Cerebral malaria in children is associated with long-term cognitive impairment

OBJECTIVE

Cerebral malaria affects >785000 African children every year. We previously documented an increased frequency of cognitive impairment in children with cerebral malaria 6 months after their initial malaria episode. This study was conducted to determine the long-term effects of cerebral malaria on the cognitive function of these children.

METHODS

Children who were 5 to 12 years of age and presented to Mulago Hospital, Kampala, Uganda, with cerebral malaria (n = 44) or uncomplicated malaria (n = 54), along with healthy, asymptomatic community children (n = 89), were enrolled in a prospective cohort study of cognition. Cognitive testing was performed at enrollment and 2 years later. The primary outcome was presence of a deficit in >or=1 of 3 cognitive areas tested.

RESULTS

At 2-year follow-up testing, 26.3% of children with cerebral malaria and 12.5% with uncomplicated malaria had cognitive deficits in >or=1 area, as compared with 7.6% of community children. Deficits in children with cerebral malaria were primarily in the area of attention (cerebral malaria, 18.4%, vs community children, 2.5%). After adjustment for age, gender, nutrition, home environment, and school level, children with cerebral malaria had a 3.67-fold increased risk for a cognitive deficit compared with community children. Cognitive impairment at 2-year follow-up was associated with hyporeflexia on admission and neurologic deficits 3 months after discharge.

CONCLUSIONS

Cerebral malaria is associated with long-term cognitive impairments in 1 of 4 child survivors. Future studies should investigate the mechanisms involved so as to develop interventions aimed at prevention and rehabilitation.

Cognitive impairment after cerebral malaria in children: a prospective study

OBJECTIVE

This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria.

METHODS

Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later.

RESULTS

Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits.

CONCLUSIONS

Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.

Crassulacean acid metabolism and fitness under water deficit stress: if not for carbon gain, what is facultative CAM good for?

BACKGROUND

In obligate Crassulacean acid metabolism (CAM), up to 99 % of CO(2) assimilation occurs during the night, therefore supporting the hypothesis that CAM is adaptive because it allows CO(2) fixation during the part of the day with lower evaporative demand, making life in water-limited environments possible. By comparison, in facultative CAM (inducible CAM, C(3)-CAM) and CAM-cycling plants drought-induced dark CO(2) fixation may only be, with few exceptions, a small proportion of C(3) CO(2) assimilation in watered plants and occur during a few days. From the viewpoint of survival the adaptive advantages, i.e. increased fitness, of facultative CAM and CAM-cycling are not obvious. Therefore, it is hypothesized that, if it is to increase fitness, CAM must aid in reproduction. Scope An examination of published reports of 23 facultative CAM and CAM-cycling species finds that, in 19 species, drought-induced dark CO(2) fixation represents on average 11 % of C(3) CO(2) assimilation of watered plants. Evidence is discussed on the impact of the operation of CAM in facultative and CAM-cycling plants on their survival--carbon balance, water conservation, water absorption, photo-protection of the photosynthetic apparatus--and reproductive effort. It is concluded that in some species, but not all, facultative and cycling CAM contribute, rather than to increase carbon balance, to increase water-use efficiency, water absorption, prevention of photoinhibition and reproductive output.

Assessment of anhedonia in psychological trauma: development of the Hedonic Deficit and Interference Scale

Symptoms of anhedonia, or deficits in the ability to experience positive affect, are increasingly recognized as an outcome of traumatic stress. Herein we demonstrate a phenomenon of "negative affective interference", specifically, negative affective responses to positive events, in association with childhood trauma history. Young adults (n=99) completed a Hedonic Deficit & Interference Scale (HDIS), a self-report measure developed for this study, as well as a modified version of the Fawcette-Clarke Pleasure Capacity Scale that assessed not only positive but also negative affective responses to positive events. The two assessment approaches demonstrated convergent validity and predicted concurrent individual differences in trait positive and negative affect, and extraversion and neuroticism. Histories of childhood emotional and sexual abuse were differentially associated with negative affective responses to positive events. Future research and clinical directions are discussed.

Deficit schizophrenia: association with serum antibodies to cytomegalovirus

BACKGROUND

Patients with deficit schizophrenia differ from nondeficit patients with schizophrenia relative to several neurobiological correlates and relative to the risk factors of family history and season of birth. Exposure to human herpesviruses is a possible risk factor for schizophrenia. We hypothesized that there would be deficit/nondeficit difference in the prevalence of serum antibodies to human herpesviruses.

