bluuebunny/crossref_metadata_2025 huggingface dataset:
Eosinophils at diagnosis are elevated in amyotrophic lateral sclerosis
Authors: Yang Jing , Liu Tingting , Zhang Lei , Li Xin , Du Feng Ping , Liu Qi , Dong Hui , Liu Yaling
Published: December 2023

Introduction

Amyotrophic lateral sclerosis (ALS) is a rare, devastating neurodegenerative disease that affects upper and lower motor neurons. To date, no effective treatment or reliable biomarker for ALS has been developed. In recent years, many factors have been proposed as possible biomarkers of ALS; however, no consensus has been reached. Therefore, a reliable biomarker is urgently needed. Eosinophils may play a crucial role in healthy humans and diseases, and serve as a biomarker for many chronic diseases.

Methods

Routine blood test results were collected from 66 healthy controls and 59 patients with ALS. The percentages and total numbers of each cell population were analyzed, and the correlation between these indicators and patient ALS functional rating scale–revised (ALSFRS-R) score or disease progression rate (ΔFS score) was analyzed.

Results

Compared to healthy controls, the number of blood leukocytes, neutrophils, monocytes, and basophils was significantly decreased in patients with ALS (p = 0.002, p = 0.001, p = 0.049, and p < 0.0001, respectively). There was an increase in the number of eosinophils (p < 0.0001), but no difference in the number of lymphocytes between patients with ALS and healthy controls was found (p = 0.563). Compared to healthy controls, the percentage of neutrophils was decreased and the percentage of lymphocytes and eosinophils was increased in patients with ALS (p = 0.01, p = 0.012, and p = 0.001, respectively). There was no difference between patients with ALS and healthy controls in the percentage of monocytes and basophils (p = 0.622 and p = 0.09, respectively). However, only the percentage and number of eosinophils had a correlation with the ΔFS score. Further multivariate analysis revealed a significant correlation between the disease duration, eosinophil count and percentage, and the disease progression rate (p < 0.0001, p = 0.048, and p = 0.023, respectively). The neutrophil-to-eosinophil ratio (NER), lymphocyte-to-eosinophil ratio (LER), and monocyte-to-eosinophil ratio (MER) were significantly lower in patients with ALS than in healthy controls. However, only the LER was significantly correlated with the ΔFS score.

Conclusion

These observations implicate neutrophils, lymphocytes, and eosinophils as important factors, and increasing eosinophil counts were negatively correlated with the ΔFS score in patients with ALS.
Neurorehabilitation of the upper extremity – immersive virtual reality vs. electromechanically assisted training. A comparative study
Authors: Lülsdorff Kira , Junker Frederick Benjamin , Studer Bettina , Wittenberg Heike , Pickenbrock Heidrun , Schmidt-Wilcke Tobias
Published: December 2023

Background

Severe paresis of the contralesional upper extremity is one of the most common and debilitating post-stroke impairments. The need for cost-effective high-intensity training is driving the development of new technologies, which can complement and extent conventional therapies. Apart from established methods using electromechanical devices, immersive virtual reality (iVR) systems hold promise to provide cost-efficient high-intensity arm training.

Objective

We investigated whether iVR-based arm training yields at least equivalent effects on upper extremity function as compared to an electromechanically assisted training in stroke patients with severe arm paresis.

Methods

52 stroke patients with severe arm paresis received a total of ten daily group therapy sessions over a period of three weeks, which consisted of 20 min of conventional therapy and 20 min of either electromechanically assisted (ARMEOSpring®) or iVR-based (CUREO®) arm training. Changes in upper extremity function was assessed using the Action Research Arm Test (ARAT) and user acceptance was measured with the User Experience Questionnaire (UEQ).

Results

iVR-based training was not inferior to electromechanically assisted training. We found that 84% of patients treated with iVR and 50% of patients treated with electromechanically assisted arm training showed a clinically relevant improvement of upper extremity function. This difference could neither be attributed to differences between the groups regarding age, gender, duration after stroke, affected body side or ARAT scores at baseline, nor to differences in the total amount of therapy provided.

Conclusion

The present study results show that iVR-based arm training seems to be a promising addition to conventional therapy. Potential mechanisms by which iVR unfolds its effects are discussed.
Cortical gray-white matter contrast abnormalities in male children with attention deficit hyperactivity disorder
Authors: Wang Changhao , Shen Yanyong , Cheng Meiying , Zhu Zitao , Lv Yuan , Zhang Xiaoxue , Feng Zhanqi , Yang Zhexuan , Zhao Xin
Published: December 2023

Purpose

Presently, research concerning alterations in brain structure among individuals with attention deficit hyperactivity disorder (ADHD) predominantly focuses on entire brain volume and cortical thickness. In this study, we extend our examination to the cortical microstructure of male children with ADHD. To achieve this, we employ the gray-white matter tissue contrast (GWC) metric, allowing for an assessment of modifications in gray matter density and white matter microstructure. Furthermore, we explore the potential connection between GWC and the severity of disorder in male children by ADHD.

