bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent advances in wave-driven triboelectric nanogenerators: from manufacturing to applications
Authors: Zhu Chuanqing , Xiang Cheng , Wu Mengwei , Yu Chengnuo , Dai Shu , Sun Qijun , Zhou Tongming , Wang Hao , Xu Minyi
Published: September 2024

The ocean is the largest reservoir of renewable energy on earth, in which wave energy occupies an important position due to its high energy density and extensive distribution. As a cutting-edge technology, wave-driven triboelectric nanogenerators (W-TENGs) demonstrate substantial potential for ocean energy conversion and utilization. This paper provides a comprehensive review of W-TENGs, from materials manufacturing and structural fabrications to marine applications. It highlights the versatility in materials selection for W-TENGs and the potential for unique treatments to enhance output performance. With the development of materials science, researchers can manufacture materials with various properties as needed. The structural design and fabrication of W-TENGs is the pillar of converting wave energy to electrical energy. The flexible combination of TENG’s multiple working modes and advanced manufacturing methods make W-TENGs’ structures rich and diverse. Advanced technologies, such as three-dimensional printing, make manufacturing and upgrading W-TENGs more convenient and efficient. This paper summarizes their structures and elucidates their features and manufacturing processes. It should be noted that all efforts made in materials and structures are aimed at W-TENGs, having a bright application prospect. The latest studies on W-TENGs for effective application in the marine field are reviewed, and their feasibility and practical value are evaluated. Finally, based on a systematic review, the existing challenges at this stage are pointed out. More importantly, strategies to address these challenges and directions for future research efforts are also discussed. This review aims to clarify the recent advances in standardization and scale-up of W-TENGs to promote richer innovation and practice in the future.
History and Drafting of the Indian Contract Act 1872
Authors: Swain Warren
Published: September 2024

This chapter covers the history and drafting of the Indian Contract Act 1872. It explains that India provides a good example of how the British were prepared to adapt the common law for colonial conditions while demonstrating the limits of that indulgence. Although the British Empire is a central component in the narrative, the Indian Contract Act of 1872 fits within two wider nineteenth-century debates about the merits of codification and the structure of contract law. The chapter details the law-making in the British Empire, showing how the common law was complicated since the country was run as a corporate state by the East India Company before 1858. Even though the final legislation of the Indian contract law was close to English contract law, it also differed in a few respects, not least in that it possessed an ordered and principled structure that was difficult to achieve in a common law system.
Migration of the Indian Contract Act 1872
Authors: Fong Cheong May
Published: September 2024

This chapter traces the migration of the Indian Contract Act 1872 to Malaysia. It explains that the Malaysian Contracts Act 1950 is a product of a double legal transplant modelled on the Indian Contract Act. The double legal transplant of the Malaysian Act invites deliberation as to the extent of Malaysian contract law’s engagement with developments in the United Kingdom and India. The analysis of Malaysian case law indicates a tension in the relationship between statute and the common law while considering the creativity of the courts in adapting a statute enacted in 1872. Even though Indian case law was highly influential in the early development of Malaysian contract law, its influence gradually declined as Malaysian courts referred to English law, the source jurisdiction, and decisions from other Commonwealth jurisdictions.
Consideration
Authors: Nuggehalli Nigam , Surana Ragini
Published: September 2024

This chapter introduces the notion of consideration, which is an integral part of the contract law of India. Consideration is used to designate the price or value exchanged under the contract. The doctrine of consideration continues to form an essential component of the the idea of a bargain in the common law. Under section 10 of the Indian Contract Act, to be enforceable, an agreement must be made for lawful consideration. The chapter provides an overview of the historical background and scope of the doctrine of consideration.
Parties and Assignment
Authors: Naravane Shantanu
Published: September 2024

This chapter discusses the privity of contract, which is one of the pillars of English contract law. Indian law accepts the common law’s starting position and the strength of the edifice built through repeated judicial affirmation. The privity of contract deals with the effect of a contract on third parties, while the privity of consideration instead covers what role, if any, third parties may play in the formation of a contract. The chapter then considers the exceptions to the privity of contract, including collateral contracts, implied contracts, trusts, marriage settlements, and assignments. It explains that the assignment of contractual rights is subject to restrictions on the transfer of property under Indian law.
Incapacity and Its Consequences
Authors: Maitra Neel
Published: September 2024

This chapter examines the capacity of parties to contract under the Indian Contract Act 1872 (‘the Contract Act’) and the judicial treatment of agreements with the incapacitated. It outlines the categories of incapacity under the Contract Act before detailing the consequences and remedies of incapacity for the agreement. According to courts and commentators, the current state of the Indian law on incapacity under the Contract Act is unsatisfactory. The chapter enumerates the notions of minority, unsoundness of mind, and legal disqualification as each type of incapacity. It cites that the advent of online contracting, with its relative anonymity, raised new issues of incapacity and misrepresentation before Indian courts.
Fraud, Misrepresentation, and Mistake
Authors: Krishnaprasad KV
Published: September 2024