METHODS

In deficit (N = 88) and nondeficit (N = 235) schizophrenia patients, we measured IgG class antibodies to the 6 known human herpesviruses: herpes simplex virus type 1, herpes simplex virus type 2, cytomegalovirus, Epstein-Barr virus, human herpes virus 6, and varicella-zoster virus.

RESULTS

Deficit categorization was associated with the presence of serum antibodies to cytomegalovirus (odds ratio = 2.01, p = .006). This association remained significant after covarying for positive psychotic symptoms and demographic features known to be associated with cytomegalovirus seropositivity and after correcting for multiple comparisons. An association between herpes simplex virus type 1 and deficit status was not significant after covarying for potentially confounding variables. No other human herpesvirus was significantly associated with deficit versus nondeficit categorization.

CONCLUSIONS

The association between deficit schizophrenia and cytomegalovirus antibody seropositivity provides further evidence for differences in etiopathophysiology between deficit and nondeficit schizophrenia.

More than $1 billion needed annually to secure Africa's protected areas with lions

Protected areas (PAs) play an important role in conserving biodiversity and providing ecosystem services, yet their effectiveness is undermined by funding shortfalls. Using lions (Panthera leo) as a proxy for PA health, we assessed available funding relative to budget requirements for PAs in Africa's savannahs. We compiled a dataset of 2015 funding for 282 state-owned PAs with lions. We applied three methods to estimate the minimum funding required for effective conservation of lions, and calculated deficits. We estimated minimum required funding as $978/km2 per year based on the cost of effectively managing lions in nine reserves by the African Parks Network; $1,271/km2 based on modeled costs of managing lions at ≥50% carrying capacity across diverse conditions in 115 PAs; and $2,030/km2 based on Packer et al.'s [Packer et al. (2013) Ecol Lett 16:635-641] cost of managing lions in 22 unfenced PAs. PAs with lions require a total of $1.2 to $2.4 billion annually, or ∼$1,000 to 2,000/km2, yet received only $381 million annually, or a median of $200/km2 Ninety-six percent of range countries had funding deficits in at least one PA, with 88 to 94% of PAs with lions funded insufficiently. In funding-deficit PAs, available funding satisfied just 10 to 20% of PA requirements on average, and deficits total $0.9 to $2.1 billion. African governments and the international community need to increase the funding available for management by three to six times if PAs are to effectively conserve lions and other species and provide vital ecological and economic benefits to neighboring communities.

Digital phenotyping of negative symptoms: the relationship to clinician ratings

Negative symptoms are a critical, but poorly understood, aspect of schizophrenia. Measurement of negative symptoms primarily relies on clinician ratings, an endeavor with established reliability and validity. There have been increasing attempts to digitally phenotype negative symptoms using objective biobehavioral technologies, eg, using computerized analysis of vocal, speech, facial, hand and other behaviors. Surprisingly, biobehavioral technologies and clinician ratings are only modestly inter-related, and findings from individual studies often do not replicate or are counterintuitive. In this article, we document and evaluate this lack of convergence in 4 case studies, in an archival dataset of 877 audio/video samples, and in the extant literature. We then explain this divergence in terms of "resolution"-a critical psychometric property in biomedical, engineering, and computational sciences defined as precision in distinguishing various aspects of a signal. We demonstrate how convergence between clinical ratings and biobehavioral data can be achieved by scaling data across various resolutions. Clinical ratings reflect an indispensable tool that integrates considerable information into actionable, yet "low resolution" ordinal ratings. This allows viewing of the "forest" of negative symptoms. Unfortunately, their resolution cannot be scaled or decomposed with sufficient precision to isolate the time, setting, and nature of negative symptoms for many purposes (ie, to see the "trees"). Biobehavioral measures afford precision for understanding when, where, and why negative symptoms emerge, though much work is needed to validate them. Digital phenotyping of negative symptoms can provide unprecedented opportunities for tracking, understanding, and treating them, but requires consideration of resolution.