Methods

We acquired 3DT1 sequences from the public ADHD-200 database. In this study, we conducted a comparative analysis between 43 male children diagnosed with ADHD and 50 age-matched male controls exhibiting typical development trajectories. Our investigation entailed assessing differences in GWC and cortical thickness. Additionally, we explored the potential correlation between GWC and the severity of ADHD. To delineate the cerebral landscape, each hemisphere was subdivided into 34 cortical regions using freesurfer 7.2.0. For quantification, GWC was computed by evaluating the intensity contrast of non-normalized T1 images above and below the gray-white matter interface.

Results

Our findings unveiled elevated GWC within the bilateral lingual, bilateral insular, left transverse temporal, right parahippocampal and right pericalcarine regions in male children with ADHD when contrasted with their healthy counterparts. Moreover, the cortical thickness in the ADHD group no notable distinctions that of control group in all areas. Intriguingly, the GWC of left transverse temporal demonstrated a negative correlation with the extent of inattention experienced by male children with ADHD.

Conclusion

Utilizing GWC as a metric facilitates a more comprehensive assessment of microstructural brain changes in children with ADHD. The fluctuations in GWC observed in specific brain regions might serve as a neural biomarker, illuminating structural modifications in male children grappling with ADHD. This perspective enriches our comprehension of white matter microstructure and cortical density in these children. Notably, the inverse correlation between the GWC of the left transverse temporal and inattention severity underscores the potential role of structural and functional anomalies within this region in ADHD progression. Enhancing our insight into ADHD-related brain changes holds significant promise in deciphering potential neuropathological mechanisms.
Outcome differences in HPV-driven head and neck squamous cell carcinoma attributable to altered human leukocyte antigen frequencies
Authors: Wichmann Gunnar , Vetter Nathalie , Lehmann Claudia , Landgraf Ramona , Doxiadis Ilias , Großmann Rebecca , Vorobeva Ekaterina , Dietz Andreas , Zebralla Veit , Wiegand Susanne , Wald Theresa
Published: December 2023

Background

Effective immune surveillance requires a functioning immune system and natural killer (NK) and T cells for adequate innate and antigen-specific immune responses critically depending on human leukocyte antigens (HLAs) and haplotypes representing advantageous combinations of HLA antigens. Recently, we reported a link between altered frequencies of HLA alleles and haplotypes and developing head and neck squamous cell carcinoma (HNSCC). Whereas the majority of HNSCCs seem to be related to classical risk factors alcohol and tobacco, a subset of HNSCC and especially oropharyngeal squamous cell carcinoma (OPSCC) were etiologically linked to human papillomavirus (HPV) recently. Here, we demonstrate in HPV-driven (p16-positive high risk-HPV DNA-positive) HNSCC a deviating distribution of HLA antigens and haplotypes and their relevance to outcome.

Methods

Leukocyte DNA ofn= 94 HPV-driven HNSCC patients (n= 57 OPSCC,n= 37 outside oropharynx) underwent HLA SSO typing, allowing allele, antigen (allele group), and haplo-typing. Besides comparing these frequencies with those of German blood donors, we analyzed their impact on outcome using Kaplan–Meier plots and Cox proportional hazard regression.

Results

Antigen and haplotype frequencies demonstrate enrichment of rare antigens and haplotypes. The HLA score for unselected HNSCC patients was not predictive for outcome here. However, together with alcohol consumption, tobacco smoking, T category, and extranodal extension of locoregional metastases and treatment applied, eight HLA traits allow for predicting progression-free and tumor-specific survival.

Conclusion

Patients can be categorized into low, intermediate-low, intermediate-high, and high risk groups. Using a new PFS risk score for HPV-driven HNSCC may allow to improve prognostication.
Utilization of cancer immunotherapy in sub-Saharan Africa
Authors: Olatunji Elizabeth , Patel Saloni , Graef Katy , Joseph Adedayo , Lasebikan Nwamaka , Mallum Abba , Chigbo Chinelo , Jaffee Elizabeth , Ngwa Wil
Published: December 2023

Introduction

The Lancet Oncology Commission for sub-Saharan Africa (SSA) predicts that cancer deaths will double from 520,158 per year to more than 1 million per year by the year 2040. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy’s significant therapeutic potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA.