This chapter examines the provisions of the Indian Contract Act 1872 that govern fraud, misrepresentation, and mistake. The chapter advances three key arguments. First, the provisions of the Contract Act that govern fraud and misrepresentation suffer from a drafting flaw. Once the drafting error is recognised, it becomes clear that the Contract Act regulates the contractual consequences of fraud and misrepresentation in two stages: a consent-based first stage and a more pluralistic second stage. Second, the second paragraph of section 19 of the Contract Act requires a misrepresentee to be “put in the position in which he would have been if the representations made had been true”. This provision treats all pre-contractual representations as though they were enforceable promises. This is indefensible. Third, when considering the contractual consequences of the parties’ mistakes, nineteenth century English Courts were faced with the task of reconciling Pothier’s ‘Will Theory’ with the common law doctrine of objectivity. This conflict is also reflected in the Contract Act. Understanding this tension yields important insights as to the way in which the Contract Act regulates mistakes.
Illegality
Authors: Sebastian Thomas , Ahluwalia Aman
Published: September 2024

This chapter examines the rules relating to illegality under the Indian Contract Act of 1872. The rule against the enforceability of illegal agreements reflects the regulatory objective of ensuring that the private law of contract does not facilitate conduct that is prohibited by other laws or conduct that is disfavoured as a matter of public policy or morality. While the rules relating to illegality can serve to promote regulatory objectives, they can also lead to injustice in the form of enrichment of a party who is complicit in illegality and the imposition of financial losses that may be excessive. The chapter provides an overview of the relevant statutory framework, the degree of connection that the law requires between illegal conduct and a contract before it will intervene to make the contract unenforceable, the categories of illegality, and the legal consequences of illegality. The chapter concludes that the Indian law of illegality strikes a defensible balance between promoting regulatory objectives and minimising injustice to individual contracting parties.
Restraint of Trade in India
Authors: Zhong Xing Tan , Varottil Umakanth
Published: September 2024

This chapter focuses on the restraint of trade in India. It discusses how the restraint-of-trade doctrine aims to mediate between the competing policies of freedom of contract and the protection of a person’s fundamental liberty to earn a living across the common law world. The rule governing agreements in restraint of trade is found under section 27 of the Indian Contract Act 1872. The chapter explains that the restraint doctrine is dynamic, referring to the degree of balancing between the legitimate commercial interests of parties and the autonomy interest of those subject to restraints. It then considers the future of the restraint of trade doctrine in India.
Indemnity and Guarantee
Authors: Courtney Wayne
Published: September 2024

This chapter provides an overview on indemnity and guarantee. It notes that the Indian Contract Act 1872 (‘the Contract Act’) contains two provisions defining the nature of a contract of indemnity and the rights of the promisee under it, and that these are immediately followed by twenty-two provisions on guarantees. Sections 124 and 125 of the Contract Act address actions against the indemnified party, with the principal concern being with promises to indemnify against claims by, or liabilities to, third parties. Meanwhile, section 126 defines a guarantee as a contract to perform the promise, or discharge the liability, of a third person in case of his default. The chapter considers the several observations about the reforms proposed by the Law Commission of India in its Thirteenth Report.
Shareholder Agreements in India
Authors: Jha Nemika , Khanna Vikramaditya S
Published: September 2024

This chapter examines the unsettled jurisprudence relating to shareholder agreements (SAs) in India. India has also witnessed a rise in SAs, particularly with foreign private equity players, which reflects a level of sophistication and formality in contract negotiations that was not always present when such agreements were between family or affinity groups. This has placed increasing pressure on Indian case law to evolve in response to these agreements.

The chapter explains that greater conceptualization of the concerns at play would facilitate the development of a less confusing jurisprudence that would inure to the benefit of all. It discusses the policy concerns, state of Indian law on SAs, and the proposal of the Securities and Exchange Board of India to require disclosure of certain agreements.
Introduction
Authors: Liggins David
Published: September 2024

The aims of the book are to bring nihilism into debates over truth and paradox, and to show that a nihilist approach to truth is a serious contender. By nihilism is meant a theory that denies the existence of some sort of thing; in the context of debates about truth, nihilism is the view that nothing is true. Some have taken the theory to be easy to refute—but the easy refutations do not touch more sophisticated versions of the theory. The main grounds for taking the view seriously are the elegant solutions it provides to a wide range of paradoxes involving truth, and its epistemological superiority to theories that posit truths. Making that case is the main task of the book. The book is also a challenge to deflationism. By showing that we can well do without truths, it is argued that deflationism is actually too lavish a position.
Tree-based scan statistics to generate drug repurposing hypotheses: a test case using sodium-glucose cotransporter-2 inhibitors
Authors: Tan George S Q , Maro Judith C , Wang Shirley V , Toh Sengwee , Morton Jedidiah I , Ilomäki Jenni , Wong Jenna , Li Xiaojuan
Published: September 2024