Resection of tumors within the primary motor cortex using high-frequency stimulation: oncological and functional efficiency of this versatile approach based on clinical conditions

OBJECTIVE

Brain mapping techniques allow one to effectively approach tumors involving the primary motor cortex (M1). Tumor resectability and maintenance of patient integrity depend on the ability to successfully identify motor tracts during resection by choosing the most appropriate neurophysiological paradigm for motor mapping. Mapping with a high-frequency (HF) stimulation technique has emerged as the most efficient tool to identify motor tracts because of its versatility in different clinical settings. At present, few data are available on the use of HF for removal of tumors predominantly involving M1.

METHODS

The authors retrospectively analyzed a series of 102 patients with brain tumors within M1, by reviewing the use of HF as a guide. The neurophysiological protocols adopted during resections were described and correlated with patients' clinical and tumor imaging features. Feasibility of mapping, extent of resection, and motor function assessment were used to evaluate the oncological and functional outcome to be correlated with the selected neurophysiological parameters used for guiding resection. The study aimed to define the most efficient protocol to guide resection for each clinical condition.

RESULTS

The data confirmed HF as an efficient tool for guiding resection of M1 tumors, affording 85.3% complete resection and only 2% permanent morbidity. HF was highly versatile, adapting the stimulation paradigm and the probe to the clinical context. Three approaches were used. The first was a "standard approach" (HF "train of 5," using a monopolar probe) applied in 51 patients with no motor deficit and seizure control, harboring a well-defined tumor, showing contrast enhancement in most cases, and reaching the M1 surface. Complete resection was achieved in 72.5%, and 2% had permanent morbidity. The second approach was an "increased train approach," that is, an increase in the number of pulses (7-9) and of pulse duration, using a monopolar probe. This second approach was applied in 8 patients with a long clinical history, previous treatment (surgery, radiation therapy, chemotherapy), motor deficit at admission, poor seizure control, and mostly high-grade gliomas or metastases. Complete resection was achieved in 87.5% using this approach, along with 0% permanent morbidity. The final approach was a "reduced train approach," which was the combined use of train of 2 or train of 1 pulses associated with the standard approach, using a monopolar or bipolar probe. This approach was used in 43 patients with a long clinical history and poorly controlled seizures, harboring tumors with irregular borders without contrast enhancement (low or lower grade), possibly not reaching the cortical surface. Complete resection was attained in 88.4%, and permanent morbidity was found in 2.3%.

CONCLUSIONS

Resection of M1 tumors is feasible and safe. By adapting the stimulation paradigm and probe appropriately to the clinical context, the best resection and functional results can be achieved.

Bridging sensory and language theories of dyslexia: Toward a multifactorial model

Competing theories of dyslexia posit that reading difficulties arise from impaired visual, auditory, phonological, or statistical learning mechanisms. Importantly, many theories posit that dyslexia reflects a cascade of impairments emanating from a single “core deficit”. Here we report two studies evaluating core deficit and multifactorial models. In Study 1, we use publicly available data from the Healthy Brain Network to test the accuracy of phonological processing measures for predicting dyslexia diagnosis and find that over 30% of cases are misclassified (sensitivity = 66.7%; specificity = 68.2%). In Study 2, we collect a battery of psychophysical measures of visual motion processing and standardized measures of phonological processing in 106 school‐aged children to investigate whether dyslexia is best conceptualized under a core‐deficit model, or as a disorder with heterogenous origins. Specifically, by capitalizing on the drift diffusion model to analyze performance on a visual motion discrimination experiment, we show that deficits in visual motion processing, perceptual decision‐making, and phonological processing manifest largely independently. Based on statistical models of how variance in reading skill is parceled across measures of visual processing, phonological processing, and decision‐making, our results challenge the notion that a unifying deficit characterizes dyslexia. Instead, these findings indicate a model where reading skill is explained by several distinct, additive predictors, or risk factors, of reading (dis)ability.

A study of pediatric cerebral arteriovenous malformations: clinical presentation, radiological features, and long-term functional and educational outcomes with predictors of sustained neurological deficits

OBJECTIVE

Large experiences with the treatment of pediatric arteriovenous malformations (AVMs) remain relatively rare, with limited data on presentation, treatment, and long-term functional outcomes. Because of the expected long lifespan of children, caregivers are especially interested in outcome measures that assess quality of life. The authors' intention was to describe the long-term functional outcomes of pediatric patients who undergo AVM surgery and to identify predictors of sustained neurological deficits.

METHODS

The authors analyzed a 21-year retrospective cohort of pediatric patients with intracranial AVMs treated with microsurgery at two institutions. The primary outcome was a persistent neurological deficit at last follow-up. Secondary outcome measures included modified Rankin Scale (mRS) score and independent living.

