bluuebunny/crossref_metadata_2025 huggingface dataset:
A-200 Which Domains of Neuropsychological Functioning are Most Strongly Related to Impairment in Instrumental Activities of Daily Living?
Authors: H Clark , R Schroeder , P Martin
Published: August 2020

Objective

The current study investigated relationships between neuropsychological test findings and instrumental activities of daily living (IADLs) in a mixed sample of Mild and Major Neurocognitive Disorder (NCD).

Method

Archival data from a memory disorder clinic were analyzed. Patients (n = 68, mean age = 72.3, mean education = 13.2 years, 26.5% Mild NCD, 73.5% Major NCD) minimally completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Delis-Kaplan Executive Function System (D-KEFS). Information on IADLs was obtained from family members via the Functional Activities Questionnaire (FAQ). Spearman correlations were calculated between individual IADLs from the FAQ, total FAQ ratings, RBANS index scores, and a composite executive functioning score (average scaled score on DKEFS Trail Making, Verbal Fluency, and Tower).

Results

Executive functioning was the only cognitive domain that significantly correlated (p < .05) with total FAQ ratings. However, all cognitive domains except language significantly correlated with individual IADLs. Tracking current events correlated with immediate memory, while financial management correlated with delayed memory. Attending to, understanding, and discussing TV, books, and magazines correlated with executive functioning and immediate and delayed memory. Remembering events correlated with attention and executive functioning. Shopping alone correlated with immediate memory, attention, and executive functioning, while operating basic kitchen appliances correlated with visuospatial skills, attention, and executive functioning. Traveling also correlated with visuospatial skills and executive functioning.

Conclusions

Executive functioning was the only domain associated with overall daily functioning; however, all domains except language corresponded with individual IADLs. Current findings highlight the utility of neuropsychological test findings in understanding the nuances of deficits in daily functioning.
A-202 A Normative Study of Neuropsychological Functioning in a Clinical Sample of Aviation Pilots
Authors: A Crane , A Dacosta , A Roccaforte , M Davies , D Prewett , F Webbe , A Logalbo
Published: August 2020

Objective

Neuropsychological evaluations are mandated by the Federal Aviation Administration (FAA) to ensure that pilots with certain known or suspected medical/neurological or psychiatric conditions do not have neurocognitive sequelae that would impair their ability to safely carry out their responsibilities (Federal Aviation Administration, 2020). However, intact pilots’ performance on cognitive measures appears unique compared to the general population (Causse, Dehias, Arexis, & Pastor, 2011). In an effort to make appropriate comparisons, the current study thus presents normative data on the FAA core neuropsychological test battery.

Method

Sixty-three aviation pilots (age 25–62, M = 44.9, SD = 0.235) underwent neuropsychological testing using the FAA core battery following referral for alcohol utilization. All participants were considered to be cognitively intact at the time of their evaluations.

Results

Participants’ average IQ on the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV) fell in the Superior range using traditional norms (M = 125.29, SD = 10.04). Pilots performed better than “average” across a number of neuropsychological measures. For example, pilots completed Trails-A in 19.38 seconds (SD = 4.10) and Trails-B in 40.73 seconds (SD = 10.56), which is approximately 10 seconds faster than average among individuals aged 35–44 years. Meanwhile, pilots recalled an average of 15.08 out of 16 words on the California Verbal Learning Test Version 2 (CVLT-II) short delay and 15.34 words on the CVLT-II long delay.

Conclusion(s)

This study provides comparison data for future neuropsychological evaluations of pilots with alcohol concerns. The data suggests that pilots generally outperform the civilian population across neuropsychological tests.
A-205 Digit Span Raw, A Newly Derived Embedded Performance Validity Test
Authors: R Schroeder , D Soden , H Clark , P Martin
Published: August 2020

Objective

Outside of Reliable Digit Span (RDS), there has been minimal research examining the utility of Digit Span (DS) score combinations from the Wechsler Adult Intelligence Scale—4th Edition (WAIS-IV) as possible performance validity tests (PVTs). We sought to determine if other DS scores/score combinations might work more effectively than RDS as a PVT.

Method

Patients included 318 individuals who completed neuropsychological evaluations. Individuals were excluded if they were not administered DS; were not administered at least 4 criterion PVTs; had diagnoses of dementia, intellectual disability, or left hemisphere cerebrovascular accident; or had indeterminate validity results (i.e., failure of one PVT). Valid performers (n = 248) were those who passed all criterion PVTs while invalid performers (n = 70) failed two or more criterion PVTs. Receiver operating characteristic curves were conducted for multiple DS indices.

Results

Area under the curve (AUC) was highest for the DS index that combined raw scores from all three trials (Digit Span Raw; AUC = .821). Likewise, when examining cutoffs that maintained 90% specificity for each DS index, a Digit Span Raw cutoff of < 20 produced the highest sensitivity rate (52%) of all indices. For comparison, RDS, RDS with sequencing, and DS scaled score had AUC values of .758, .802, and .811, respectively. When maintaining specificity at 90%, sensitivity rates were 28%, 43%, and 43%, respectively.

