bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP91: Pre-stroke Sulfonylurea Exposure Leads To Worse Outcomes
Authors: Shu Liqi , Yaghi Shadi , Grilli Anais , De Havenon Adam H , Johnston Karen C , Goldstein Eric D
Published: February 2023

Introduction:
Sulfonylurea medications may reduce cerebral edema following ischemic stroke. Prior retrospective studies evaluated the impact of pre-stroke sulfonylurea exposure on outcome metrics yielding inconclusive results and have not provided results based on stroke subtype. We hypothesize that exposure to pre-stroke sulfonylureas would have a better outcome than unexposed regardless of stroke etiology.

Methods:
We performed a post-hoc analysis of the Stroke Hyperglycemia Insulin Network Effort (SHINE) dataset. Only those with pre-enrollment diabetes mellitus were included. The primary exposure was pre-stroke sulfonylurea usage. The primary outcome was 90-day functional outcome by mRS 0 - 2 (good) versus 3 - 6 (poor). Ischemic stroke was categorized as lacunar or non-lacunar. Standard descriptive and logistic regression analyses were used for data interpretation.

Results:
A total of 919 individuals met inclusion criteria: mean age 65 years, 58% male, 256 (28%) being sulfonylurea exposed. Lacunar stroke was diagnosed in 220 (24%) of the cohort. Pre-stroke sulfonylurea exposure was reported in 256 participants (lacunar: 59 vs. non-lacunar: 197, p = 0.69). Amongst the whole cohort, exposed individuals were more likely to have a poor outcome (OR 1.7, 95%CI 1.25 - 2.32, p = <0.001). The association between sulfonylurea exposure and poor outcome remains in those with non-lacunar stroke (OR 1.67, 95%CI 1.19 - 2.32, p = 0.003) as opposed to lacunar stroke (OR 0.60, 95%CI 0.43 - 0.84, p = 0.003) (pinteraction 0.1).

Conclusion:
Patients with pre-stroke sulfonylurea exposure were more likely to have a poor outcome at 90 days. Current trials investigating sulfonylurea infusion for cerebral edema, though these data suggest chronic oral administration may mitigate this response. Limitations exist including potential unaccounted differences amongst the cohort. This is a hypothesis generating study with future studies needed expand and corroborate our findings.
Abstract WP92: Developing A Culturally Competent Stroke Education Curriculum For Marginalized Asian Americans To Improve Health Disparities In West Michigan
Authors: Anderson Taylor R , Ngo Vincent , Park Sojung , Antonio Aileen , Farooq Muhammad , Koehler Tracy , Gorelick Philip B
Published: February 2023

Introduction:
The presence of health disparities and poor health outcomes in minority groups in the United States is well described. Compared to the white patients, Asian American minorities and subgroups have more severe ischemic strokes, are less likely to receive thrombolytics with more hemorrhagic complications after administration, and experience worse functional outcomes. With this in mind, our team developed an educational community outreach program to address stroke knowledge gaps and promote health equity in local Asian American marginalized subgroups.

Methods:
A culturally competent stroke curriculum was developed and modified (e.g., translated) to fit each population. A series of community-level interventions have been performed to date (two sessions; 35 participants). Pre- and post-test data were collected related to stroke knowledge to assess the effectiveness of the intervention. Feedback from each session was used to make improvements for the next.

Results:
Feedback from each session was positive. Post-test data showed significant (p<0.001) improvements in ability to identify symptoms of stroke including weakness (20% vs 54.3%), speech changes (2.9% vs 65.7%), vision changes (2.9% vs 60%), and facial droop (8.6% vs. 65.7%), as well as risk factors for stroke including hypertension (14.3% vs 80%), sedentary lifestyle (2.9% vs 65.7%), hyperlipidemia (2.9% vs 77.1%), and diabetes (2.9% vs 54.3%). Participants showed improvements in recognizing the need for urgent medical attention when a stroke is suspected (11.4% vs 88.6%).