RESULTS

Overall, 97 patients (mean age 11.1 ± 4.5 years; 56% female) were treated surgically for intracranial AVMs (mean follow-up 77.5 months). Sixty-four patients (66%) presented with hemorrhage, and 45 patients (46%) had neurological deficits at presentation. Radiologically, 39% of lesions were Spetzler-Martin grade II. Thirty-seven patients (38%) with persistent neurological deficits at last follow-up were compared with those without deficits; there were no differences in patient age, presenting Glasgow Coma Scale score, AVM size, surgical blood loss, or duration of follow-up. Multivariate analysis demonstrated that a focal neurological deficit on presentation, AVM size > 3 cm, and lesions in eloquent cortex were independent predictors of persistent neurological deficits at long-term follow-up. Overall, 92% of the children had an mRS score ≤ 2 on long-term follow-up.

CONCLUSIONS

Pediatric patients with AVMs treated with microsurgical resection have good functional and radiological outcomes. There is a high rate (38%) of persistent neurological deficits, which were independently predicted by preoperative deficits, AVMs > 3 cm, and lesions located in eloquent cortex. This information can be useful in counseling families on the likelihood of long-term neurological deficits after cerebral AVM surgery.

Progress in the study of negative symptoms

A selective review of the negative symptoms of schizophrenia is an appropriate article to result from the festschrift honoring William T. Carpenter Jr, as he has made substantial contributions in this area. This review assesses progress in 3 areas in which he has been an important investigator: the distinction between primary vs secondary negative symptoms; the appropriate design for treatment trials; and the nosology of negative symptoms.

Psychiatric symptom versus neurocognitive correlates of diminished expressivity in schizophrenia and mood disorders

Diminished expressivity is a poorly understood, but important construct for a range of mental diseases. In the present study, we employed computerized acoustic analysis of natural speech to understand diminished expressivity in patients with schizophrenia and mood disorders. We were interested in the degree to which speech characteristics tapping alogia (i.e., average pause duration) and blunted affect (i.e., prosody computed from fundamental frequency and intensity) reflected psychiatric symptoms (i.e., depression, anxiety, paranoia and bizarre behavior) versus neurocognitive deficits. Twenty-six subjects with schizophrenia and 22 subjects with mood disorders provided speech samples in response to a variety of laboratory stimuli and completed neuropsychological batteries assessing a range of abilities. For both the schizophrenia and mood disorder groups, attentional coding deficits were significantly correlated with increased pause time (at large effect size levels) and, for the schizophrenia group only, reduced prosody (also at a large effect size level). For the mood disorder but not the schizophrenia group, increased average pause time was also significantly associated with neurocognitive deficits on a range of other tests (medium to large effect size levels). Psychiatric symptoms were not significantly associated with speech characteristics for either group (generally, negligible effect sizes). These results suggest that there is a link between expressivity and neurocognitive dysfunctions for both patients with schizophrenia and mood disorders. Implications and future research directions are discussed.

Neurologic recovery after anterior cervical discectomy and fusion

Study Design Retrospective review. Objective The objective of this study is to describe the natural history of neurologic recovery after anterior cervical discectomy and fusion (ACDF). Methods Patients between 18 and 80 years of age, diagnosed with cervical radiculopathy, who underwent single-level ACDF and were followed for a minimum of 2 years were identified from a single-center database. Sensory and motor deficits were documented and graded based on physical examination findings at preoperative and postoperative visits, and used to calculate deficit rates. Results One hundred eighteen patients were included in the study. Mean age was 46 ± 9.2 years and mean follow-up time was 3.8 ± 2.1 years. At the time of surgery, 66% had a sensory deficit. Recovery of sensory function was seen in 85% of patients within 1 year. At final follow-up, new sensory deficits had developed in 30% of patients, 60% of whom had adjacent-level sensory deficits. Patients with preoperative sensory deficits tended to be more likely to develop a new deficit postoperatively (p = 0.05). At the time of surgery, 55% had a motor deficit. Recovery of motor function was seen in 95% of patients within 1 year, and 14% developed new postoperative motor deficits by final follow-up. Of those patients who developed a new motor deficit postoperatively, 76% did so at an adjacent level. Conclusions In our series, a high percentage of patients recovered neurologic function during the first year after ACDF. Adjacent-level and remote-level degeneration were large contributors to neurologic deficits that occurred in subsequent years.