Methods

A Qualtrics survey assessing the existing infrastructure and training for safe immunotherapy administration was developed and distributed online via email and WhatsApp to 3,231 healthcare providers across SSA, with a target audience of healthcare providers serving patients with cancer. The survey contained 22 questions evaluating the accessibility, use, knowledge, and training on immunotherapy in SSA. Responses were collected between January and February 2023. Microsoft Excel was used to summarize and visually present the distribution of responses as counts and proportions.

Results

292 responses were included from 28 countries in SSA. 29% of all respondents indicated their clinic has easy access to cancer immunotherapy and 46% indicated their clinic currently practices it. Of clinics that practiced immunotherapy (n = 133), 12% used genomic sequencing to assess the tumor mutational burden biomarker, and 44% assessed expression of the PD-L1 biomarker prior to immunotherapy administration. 46% of all respondents were familiar with immunotherapy. 11% indicated being adequately trained to administer it. Of these (n=33), 52% indicated also being trained to manage immune-related adverse events related to immunotherapy administration.

Conclusion

Immunotherapy utilization and training is low in SSA and insufficient for the rising cancer burden. Increased accessibility and usage of biomarker testing to predict immunotherapy response, incorporation of immunotherapy training into continuous medical education, and increased access to immunotherapy drugs may be prerequisites for expanded utilization of immunotherapy in SSA.
Hepatic arterial infusion chemotherapy and trastuzumab in gastric cancer with liver metastases: a case report
Authors: Li Hui-qin , Wang Qin , Zhang Liu-yan , Li Jia-yin , Wang Ying-jie , Wei Li , Yao Li-ge
Published: December 2023

Background

Gastric cancer is a common cancer worldwide and is responsible for over one million new cases in 2020 and an estimated 769,000 deaths, ranking fifth for incidence and fourth for mortality globally. Incidence rates are highest in Eastern Asia and Eastern Europe. Gastric cancer is highly heterogeneous and progresses rapidly. The prognosis of gastric cancer with liver metastases is poor, and clinical treatment remains challenging. Human epidermal growth factor receptor 2 (HER2) positivity is correlated to a bad prognosis for gastric cancer. Trastuzumab combined with systemic chemotherapy is the preferred treatment for HER2-positive advanced gastric cancer. However, intravenous chemotherapy has severe systemic toxicity, which reduces the local drug concentration and tumor uptake rate, and the effect is unsatisfactory.

Case summary

We reported a 66-year-old patient with HER2-positive advanced gastric cancer with jaundice due to multiple liver metastases, after 6 cycles of trastuzumab combined with hepatic arterial infusion chemotherapy (HAIC), the tumor retracted significantly, the jaundice subsided, and the patient recovered well. The patient achieved disease control with an intensive regimen followed by less toxic maintenance therapy. Trastuzumab combined with capecitabine maintenance therapy followed up for more than 16 months.

Conclusion

HAIC plus trastuzumab may be a tolerable treatment option for patients with severe liver metastases from HER2-positive gastric cancer to achieve local control and prolong survival.
Development and optimization of AI algorithms for wrist fracture detection in children using a freely available dataset
Authors: Till Tristan , Tschauner Sebastian , Singer Georg , Lichtenegger Klaus , Till Holger
Published: December 2023

Introduction

In the field of pediatric trauma computer-aided detection (CADe) and computer-aided diagnosis (CADx) systems have emerged offering a promising avenue for improved patient care. Especially children with wrist fractures may benefit from machine learning (ML) solutions, since some of these lesions may be overlooked on conventional X-ray due to minimal compression without dislocation or mistaken for cartilaginous growth plates. In this article, we describe the development and optimization of AI algorithms for wrist fracture detection in children.

Methods

A team of IT-specialists, pediatric radiologists and pediatric surgeons used the freely available GRAZPEDWRI-DX dataset containing annotated pediatric trauma wrist radiographs of 6,091 patients, a total number of 10,643 studies (20,327 images). First, a basic object detection model, a You Only Look Once object detector of the seventh generation (YOLOv7) was trained and tested on these data. Then, team decisions were taken to adjust data preparation, image sizes used for training and testing, and configuration of the detection model. Furthermore, we investigated each of these models using an Explainable Artificial Intelligence (XAI) method called Gradient Class Activation Mapping (Grad-CAM). This method visualizes where a model directs its attention to before classifying and regressing a certain class through saliency maps.

Results

Mean average precision (mAP) improved when applying optimizations pre-processing the dataset images (maximum increases of +25.51% mAP@0.5 and +39.78% mAP@[0.5:0.95]), as well as the object detection model itself (maximum increases of +13.36% mAP@0.5 and +27.01% mAP@[0.5:0.95]). Generally, when analyzing the resulting models using XAI methods, higher scoring model variations in terms of mAP paid more attention to broader regions of the image, prioritizing detection accuracy over precision compared to the less accurate models.