Conclusions:
Immediate improvements in stroke knowledge and awareness were seen following our community-level educational interventions. Sessions were positively received. Future education sessions and assessment of long-term retention are planned.
Abstract WP94: Prediction Of Stroke Thrombectomy Outcomes From The Neurovascular Quality Initiative-quality Outcomes Database (NVQI-QOD) Registry Using Probabilistic Learning Models
Authors: Zhou Chaochao , Faruqui Syed Hasib Akhter , Patel Abhinav , Abdalla Ramez N , Shaibani Ali , Potts Matthew B , Jahromi Babak S , Ansari Sameer A , Cantrell Donald R
Published: February 2023

Introduction:
Mechanical Thrombectomy (MT) is standard-of-care interventional management of Acute Ischemic Stroke (AIS) due to large vessel occlusions. However, patient outcomes remain variable after intervention, with unclear optimization strategies for patient selection. The NVQI-QOD registry documents detailed patient characteristics, pre-operative imaging, procedure metrics, and post-operative outcomes of neurointerventional procedures. Data are highly informative, but there is inherent uncertainty in all medical interventions. We introduce a probabilistic learning model that predicts the expected distribution of MT outcomes.

Methods:
We identified two groups of variables from the NVQI-QOD AIS Thrombectomy registry: 1) data available at the time of MT (Group-preop), and 2) data available 24 h after MT, which can be valuable for prognostication (Group-24h). After filtering missing values, there were 1174 and 1405 examples in the two groups, respectively. In each group, training and test datasets were split using a ratio of 8:2. A probabilistic Neural Network (NN) (
Fig. 1a
) was developed to predict the distribution of changes in pre- and post-MT NIH Stroke Scale (NIHSS) (
y
), and it was trained using both groups of variables as inputs.

Results:
After training, the probabilistic network accurately described the distributions of changes in the NIHSS (represented by predicted means and SDs) based on input variables (
Fig. 1b
-
upper
). Notably, in Group-preop, even patients with the worst predicted outcomes had an approximately 50% chance of improvement.
Fig. 1b
-
lower
demonstrates the relative importance of variables to the NN.

Conclusions:
This NN model demonstrates the utility of probabilistic learning in clinical decision-making and prognosis. Our results reinforce the substantial benefits of MT, that can still improve outcomes in nearly half of patients with the worst predicted change in NIHSS on pre-operative analysis.
Abstract WP96: Quantitative Imaging Markers On Vessel Wall Magnetic Resonance Imaging Correlate With Disease Activity And Treatment Response In Cerebral Vasculopathies
Authors: Kharal Abbas , Ibrikji Sidonie , Kiczek Matthew , Shoskes Aaron , Russman Andrew N
Published: February 2023

Introduction:
Little is known about the utility of vessel wall magnetic resonance imaging (VWMRI) in assessing treatment response in various inflammatory and non-inflammatory intracranial vasculopathies, and if there is any correlation of vessel wall enhancement (VWE) with disease activity. We aimed to quantitatively investigate the differences in VWE patterns on follow-up VWMRI in patients with primary CNS vasculitis (PCNSV), secondary CNS vasculitis (SCNSV) and intracranial atherosclerotic disease (ICAD).

Methods:
VWMRI scans of patients with a confirmed diagnosis of either PCNSV, SCNSV or ICAD presenting to our tertiary care center between January 2015 and January 2021 were reviewed. Inclusion criteria were age greater than 18 years and at least 2 VWMRI scans available, including one from time of first clinical presentation with active disease. For each patient, 20 arterial segments were evaluated on VWMRI for the presence of VWE and the total number of enhancing arterial segments were reported. Percent concentricity, median number of enhancing arterial segments (MEAS) and percent change in MEAS was calculated and compared across all 3 diagnoses.