Cognitive dysfunction in pediatric multiple sclerosis

Cognitive and neuropsychological impairments are well documented in adult multiple sclerosis (MS). Research has only recently focused on cognitive disabilities in pediatric cases, highlighting some differences between pediatric and adult cases. Impairments in several functions have been reported in children, particularly in relation to attention, processing speed, visual-motor skills, and language. Language seems to be particularly vulnerable in pediatric MS, unlike in adults in whom it is usually preserved. Deficits in executive functions, which are considered MS-specific in adults, have been inconsistently reported in children. In children, as compared to adults, the relationship between cognitive dysfunctions and the two other main symptoms of MS, fatigue and psychiatric disorders, was poorly explored. Furthermore, data on the correlations of cognitive impairments with clinical and neuroimaging features are scarce in children, and the results are often incongruent; interestingly, involvement of corpus callosum and reduced thalamic volume differentiated patients identified as having a cognitive impairment from those without a cognitive impairment. Further studies about pediatric MS are needed in order to better understand the impact of the disease on brain development and the resulting effect on cognitive functions, particularly with respect to different therapeutic strategies.

Surgical intervention for pituitary apoplexy: an analysis of functional outcomes

OBJECTIVE Pituitary apoplexy is a clinical syndrome consisting of neurological and endocrine abnormalities secondary to hemorrhage or ischemia of an underlying pituitary adenoma. The authors investigated whether there was a significant difference in neurological, endocrine, and nonneuroendocrine outcomes for patients with pituitary apoplexy, based on the time between symptom onset and surgical intervention. METHODS The authors retrospectively analyzed the medical records of 32 patients who had presented to their institution with acute pituitary apoplexy and subsequently undergone endonasal transsphenoidal resection in the period from 2003 to 2014. All patients had undergone preoperative MRI demonstrating evidence of apoplexy in the form of intratumoral hemorrhage, ischemia, and necrosis. Neurological deficits, partial or complete endocrinopathy, and nonneuroendocrine abnormalities were analyzed both pre- and postoperatively. RESULTS Preoperatively, neurological deficits including visual loss and cranial nerve palsies were found in 31 (97%) of the 32 patients, endocrinopathy in the form of partial or panhypopituitarism was seen in 28 patients (88%), and nonneuroendocrine signs and symptoms were seen in 32 patients (100%). Thirteen patients (41%) underwent surgery within 72 hours of symptom onset ("early"), whereas 19 patients (59%) underwent surgery more than 72 hours from symptom onset ("delayed"). Early versus delayed resection did not appear to significantly improve visual deficits, total visual loss, resolution of oculomotor palsy, recovery from hypopituitarism, or nonneuroendocrine signs and symptoms such as headache and encephalopathy. Overall, visual improvement was seen in 77% of patients, complete restoration of normal vision in 38% of patients, and resolution of preoperative oculomotor palsies in 81% of patients. Only 6 (21%) of 28 patients showed evidence of partial hormone recovery following preoperative hypopituitarism. An absence of benefit for early surgery held true even when considering time to surgery from symptom onset as a continuous variable. CONCLUSIONS Neurological deficits such as visual loss and cranial neuropathies show moderate improvement following surgical decompression, as does preoperative hypopituitarism. The timing of surgical intervention relative to the onset of symptoms does not appear to significantly affect the resolution of neurological or endocrinological deficits.

Inferior alveolar nerve injuries associated with mandibular fractures at risk: a two-center retrospective study

The aim of the study was to investigate the incidence of the inferior alveolar nerve (IAN) injury in mandibular fractures. This study is based on two databases that have continuously recorded patients hospitalized with maxillofacial fractures in two departments-Department of Maxillofacial Surgery, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands, and Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy. Demographic, anatomic, and etiology variables were considered for each patient and statistically assessed in relation to the neurosensory IAN impairment. Statistically significant associations were found between IAN injury and fracture displacement (p = 0.03), isolated mandibular fractures (p = 0.01), and angle fractures (p = 0.004). A statistically significant association was also found between IAN injury and assaults (p = 0.03). Displaced isolated mandibular angle fractures could be considered at risk for increased incidence of IAN injury. Assaults seem to be the most important etiological factor that is responsible for IAN lesions.