Conclusions

Results suggest that the most effective embedded DS index might be a new one, which we term Digit Span Raw. Cross-validation of these findings could provide support for using this index instead of the more commonly examined RDS.
A-208 The Effect of Language on Invalid Baselines in ImPACT
Authors: H Kuwabara , K Grant , S Moore , J Maietta , T Kinsora , S Ross , D Allen
Published: August 2020

Objective

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized assessment of cognitive abilities used for management of sport-concussion that has been translated into 22 languages. Research suggests that language of administration may affect ImPACT performance in bilingual individuals. This study examined the rate of invalid baselines in bilingual/monolingual athletes and in different languages of administrations to explore any potential language biases in ImPACT’s validity index.

Methods

Participants included 47,677 athletes (Mage = 15.11; 57.37% male) from across Nevada who completed a baseline assessment. There were 90 different languages reported among 10,798 bilingual athletes (22.65%). Chi-square analyses were conducted to examine group differences in rate of invalid baselines by language (monolingual/bilingual) and administration language.

Results

Overall, 6.2% of athletes produced invalid baselines. There were no significant differences in the rate of invalid baselines in self-reported monolingual (6.1%) and bilingual athletes (6.4%; p > .05). There were 12 different languages of administration; however, due to small sample sizes of some administration languages, further analyses were only conducted with English and Spanish administrations. There were no significant differences in invalid baselines in English (6.2%) and Spanish administrations (7.3%; p > .05). Additionally, among the bilingual Spanish/English speakers, there were no significant differences in invalid baselines in English (6.4%) and Spanish administrations (6.5%; p > .05).

Conclusion

The current study demonstrates that rates of invalid baselines do not differ based on monolingualism/bilingualism or administration language. This is promising given the high demand for baseline testing, an increase in athletes’ diverse language abilities, and various available languages of ImPACT administration.
A-210 Does Rounding Matter? Cross-Validation of E-Score Calculation Method for the Dot Counting Test
Authors: T Rhoads , Z Resch , G Ovsiew , J Soble
Published: August 2020

Objective

Recent evidence suggested the traditional “rounding” procedure used to calculate Dot Counting Test (DCT) E-score cut-offs provides little advantage and may inadvertently lower test sensitivity. This study examined whether DCT psychometric properties differ when E-score values are rounded.

Method

This cross-sectional study included 132 mixed neuropsychiatric patients who completed the DCT during outpatient evaluation. The sample was 55% female/45% male and 36% Caucasian/35% African American/20% Hispanic/7% Asian/2% other, with mean age of 44.4 (SD=16.1), and mean education of 14.0 years (SD=2.5). In total, 105 (80%) had valid neuropsychological test performance and 27 (20%) had invalid performance based on 4 independent criterion performance validity tests.

Results

In the overall sample, receiver operating characteristic (ROC) curve analyses yielded significant areas under the curve (.802-.817) for both rounded and unrounded E-score values with respective optimal cut-scores of ≥19 and ≥19.73, both producing 44% sensitivity/93% specificity. Among cognitively impaired patients, ROC curve analyses yielded significant AUCs (.756-.764), and suggested the same cut-scores and sensitivities, albeit with minimally reduced specificity (traditional: 91%; unrounded: 92%). In contrast, more liberal cut-scores of ≥13 (traditional) and ≥13.745 (unrounded) were indicated among cognitively unimpaired patients (AUCs: .880-.906), and sensitivity was notably improved (traditional: 74%; unrounded: 67%) with equivalent specificity (90%).

Conclusions

Findings from the overall sample suggested marginally better classification accuracy for the traditional E-score, though both methods demonstrated comparable psychometric properties. The optimal cut-score for cognitively unimpaired patients replicated findings from prior literature, but a higher cut-score was indicated for cognitively impaired patients.
A-219 Cross-validation of a Delis-Kaplan Executive Function System Color Word Interference Test embedded performance validity test
Authors: R Schroeder , H Clark , P Martin
Published: August 2020

Objective

Eglit and colleagues (2019) found that the sum of the four age-corrected scaled scores from the Color Word Interference Test (CWIT) of the Delis-Kaplan Executive Function System (D-KEFS) could act as a useful embedded performance validity test (PVT). As such, we attempted to cross-validate their findings.

Method

Patients included 312 individuals who completed neuropsychological evaluations. Individuals were excluded if they were not administered CWIT, were not administered at least 4 criterion PVTs, had diagnoses of dementia or intellectual disability, or had indeterminate validity results (i.e., failure of one PVT). Valid performers (n = 231) were those who passed all criterion PVTs while invalid performers (n = 81) failed two or more criterion PVTs. A receiver operating characteristic curve was conducted for the CWIT embedded PVT.

Results

Area under the curve (AUC) was .804. At a cutoff of < 26, specificity was 90% and sensitivity was 48%. At a cutoff of < 20 (the first cutoff at which 90% specificity was found by Eglit et al.), specificity was 95% and sensitivity was 32%. At an even more conservative cutoff of < 18 (the cutoff recommended by Eglit et al.), specificity was 96% and sensitivity was 22%.