Discussion

This paper supports the implementation of ML solutions for pediatric trauma care. Optimization of a large X-ray dataset and the YOLOv7 model improve the model’s ability to detect objects and provide valid diagnostic support to health care specialists. Such optimization protocols must be understood and advocated, before comparing ML performances against health care specialists.
Development and performance of the c4c national clinical trial networks for optimizing pediatric trial facilitation
Authors: Degraeuwe Eva , van der Geest Tessa , Persijn Laura , Nuytinck Lieve , Raes Ann , Turner Mark , Fernandes Ricardo M. , Vande Walle Johan , de Wildt Saskia N. ,   IMI2 project conect4children (c4c) consortium, including National Hubs/Networks Belgian Pediatric Clinical Research Network (BPCRN) (Belgium) and Pedmed-NL (Netherlands)
Published: December 2023

Introduction

The high failure rate of industry-driven pediatric clinical trials leads to insufficient timely labeling of drugs in children and a lack of scientific evidence, resulting in the persistently high off-label drug use. National clinical trial networks can facilitate collaboration between sites, investigators, and experts, increasing the likelihood of successful trials. Within the conect4children (c4c) network, an Innovative Medicines Initiative 2-funded project, National Hubs hosted by National Clinical Trials Networks were set up across 21 European countries to facilitate the setup and execution of pediatric clinical trials. In this paper, we aim to present the performance metrics of the trial feasibility process as well as learnings and challenges encountered by the Belgian and Dutch Networks in working within the European c4c project.

Method

The c4c National Hubs streamline pediatric clinical trials by initiating early country outreach, identifying overlapping studies, recommending quality trial sites, and supporting trial budgeting for both industry and academic settings. To show the impact of Pedmed-NL and Belgian Pediatric Clinical Research Network (BPCRN), internal metrics were collected from 2019 to 2022 on four industry-sponsored and three academic trials performed within the c4c network. Timelines and outcomes of the site identification were collected and analyzed for industry trials. A qualitative analysis was conducted through c4c platforms, sponsor interactions, and stakeholder engagement to evaluate the added value of a research network.

Results

In industry-sponsored trials, full feasibility questionnaires were completed within 2 weeks (n = 48), and inclusion rates were up to 80% of clinical sites. Before committing to c4c, 14% of sites were contacted by industry, leading to communication burdens. Utilizing national infrastructure knowledge and therapeutic environment insights helped optimize trial timelines and address feasibility challenges. In addition, national adaptations, such as bilingual staff and site development, played a role in streamlining trial operations in both academic and industry settings. Performance and experiences were similar for both networks.

Conclusion

The early-facilitation examples from the c4c trials demonstrated promising metrics for two National Hubs, including optimized start-up timelines and aiding site selection quality. The learnings and challenges of the Belgian and Dutch Networks provided insights for the development of clinical research networks.
Assessing the health literacy of caregivers in the pediatric intensive care unit: a mixed-methods study
Authors: Reddy Anireddy R. , Doshi Anushree K. , Mak Allison , Shea Judy A. , Fardad Joana T. , Moon Jiwon , Hu Paula , Garcia-Marcinkiewicz Annery G.
Published: December 2023

Background

Limited health literacy is associated with increased hospitalizations, emergency visits, health care costs, and mortality. The health literacy levels of caregivers of critically ill children are unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective.

Methods

Caregivers of patients admitted to our large, academic PICU (between August 12, 2022 and March 31, 2023) were approached to complete a survey with the Newest Vital Sign (NVS), which is a validated health literacy screener offered in English and Spanish. We additionally conducted focus groups of interdisciplinary PICU providers to identify factors which may influence implementation of health literacy screening using the Consolidated Framework for Implementation Research (CFIR) framework.

Results

Among 48 surveyed caregivers, 79% demonstrated adequate health literacy using the Newest Vital Sign screener. The majority of caregivers spoke English (96%), were mothers (85%), and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed attending rounds was helpful. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 nurse practitioners, 1 hospitalist, 2 research assistants). Focus group participants described facilitators and barriers to implementation, which were mapped to CFIR domains. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation.

Conclusion

We found the health literacy levels of PICU caregivers in our setting is similar to prior assessments of parental health literacy. Participation in morning rounds was helpful for developing understanding of their child's illness, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.
Cenobamate as add-on therapy for drug resistant epilepsies: effectiveness, drug to drug interactions and neuropsychological impact. What have we learned from real word evidence?
Authors: Pietrafusa Nicola , Falcicchio Giovanni , Russo Emilio , Lattanzi Simona , Goffredo Bianca , Simeoli Raffaele , Cairoli Sara , Corsetti Tiziana , Roberti Roberta , De Tommaso Marina , Vigevano Federico , La Neve Angela , Specchio Nicola
Published: December 2023

Background: Cenobamate (CNB) is an anti-seizure medication (ASM) approved in 2021 in Europe for adjunctive treatment of focal-onset seizures in adults who were not adequately controlled with at least two previous ASMs.