General intellectual ability does not explain the general deficit in schizophrenia

Patients with schizophrenia demonstrate a generalized deficit across multiple cognitive domains. However, it is unknown whether this deficit is largely due to lower intelligence, or if there is an impact of schizophrenia which cannot be accounted for by measures of general intellectual ability (GIA). We created four IQ-matched strata of equal width between 89 healthy volunteers (HC) and 77 patients with schizophrenia (SZ) who had very similar IQ and reading scores within each stratum, then compared each stratum's performance on the MATRICS Consensus Cognitive Battery (MCCB). We hypothesized that any patient impairment on the MCCB after matching on IQ would be evidence that GIA does not fully explain the general deficit seen in schizophrenia. We found that patients showed evidence of greater neuropsychological impairment than what would be expected based solely on their IQ and reading ability scores. Further, this deficit was stronger in some cognitive domains than others, namely, processing speed and social cognition. These results suggest the presence of a distinction between GIA and generalized neuropsychological impairment that was consistent in magnitude across all patients, regardless of IQ.

Inequity in Distribution of Psychiatry Trainee Seats and Institutes Across Indian States: A Critical Analysis

Background  The delivery of mental health services largely depends on the adequacy of human resources. In India, the deficit of psychiatrists is more than 90% and is one of the major challenges that needs to be tackled to address the huge burden of mental illness. Psychiatry trainee institutes play a vital role in reducing human resource deficit and inequality in delivering mental health care. However, the distribution pattern of psychiatry trainee seats and institutes across Indian states is unknown. Therefore, we estimated the number of psychiatry trainee seats and institutes in each Indian state and union territory (UT). Materials and Methods  In this cross-sectional study, psychiatry trainee seats and institutes were searched on the official web sites of Medical Council of India and National Board of Examinations. The data available on these web sites until December 2019 were included. State-wise data were compared using proportion and percentages. The psychiatry trainee index (PTI) was calculated and compared across Indian states and UTs. Results  Among 221 Indian psychiatry trainee institutes considered in the present study, 116 (52.48%) were private institutes and 105 (47.51%) were government institutes. Overall, more psychiatry trainee seats were reported in government institutes ( n = 565, 65.89%) than in private institutes. National PTI was considered fair (0.06), and based on their PTIs, Indian states and UTs were classified as follows: worst ( n = 9), poor ( n = 8), fair ( n = 9), average ( n = 7), good ( n = 1), and excellent ( n = 2). Conclusion  A huge deficit of psychiatry trainees and institutes exists in more than two-thirds of Indian states and UTs, along with a huge maldistribution of seats. PTI and its distribution across the states and UTs are a crucial indicator of the need to improve the access and equity of mental health care.

Aging at Work: A Review of Recent Trends and Future Directions

Demographic data suggest a rapid aging trend in the active workforce. The concept of aging at work comes from the urgent requirement to help the aging workforce of the contemporary industries to maintain productivity while achieving a work and private life balance. While there is plenty of research focusing on the aging population, current research activities on policies covering the concept of aging at work are limited and conceptually different. This paper aims to review publications on aging at work, which could lead to the creation of a framework that targets governmental decision-makers, the non-governmental sector, the private sector, and all of those who are responsible for the formulation of policies on aging at work. In August 2019 we searched for peer-reviewed articles in English that were indexed in PubMed, IEEE Xplore, and Springer and published between 2008 and 2019. The keywords included the following phrases: “successful aging at work”, “active aging at work”, “healthy aging at work”, “productive aging at work”, and “older adults at work”. A total of 47,330 publications were found through database searching, and 25,187 publications were screened. Afterwards, 7756 screened publications were excluded from the further analysis, and a total of 17,431 article abstracts were evaluated for inclusion. Finally, further qualitative analysis included 1375 articles, of which about 24 are discussed in this article. The most prominent works suggest policies that encourage life-long learning, and a workforce that comprises both younger and older workers, as well as gradual retirement.