Results:
A total of 28 patients met study inclusion criteria (median age 47, 43% male) and had a diagnosis of either PCNSV (n=6), SCNSV (n=7) or ICAD (n=15). Median time to follow-up VWMRI was 22, 20 & 11 weeks for PCNSV, SCNSV & ICAD respectively. On initial VWMRI, the MEAS was 7 for each PCNSV & SCNSV and 6 for ICAD. Higher percent concentricity of VWE was seen more with PCNSV (92.3%) and SCNSV (71.4%) compared to ICAD (22.2%). All (100%) patients with PCNSV and 2 (33%) patients with SCNSV were treated with immunosuppression whereas 3 (50%) patients with SCNSV were treated with antimicrobials. All patients with PCNSV and SCNSV improved clinically whereas those with ICAD progressed or remained stable. The MEAS on follow up VWMRI decreased with treatment in patients with PCNSV (43% decrease) and SCNSV (14% decrease) but increased in those with ICAD (16% increase) and correlated clinically with disease activity and treatment response.

Conclusion:
Percent concentricity and MEAS on VWMRI may be useful non-invasive markers to monitor disease activity & treatment response in patients with intracranial vasculopathies.
Abstract WP97: Routine MRI Reveals Prior Stroke In The Same Vascular Territory In Half Of Patients Presenting With Acute Ischemic Stroke Due To Intracranial Atherosclerotic Disease
Authors: Phan Allan Q , Hinman Jason D , Kaneko Naoki , Liebeskind David S
Published: February 2023

Introduction:
In 2012, after SAMMPRIS demonstrated worse 30-day outcomes with Wingspan intracranial stent placement for intracranial atherosclerotic disease (ICAD), the FDA narrowed the “on-label” indication to a very specific subset of patients with symptomatic ICAD. The updated criteria require a prior stroke in the territory of the symptomatic vessel based on clinical history. Limitations in the accuracy of diagnosis of clinical stroke may be overcome with the use of MRI to identify any prior stroke - whether clinical or subclinical - which could expand the number of patients who are eligible for stenting.

Methods:
This was a retrospective analysis of consecutive cases of acute ischemic stroke attributable to ICAD with 50-99% stenosis in the symptomatic vessel from July 2019 - June 2022. MRI FLAIR sequences were reviewed for imaging evidence of prior infarction in the vascular territory of the symptomatic vessel. Subgroup analysis was performed based on stroke location, infarct pattern, degree of stenosis, and premorbid medication use.

Results:
73 patients met inclusion criteria. Mean age was 72, and 41% were women. 37 patients (51%) exhibited MRI evidence of prior stroke in the same vascular territory. Of these, only 18/37 (49%) reported a prior clinical stroke. The frequency of prior stroke on MRI was similar with anterior (51%) and posterior (50%) circulation ICAD. Frequency of prior stroke based on infarct pattern was 64% for border zone infarction, 42% for thromboembolism, and 55% for branch atheromatous disease. Of the 31 patients who had degree of stenosis quantified on DSA, the frequency of prior infarction was 63% in patients with 70-99% stenosis versus 48% in those with <70% stenosis. Only 1 patient (1.4%) met FDA on-label criteria for intracranial stenting. The most common reason for ineligibility was absent history of clinical stroke in the territory of the symptomatic vessel (75%).

Conclusions:
In patients presenting with acute stroke due to symptomatic ICAD, half exhibit MRI evidence of a prior stroke in the symptomatic arterial territory, and half of these prior strokes are not reported from clinical history. Routine MRI can be a valuable tool to identify prior stroke in the symptomatic territory, which may in turn expand therapeutic options for ICAD.
Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke
Authors: Tran Phoebe M. , Warren Joshua L. , Leifheit Erica C. , Goldstein Larry B. , Lichtman Judith H.
Published: February 2023

Background:

Long-term exposure to air pollutants is associated with increased stroke incidence, morbidity, and mortality; however, research on the association of pollutant exposure with poststroke hospital readmissions is lacking.

Methods:

We assessed associations between average annual carbon monoxide (CO), nitrogen dioxide (NO
2
), ozone (O
3
), particulate matter 2.5, and sulfur dioxide (SO
2
) exposure and 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age ≥65 years hospitalized for ischemic stroke in 2014 to 2015. We fit Cox models to assess 30-day readmissions as a function of these pollutants, adjusted for patient and hospital characteristics and ambient temperature. Analyses were then stratified by treating hospital performance on the Centers for Medicare and Medicaid Services risk-standardized 30-day poststroke all-cause readmission measure to determine if the results were independent of performance: low (Centers for Medicare and Medicaid Services rate for hospital <25th percentile of national rate), high (>75th percentile), and intermediate (all others).