Methods: seizure outcome, treatment-emergent adverse events, neuropsychological profile, and blood levels of CNB and concomitant ASM were analyzed in a real world setting in two different Italian epilepsy centers in the context of CNB early access program. All patients performed a general cognitive evaluation, while 32 patients underwent the administration of a battery of neuropsychological tests at baseline and 6 months after CNB treatment. We performed CNB quantification in plasma in 31 patients at different doses in the range of 100–400 mg/day (65 measures).

Results: we enrolled 54 patients with a median age of 27.9 years. The mean follow-up was 10.7 months. Most (91%) completed the efficacy analysis. At last follow-up visit, a 69.5% median seizure reduction was registered. Thirty-two patients (59.2%) had a ≥50% reduction of seizures that was ≥75% in 20 (42.0%) cases, whilst 10 (20.2%) patients were seizure-free. The most common adverse events were somnolence (53.1%), dizziness (28.1%) and diplopia (12.5%). The correlation between CNB dose and plasma concentration, revealed a significant linear correlation (r = 0.86, p < 0.0001), and there was a significant difference in mean plasma concentration/dose administered ratio (C/D ratio) between patients taking or not at least one inducer (0.10 ± 0.04 [(μg/mL)/(mg/day)]; n = 47 vs. 0.13 ± 0.05 [(μg/mL)/(mg/day)]; n = 18, p = 0.04). CNB dose was inversely correlated (r = −0.31, p = 0.02) to the C/D ratio of Carbamazepine blood levels. and positively correlated (r = 0.74, p < 0.0001) with an increased plasma concentration of the active Clobazam metabolite N-desmethylclobazam. General Anxiety Disorder-7 showed a significant improvement of score from baseline evaluation of 6.82 to follow-up 6 months evaluation of 4.53 (p = 0.03).

Conclusion: In this real-world study, we registered a clinically meaningful reduction in seizure frequency after CNB administration in most patients along with a good tolerability profile. CNB treatment is correlate to a reduction in symptom severity of anxiety score. Plasma levels measurements confirm that CNB acts both as “victim” and as “perpetrator” of drug-drug interactions.
Semiconductor elastic medium with electromagnetic porosity, photothermal excitation, and the Thomson effect
Authors: Alhejaili Weaam , Elamin Mahjoub A. , Chtioui Houda , Chteoui Riadh , El-Bary Alaa A. , Anwer N. , Tantawi Ramdan S. , Lotfy Kh.
Published: December 2023

The Thomson influence on semiconductors can be studied by investigating the connection between the presence of thermoelectric and magnetic fields and porosity and the photothermal transport mechanism. Elastic waves, voids, magnetic fields, and thermoelectric effects in plasma are investigated. The governing equations were analyzed for a uniformly distributed and isotropic medium under two-dimensional [electronic and elastic (plasmaelastic)] deformations. The charge density is considered solely dependent on the induced electric current over time. The Laplace-Fourier transforms method in two dimensions is employed to obtain solutions for the primary variables. The recombination process results in the application of electro-mechanical loads and thermal effects on the free surface of a porous medium. The Laplace-Fourier transformations inversion operations help obtain comprehensive solutions in this study. The effects of porosity parameters and silicon (Si) on a semiconductor porous material are considered, and the resulting physical field distributions are analyzed and represented graphically.
Cholecystokinin-A signaling regulates automaticity of pacemaker cardiomyocytes
Authors: Ruan Hongmei , Mandla Ravi , Ravi Namita , Galang Giselle , Soe Amanda W. , Olgin Jeffrey E. , Lang Di , Vedantham Vasanth
Published: December 2023

Aims: The behavior of pacemaker cardiomyocytes (PCs) in the sinoatrial node (SAN) is modulated by neurohormonal and paracrine factors, many of which signal through G-protein coupled receptors (GPCRs). The aims of the present study are to catalog GPCRs that are differentially expressed in the mammalian SAN and to define the acute physiological consequences of activating the cholecystokinin-A signaling system in isolated PCs.

Methods and results: Using bulk and single cell RNA sequencing datasets, we identify a set of GPCRs that are differentially expressed between SAN and right atrial tissue, including several whose roles in PCs and in the SAN have not been thoroughly characterized. Focusing on one such GPCR, Cholecystokinin-A receptor (CCKAR), we demonstrate expression of Cckar mRNA specifically in mouse PCs, and further demonstrate that subsets of SAN fibroblasts and neurons within the cardiac intrinsic nervous system express cholecystokinin, the ligand for CCKAR. Using mouse models, we find that while baseline SAN function is not dramatically affected by loss of CCKAR, the firing rate of individual PCs is slowed by exposure to sulfated cholecystokinin-8 (sCCK-8), the high affinity ligand for CCKAR. The effect of sCCK-8 on firing rate is mediated by reduction in the rate of spontaneous phase 4 depolarization of PCs and is mitigated by activation of beta-adrenergic signaling.