Conclusions

These results cross-validate Eglit et al.’s findings, indicating that the sum of age-corrected scaled scores across the four CWIT trials can effectively serve as an embedded PVT. A more liberal cutoff was able to be applied in our sample but, even at conservative cutoffs documented in Eglit et al., sensitivity rates were adequate enough to warrant use of the index as an embedded PVT.
A-220 Screening for Cognitive Over-Reporting with the Neurobehavioral Symptom Inventory
Authors: S Rolin , K Kitchen Andren , C Mullen , N Kurniadi , J Davis
Published: August 2020

Objective

Considerable research in veteran and military populations has focused on the development of embedded symptom validity indicators on the Neurobehavioral Symptom Inventory (NSI) including the low frequency (LOW6), negative impression management (NIM5), and validity (VAL10) scales. These measures have been less studied in other clinical settings. This study examined embedded NSI validity scales in a rehabilitation setting.

Method

Participants (N = 94) underwent outpatient neuropsychological evaluation using the NSI, MMPI-2-RF, and Memory Complaints Inventory (MCI), among other measures. Cognitive symptom over-reporting was psychometrically determined if the MCI (average score > 39) and MMPI-2-RF (RBS > 79 T or FBS > 79 T) were elevated.

Results

Thirty-four participants (36%) met over-reporting criteria. NSI total scores were significantly different between over-reporting (M = 48.7, SD = 12.2) and non-over-reporting (M = 28.1, SD = 14.3) groups (p < .0001, d = 1.5). Receiver operating characteristic analysis using embedded NSI scales to classify cases showed area under the curve (AUC) values of .82 for LOW6 and NIM5, and .83 for VAL10. A VAL10 cutoff (>18) showed sensitivity of 56% and 90% specificity. VAL10 scores of 4 or below demonstrated 100% sensitivity and may be considered evidence that additional assessment of cognitive over-reporting is not needed.

Conclusion

Findings support the utility of NSI validity indicators to screen for cognitive over-reporting in a rehabilitation setting.
A-223 Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) Embedded Performance Validity Analyses in a Healthy Non-Clinical Sample
Authors: A Arzuyan , A Mathew , A Rosenblatt , E Gracian , D Osmon
Published: August 2020

Objective

The Hopkins Verbal Learning Test–Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) are memory tests with embedded measures of performance validity (Recognition Discrimination [RD] and Discrimination Index [DI], respectively). We evaluated whether cognitive ability and age influenced embedded measures of effort.

Methods

Participants included 30 young adults (YA) and 29 older adults (dichotomized into unimpaired [OAu] and impaired [OAi]). Participants completed a medication management ability assessment (MMAA), daily memory lapses survey (DM), digit span, and the Transverse Patterning (TP) and Reversal Learning (RL) computerized tests. Two Repeated-Measures MANOVAs were conducted to determine if Passing PVT and Age/Cognitive Ability influenced performance. An ROC analysis was conducted for HVLT-RD and BVMT-DI to determine pass/fail, and false positives/negatives on embedded measures.

Results

Those in the YA group who failed RDS (YA-fail), performed better than OAi-fail and OAi-pass groups on RT Errors (p < .0001). On TP Errors, the YA group differed from all four OA groups (p < .0001). On MMAA a significant difference was observed between OAi-fail and all other groups (p < .001). On RD, YA groups differed from both OAi groups (p = .0008). On DI, the YA groups differed from the OAi-fail group (p = .002). A logistic regression classified 43/57 participants successfully into the three cognitive groups using the six predictors (χ2 = 55.73, p < .0001, R2 = .468). RT Errors and TP were significant (Likelihood χ2 = 7.25, p = .027).

Conclusion

HVLT-RD failed to detect validity for OAi, as did BVMT-DI for YA and OAu. Instead, impairment effects are seen on HVLT-RD and BVMT-DI where YA groups differed from some combination of both/one of the OA groups.
A-227 Boston Naming Test as an Embedded Performance Validity Test: A Replication Study
Authors: D Abramson , D White , Z Resch , G Ovsiew , J Soble
Published: August 2020

Objective

The Boston Naming Test (BNT) has recently been proposed as an embedded performance validity test (PVT) with high specificity/low sensitivity; however, this has not been replicated. This study therefore aimed to cross-validate findings in a mixed clinical neuropsychiatric sample.

Method

This cross-sectional study of 136 primary monolingual English-speaking patients who completed the BNT during outpatient evaluation was 57% female/43% male, 38% Caucasian, 39% African American, 16% Hispanic, and 6% Asian with mean age of 47.7 years (SD = 16.6) and mean education of 14.0 years (SD = 2.7). In total, 109/136 (80%) were classified as valid and 27/136 (20%) as invalid based on 4 independent criterion PVTs.