Most drug repurposing studies using real-world data focused on validating, instead of generating, hypotheses. We used tree-based scan statistics to generate repurposing hypotheses for sodium-glucose cotransporter-2 inhibitors (SGLT2i). We used an active-comparator, new-user design to create a 1:1 propensity-score matched cohort of SGLT2i and dipeptidyl peptidase-4 inhibitors (DPP4i) initiators in the MerativeTM MarketScan® Research Databases. Tree-based scan statistics were estimated across an ICD-10-CM-based hierarchical outcome tree using incident outcomes identified from hospital and outpatient diagnoses. We used an adjusted P≤0.01 as the threshold for statistical alert to prioritize associations for evaluation as repurposing signals. We varied the analyses by tree size, scanning level, and clinical settings for outcomes. There were 80,510 matched SGLT2i-DPP4i initiator pairs with 215,333 outcomes among SGLT2i initiators and 223,428 outcomes among DPP4i initiators. There were 18 prioritized associations, which included chronic kidney disease (P=0.0001), an expected signal, and anemia (P=0.0001). Heart failure (P=0.0167), another expected signal, was identified slightly beyond the statistical alert threshold. Narrowing the outcome tree, scanning at different tree levels, and including outcomes from different clinical settings influenced the scan statistics. We identified signals aligning with recently approved indications of SGLT2i, plus potential repurposing signals supported by existing evidence but requiring future validation.
Pharmacy prevalence of second victim syndrome in a comprehensive cancer center
Authors: Johnson Tami N , Tucker Anne M
Published: September 2024

Purpose

The results of a survey to determine the pharmacy prevalence of second victim syndrome (SVS) at a comprehensive cancer center are presented.

Methods

The division of pharmacy was surveyed using a 47-item online Qualtrics-platform questionnaire to help determine the prevalence of SVS. The questionnaire included demographic questions, questions about self-perceived SVS, and the validated Second Victim Experience and Support Tool (SVEST). The questionnaire was distributed electronically through senior leadership.

Results

The response rate was 95%, with self-perceived SVS reported in 37% of all respondents. Overall, 53% of pharmacists and 15% of pharmacy technicians reported having experienced SVS in their lifetime. Self-perceived time needed to recover from the most pronounced event was either less than a week or less than a month for 60% of respondents, with 10% never fully recovering. The SVEST score, which helped assess SVS impact, was neutral with a mean (SD) of 2.79 (0.51). The psychological distress and professional self-efficiency dimensions of SVEST each had a mean score of 3.5 or higher, suggesting prevalence of SVS symptoms. The resources most desired to help individuals recover from SVS were a peer support program, a specified peaceful location, time away from the unit, and an employee assistance program.

Conclusion

The pharmacy division at a comprehensive cancer center is experiencing SVS. Programs targeting SVS should be considered for a pharmacy department or division at a comprehensive cancer center to help improve their employees’ well-being and job performance. Multiple avenues of support resources are needed to meet everyone’s needs.
Naltrexone augmented with prazosin for alcohol use disorder: results from a randomized controlled proof-of-concept trial
Authors: Simpson Tracy L , Achtmeyer Carol , Batten Lisa , Reoux Joseph , Shofer Jane , Peskind Elaine R , Saxon Andrew J , Raskind Murray A
Published: September 2024

Aims

We conducted a proof-of-concept randomized controlled trial of the mu-opioid receptor antagonist, naltrexone, augmented with the alpha-1 adrenergic receptor antagonist, prazosin, for alcohol use disorder in veterans. We sought a signal that the naltrexone plus prazosin combination regimen would be superior to naltrexone alone.

Methods

Thirty-one actively drinking veterans with alcohol use disorder were randomized 1:1:1:1 to naltrexone plus prazosin (NAL-PRAZ [n = 8]), naltrexone plus placebo (NAL-PLAC [n = 7]), prazosin plus placebo (PRAZ-PLAC [n = 7]), or placebo plus placebo (PLAC-PLAC [n = 9]) for 6 weeks. Prazosin was titrated over 2 weeks to a target dose of 4 mg QAM, 4 mg QPM, and 8 mg QHS. Naltrexone was administered at 50 mg QD. Primary outcomes were the Penn Alcohol Craving Scale (PACS), % drinking days (PDD), and % heavy drinking days (PHDD).

Results

In the NAL-PRAZ condition, % reductions from baseline for all three primary outcome measures exceeded 50% and were at least twice as large as % reductions in the NAL-PLAC condition (PACS: 57% vs. 26%; PDD: 51% vs. 22%; PHDD: 69% vs. 15%) and in the other two comparator conditions. Standardized effect sizes between NAL-PRAZ and NAL-PLAC for each primary outcome measure were >0.8. All but one participant assigned to the two prazosin containing conditions achieved the target prazosin dose of 16 mg/day and maintained that dose for the duration of the trial.

Conclusion

These results suggest that prazosin augmentation of naltrexone enhances naltrexone benefit for alcohol use disorder. These results strengthen rationale for an adequately powered definitive randomized controlled trial.
Phylogenomic analysis of target enrichment and transcriptome data uncovers rapid radiation and extensive hybridization in the slipper orchid genus Cypripedium
Authors: Lagou Loudmila Jelinscaia , Kadereit Gudrun , Morales-Briones Diego F
Published: September 2024

Background and Aims

Cypripedium is the most widespread and morphologically diverse genus of slipper orchids. Despite several published phylogenies, the topology and monophyly of its infrageneric taxa remained uncertain. Here, we aimed to reconstruct a robust section-level phylogeny of Cypripedium and explore its evolutionary history using target capture data for the first time.

