono-rhamnolipid; the results of the ultra-performance-liquid chromatography/mass spectrometry (UPLC/MS) analysis revealed that the Thermoanaerobacter sp. CM-CNRG TB177 strain produces a mixture of three rhamnolipids, whose masses correspond to mono-rhamnolipid. The rhamnolipids mixture obtained using 2.5% molasses as carbon source diminished the surface tension of water to 29.67 mNm^-1, indicating that the concentration of molasses influenced the capacity of the produced surfactant to reduce the surface tension of water. Also, the microorganism was not capable of growing in the absence of yeast extract as nitrogen source. To the best of our knowledge, the presented results describe for the first time the nature of the biosurfactant produced by a bacterium of the Thermoanaerobacter genus.Key points• Thermoanaerobacter sp. CM-CNRG TB177 produces biosurfactants, and its glycolipid nature is described for the first time.• The HPLC analysis revealed a mixture of three rhamnolipid congeners, and UPLC/MS analysis determined that two of the congeners are the rhamnolipids Rha-C8-C10 and Rha-C12-C10.• The lowest surface tension of 29.67 mNm^-1 was obtained with molasses as source of carbon at a 2.5% concentration.

Psychometric Validation of the PERMA-Profiler as a Well-Being Measure for Young Adult Survivors of Pediatric Central Nervous System Tumor

This study aims to validate a measure of well-being, the PERMA-Profiler, among a sample of young adult survivors of pediatric central nervous system (CNS) tumor. Measurement structure of the PERMA-Profiler was evaluated using exploratory factor analysis and confirmatory factor analysis using pretest–posttest data. Reliability and concurrent validity of the PERMA-Profiler were examined. This study included 127 young adult survivors of pediatric CNS tumor between the ages of 18 and 30 ( M = 23.83, SD = 3.00) years. The results of factor analyses yielded a single-factor solution for well-being. Significant relationships between well-being and happiness, life satisfaction, perceived stress, and physical health were observed, providing support for the concurrent validity of the PERMA-Profiler. The PERMA-Profiler displayed good internal consistency and test–retest reliability. The PERMA-Profiler can help rehabilitation researchers and counselors better evaluate well-being in young adult survivors of pediatric CNS tumor, which provides opportunity for more targeted psychosocial interventions.

The tripartite efficacy beliefs model in vocational rehabilitation: Implications for working alliance and client engagement

BACKGROUND: Given the importance of working alliance to client engagement and outcomes in vocational rehabilitation, there is a need to better understand predictors of the client counselor relationship. Research has shown the tripartite efficacy model as a way of understanding working alliance in various contexts but has never been examined in vocational rehabilitation. OBJECTIVE: This study evaluates the relationship among tripartite efficacy beliefs constructs (self-efficacy, other-efficacy, and relation-inferred self-efficacy [RISE]), working alliance, and engagement for 350 clients receiving state vocational rehabilitation services. METHODS: Researchers used a path analysis to assess the hypothesis that the tripartite efficacy model would predict client engagement through its impact on working alliance. RESULTS: The hypothesized model had a close fit. Other-efficacy and RISE beliefs had significant positive direct effects on working alliance and indirect effects on client engagement. Self-efficacy had a significant negative direct effect on working alliance and client engagement. CONCLUSIONS: The study supports the tripartite efficacy beliefs model as a way of better understanding client perceptions of working alliance in vocational rehabilitation.

Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities

Purpose

The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses.

Methods

This is a cross-sectional correlational design study. Our participants are 156 veterans with self-reported mental illness (M_age = 37.85; SD_age = 10.74). Descriptive, correlation, and mediation analyses were conducted for the current study.

Results

Pain intensity was negatively correlated with physical health QOL, ability to participate in social roles and activities, and mental health QOL. Physical health QOL and ability to participate in social roles and activities were positively associated with mental health QOL, respectively. Physical health QOL was positively correlated with a ability to participate in social roles and activities. Study results indicate that the effect of pain intensity on mental health QOL can be explained by physical health QOL and ability to participate.

Conclusions

Specific recommendations for practitioners include implementing treatment goals that simultaneously focus on physical health and ability to participate in social roles and activities for clients who present with both physical pain and low mental health QOL.

Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis

AIM

Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications.

MATERIAL AND METHODS

40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality.

RESULTS

40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences.

CONCLUSIONS

SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN.

Influence of Acculturation on Emotional Learning and Memory in Spanish and English Speakers

Objective

The Emotional Verbal Learning Test-Spanish (EVLT-S) is a novel list learning test similar in structure to traditional verbal memory tests but contains words from 4 discrete emotional categories. Influence of acculturation on emotional learning was examined on EVLT-S learning trials 1 to 5.