Results:

Of 448 148 patients with stroke, 12.5% were readmitted within 30 days. Except for tropospheric NO
2
(no national standard), average 2-year CO, O
3
, particulate matter 2.5, and SO
2
values were below national limits. Each one SD increase in average annual CO, NO
2
, particulate matter 2.5, and SO
2
exposure was associated with an adjusted 1.1% (95% CI, 0.4–1.9%), 3.6% (95% CI, 2.9%–4.4%), 1.2% (95% CI, 0.2%–2.3%), and 2.0% (95% CI, 1.1%–3.0%) increased risk of 30-day readmission, respectively, and O
3
with a 0.7% (95% CI, 0.0%–1.5%) decrease. Associations between long-term air pollutant exposure and increased readmissions persisted across hospital performance categories.

Conclusions:

Long-term air pollutant exposure below national limits was associated with increased 30-day readmissions after stroke, regardless of hospital performance category. Whether air quality improvements lead to reductions in poststroke readmissions requires further research.
Fibrin clot interference in a human chorionic gonadotrophin assay causing a false Down syndrome screening result
Authors: Akagac Arzu Etem , Yavuz Hatice Bozkurt
Published: February 2023

Serum samples are generally used for the measurement of human chorionic gonadotrophin (hCG) to calculate second-trimester maternal screening results. Lower hCG concentrations correlate with a lower calculated risk of Down syndrome (DS). Hence, erroneously low hCG results due to fibrin clot may lead to misinterpretation. We present a 23-year-old woman with a pregnancy of 17+3 weeks. Blood was taken into the Becton-Dickinson (BD) vacutainer SST-II Advance tube (Ref: 367955). The hCG test was performed on Immulite 2000 XPi analyser (Siemens Healthcare Diagnostics Inc, Tarrytown, USA) with original reagents. The results of the same sample were found as 2566 U/L, 18,153 U/L, and 7748 U/L. Three consecutive results after removal of the small fibrin clot and recentrifugation were 18,878, 20,255, and 22,339 U/L. The risk of DS and MoM for the concentration of 2556 U/L hCG was < 1/10,000 and 0.14, respectively. For a hCG concentration of 20,255 U/L, these values were 1/5632 and 1.13, respectively. Laboratory professionals and technicians should be aware that erroneously low hCG results can be measured with the Immulite 2000 XPi due to interference from small fibrin clots. Falsely underestimated hCG values reduce the MoM values and thus the calculated risk of DS.
HISTORY ОF CHINESE PSYCHOLOGY: OVERVIEW
Authors: Yunsheng Ju , Matveev Mikhail O.
Published: February 2023

Background. Th is material will be very useful for Russian scientists, as it will allow them to evaluate the achievements of Chinese psychology. Th e authors of the article believe that Russian psychologists will be interested in the history, state of development and achievements of Chinese psychological science. Objective. Th is article presents the history of the development of Chinese psychology in various historical periods, and also presents the results of psychology research in various periods in China. Th e authors try to separate the basic terms “Chinese psychology” and “psychology in China”.Materials. In ancient times, there were quite a lot of scientifi c research, theories and ideas in China, but psychology (Xinlisue) as a scientifi c discipline was not. Th is term was borrowed from the Japanese language. Chinese psychology is divided into two parts: one is the Western theory of psychology, and the other is the theory of psychology of the indigenous peoples of China. Th is article clarifi es the content of only the second part. In modern China, psychology is a discipline that studies the objective laws of psychological phenomena. Modern Chinese psychology is gradually being formed and developed on the basis of ancient Chinese psychological ideas adapted to the needs of Chinese social development and incorporating the positive results of foreign modern psychological sciences, especially aft er the founding of the People’s Republic of China. Th e philosophical basis of Chinese psychology is Marxism, as well as the ideas of Mao Zedong, it is developing rapidly. Chinese psychologists note that China has its own cultural traditions that defi ne the identity of the Chinese psychological school. Methods. Making the goal achievemental, we will use such general scientifi c methods as the analysis of scientifi c literature, the comparative method, the method of generalization. Results. With the development of psychology, the importance of applied psychology has increased. Th e achievements of psychology are extremely important for such fi elds as education, medicine, and political science. In recent years, technological changes have aff ected all spheres of life, and the advent of the Internet has also given scope for new approaches and methods of theoretical and applied psychology research. Th anks to Internet technologies, Chinese psychology began to develop actively. Conclusion. Today, when psychology has become an independent science for more than 100 years of development, it is necessary to study the achievements of ancient Chinese psychological thought for four reasons: fi rstly, China is one of the birthplaces of psychology; secondly, Chinese psychology has enriched other psychological schools; thirdly, work is needed to create a psychological system with Chinese specifi cs Fourth, the study of Chinese psychology will allow you to study culture and join the knowledge of ancient Chinese thinkers
REVIEW OF FOREIGN RESEARCH ON CREATIVE THINKING IN DEVELOPMENTAL PSYCHOLOGY
Authors: Bayanova Larisa F. , Khamatvaleeva Dinara G.
Published: February 2023