Conclusion: (1) PCs express many GPCRs whose specific roles in SAN function have not been characterized, (2) Activation of the cholecystokinin-A signaling pathway regulates PC automaticity.
A novel technique for delineating the effect of variation in the learning rate on the neural correlates of reward prediction errors in model-based fMRI
Authors: Chase Henry W.
Published: December 2023

Introduction

Computational models play an increasingly important role in describing variation in neural activation in human neuroimaging experiments, including evaluating individual differences in the context of psychiatric neuroimaging. In particular, reinforcement learning (RL) techniques have been widely adopted to examine neural responses to reward prediction errors and stimulus or action values, and how these might vary as a function of clinical status. However, there is a lack of consensus around the importance of the precision of free parameter estimation for these methods, particularly with regard to the learning rate. In the present study, I introduce a novel technique which may be used within a general linear model (GLM) to model the effect of mis-estimation of the learning rate on reward prediction error (RPE)-related neural responses.

Methods

Simulations employed a simple RL algorithm, which was used to generate hypothetical neural activations that would be expected to be observed in functional magnetic resonance imaging (fMRI) studies of RL. Similar RL models were incorporated within a GLM-based analysis method including derivatives, with individual differences in the resulting GLM-derived beta parameters being evaluated with respect to the free parameters of the RL model or being submitted to other validation analyses.

Results

Initial simulations demonstrated that the conventional approach to fitting RL models to RPE responses is more likely to reflect individual differences in a reinforcement efficacy construct (lambda) rather than learning rate (alpha). The proposed method, adding a derivative regressor to the GLM, provides a second regressor which reflects the learning rate. Validation analyses were performed including examining another comparable method which yielded highly similar results, and a demonstration of sensitivity of the method in presence of fMRI-like noise.

Conclusion

Overall, the findings underscore the importance of the lambda parameter for interpreting individual differences in RPE-coupled neural activity, and validate a novel neural metric of the modulation of such activity by individual differences in the learning rate. The method is expected to find application in understanding aberrant reinforcement learning across different psychiatric patient groups including major depression and substance use disorder.
Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study
Authors: Jafari-Oori Mehdi , Dehi Manigeh , Ebadi Abbas , Moradian Seyed Tayeb , Sadeghi Hajar , Jafari Mojtaba
Published: December 2023

Background

Pre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic.

Methods

This phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi’s approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research.

Results

A total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage.

Conclusion

The findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.
Independent living, emotional well-being, and quality of life in people with disabilities: the mediator role of self-determination and satisfaction with participation
Authors: Cegarra Blanca , Cattaneo Gabriele , Ribes Alina , Solana-Sánchez Javier , Saurí Joan
Published: December 2023

Background

In the field of disability and rehabilitation, participation in society has become an important therapeutic objective due to its potential impact on rehabilitation, prognosis, and patient’s mid and long-term well-being. However, only a few studies have explored this issue in relation with the subjective perspective of individuals with disabilities about their decision-making capacity and satisfaction with the activities in which they participate.

Objective

Our aim is to analyze the relationship between participation in society of people with disabilities and both emotional well-being and quality of life, including variables about subjective perspective of participation (satisfaction) and the ability to decide and pursue their own preferences.

Method

The cross-sectional study presented here includes 424 participants with disabilities over 18-years-old from Spain. This research is part of a larger ongoing longitudinal cohort study called Participa (https://participa.guttmann.com/en/). Participants were asked to complete several on-line surveys to explore quality of life, emotional well-being, participation in society, self-determination, and independent living.

Results

The results revealed an association between the dimensions of participation satisfaction, self-determination, and levels of independent living with both quality of life and emotional well-being. Mediation models indicated that satisfaction and self-determination partially mediated the relationship between independent living and both quality of life and emotional well-being.