Results

Respective mean BNT raw/T-scores were 49.5 (SD = 9.2)/45.3 (SD = 10.9) for the valid group and 45.8 (SD = 8.2)/41.1 (SD = 7.8) for the invalid group. Analyses of variance fell just above significance for both BNT raw F(1, 134) = 3.75, p = .05 and T-scores F(1, 134) = 3.55, p = .06. Receiver operator characteristic curve analysis for the raw score was significant, with an area under the curve (AUC) of .67 (p < .01) and an optimal cutoff of ≤ 35 (4% specificity/90% sensitivity). BNT raw scores remained significant after removing bilingual participants, (AUC = .68; p < .01), with identical psychometric properties. In contrast, analysis of BNT T-scores (AUC = .61; p = .08) were nonsignificant.

Conclusions

Overall, results showed that the BNT cannot psychometrically distinguish valid versus invalid performance and therefore has questionable utility as a PVT in a mixed clinical setting. Findings contribute to a growing literature base cautioning against the indiscriminate use of measures of actual cognitive ability as validity indicators, particularly in populations with cognitive impairment.
A-232 Using Rates of Low Scores to Assess Agreement between ImPACT and a Traditional Battery of Neuropsychological Tests
Authors: B Ivins , J Arrieux , W Cole , K Schwab
Published: August 2020

Objective

ImPACT is a brief computerized test battery used to assess cognitive function most often following sports concussion. We compare intra-individual agreement between ImPACT and a battery of traditional neuropsychological tests using rates of low scores.

Methods

Complete and valid data from 246 healthy soldiers and 177 soldiers ≤ 7 days from sustaining mild TBI (mTBI) were used in this analysis. All soldiers were consecutively administered ImPACT and a traditional test battery consisting of: TOPF, WAIS-IV, CVLT-II, RCFT, DKEFS, and CPT-II. We performed base rate analyses of both batteries to determine the proportions of soldiers who had various numbers of scores that were 1.0+, 1.5+, and 2.0+ standard deviations below the normative mean. We used those rates to place Soldiers into a “low score hierarchy” ranging from the least poor (i.e. ~ > 10th %ile) to the worst overall performance (i.e. ~ ≤ 10th %ile). We then compared agreement between the batteries at each of those levels.

Results

More soldiers with mTBI had low scores than healthy soldiers on both batteries. Of the soldiers who performed at the worst level on one battery, 100.0% from ImPACT and 73.1% from traditional had some level of poor performance on the other battery. However, of the soldiers who performed at the worst level on either battery, only 42.9% from ImPACT and 34.6% from traditional also performed at the worst level on the other battery.

Conclusion

These batteries similarly identify poor performance to a degree, though with some potentially meaningful differences still present.
A-233 Incremental Utility of the Montreal Cognitive Assessment (MoCA) Memory Index Score (MIS) for Detection of Cognitive Impairment
Authors: K Bain , J Marceaux , A Kruzelock
Published: August 2020

Objective

To investigate the incremental utility of the optional MoCA Memory Index Score (MIS) for detection of cognitive impairment.

Method

This cross-sectional study utilized data collected from a mixed clinical sample of 153 veterans referred for clinical neuropsychological evaluations at a VA hospital. The sample was 87% male (n = 133), with an average age of 63.23 years (range 20–91) and average education level of 13.6 years (range 6–20). All participants completed the MoCA, including the MIS items. Participants meeting criteria for mild (n = 66) or major neurocognitive disorder (n = 24) were classified as cognitively impaired (CI). Sixty-three participants who did not meet criteria for a neurocognitive disorder were classified as having no cognitive impairment (NCI). Chi square analysis and logistic regression were utilized to determine the sensitivity of the MoCA total score for detection of cognitive impairment, and to determine whether the MIS significantly improved classification accuracy.

Results

The MoCA total score was a significant predictor of cognitive impairment status (X2 = 40.92, p < .001), with 73% sensitivity, 67% specificity, and 71% classification accuracy. When the MIS was added, the model retained significance (X2 = 41.13, p < .001), but overall sensitivity, specificity, and classification accuracy were unchanged; MIS was not a significant predictor in the combined model.

Conclusions

The optional MIS score did not significantly improve the sensitivity of the MoCA for detection of cognitive impairment.
A-237 Investigating the Reliability and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form
Authors: G Iverson , J Marsh , E Connors , D Terry
Published: August 2020

Objective

We present the normative reference values, item level endorsement, and the internal consistency reliability of the PROMIS® v2.0 Cognitive Function-8-Item Short Form.

Method

The PROMIS® v2.0 Cognitive Function 8-Item Short Form measures subjective cognitive difficulties (raw score range = 8–40). A cohort of 1,009 adults (51.1% women) from the US population completed this measure. The total sample was stratified by gender and health status for analyses. A healthy subgroup (n = 475; 49.5% women) reported no personal history of mental health, neurological, or sleep disorders and rated their overall health, functioning, and quality of life as “good” or better.

Results

The healthy group reported less cognitive symptoms (i.e., higher raw score) than the total sample (total sample, M = 32.17, SD = 7.57, Md = 34; healthy sample, M = 35.02, SD = 5.94, Md = 38). This pattern was shown in men [all men, M = 31.06, SD = 7.68, Md = 32; healthy men, M = 33.95, SD = 6.34, Md = 36] and women [all women, M = 33.23, SD = 7.32, Md = 36; healthy women, M = 36.12, SD = 5.30, Md = 39]. The base rates for endorsing three or more cognitive symptoms were consistently lower among the healthy samples (total sample = 14.8%, total healthy sample = 4.8%, all men = 19.7%, healthy men = 7.5%, all women = 10.1%, and healthy women = 2.1%). Internal consistency, as measured by Cronbach’s alpha, ranged from 0.89 to 0.95 depending on subgroup.