Background. Th e development of creative thinking in childhood is of great importance as a resource for further self-realization of the individual. Th e study of the mechanisms of formation of creative thinking is one of the permanently developing areas in psychology. In modern conditions around the world, the indicator of creativity as a skill of the 21st century acts as an indicator of the quality of the educational environment, which confi rms the high degree of social demand for the study of the psychology of creative thinking. Objective. A review of modern empirical research by foreign scientists on the development of creative thinking in childhood, carried out in recent years. Methods. Critical analysis of the literature on the development of creative thinking in childhood. Results. Th e analysis of sources shows that the predominant works are longitudinal studies of creative thinking in order to identify the most favorable period for its development. Th e E. Torrance test is used as the main method for identifying creative thinking. Among the indicators of creativity, scientists consider he divergence of thinking. Disunity of research lines of foreign and Russian scientists is noted, which is confi rmed by the absence of references to the works of Russian authors in foreign articles on creativity. Conclusion. A review of sources on the development of creative thinking in childhood makes it possible to identify general trends in research design, the prevailing methods used to diagnose children’s creativity. Th e general line of research shows that most of them are longitudinal. Studies of creative thinking are aimed at identifying the causes that determine it. Creative thinking is considered in connection with the conditions of the educational environment and activities. In particular, the possibilities of organizing children’s play activities for the development of creative thinking are being explored.
AGE SPECIFICITY OF THE RELATIONSHIP BETWEEN THE EMOTIONAL AND CONCEPTUAL COMPONENTS OF LEARNING MOTIVATION
Authors: Vartanova Irina I.
Published: February 2023

Background. Th e work is devoted to the study of age and gender characteristics of the relationship of emotional refl ection by high school students of objectsvalues of school life and their awareness of the reasons for the need for schooling (motivations). Objective. Of this work was to study the gender and age characteristics of the relationship of emotional refl ection by high school students of the objectsvalues of school life and their awareness of the reasons for the need for schooling (motivations). Methods. Th e structure of the emotional attitude to the values of school life was revealed with the help of factor analysis of assessments according to the method of Semantic Diff erential. Variants of explanations-motivators of the reasons for attending school (70 variants) were identifi ed using a special questionnaire. Th e degree of relationship between the identifi ed factors of emotional attitude and motivations was assessed by calculating Pearson’s correlation coeffi cients. Sample. Pupils in grades 8–11 (aged 15–17) of two Moscow schools with a traditional learning paradigm took part in the survey voluntarily (with the consent of their parents). According to method 1 (semantic diff erential), a total of 346 students were interviewed, of which only 197 students were interviewed using method 2 (questionnaire). As a result, data were obtained for four groups of students consisting of 1) 46 junior (grades 8–9) and 2) 51 older (grades 10–11) boys, 3) 48 junior (grades 8–9) and 4) 52 older (grades 10–11) girls who underwent both methods simultaneously. Results. As a result, it was found that in younger and older girls four emotional-motivational factors are distinguished, while in younger boys only three. Th e motivation of boys becomes more diff erentiated as they grow up (four factors are distinguished). Th e revealed interrelations between factors-motives of emotional attitude and variants of conscious explanation of the reasons for studying at school (motivations) reveal signifi cant diff erences between students of diff erent sex and age. Conclusion. Th e degree and nature of coordination during development is largely determined by the type of dominant motivation for learning activity. For students with achievement motivation, self-affi rming educational and educational cognitive motivation, the emotional and verbal level of attitude to the values of school life is well coordinated.
EXPERIENCE IN APPLYING THE CLASS METHOD FOR ASSESSING THE QUALITY OF THE EDUCATIONAL ENVIRONMENT OF A KINDERGARTEN
Authors: Bukhalenkova Daria A. , Almazova Olga V.
Published: February 2023