Conclusion

The level of independent living, self-determination, and satisfaction with participation are fundamental aspects for promoting a high quality of life and emotional well-being in people with disabilities. These findings carry significant implications for health and social services, as well as policies guidelines, highlighting the need to prioritize empowerment and self-determination in all interventions designed for people with disabilities.
Neuromodulation and memory: exploring ethical ramifications in memory modification treatment via implantable neurotechnologies
Authors: González-Márquez Claudia
Published: December 2023

Invasive implantable neurotechnologies capable of simultaneously altering and recording neural activity are no longer the exclusive province of science fiction but a looming reality that will revolutionize medical practice. These advancements, particularly in their memory-altering capabilities, herald a vast array of opportunities for addressing the complex landscape of neurodegenerative and psychiatric conditions linked to memory impairments. However, the panoply of ethical implications arising from such a novel neurotechnology remains relatively unexplored by the neuroethics literature. This study examines and contrasts the potential ethical implications of memory modification treatment via implantable neurotechnologies. The study contends that undesired side effects resulting from memory modulation can lead to significant identity harms, disrupting the coherence of self-narratives and impinging on our authenticity. To evince the practical impact of this moral argument, the study conducts a practical ethical assessment of how employing implantable neurotechnologies to modulate memory may jeopardize (i) our moral responsiveness to events and core system of values and (ii) the emotional component associated with the altered memory. From a first-person standpoint, changes to the way we reasonably feel and react to past events and future intentions may be deemed ethically problematic as these profound changes can yield significant moral disruptions and negatively impact our personal lives and interpersonal relationships. In addition, the study discusses further ethical conundrums from a third-person perspective as these disruptions can inhibit social activism against structural injustices, thereby hindering societal progress. Thus, taking into account this societal dimension is paramount when evaluating the ethical permissibility of memory modification procedures.
The impact of college experience on female students’ self-perceived employability in STEM majors
Authors: Wen Wen , Zhou Lu , Hu Die , Zhang Mingyu , Yan Zehua , Tang Xiaofeng
Published: December 2023

Introduction

The under representation of women in STEM fields is a persistent issue worldwide. In China, although women have made significant progress in pursuing STEM degrees in recent years, they continue to face challenges in the workforce. Given the importance of the self-perceived employability (SPE) of female STEM students in China, the research questions are: How do curriculum experience, extracurricular experience, and faculty supportive activities affect the SPE of female STEM students in Chinese universities? To what extent does university stratification affect the relationship between college experience and female STEM students’ SPE?

Methods

We analyzed the 2018 data of the Chinese College Student Survey (CCSS) consisting of a sample of 59,066 students, and six focus group interviews.

Results

The findings suggest that curriculum experience, extracurricular experience and faculty supportive activities have a positive impact on the SPE of female students, but the gender gap in SPE is still valid as reflected by the fact that women have lower SPE than men in each tier of universities and that men benefit more in terms of the increase in SPE from most types of college activities and support except academic ones.

Discussion

This study reveals that the different tiers of universities in China affect female students’ SPE in different ways, and provides valuable evidence for academic as well as university administrators and policymakers regarding how college experience affect women and how university stratification can affect female students’ college experience and their career expectations and paths.
Association between attention performance and the different dimensions of DSM-5 depression symptoms
Authors: Taboada Gjorup Ana Lucia , Tolentino Júnior Julio César , van Duinkerken Eelco , Marques André Casarsa , do Carmo Filho Aureo , Joaquim Alan Marques , Neves Vithória Vidotti , Schmidt Sergio Luis
Published: December 2023

Objective

Depressive symptoms can be assessed with self-reported questionnaires, such as the Patient Health Questionary-9 (PHQ-9). Previous studies have suggested that the PHQ-9 items can be grouped into somatic and non-somatic clusters. However, the classification of the PHQ-9 item “concentration difficulties” into somatic or non-somatic is still controversial. This controversy may be explained by difficulties experienced by subjects in accurately evaluating their attention problems. The primary objective of this study was to determine the correlation between objective attentional performance and the two clusters of depressive symptoms in hospital employees working in stressful conditions.

Methods

The participants filled out the PHQ-9 to identify their depressive symptoms. Based on the PHQ-9, the somatic or non-somatic symptoms were measured without considering the question about subjective concentration difficulties. Then, a brief version of the Continuous Visual Attention Test (CVAT) was applied to assess four attentional subdomains. The CVAT is a Go/No-go task that measures number of correct responses (focused attention), number of incorrect responses (behavior-inhibition), average reaction time of correct responses (RT-alertness), and variability of reaction time (VRT-sustained attention). The entire task lasted 90 s. Correlation analyses assessed the relationships between attentional performance and the two dimensions of depressive symptoms.

Results

After applying the inclusion/exclusion criteria, 359 individuals were selected. Their age ranged from 20 to 70 years (mean = 40.5, SD = 10.37), and the majority was female (67.6%). A predominance in somatic depressive symptoms was present in 231 (64%) participants, whereas 59 (16%) showed a predominance of non-somatic symptoms. Sixty-nine participants (20%) did not show any predominance. Higher somatic scores were associated with higher RTs, whereas higher non-somatic scores were related to an increase in the number of incorrect responses.