Methods

We used the orchid-specific bait set Orchidaceae963 in combination with transcriptomic data to reconstruct the phylogeny of Cypripedium based on 913 nuclear loci, covering all 13 sections. Subsequently, we investigated discordance among nuclear and chloroplast trees, estimated divergence times and ancestral ranges, searched for anomaly zones, polytomies and diversification rate shifts, and identified potential gene (genome) duplication and hybridization events.

Key Results

All sections were recovered as monophyletic, contrary to the two subsections within sect. Cypripedium. The two subclades within this section did not correspond to its subsections but matched the geographical distribution of their species. Additionally, we discovered high levels of discordance in the short backbone branches of the genus and within sect. Cypripedium, which can be attributed to hybridization events detected based on phylogenetic network analyses, and incomplete lineage sorting caused by rapid radiation. Our biogeographical analysis suggested a Neotropical origin of the genus during the Oligocene (~30 Ma), with a lineage of potentially hybrid origin spreading to the Old World in the Early Miocene (~22 Ma). The rapid radiation at the backbone probably occurred in Southeast Asia around the Middle Miocene Climatic Transition (~15–13 Ma), followed by several independent dispersals back to the New World. Moreover, the glacial cycles of the Pliocene–Quaternary may have contributed to further speciation and reticulate evolution within Cypripedium.

Conclusions

Our study provides novel insights into the evolutionary history of Cypripedium based on high-throughput molecular data, shedding light on the dynamics of its distribution and diversity patterns from its origin to the present.
Development of a root-zone temperature control system using air-source heat pump and its impact on the growth and yield of paprika
Authors: Myung Jeesang , Cui Meiyan , Lee Byungkwan , Lee Hyein , Shin Jaewook , Chun Changhoo
Published: September 2024

By developing and implementing a local temperature control system, such as a root zone, with a high energy efficiency heat source, we can ensure both yield and energy efficiency against extreme temperatures. This system, designed with practicality in mind, has a remarkably positive impact on paprika plants’ growth and yield in greenhouse cultivation. In the summer season, paprika plants were grown with no cooling, nutrient solution cooling (NSC) and the combination of NSC and substrate surround cooling (SSC) (NSC + SSC). In the case of SSC, cooled water circulated through the pipe surrounding the substrate to lower the substrate temperature. The cooling system maintains the nutrient solution temperature at 18 °C and the circulating water temperature at the system in the winter season; the paprika plants were grown with no heating (NH), nutrient solution heating (NSH) and the combination of NSH and substrate surround heating (SSH) (NSH + SSH). The heating system maintains the nutrient solution temperature at 25 °C and the circulating water temperature at 30 °C. In the summer, the root fresh and dry weights, stem fresh and dry weights, stem length and node number were increased in the NSC + SSC. In the winter season, the stem fresh and dry weights, leaf area and leaf fresh and dry weights were increased in the NSH + SSH. In both seasons, root-zone temperature control increased the fruit quality and yield. The result indicates that this easy-to-install root-zone temperature control system can be applied to the commercial greenhouse to secure paprika growth and yield in year-round cultivation.
Symbiotic nitrogen fixation reduces belowground biomass carbon costs of nitrogen acquisition under low, but not high, nitrogen availability
Authors: Perkowski Evan A , Terrones Joseph , German Hannah L , Smith Nicholas G
Published: September 2024

Many plant species form symbiotic associations with nitrogen-fixing bacteria. Through this symbiosis, plants allocate photosynthate belowground to the bacteria in exchange for nitrogen fixed from the atmosphere. This symbiosis forms an important link between carbon and nitrogen cycles in many ecosystems. However, the economics of this relationship under soil nitrogen availability gradients is not well understood, as plant investment toward symbiotic nitrogen fixation tends to decrease with increasing soil nitrogen availability. Here, we used a manipulation experiment to examine how costs of nitrogen acquisition vary under a factorial combination of soil nitrogen availability and inoculation with Bradyrhizobium japonicum in Glycine max L. (Merr.). We found that inoculation decreased belowground biomass carbon costs to acquire nitrogen and increased total leaf area and total biomass, but these patterns were only observed under low fertilization and were the result of increased plant nitrogen uptake and no change in belowground carbon allocation. These results suggest that symbioses with nitrogen-fixing bacteria reduce carbon costs of nitrogen acquisition by increasing plant nitrogen uptake, but only when soil nitrogen is low, allowing individuals to increase nitrogen allocation to structures that support aboveground growth. This pattern may help explain the prevalence of plants capable of forming these associations in less fertile soils and provides useful insight into understanding the role of nutrient acquisition strategy on plant nitrogen uptake across nitrogen availability gradients.
How to approach expropriation risk as a controversial component of country risk in investment arbitration
Authors: Havan M Emirhan
Published: September 2024

Country risk premium is one of the principal factors that affects the value of investments and is based on the assumption that investments located in an unstable country are worth less than similar investments in a stable country. Tribunals impose a discount rate called a country risk premium in accordance with this by assessing the economic and political risks of the host country where the investment is being made. This article discusses whether a state can take advantage of its own unlawful acts that aggravate political risks in order to raise its country risk premium and thus the discount rate on the value of investments.
PGR – 1 Neurorehabilitation of a Pediatric Patient Diagnosed with Febrile Infection-Related Epilepsy Syndrome (FIRES)
Authors: Anastasiadis William A , Lantagne Ann , Tlustos Sarah J , Wyrwa Jordan M , Colbert Alison M
Published: September 2024

Objective

Given its complexity and rarity, pediatric autoimmune encephalitis (AE) presents a significant challenge to clinicians. AE can precipitate febrile infection-related epilepsy syndrome (FIRES), further complicating a patient’s course. This case study will explore the progression of neurocognitive recovery across inpatient and outpatient settings to inform future research and clinical management of FIRES.