Conclusions

The PROMIS® v2.0 Cognitive Function 8-Item Short Form is a reliable self-report measure of cognitive difficulties. Participants who reported their overall health status to be good tended to report less cognitive difficulties. The presented normative reference values can be useful in both research and clinical practice when assessing cognition in the general population.
A-243 Cross-Validation of the Dissimulation ADHD Scale in an Outpatient Veteran Sample
Authors: A Andrews , J Caron
Published: August 2020

Objective

The Dissimulation ADHD (Ds-ADHD) scale for the Minnesota Multiphasic Personality Inventory-2-Restructured Form was developed by Robinson and Rogers (2017) using college students. The authors reported good discriminant validity and a 3% false positive (FP) rate when used in a sample of people with genuine ADHD. The objective of this study was to see if the FP rate would remain low when used in a sample of U.S. military veterans.

Method

Archival data was gathered from ADHD assessments conducted at an outpatient VA medical center. Participants were excluded if they did not meet DSM-5 diagnostic criteria for ADHD (as a child and at time of assessment), or if they produced invalid scores on symptom validity measures from any of the self-report measures given at the time of the assessment. The final sample included 58 participants (mean age and education were 42 and 14, respectively; 91% male and 90% Caucasian).

Results

Using the published cutoff of < 13, the Ds-ADHD scale’s FP rate in the sample of Veterans with genuine ADHD was 12.1%. This is slightly above most standards for acceptable FP rates (typically < 10%), and four times higher than the original study’s genuine ADHD sample. When the cutoff was lowered to < 12, the FP rate decreased to 5.2%, which is very good and more comparable to the original study.

Discussion

Using the published cutoff of < 13 with veterans may lead to higher misclassification of feigning than when used in a university setting. Using a cut score of < 12 for veterans may be more appropriate.
A-252 New Onset Severe Epilepsy in a Child with Existing Cerebral Palsy: Neuropsychological Findings Inform Medical Management
Authors: C Mullen , F Fulton
Published: August 2020

Objective

Pediatric epilepsy is associated with a wide range of neurodevelopmental challenges. Few studies have established children’s cognitive function prior to seizure onset making study of the direct impact of seizures challenging. This is especially true in cases with preexisting neurological disorders. The present case provides insight into the impact that new onset of seizures (including status epilepticus) have on cognitive development and illustrates how documented cognitive change informs clinical decision-making.

Method

The patient is a 10-year-old boy with a history of cerebral palsy who initially completed neuropsychological testing in the fall of 2018. New onset of drug-resistant seizures presented in January 2019, including episodes of status epilepticus leading to repeat neuropsychological evaluation in the fall of 2019. EEG studies in infancy showed poorly regulated background rhythm and MRI showed dysplastic corpus callosum and bilateral occipital heterotopias. Following the onset of seizures EEG showed independent seizure foci over temporal regions bilaterally. MRI showed extensive bilateral temporal and occipital subependymal gray matter heteropi, and dysgenesis of the corpus callosum, cerebral vermis, and anterior commissure.

Results

Repeated neuropsychological assessment documented significant declines in intellectual function, visual and verbal memory (visual worse than verbal), and executive function, with limited academic progression. Persistent epileptic symptoms throughout testing complicated interpretation.

Conclusions

Findings were highly concerning for cognitive deterioration and the neurosurgical team deemed him as high risk for sudden unexpected death in epilepsy. He underwent right anterior temporal lobectomy and left stereoelectroencephalography placement in January 2020. Scheduled repeat neuropsychological evaluation will further monitor neurocognitive functioning post neurosurgical intervention.
A-253 A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery
Authors: C Andrew , M Smith
Published: August 2020

Objective

To describe neurobehavioral consequences and recovery course in a case of acute infarct of the fornix superimposed on chronic subcortical cerebrovascular disease.

Method

We present a right-handed, 72-year-old, African American man with cardiovascular risk factors, chronic kidney disease, and history of CVA with no prior functional or cognitive difficulties. He was evaluated twice, first four days post and again two months post-infarct of the bilateral fornix.