Participants and Method

Participants included 50 bilingual healthy individuals in the Spanish-dominant group (Age M = 20.3years; 72% female) and 27 in the English-dominant group (Age M = 23.4years, 51.9% female). They were administered a battery of tests including the EVLT, a non-emotional verbal list learning test (LLT), Vocabulary (VC), Digit Span (DS), and The Short Acculturation Scale for Hispanics (SASH) in their dominant language. To examine learning curves a mixed model ANOVA was conducted with test (EVLT-S/EVLT, LLT-S/LLT) and trial as within-subjects variables and group (Spanish, English) as a between-subjects variable.

Results

There were significant main effects (p &lt; .005) for test, trial, and group. The Spanish-dominant group had the lowest overall performance on the EVLT-S (main effect for group). Post hoc comparisons of the Spanish-dominant group’s LLT-S and EVLT-S performance indicated significant differences at each trail (p &lt; .01), with the EVLT-S scores being lower than the LLT-S scores. The ANOVA was repeated with VC, DS, and SASH included as covariates. When controlling for these variables, the main effect for group was no longer significant. A significant trial by acculturation interaction effect emerged (p&lt;.05), with the English-dominant group generally performing better than the Spanish-dominant group.

Conclusions

Results suggest that Spanish and English language group differences were largely accounted for by word knowledge (VC), working memory (DS), and acculturation differences (SASH) between the groups. The role of these variables is discussed further in the context of acculturation.

Barriers and Concerns Regarding Board Certification in Clinical Neuropsychology: A Program Evaluation

Objective

The Relevance 2050 Initiative’s Student Pipeline Subcommittee and the Board Certification Promotion Committee of the American Academy of Clinical Neuropsychology, in collaboration with the American Board of Clinical Neuropsychology, produced the first installment of a free webinar series to promote early education on board certification (BC) in clinical neuropsychology. A pre-webinar survey was given to inform future webinar topics and initiatives, including identification of specific barriers/concerns about BC.

Method

A total of 197 respondents completed the survey and self-identified as White (61%), Asian (16%), Hispanic (11%), African American (6%) and Multiracial (6%). Respondents’ demographics, type of doctoral program, program accreditation status, level of interest in pursuing BC, and specific barriers/concerns about BC were collected. Respondents self-identified with the following diverse groups: first-generation college student (19% White, 38% Asian, 18% Hispanic, 16% African American, 41% Multiracial), low SES (8% White, 6% Asian, 36% Hispanic, 33% African American, 33% Multiracial) and sexual gender minority (6% White, 6% Asian, 9% Hispanic, 43% Multiracial).

Outcomes

Qualitative data analysis of barriers/concerns identified the following themes: money, time, knowledge about BC, training flexibility, breadth of knowledge, training/mentor opportunities, international issues, and documentation. The top three barriers included training/mentor opportunities, training flexibility, and knowledge about BC. More than half of non-White trainees (60%; χ2 = 3.864, p = .049) endorsed training/mentor opportunities as a barrier relative to White trainees (41%), particularly among Hispanic trainees (82%) relative to other minority trainees.

Discussion

Results highlight the need to increase awareness and information about the BC. Also suggested is prioritization of resources for training/mentor opportunities, particularly for minority trainees.

Molecular Cytogenetic Characterization of a Karyotype of a Female Patient with Secondary Amenorrhea with a Cell Line Showing 46,X,+mar

Disorders of sex development (DSD) include a group of conditions in which genotypes do not correlate with the typical male and female phenotypes. Numerical and structural abnormalities involving both autosomes and sex chromosomes have been observed in DSD. Specifically, deletions, duplications, and translocations involving specific genes as well as point mutations and less common aberrations have been implicated in the pathogenesis of these conditions. Finally, recent advances in analytical tools, namely chromosomal microarrays and sequencing methods, have greatly enhanced the precision with which DSD are genetically characterized and phenotypically correlated. Herein we report a case of a 24-year-old female patient who presented with secondary amenorrhea. Cytogenetic studies of her peripheral blood showed an abnormal clone with 45,X in three cells and the other was initially observed by chromosome analysis as 46,X,+mar in 27 cells. Molecular cytogenetics were performed to characterize the marker chromosome that showed two copies of the SRY, two copies of the heterochromatin Yq12, and two copies of the Y centromere Yp11.1-q11.1 on the marker chromosome, resulting in the identification of an isodicentric Y chromosome. Females with a 46,XY karyotype have gonadal dysgenesis and typically present as mosaic, along with a 45,X cell line. Some show small deletions of the short arm of the Y chromosome. Further studies based on the clinical picture, as well as possible prophylactic gonadectomy due to an increased risk of gonadal malignancy, gonadoblastoma or dysgerminoma, are suggested. Genetic counseling was recommended.