Capturing the Cranio-Caudal Signature of a Turn with Inertial Measurement Systems: Methods, Parameters Robustness and Reliability

Background

Turning is a challenging mobility task requiring coordination and postural stability. Optimal turning involves a cranio-caudal sequence (i.e., the head initiates the motion, followed by the trunk and the pelvis), which has been shown to be altered in patients with neurodegenerative diseases, such as Parkinson’s disease as well as in fallers and frails. Previous studies have suggested that the cranio-caudal sequence exhibits a specific signature corresponding to the adopted turn strategy. Currently, the assessment of cranio-caudal sequence is limited to biomechanical labs which use camera-based systems; however, there is a growing trend to assess human kinematics with wearable sensors, such as attitude and heading reference systems (AHRS), which enable recording of raw inertial signals (acceleration and angular velocity) from which the orientation of the platform is estimated. In order to enhance the comprehension of complex processes, such as turning, signal modeling can be performed.

Aim

The current study investigates the use of a kinematic-based model, the sigma-lognormal model, to characterize the turn cranio-caudal signature as assessed with AHRS.

Methods

Sixteen asymptomatic adults (mean age = 69.1 ± 7.5 years old) performed repeated 10-m Timed-Up-and-Go (TUG) with 180° turns, at varying speed. Head and trunk kinematics were assessed with AHRS positioned on each segments. Relative orientation of the head to the trunk was then computed for each trial and relative angular velocity profile was derived for the turn phase. Peak relative angle (variable) and relative velocity profiles modeled using a sigma-lognormal approach (variables: Neuromuscular command amplitudes and timing parameters) were used to extract and characterize the cranio-caudal signature of each individual during the turn phase.

Results

The methodology has shown good ability to reconstruct the cranio-caudal signature (signal-to-noise median of 17.7). All variables were robust to speed variations (p > 0.124). Peak relative angle and commanded amplitudes demonstrated moderate to strong reliability (ICC between 0.640 and 0.808).

Conclusion

The cranio-caudal signature assessed with the sigma-lognormal model appears to be a promising avenue to assess the efficiency of turns.

Cognitively Impaired Physicians: How Do We Detect Them? How Do We Assist Them?

Our older physicians, an increasing number of those in practice, constitute a valuable human resource in the medical profession. Professional satisfaction, increasing life expectancy, concerns regarding financial security, and reluctance to retire are among the many reasons a physician might choose to extend practice into later adulthood. Despite the benefits of experience and expertise acquired by older physicians, cognitive changes associated with normal or pathological aging have been shown to have a significant negative effect on physician performance. Age-based cognitive assessment of physicians has been adopted in some countries and by some U.S. healthcare institutions for patient protection and improvement of physician quality of life, but there is no general guideline for the assessment and assistance of cognitively impaired late career physicians in the United States. Self-reports and reports from peers are an inadequate safeguard, leaving impaired physicians and their patients at risk. In this discussion, we will describe cognitive aging, the effects of cognitive aging on physician performance, some current monitoring systems, and recommendations for identifying and assisting physicians found to be impaired.

Deep learning-based identification of acute ischemic core and deficit from non-contrast CT and CTA

The accurate identification of irreversible infarction and salvageable tissue is important in planning the treatments for acute ischemic stroke (AIS) patients. Computed tomographic perfusion (CTP) can be used to evaluate the ischemic core and deficit, covering most of the territories of anterior circulation, but many community hospitals and primary stroke centers do not have the capability to perform CTP scan in emergency situation. This study aimed to identify AIS lesions from widely available non-contrast computed tomography (NCCT) and CT angiography (CTA) using deep learning. A total of 345AIS patients from our emergency department were included. A multi-scale 3D convolutional neural network (CNN) was used as the predictive model with inputs of NCCT, CTA, and CTA+ (8 s delay after CTA) images. An external cohort with 108 patients was included to further validate the generalization performance of the proposed model. Strong correlations with CTP-RAPID segmentations (r = 0.84 for core, r = 0.83 for deficit) were observed when NCCT, CTA, and CTA+ images were all used in the model. The diagnostic decisions according to DEFUSE3 showed high accuracy when using NCCT, CTA, and CTA+ (0.90±0.04), followed by the combination of NCCT and CTA (0.87±0.04), CTA-alone (0.76±0.06), and NCCT-alone (0.53±0.09).

Increased serum levels of apoptosis in deficit syndrome schizophrenia patients: a preliminary study

BACKGROUND

Schizophrenia is a chronic and debilitating disorder, the etiology of which remains unclear. Apoptosis is a programmed cell death mechanism that might be implicated in neuropsychiatric disorders, including schizophrenia. In this study, we aimed to compare the serum levels of apoptosis among deficit schizophrenia (DS) syndrome patients, nondeficit schizophrenia (NDS) patients, and healthy controls (HCs).