Results

Initial inpatient testing revealed impaired verbal memory characterized by rapid forgetting (HVLT-R Delay T = < 20) with some benefit from recognition cues, and subtle deficits in constructional praxis and practical judgement.
Quantifying the impact of nonpharmaceutical interventions during the COVID-19 outbreak: The case of Sweden
Authors: Cho Sang-Wook (Stanley)
Published: August 2020

This paper estimates the effect of nonpharmaceutical intervention policies on public health during the COVID-19 outbreak by considering a counterfactual case for Sweden. Using a synthetic control approach, I find that strict initial lockdown measures play an important role in limiting the spread of the COVID-19 infection, as the infection cases in Sweden would have been reduced by almost 75 percent had its policymakers followed stricter containment policies. As people dynamically adjust their behaviour in response to information and policies, the impact of nonpharmaceutical interventions becomes visible, with a time lag of around 5 weeks. Supplementary robustness checks and an alternative difference-in-differences framework analysis do not fundamentally alter the main conclusions. Finally, extending the analysis to excess mortality, I find that the lockdown measures would have been associated with a lower excess mortality rate in Sweden by 25 percentage points, with a steep age gradient of 29 percentage points for the most vulnerable elderly cohort. The outcome of this study can assist policymakers in laying out future guidelines to further protect public health, as well as facilitate plans for economic recovery.
May Measurement Month 2018: an analysis of blood pressure screening campaign results in India
Authors: Maheshwari Anuj , Verma Narsingh , Bhardwaj Shipra , Jose Arun P , Bhalla Sandeep , More Arun , Patil Mansi , Gupta Amit , Gupta Bal Kishen , Takalkar Anant , Gupta Priyanka , Pandey Nikki , Patil Vishal , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

Hypertension (HTN) is the greatest attributable risk factor for cardiovascular disease in India. Recent studies have reported the crude prevalence of HTN in India to be 25.3%. In the May Measurement Month (MMM) screening campaign of 2017 conducted in India, 31.8% had HTN. In order to ratify earlier results, and further understand the awareness and control levels of HTN in India, organizations that participated in MMM 2017 decided to participate in the MMM global screening initiative of the International Society of Hypertension for a 2nd consecutive year. A total of 345 234 individuals were screened in MMM 2018. There were more than 1000 screening locations that included hospitals, clinics, workplaces, and special health camps organized across the country. After applying multiple imputation, a total of 111 462 (32.3%) individuals had HTN of whom 63 415 (55.6%) were aware of HTN and 61 646 (55.3%) were on antihypertensive medicines, out of which 15 583 (25.3%) were uncontrolled. Overall 57 864 (41.3%) hypertensives were uncontrolled. About half (44.7%) of hypertensive population in India were not on treatment. Around two-thirds (65.7%, n = 226 924) had not measured their blood pressure (BP) in last 12 months and 64% measured their BP for the first time in their life during the campaign, which strongly indicates the need for large scale awareness drives. This study suggests that opportunistic periodic public health screening at a national level is needed to increase HTN detection, treatment, control, and countrywide awareness in highly populated nations like India.
May Measurement Month 2018: an analysis of blood pressure screening results from Indonesia
Authors: Turana Yuda , Widyantoro Bambang , Situmorang Tunggul D , Delliana Juzi , Roesli Rully M A , Danny Siska S , Suhardjono  , Sofiatin Yulia , Hermiawaty Eka , Kuncoro Ario S , Barack Rossana , Beaney Thomas , Ster Anca Chis , Poulter Neil R , Santoso Anwar
Published: August 2020

Elevated blood pressure (BP) is a significant burden worldwide, leading to high cardio-cerebro-reno-vascular morbidity and mortality. For the second year of the May Measurement Month (MMM) campaign in Indonesia in 2018, we recruited 174 sites in 31 out of 34 provinces in Indonesia and screened through convenience sampling in public areas and rural primary health centres. Hypertension was defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or both, or on the basis of receiving antihypertensive medication. Blood pressure was measured three times followed the standard global MMM protocol, multiple imputation was used to estimate the mean of the 2nd and 3rd BP readings if these were not recorded. A total of 91 222 individuals were screened, and after multiple imputations, 27 331 (30.0%) had hypertension. Of individuals not receiving antihypertensive medication, 14 367 (18.4%) were hypertensive. Among the 47.4% of hypertensive individuals on antihypertensive medication, 10 106 (78.0%) had uncontrolled BP. MMM17 and MMM18 were still the most extensive standardized screening campaigns for BP measurement in Indonesia. Compared to the previous study, the proportion with uncontrolled BP on medication was significantly higher and provided the substantial challenges in managing hypertension in the rural community.
May Measurement Month 2018: an analysis of blood pressure screening results from Malawi
Authors: Ndhlovu Henry L L , Masiye Jones K , Chirwa Maureen L , Nyirenda Nancy M , Dhlamini Tiyezge D , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

Raised blood pressure (BP) is a growing health care problem in the world leading to over 10 million deaths annually. May Measurement Month (MMM), which aims at raising awareness and screening people for raised BP, is assisting people to know their BP status. In 2018, an opportunistic cross-sectional survey was carried out during May and June in 10 791 volunteers aged 18 years and above following that done in 2017. The screening took place in Lilongwe, Blantyre, Dedza, Kasungu, and Nkhatabay districts mostly in hospitals/clinics, marketplaces, workplaces, and churches/mosques with Kasungu and Nkhatabay in rural areas. After multiple imputation, 2404 (22.3%) had hypertension. Of individuals not receiving antihypertensive treatment, 2101 (20.0%) were found to have raised BP. Only 303 (12.6%) of those with hypertension were receiving antihypertensive treatment, and of these 101 (33.3%) had uncontrolled BP. MMM was the largest BP screening campaign ever undertaken in Malawi. The results identified a large number of individuals with raised BP who were unaware and not on treatment and over one-third of those on treatment were uncontrolled, indicating the need for better management of cases. These results suggest that opportunistic screening can identify significant numbers with raised BP.
May Measurement Month 2018: an analysis of blood pressure screening results from Oman
Authors: Nadar Sunil K , Al-Riyami Hassan , Al-Riyami Adil , Al-Lawati Hatim , Panakkal Benny , Mohammed Shafeek , Nagaraju G B , Sharma S N , Abdulkader Muhamed M , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