An autonomous robot for continuous tracking of millimetric-sized walkers

The precise and continuous tracking of millimetric-sized walkers-such as ants-is quite important in behavioral studies. However, due to technical limitations, most studies concentrate on trajectories within areas no more than 100 times bigger than the size of the walker or longer trajectories at the expense of either accuracy or continuity. Our work describes a scientific instrument designed to push the boundaries of precise and continuous motion analysis up to 1000 body lengths or more. It consists of a mobile robotic platform that uses digital image processing techniques to track the targets in real time by calculating their spatial position. During the experiments, all the images are stored and afterwards processed to estimate with higher precision the path traced by the walkers. Some preliminary results achieved using the proposed tracking system are presented.

Flourishing in Student Veterans With and Without Service-Connected Disability: Psychometric Validation of the Flourishing Scale and Exploration of Its Relationships With Personality and Disability

Veterans are an increasing population in postsecondary education. Many student veterans have disabilities affecting their well-being and success in college. This study aims to add to current knowledge on well-being by exploring the relationship between flourishing, personality traits, and service-connected disability among student veterans. First, we set out to psychometrically validate the Flourishing Scale (FS) for student veterans. Second, we evaluated the association of the Big-Five personality traits and flourishing. Finally, we evaluated the differences in flourishing among student veterans with and without service-connected disabilities. Two hundred five student veterans were recruited for the current study. A random split-half approach was adopted to perform an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Subsequent to conducting the EFA and CFA, a hierarchical multiple regression analysis was performed to investigate the relationships between flourishing and Big-Five personality traits. Finally, an independent-samples t test was conducted to compare the flourishing scores of student veterans with and without a service-connected disability. Findings indicated FS is a reliable and valid scale that could be used to measure flourishing in student veterans. Detailed findings and their implications for rehabilitation counseling are provided.

Two-Photon Microscopy and Spectroscopy Studies to Determine the Mechanism of Copper Oxide Nanoparticle Uptake by Sweetpotato Roots during Postharvest Treatment

The interaction of engineered nanoparticles with plant tissues is still not well understood. There is a lack of information about the effects of curing (postharvest treatment) and lignin content on copper uptake by sweetpotato roots exposed to copper-based nanopesticides. In this study, Beauregard-14 (lower lignin) and Covington (higher lignin) varieties were exposed to CuO nanoparticles (nCuO), bulk CuO (bCuO), and CuCl₂ at 0, 25, 75, and 125 mg/L. Cured and uncured roots were submerged into copper suspensions/solutions for 30 min. Subsequently, root segments were sliced for imaging with a 2-photon microscope, while other root portions were severed into periderm, cortex, perimedulla, and medulla. They were individually digested and analyzed for Cu content by inductively coupled plasma-optical emission spectroscopy. Microscopy images showed higher fluorescence in periderm and cortex of roots exposed to nCuO, compared with bCuO. At 25 mg/L, only bCuO showed higher Cu concentration in the periderm and cortex of Beauregard-14 (2049 mg/kg and 76 mg/kg before curing; 6769 mg/kg and 354 mg/kg after curing, respectively) and in cortex of Covington (692 mg/kg before curing and 110 mg/kg after curing) compared with controls ( p ≤ 0.05). In medulla, the most internal tissue, only Beauregard-14 exposed to 125 mg bCuO/L showed significantly ( p ≤ 0.05) more Cu before curing (17 mg/kg) and after curing (28 mg/kg), compared with control. This research has shown that the 2-photon microscope can be used to determine CuO particles in nondyed plant tissues. The lack of Cu increase in perimedulla and medulla, even in roots exposed to high CuO concentrations (125 mg/L), suggests that nCuO may represent a good alternative to protect and increase the shelf life of sweetpotato roots, without exposing consumers to excess Cu.

Endoscopic ultrasound cytologic brushing vs endoscopic ultrasound - fine needle aspiration for cytological diagnosis of cystic pancreatic lesions. A multicenter, randomized open-label trial

INTRODUCTION

the incidence of cystic pancreatic lesions (CPL) in the asymptomatic population is increasing. Achieving a preoperative diagnosis of CPL still remains a challenge.