PATIENTS AND METHODS

After the inclusion and exclusion criteria were applied, 23 DS patients, 46 NDS patients, and 33 HCs were included in the study. The serum apoptosis levels were measured using a quantitative sandwich enzyme immunoassay with human monoclonal antibodies directed against DNA and histones.

RESULTS

There was a significant difference among the three groups in terms of the levels of apoptosis (F 2,96=16.58; P<0.001). The serum apoptosis levels in the DS and NDS groups were significantly higher than those in the HC group. Furthermore, the serum apoptosis levels in the DS group were significantly higher than the levels in the NDS group.

CONCLUSION

This study suggests that increased levels of apoptosis may be implicated in the pathophysiology of DS syndrome. However, further studies are needed to support the role of apoptosis in DS.

Cranio-Caudal Kinematic Turn Signature Assessed with Inertial Systems As a Marker of Mobility Deficits in Parkinson's Disease

Background

Turning is a challenging mobility task requiring proper planning, coordination, and postural stability to be executed efficiently. Turn deficits can impair mobility and lead to falls in patients with neurodegenerative disease, such as Parkinson's disease (PD). It was previously shown that the cranio-caudal sequence involved during a turn (i.e., motion is initiated by the head, followed by the trunk) exhibits a signature that can be captured using an inertial system and analyzed through the Kinematics Theory. The so-called cranio-caudal kinematic turn signature (CCKS) metrics derived from this approach could, therefore, be a promising avenue to develop and track markers to measure early mobility deficits.

Objective

The current study aims at exploring the discriminative validity and sensitivity of CCKS metrics extracted during turning tasks performed by patients with PD.

Methods

Thirty-one participants (16 asymptomatic older adults (OA): mean age = 69.1 ± 7.5 years old; 15 OA diagnosed with early PD ON and OFF medication, mean age = 65.8 ± 8.4 years old) performed repeated timed up-and-go (TUG) tasks while wearing a portable inertial system. CCKS metrics (maximum head to trunk angle reached and commanded amplitudes of the head to trunk neuromuscular system, estimated from a sigma-lognormal model) were extracted from kinematic data recorded during the turn phase of the TUG tasks. For comparison purposes, common metrics used to analyze the quality of a turn using inertial systems were also calculated over the same trials (i.e., the number of steps required to complete the turn and the turn mean and maximum velocities).

Results

All CCKS metrics discriminated between OA and patients (p ≤ 0.041) and were sensitive to change in PD medication state (p ≤ 0.033). Common metrics were also able to discriminate between OA and patients (p < 0.014), but they were unable to capture the change in medication state this early in the disease (p ≥ 0.173).

Conclusion

The enhanced sensitivity to change of the proposed CCKS metrics suggests a potential use of these metrics for mobility impairments identification and fluctuation assessment, even in the early stages of the disease.

False memory and obsessive-compulsive symptoms

BACKGROUND

The memory deficit hypothesis has been used to explain the maintenance of repetitive behavior in individuals with obsessive-compulsive disorder, yet the majority of studies focusing on verbal memory show mixed results. These studies primarily evaluated memory accuracy via the inclusion or omission of previously encountered material, as opposed to false recognition (i.e., the inclusion of erroneous material). We evaluated false memories and memory processes in individuals with obsessive-compulsive washing symptoms (OC), individuals matched on depression and anxiety without OC symptoms (D/A), and in nonanxious individuals (NAC).

METHODS

Twenty-eight OC, 28 D/A, and 29 NAC individuals read OC-threat relevant, positive, and neutral scenarios and then performed a recognition test. Erroneous recognition of words associated to encoded, but not previously viewed, scenarios were classified as false memories. To evaluate processes underlying memory, participants completed a modified remember/know task to examine whether the OC individuals differed from the other individuals in recollective clarity for false memories of OC-relevant (e.g., germs), positive (e.g., lottery), and neutral (e.g., bread) material.

RESULTS

The OC individuals used "know" more than the D/A and NAC individuals for false memories of threat. For veridical memories, the OC individuals used "know" more than the NAC, but not, D/A individuals.

CONCLUSIONS

The greater reliance on "know" (i.e., feelings of familiarity) in general and false threat memories in particular in individuals with OC symptoms may add to feelings of uncertainty for threat-relevant material, which may contribute to compulsive behavior.