As per WHO estimates, around 17% of the adult Omani population are hypertensive. However, people with hypertension are often unaware of the diagnosis, and so the May Measurement Month (MMM) programme was set up to raise awareness of the importance of blood pressure (BP) screening. A cross-sectional screening of BP of subjects aged 18 years or more was carried out in May 2018 at various sites in Muscat, Oman. Screening sites were set up at the reception areas of participating hospitals, and at a few public areas such as shopping malls and workplaces of the volunteers. Blood pressure was measured according to a standardized protocol, and hypertension was defined as per the 2018 European Society of Hypertension guidelines. The data were analysed centrally by the MMM project team. A total of 12 689 individuals (mean age 40.6 ± 12.5 years, 72% male) were screened. The crude mean BP of the second and third readings (where three readings were taken, n = 4 738) was 127.1/79.2 mmHg. After multiple imputations, the average age and sex standardized BP was 127.3/80.2 mmHg. Of all participants, 29.8% had hypertension. There were 1 983 patients with a previous diagnosis of hypertension, of whom 1 810 were on antihypertensive medication. A further 1 973 subjects were newly diagnosed with hypertension. Of those on antihypertensive medication, 34.9% had uncontrolled BP readings. Screening programmes such as MMM are useful to identify persons with undiagnosed hypertension. However, more educational activities are required to increase the public awareness regarding the dangers of hypertension.
May Measurement Month 2018: an analysis of blood pressure screening results from United Arab Emirates
Authors: Yusufali Afzalhussein , Bazargani Nooshin , Bin Belaila Buthaina A , Suhail Aisha M , Shuri Hassan H , Agrawal Amrish , Muhammed Khalifa , Gabroun Ahmed , Albawab Amer , Vazir Zainab , Ravi Kumar Rajakumari , Ghannam Dana , Beaney Thomas , Ster Anca Chis , Poulter Neil R
Published: August 2020

Hypertension is one of the most important modifiable risk factors for cardiovascular disease and death even in high-income countries. According to the PURE Study, globally only half of hypertensives are aware and less than a fifth controlled. May Measurement Month (MMM) is a global campaign to raise awareness and screen for high blood pressure (BP) in lieu of formal screening. United Arab Emirates (UAE) has taken part in MMM since its inception and here data from MMM18 are reported. Trained volunteers from 54 sites screened 31 316 individuals from all the Emirates of UAE using convenience sampling. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. The mean age was 36.8 ± 11.4 years and 18 411(59%) were male. Participants of Arab descent were 11 829 (38%) and 11 569 (37%) were South Asian. Mean body mass index was 26.8 ± 5.29 kg/m2. Of those screened, 7 917 (25%) had never had a BP recorded, while 16 892 (54%) had recorded BP in the previous year. After imputation, 6 243 (20%) had hypertension. Of those participants, only 2 540 (41%) were aware and 2 331 (37%) were on antihypertensive medication, of which 61% were controlled. Of all hypertensives, only 23% were controlled. May Measurement Month in UAE expanded significantly compared to 2017. A quarter had never had BP measured and awareness of hypertension low (41%). This opportunistic screening method found a substantial number of adults with untreated or inadequately treated hypertension.
Pinioning the Peacekeepers: Sovereignty, Host-State Resistance against Peacekeeping Missions, and Violence against Civilians
Authors: Duursma Allard
Published: August 2020

Why and how do host-states resist contemporary peacekeeping missions? This article puts forward the argument that host-state resistance against peacekeepers is a strategy to balance challenges to the internal and external faces of a civil war state's sovereignty. Government officials might see an intense counter-insurgency campaign as an effective way to regain the monopoly on violence and thus strengthen the internal sovereignty of the state, but this will often lead to criticism from the international community and thus also lead to an erosion of the external sovereignty of the state. Conversely, the acceptance of a peacekeeping mission can strengthen a civil war state's external sovereignty as this acceptance signals a willingness to manage armed violence, but the deployment of peacekeepers is at the expense of internal sovereignty as it often limits the ability of government troops to conduct their counter-insurgency efforts. States can resolve this dilemma by accepting a peacekeeping mission to prop up their external sovereignty, but at the same time trying to limit the effectiveness of peacekeepers in those areas where peacekeeping activities potentially interfere with the efforts of government troops to regain the monopoly on the use of violence. The article zooms in on how the Sudanese government accepted the deployment of the United Nations–African Union Peacekeeping Mission in Darfur (UNAMID), but at the same undermined its civilian protection efforts, though other cases are considered as well.
Development of Hydrotaea spinigera (Diptera: Muscidae) at Constant Temperatures and Its Significance for Estimating Postmortem Interval
Authors: Wang Yu , Zhang Yingna , Wang Man , Hu Guoliang , Fu Yangfan , Zhi Rong , Wang Jiangfeng
Published: August 2020