OBJECTIVES

to evaluate the diagnostic accuracy of the cytological diagnosis of CPL from samples obtained by cytology brush versus standard endoscopic ultrasound fine needle aspiration (EUS-FNA).

METHODS

a multicenter, randomized, open-label trial was performed of EUS-cytology brush (EUS-EB) versus EUS-FNA for the cytological diagnosis of CPL. Patients that underwent EUS-FNA with a CPL > 15 mm were included and randomized into two groups: group I, EUS-EB; group II, EUS-FNA. The final diagnosis was based on the histological evaluation of surgical specimens and clinical parameters, imaging and a five year follow-up in non-operated patients. The main outcome was the diagnostic accuracy of both methods. Secondary outcomes were the diagnostic adequacy of specimens and the rate of adverse events. Data were compared using the Chi-squared test. An intention to treat (ITT) and per-protocol (PP) analysis were performed.

RESULTS

sixty-five patients were included in the study, 31 in group I and 34 in group II. Three patients initially randomized to group I were changed to group II as it was impossible to obtain a sample using the brush. The mean size of the CPL was 28.2 mm (range 16-60 mm). The diagnostic accuracy of EUS-EB was not superior to EUS-FNA, neither in the ITT nor the PP analysis (44.8% vs 41.1%, p = 0.77 and 38.4% vs 45.9%, p = 0.55).

CONCLUSIONS

EUS-EB does not improve the diagnostic accuracy of CPL in comparison with EUS-FNA.

Modeling children's development in gross motor coordination reveals key modifiable determinants. An allometric approach

Children change their body size, shape, and gross motor coordination (GMC) as they grow. Further, GMC is expected to link to changes in children's body size, physical activity (PA), and physical fitness (PF). The objective was to model GMC changes in children followed longitudinally and to investigate associations between these changes and PA and PF levels. A total of 245 children (122 girls) were observed at 6 years of age and followed annually until 9 years. A sequence of allometric models was fitted, that is, 1. body mass, stature, and PA; 2. addition of four PF tests; 3. addition of four more PF tests. In Model 1, changes in GMC are nonlinear, and body mass (-0.60 ± 0.07, P < .001) and stature (2.91 ± 0.35, P < .001) parameter estimates were significant suggesting children with a more linear body size/shape showed higher GMC performances. Girls tend to outperform boys across time, and PA was not associated with GMC changes. Model 2 fitted the data better, and the PF tests (handgrip, standing long jump, 50-yard dash, and shuttle run) were significantly linked to GMC change. In Model 3, adding the remaining PF tests did not change the order of any factors importance. The greatest GMC changes were achieved by children whose body size/shape has an ectomorphic dominance across the years. Considering that leaner and physically fitter children tended to be more coordinated, physical education should also focus on PF development in components related to muscular strength, speed, agility, and aerobic capacity, along with nutritional education to reduce fat mass.

Desflurane versus propofol in post-operative quality of recovery of patients undergoing day laparoscopic cholecystectomy. Prospective, comparative, non-inferiority study

OBJECTIVE

Recently, the evaluation of postoperative results has focused on the opinion of the patient as of great relevance. Our objective was to evaluate the quality of recovery by questionnaire (QoR-15) in patients undergoing laparoscopic cholecystectomy, comparing desflurane versus a total intravenous technique with propofol (TIVA). A non-inferiority hypothesis was proposed between both techniques.

MATERIAL AND METHODS

Prospective longitudinal cohort study in patients undergoing laparoscopic cholecystectomy in which multimodal management was applied including low pneumoperitoneum pressures, deep neuromuscular block and pain prevention strategy and PONV. Anaesthesia maintenance was performed with either desflurane or propofol at the discretion of the anaesthesiologist. QoR-15 was evaluated pre-and 24hours after surgery.

RESULTS

Sixty-one patients were evaluated: 29 in the desflurane group and 32 in the TIVA group with no differences in demographic parameters, ASA grade, and preoperative QoR-15 questionnaire. The duration of the intervention was superior in TIVA group, 55 ± 15 vs. 45 ± 9min in desflurane group; p =.05. The desflurane group received more fentanyl than the TIVA group: 200 ± 65 vs. 113 ± 38μg; p =.05. No differences in pain, PONV or time of stay between groups. QoR-15 at 24h decreased 7% relative to baseline, with no differences between groups.

CONCLUSIONS

The quality of recovery evaluated by the patient was as favourable in the patients of the desflurane group as in those of the TIVA group in patients undergoing laparoscopic cholecystectomy as outpatients.