Method

Previously healthy, the current patient was a 6-year-old White non-Hispanic/Latine monolingual English-speaking female who initially presented with status epilepticus in the setting of a fever. Initial electroencephalogram (EEG) captured numerous left temporal focal seizures, and brain magnetic resonance imaging (MRI) revealed edema within the fornix-fimbria complex. Unremarkable lumbar puncture and infectious studies suggested her course was most consistent with FIRES.

Results

The patient was administered serial neurocognitive screening measures during her inpatient stay, targeted discharge neuropsychological testing, and comprehensive outpatient follow-up neuropsychological testing (see Appendix). Upon admission, initial screening was consistent with a minimally conscious state. She made gradual progress while inpatient and discharge testing revealed vulnerabilities in attention, executive functioning, and learning/memory. Outpatient testing approximately seven months post-discharge revealed below-average intellectual ability, with impairments in academics, cognitive efficiency, disruptive behavior, and fine motor skills. Diagnostic impressions included attention-deficit/hyperactivity disorder (ADHD) and a mild neurocognitive disorder.

Conclusions

Although the mechanism of neurocognitive difficulties in children with FIRES remains unclear, the current case study highlights the unique benefit of multifaceted rehabilitative care in managing poly-etiologic factors and the progression of recovery in patients with FIRES. Unfortunately, many patients do not return to their premorbid level of functioning; thus, future research is essential.
AGR – 1 Long-term Neuropsychological Follow-up after 7 Years of Responsive Neurostimulation (RNS)
Authors: Cation Bailey , Bezchlibnyk Yarema , Rivera-Cruz Angelica , Leon Yolanda , Schoenberg Michael
Published: September 2024

Objective

The current case is a 35-year-old woman with a history of bitemporal lobe epilepsy who has had responsive neurostimulation (RNS) for 7 years and 3 months. The original RNS System Pivotal trial assess neurocognitive outcomes after 2 years (Loring et al., 2015). A more recent study found that self-reported cognitive functioning on the Quality of Life in Epilepsy-89 was improved after 9 years (Nair et al., 2020). The current case adds to the literature by providing objective data for a patient with RNS for over 7 years.

Method

The patient had onset of seizures at age 26 in 2014. Her ongoing epilepsy care has included video EEGs, intracranial monitoring, MRI, PET, two Wadas, and three neuropsychological evaluations (2015, 2021, and 2024). Multiple diagnostic studies confirmed bitemporal epilepsy. She underwent RNS implantation in bilateral mesial temporal lobes in 2016.

Results

The patient’s pre-RNS neuropsychological findings in 2015 included average verbal and visual memory and below average-to-low average language functioning (confrontation naming, letter fluency, verbal abstract reasoning). Her first post-RNS neuropsychological findings in 2021 included average visual memory, below average-to-low average verbal memory, and exceptionally low-to-below average language. The patient noted significant anxiety during her 2021 evaluation. Her second post-RNS neuropsychological findings in 2024 was entirely normal, showing resolution of prior deficits in verbal memory and language.

Conclusions

This case presents objective neuropsychological data for RNS over a longer follow-up interval than was investigated in the original trial. In this patient, there were no persistent cognitive declines associated with RNS for over 7 years.
Traumatic Brain Injury and Risk of Incident Dementia: Forensic Applications of Current Research
Authors: Clem Matthew , LoBue Christian , Schaffert Jeff , Cullum Munro
Published: September 2024

Objective

Traumatic Brain Injury (TBI) has been purported to increase risk for later developing neurodegenerative disorders (ND). Forensic neuropsychologists are frequently asked to opine on risk for ND after an alleged TBI. We provide an evidence-based foundation to aid forensic practice by summarizing the: role of the neuropsychologist in TBI-related litigation, complexities associated with identifying TBIs in forensic cases, science of TBI in relation to incident dementia, and current scientific evidence for chronic traumatic encephalopathy.

Data Selection

The most applicable studies to forensic settings are large prospective cohort and population-based cohort studies given their wider generalizability and long periods of follow-up/tracking for outcomes.

Data Synthesis

Developing ND after TBI is the exception rather than the rule. Only a small subset (< 5%) of individuals with moderate-to-severe TBI, and even fewer (< 1%) with mild TBI, appear to develop ND, and the characteristics that place some at risk remain unclear. Positive evidence for risk of ND after mild TBI is weak and mostly consists of observational studies characterized by methodological limitations.