Hydrotaea spinigera Stein is a necrophagous species, widely distributed in Oriental and Australasian regions. Considering that the postfeeding larvae or puparia of this species can still be found in abundance at the advanced decomposition stage or even the skeleton stage of remains, it can serve as a good supplementary indicator for estimating the minimum postmortem interval (PMImin). This could also extend the range of PMImin when the primary colonizers are no longer associated with the corpse or have emerged as adults. This study investigated the development duration, accumulated degree hours, and larval body length changes of H. spinigera at seven constant temperatures ranging from 16 to 34°C, and established three development models for estimating PMImin, including isomorphen diagram, isomegalen diagram, and thermal summation model. At 16, 19, 22, 25, 28, 31, and 34°C, the development durations of H. spinigera from egg to adult stage were 1,412.6 ± 62.9, 867.4 ± 14.9, 657.1 ± 22.9, 532.3 ± 10.1, 418.8 ± 21.3, 379.8 ± 16.6, and 340.0 ± 20.3 h, respectively. The lower developmental threshold L0 was estimated as 10.50 ± 0.20°C, and the thermal summation constant K was 7,648.83 ± 146.74 degree hours. Using regression analysis, equations were obtained modeling the change of larval body length with time after hatching at different temperatures. This study provided basic data based on the growth and development of H. spinigera for the estimation of PMImin in forensic science.
Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis
Authors: Schechter Marcos C , Ali Mohammed K , Risk Benjamin B , Singer Adam D , Santamarina Gabriel , Rogers Hannah K , Rajani Ravi R , Umpierrez Guillermo , Fayfman Maya , Kempker Russell R
Published: August 2020

Background

Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes.

Methods

We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available.

Results

Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%–99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%–91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported.

Conclusions

This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.
Recent advancements in PARP inhibitors-based targeted cancer therapy
Authors: Zhou Ping , Wang Justin , Mishail Daniel , Wang Cun-Yu
Published: August 2020

Poly(ADP-ribose) polymerase inhibitors (PARPi) are a new class of agents with unparalleled clinical achievement for driving synthetic lethality in BRCA-deficient cancers. Recent FDA approval of PARPi has motivated clinical trials centered around the optimization of PARPi-associated therapies in a variety of BRCA-deficient cancers. This review highlights recent advancements in understanding the molecular mechanisms of PARP ‘trapping’ and synthetic lethality. Particular attention is placed on the potential extension of PARPi therapies from BRCA-deficient patients to populations with other homologous recombination-deficient backgrounds, and common characteristics of PARPi and non-homologous end-joining have been elucidated. The synergistic antitumor effect of combining PARPi with various immune checkpoint blockades has been explored to evaluate the potential of combination therapy in attaining greater therapeutic outcome. This has shed light onto the differing classifications of PARPi as well as the factors that result in altered PARPi activity. Lastly, acquired chemoresistance is a crucial issue for clinical application of PARPi. The molecular mechanisms underlying PARPi resistance and potential overcoming strategies are discussed.
Minimum Wages and Consumer Credit: Effects on Access and Borrowing
Authors: Dettling Lisa J , Hsu Joanne W
Published: August 2020

This paper examines how minimum wages affect lender and borrower interactions with consumer credit markets. We find that higher state minimum wages increase the supply of unsecured credit, reduce payday loan usage, decrease delinquency, and increase credit scores. Overall, minimum wages reduce borrowing costs and have positive spillover effects on disposable income and liquidity. A back-of-the-envelope of the cost savings indicates that higher minimum wages increase disposable income by 1.3% more than implied by estimates of the direct effect on earnings.
Hemodynamic Response Function in Brain White Matter in a Resting State
Authors: Wang Ting , Wilkes D Mitchell , Li Muwei , Wu Xi , Gore John C , Ding Zhaohua
Published: August 2020

The hemodynamic response function (HRF) characterizes temporal variations of blood oxygenation level-dependent (BOLD) signals. Although a variety of HRF models have been proposed for gray matter responses to functional demands, few studies have investigated HRF profiles in white matter particularly under resting conditions. In the present work we quantified the nature of the HRFs that are embedded in resting state BOLD signals in white matter, and which modulate the temporal fluctuations of baseline signals. We demonstrate that resting state HRFs in white matter could be derived by referencing to intrinsic avalanches in gray matter activities, and the derived white matter HRFs had reduced peak amplitudes and delayed peak times as compared with those in gray matter. Distributions of the time delays and correlation profiles in white matter depend on gray matter activities as well as white matter tract distributions, indicating that resting state BOLD signals in white matter encode neural activities associated with those of gray matter. This is the first investigation of derivations and characterizations of resting state HRFs in white matter and their relations to gray matter activities. Findings from this work have important implications for analysis of BOLD signals in the brain.