Conclusion

The predominance of the somatic cluster was related to lower alertness, whereas the predominance of non-somatic cluster was associated with impulsivity/hyperactivity. This result may explain the difficulties associated with correctly classifying the item concentration difficulties. A brief attentional task can be used as an auxiliary tool to correctly identify the different dimensions of attention that are associated with different clusters of depressive symptoms.
The impact of the peer effect on adolescent drinking behavior: instrumental-variable evidence from China
Authors: Liu Meng , Zhao Wen-Qing , Zhao Qi-Ran , Wang Yu , Li Shun-Guo
Published: December 2023

Background

Governments around the world have taken measures to limit adolescent drinking, however, rates are still alarmingly high. However, most of these measures ignore the peer effect of drinking among adolescents. Previous studies have not sufficiently considered the reciprocal relationship between adolescent alcohol consumption and peer alcohol consumption, which may lead to an overestimation of the peer effect and mask underlying issues. Good instrumental variables are powerful but rare tools to address these issues.

Objective

This paper aims to correctly estimate the peer effect of drinking on adolescent drinking behavior in China.

Methods

Owing to the detailed information of household background in the dataset of our survey, we were able to use the drinking behaviors of peers’ fathers and their beliefs about the health risks of alcohol as instrumental variables, which are more powerful than school-average instrumental variables. We collected data from the 2017 Health and Nutrition Panel survey, which surveyed 10,772 primary school students from 59 urban migrant and 60 rural public schools.

Results

The instrumental variable method estimation revealed that peer drinking significantly influences adolescent drinking behavior, with adolescents who have peers who drink alcohol being 10.5% points (2 stage least square, i.e., 2SLS, full sample estimation) more likely to engage in drinking compared to those without such peers. Furthermore, the effect differs significantly between migrant and rural adolescents.

Conclusion

The study found that parental care plays a significant role in the degree of peer effect, with the absence of parental care being a key factor in the presence of the peer effect.
Late onset psychosis treatment with adjunctive medicines
Authors: Boksha Irina , Savushkina Olga , Sheshenin Vladimir , Tereshkina Elena , Prokhorova Tatyana , Pochueva Valeriya , Burbaeva Gulnur
Published: December 2023

Background

A number of studies have shown the feasibility of using adjunctive drugs in late onset psychosis (LOP).

Aim

Testing hypothesis that among LOP people treated with antipsychotics and antidepressants, basing on certain clinical characteristics a subgroup of patients might be distinguished, for whom adjunctive therapy is advantageous. This subgroup might be identified by measurement of blood biochemical parameters.

Methods

59 in-patients with LOP, treated neuroleptics and antidepressants, were included, and followed in real clinical practice. Database containing demographic, clinical data (scores by PANSS, CDSS, CGI-S, HAMD-17), prescribed therapy, adverse effects of antipsychotic and antidepressant treatment, and blood biochemical parameters (enzymatic activities of glutamate- and glutathione metabolism enzymes in platelets and erythrocytes) at baseline and after the treatment course was created.

Results

Three groups of patients (Gr1, Gr2, and Gr3), based on the adjunctive therapy usage were identified: Gr1 (n = 16) was without adjunctive therapy, two other groups (Gr2 and Gr3) were with adjunctive medicines, such as 2-ethyl-6-methyl-3-hydroxypyridine succinate (EMHS; Gr2, n = 20), or other drugs, such as citicoline, cerebrolysin, cortexin, actovegin, gliatilin (choline alfoscerate; Gr3, n = 23). The enzymatic activities were assessed also in the matched control group (n = 38). In all three patient groups, as compared with controls, activity of erythrocyte glutathione reductase was decreased at baseline and after the treatment course. In Gr2, unlike Gr1 or Gr3, there was a significant decrease in baseline glutamate dehydrogenase and glutathione-S-transferase activities. Certain clinical criteria were also elucidated for prescription of EMHS as adjunctive therapy for patients of Gr2. Glutamate dehydrogenase and glutathione-S-transferase activities returned closer to control levels after the treatment course in Gr2, unlike Gr1, where they declined yet more after psychotropic treatment without adjunctive medicine. Different significant links between biochemical parameters and scores by clinical scales were observed in Gr1, Gr2, and Gr3, some having predictive value for evaluation of antipsychotic treatment efficacy.

Conclusion

We demonstrate the validity of adjunctive neuroprotective medicines’ usage in addition to antipsychotic and antidepressant therapy in distinct subgroups of patients suffering with LOP, especially those who have prominent side effects accompanying their psychotropic treatment. Returning of biochemical parameters to control range following the treatment course observed in patients of the subgroup treated with adjunctive EMHS is evidence for their metabolism normalization.
Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care
Authors: Serón Constanza , Olivero Pablo , Flores Nicolás , Cruzat Benjamín , Ahumada Francisca , Gueyffier François , Marchant Ivanny
Published: December 2023

Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.