Conclusions

Forensic methods used to establish the likely occurrence of TBI are typically more extensive than those used in clinical evaluations, while TBI definitions used in current research are even more rudimentary and inconsistent. Applying clinical research findings regarding TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote TBI/concussion in a causal manner to ND risk is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.
Access to Care among Hispanic/Latin American Patients in Neuropsychology: Addressing Potential Barriers to Appointment Adherence
Authors: Perez Marcano Alejandro E , Rosenstein Leslie D , Stagni Alessandra M , Woolsey Alex N , Nieves Emmanuel Rosario
Published: September 2024

Objective

We will review barriers impacting access to care among Hispanic/Latin American patients, focusing on factors contributing to no-shows and possible interventions.

Method

We implemented an appointment management system to improve attendance using native Spanish speakers when indicated. We then recorded demographic data and attendance from 211 consecutive Hispanic/Latin American patients (123 females/88 males; mean age = 55 years, SD = 17.3; mean years formal education = 8.7, SD = 4.5). These were from a study of 537 patients in which we conducted MANOVA assessing the relationship between attendance and age, education, proxy income, and prior no-show rate, and Chi-Squares assessing associations between appointment status and gender, payor, race/ethnicity, MyChart Activation, and availability of collaterals. Among Hispanic/Latin American patients, we assessed associations between appointment status and language, MyChart activation, and availability of collaterals.

Results

Our system improved attendance, though no-shows remained high (17% among Latin American/Hispanic patients) with significant associations between attendance and language (χ2 = 9.884, p = 0.007), MyChart access and language (χ2 = 11.315 p = 0.004), and availability of collaterals and language (χ2 = 8.785, p = 0.012). Being monolingual Spanish speaking was associated positively with collateral availability (p < 0.05), while the relationships between language and attendance and between language and MyChart activation were complex. In the larger sample, older age, higher prior no-show rates, and no MyChart activation were associated with poorer appointment attendance; education and availability of collaterals were not.

Conclusion

There are potentially modifiable targets to improve attendance and access to care. We are now developing a health-fair model to teach patients the importance of attendance, assisting them with MyChart, transportation, and other resources.
Childhood Neighborhood Disadvantage and Cognitive Function among Veterans Recovering from Mild Traumatic Brain Injury
Authors: O'Connor Victoria , Martindale Sarah
Published: September 2024

Objective

Identifying risk factors and interventions for chronic symptoms following mild traumatic brain injury (TBI) is an important area of research for Veterans. Growing up in a disadvantaged neighborhood is associated with poorer health outcomes. We examined the relationship between childhood neighborhood disadvantage and cognitive outcomes among symptomatic Veterans with history of mild TBI.

Method

58 Participants completed neuropsychological tests (CVLT-3, TMT A&B, COWA, Category Test), NSI, and PCL-5. The Neighborhood Atlas was used to derive disadvantage scores using childhood addresses. Global deficit scores were calculated as described by Heaton (2004).

Results

Neighborhood disadvantage was significantly correlated with CVLT-3 Total Learning (r = −0.26, p = 0.046), but not the overall global deficit or deficit performance across CVLT-3 Delayed Recall, TMT-A, TMT-B, COWA, and Category Test. There was a significant difference in neighborhood disadvantage between participants scoring in the deficit and normal ranges on CVLT-3 Total Learning (p = 0.046). There were no other differences in neighborhood disadvantage across other neuropsychological tests. There was a significant difference in PTSD symptoms between participants scoring within the deficit and normal ranges on the COWA (p = 0.002). There were no other significant group differences in neuropsychiatric symptoms or PTSD symptom severity.

Conclusions

Among Veterans in this sample, neighborhood disadvantage was not associated with cognitive function or cognitive deficits. Although neighborhood disadvantage is an important psychosocial risk factor for poor outcomes in the civilian literature, these results suggest that it may not be an important contributing factor in recovery from mild TBI for military Veterans.
An Examination of the Impact of Single Errors on Performance Validity Testing on Neuropsychological Performance: a Youth Athlete Cohort Study
Authors: Baldini Daniel , Summers Kiara C , Lakhani Annie , Alvis Wyatt , Eve Henry S , Vang Lillian S , Hirst Rayna B
Published: September 2024

Performance validity tests (PVT) measure optimal cognitive effort (Sherman et al., 2023). As PVT scores decrease in adults, neuropsychological performance decreases systematically (Green, 2007). Similarly, evidence suggests that even a single error in PVTs influences overall cognitive performance (Erdodi et al., 2017). No studies have investigated this relationship between cognitive performance and PVT performance on multiple PVTs within a large pediatric sample. Youth athletes (n = 174; ages 8–16, M = 12.07) completed the Rey 15-Item test (RFIT), TOMM Trial 1, Reliable Digit Span (RDS), and a thorough neuropsychological battery. T-tests compared neuropsychological performance in youth who scored perfectly on the TOMM (n = 36) and RFIT (n = 90) to youth with single errors (TOMM, n = 28; RFIT, n = 26). A planned contrast analysis of neuropsychological performance was performed for RDS within score levels 6–11. On processing speed, delayed verbal memory, and working memory, the TOMM perfect score group performed better than the single error group (p’s < 0.05). On RFIT, the same relationship was seen on story memory, working memory and simple attention (p’s < 0.05). Perfect score groups scored higher on nearly all subtests (Hedge’s G’s = 0.20–0.60). Scores in perceptual reasoning, cognitive flexibility, processing speed, and visual memory increased as RDS scores increased by one point (p’s < 0.05). This study shows the impact of even subtle differences in effort on cognitive performance in youth. Measuring effort is critical in pediatric neuropsychology, and these results illustrate how important it may be to measure effort on a continuum in pediatrics, as opposed to using pass/fail cutoffs.
The Pattern of Dissociative Symptoms Differs between Post-Traumatic Stress Disorder and First Esketamine Administration for Treatment-Resistant Depression
Authors: Williamson David , Bremner J D , Vaccarino Viola , Williamson Linda
Published: September 2024

Objective

Dissociative symptoms are commonly observed during the first administration of esketamine for the treatment of Treatment-Resistant Depression (TRD) and in a substantial minority of patients with Post-Traumatic Stress Disorder (PTSD). We examine differences in the number and pattern of dissociative symptoms (depersonalization, derealization, dissociative amnesia, identity fragmentation) reported by these two groups.

Data Selection

Data for patients diagnosed with PTSD (N = 134) were drawn from studies of individuals with exposure to civilian traumas, childhood abuse or combat trauma. Data for patients with TRD undergoing their first treatment session with ESK (N = 759) were drawn from published results detailing the presentation of dissociative symptoms during FDA registration trials.

Data Synthesis

Dissociative symptoms in general were more prevalent in the ESK group (P < 0.01). However, a significant (p < 0.0001) Group x Item Domain interaction revealed that dissociative amnesia and identity fragmentation were endorsed more frequently relative to the other domains in the PTSD group relative to the ESK group. Depersonalization and derealization were the most prominent dissociative symptoms endorsed by the ESK group, whereas items from the dissociative amnesia domain were endorsed most frequently in the PTSD group.

Conclusions

The pattern of dissociative symptoms endorsed by patients with PTSD differs from that reported by patients with TRD receiving esketamine for the first time, suggesting the possibility that the etiology of “dissociative symptoms” may vary to some degree across therapeutic conditions.
The Association of Cerebrospinal Fluid Biomarkers of Alzheimer’s Disease with Cognitive Intra-Individual Variability
Authors: Milam Alicia , Aita Stephen L , Saeed Mubarick , Borgogna Nicholas , Campbell Ivan , Ikonomou Vasilios , Walker Keenan A , Kamath Vidyulata , Visscher Kristina , Murchison Charles , Geldmacher David S , Roberson Erik , Hill Benjamin D , Del Bene Victor
Published: September 2024

Objective

Cognitive intra-individual variability (IIV) is a sensitive predictor of cognitive decline and disease severity in Alzheimer’s disease (AD). Despite its sensitivity, whether IIV is merely a psychometric artifact or disease pathology biomarker remains unknown. The present study evaluated the association between IIV and cerebrospinal fluid (CSF) biomarkers of AD.

Method

Participants included 422 individuals from the National Alzheimer’s Coordinating Center Unified Dataset 3.0 who completed baseline neuropsychological assessment and had CSF data. All participants were adult monolingual English speakers. Participants with vision or hearing impairments were excluded. Cases were stratified into cognitively normal (n = 267) and AD groups (n = 155; mild cognitive impairment = 50, dementia = 105). Cross-sectional IIV was calculated by obtaining the individual standard deviation (iSD) of ten cognitive tests. Finally, the coefficient of variation (CoV) was computed by dividing iSD by the participant’s overall test battery mean. Non-parametric Spearman-rank correlations were used to assess the relation between CoV and CSF biomarkers, including beta-amyloid 1–42, total tau (t-tau), and phosphorylated tau (p-tau181).

Results

In the AD group, CoV was positively correlated with p-tau181 (r = 0.285, p = 0.003) and t-tau (r = 0.241, p = 0.009), and negatively correlated with beta-amyloid 1–42 (r = −0.314, p < 0.001). Correlations between CoV and CSF biomarkers were not significant in the cognitively normal group for beta-amyloid 1–42 (r = 0.076, p = 0.215), p-tau181 (r = −0.014, p = 0.840), and t-tau (r = −0.046, p = 0.485).

Conclusions

In people with mild cognitive impairment and dementia of presumed AD etiology, cognitive IIV is associated with CSF biomarkers. These findings provide preliminary evidence that IIV is not merely a statistical artifact, but is associated with AD neuropathology.
The Clinical Utility of Large Language Models in Diagnosing Neurocognitive Disorders among NACC Participants
Authors: Rafiuddin Hanan S , Su Charlie , Dimmick Allan A , Cicero David
Published: September 2024

Objective

Our study aimed to investigate ChatGPT’s ability to diagnose neurocognitive disorders in older adults based on neuropsychological interviews and test results and compare its accuracy with neuropsychologist consensus diagnosis.

Methods

We prompted ChatGPT-4 to provide provisional diagnoses (normal changes, mild cognitive impairment, or dementia) for each case. We also asked ChatGPT to diagnose the underlying etiology. We evaluated interrater reliability (IRR) with Cohen’s kappa and a chi-square test. Receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) values were computed to explore measures predicting diagnostic agreement.

Results

Participants were 15,048 older adults (Mage = 69.13, 56.7% female) assessed in Alzheimer’s Disease Core Centers across the United States. For cognitive diagnoses, Cohen’s kappa demonstrated fair agreement (κ = 0.42; p < 0.001). The chi-square test [χ2 (6) = 7896.51, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.51, p < 0.001) between ChatGPT and clinicians’ diagnoses. For the underlying etiology, Cohen’s kappa demonstrated fair agreement on specific diagnoses (κ = 0.38; p < 0.001). The chi-square test [χ2 (24) = 5353.04, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.30, p < 0.001) between ChatGPT and clinicians’ diagnoses. ROC curves demonstrate that no variables predicted diagnostic agreement at above chance.

Conclusion

Our findings demonstrate the potential clinical utility of integrating LLMs into neuropsychology. While significant IRR was found between ChatGPT and the neuropsychologist diagnosis, further research is needed prior to the adoption of LLMs into clinical practice, given ongoing developments of artificial intelligence in the field of medicine.
A - 1 Informant Report of Practical Judgment Is Associated with Mild Cognitive Impairment and Measures of Brain Structure in a Nondemented Sample of Older Adults
Authors: Nester Caroline O , Heller-Wight Abi , Ellis David , Quinn Crystal G , Sergeyev Nicole , Pare Nadia , Warren David , Rabin Laura A
Published: September 2024

Objective

Given the potential risks associated with compromised judgment in older adulthood, we examined whether informant-reported practical judgment abilities were associated with cognitive impairment and measures of brain structure.

Method

97 community-dwelling older adults with informants (Mage = 74.64 ± 7.42, Medu = 15.76 ± 2.42, 74%female, 92%white) underwent neuropsychological evaluation, including the Test of Practical Judgment-Informant (TOP-J-INF), a 15-item informant-reported scale of judgment ability. Participants were diagnosed with mild cognitive impairment (MCI; n = 33) or as neuropsychologically unimpaired (n = 64). Participants completed an MRI study including T1-weighted image processed with FreeSurfer software (v 6.0.0) to obtain estimates of gray matter volume and cortical thickness (parcellated with the Desikan-Killiany atlas). Logistic and linear models analyzed the association of TOP-J-INF with MCI diagnosis and brain volume/thickness (in separate models). To better support the exploratory nature of this analysis of associations with structural brain variables, we did not apply correction for multiple comparisons.

Results

Each additional point on the TOP-J-INF increased the odds of MCI diagnosis by 16.8% (OR = 1.168, p = 0.004). Worse judgment was associated with reduced brain volume in the right parahippocampal gyrus (β = −11.688, p = 0.032), superior temporal gyrus (β = −51.330, p = 0.040), rostral anterior cingulate cortex (β = −25.704, p = 0.004); and reduced thickness of the left transverse temporal gyrus (β = −0.010, p = 0.041).

Conclusions

To our knowledge, this is the first study to investigate the relationship between informant report of judgment and measures of brain structure, providing support that informant concerns about a loved one’s compromised judgment is associated with volume/thickness reduction in key brain regions. Assessing practical judgment abilities via informants could provide critical clinical information when working with vulnerable older individuals.
A - 3 The Relationship between Memory and Depression In an Elderly Chinese Cohort: a Baseline Analysis
Authors: Li Jessie T , Schwartz Eliezer , Michael Paul
Published: September 2024

Objective

Explore the relationship between depression and memory aged 60 years and older while controlling for age, gender, and education.

Method

This study utilized data from the Characterization of Dementia in Asian-Pacific Islanders study by Bruce Miller, M.D., and Howie Rosen, M.D., at the Memory and Aging Center at UCSF. Inclusion criteria included participants age 60+ who completed the Benson Figure Test, GDS-30, and the Chinese Version Verbal Learning Test (CVVLT) in English, Cantonese, or Mandarin. Exclusion criteria included participants under age 60 and or experience history of neurological strokes or injuries, and disabilities related to memory. The final sample yielded 136 participants, including 41 (30.1%) males, 95 (69.9%) females, 120 (88.2%) right-handed, 3 (2.2%) left-handed, and 7 (5.1%) ambidextrous. Average age of participants was 71.46 (SD = 7.26). A memory composite score was computed based on average of performances on the Benson Figure Task delay and the CVVLT 10-minute delay. Raw GDS-30 scores represented depression.

Results

There was a weak positive correlation between memory composite scores, gender, and education, and a weak negative correlation between memory composite scores, age, and GDS-30 scores.

Conclusions

Findings indicate some evidence for a relationship between depression and memory in elderly Chinese populations. However, the sample was skewed, and consisted of less depressed and higher memory functioning participants. Despite these limitations, it is pertinent to explore how healthcare providers may outreach to this population to monitor risk factors, improve timeliness of dementia diagnosis, and maximize treatment of reversible causes, adherence to treatment plans, and help families care plan.