Background. Th e quality of preschool education is of great importance for the subsequent adaptation and academic success. Th e ECERS-R methodology is available for Russian psychologists for assessing the quality of the educational environment of a kindergarten with a large array of accumulated data. ECERS-R is aimed at assessing more the material and subject arrangement of a preschool educational institution and the nature of the child’s interaction with the environment (including social). At the same time, in our opinion, insuffi cient attention is paid to assessing the emotional climate of interactions between children and teachers and assessing the extent to which the proposed training is in the zone of proximal development of the child. Objective. To compensate for the identifi ed defi cit, work was carried out to start adapting another tool for assessing the quality of the educational environment — the CLASS methodology, based on the ideas of L.S. Vygotsky about the optimal construction of the educational process. Methods. Th e study was conducted in 41 preparatory groups of Moscow kindergartens. In these groups, to assess the quality of the educational environment, the CLASS methodology was used, which includes 10 dimensions combined into 3 main domains: Emotional support, Classroom Organization and Instructional support. Also, on a part of the sample (N=26 groups), the ECERS-R method was additionally used. Results. Analysis of the internal reliability of the instrumentation showed satisfactory results. Although the scores for all three domains are related, the Instructional Support scores were signifi cantly lower than the Emotional Support and Classroom Organization scores. Comparison of the results of the CLASS and ECERS-R methods showed a small number of relationships between the scores of the scales of the two methods. At the same time, the CLASS parameter Instructional support is more related to ECERS-R. Conclusion. Th e data obtained confi rm our assumption that the CLASS method provides signifi cant information about the quality of interaction between a teacher and children in a kindergarten group, which complements the results of ECERS-R, which means that this tool will be useful for a full assessment of the quality of the educational environment in a kindergarten.
Postoperative complications for the new Chinese and imported bioprosthetic surgical valves replacement
Authors: Long Jing , Rao Yan , Fu Qingmei , Zhang Yibo , Pan Juan , Pan Yong
Published: February 2023

This study assessed structural valve degeneration (SVD) clinical difference of BalMedic and Edward bioprosthetic valves in Zhuzhou areas, Hunan province, China, in the past 6 years. From August 2016 to August 2022, Chinese bioprosthetic valves were implanted in 77 patients while imported
valves were implanted in 64 patients, to compare their postoperative SVD. Results showed that, 4 patients (9.1%) underwent SVD after surgery for Chinese mitral valve replacement (MVR) group. In addition, 2 patients (6.3%) underwent SVD after procedure for the imported MVR group. Both of them
showed no statistically significant difference (p > 0.05). As for the Chinese AVR group, 3 patients (9.1%) underwent SVD after operation, and in contrast, as for the imported AVR group, 4 patients (12.5%) underwent SVD after surgery. Therefore, the short-term follow-up study in Zhuzhou
area indicates good durability and efficiency of SVD, compared with its counterparts from Carpentier-Edwards PERIMOUNT Magna Ease, between mitral valve group and aortic valve group, (p>0.05)
Clinical study of combined application of iRoot-BP and collagen sponge in apical barrier surgery
Authors: Qin Han , Xu Hong-zhi , Gong Yong-qing
Published: February 2023

This research aimed to observe the clinical effects of iRoot-BP along with collagen sponge applied in apical barrier surgery. 46 immature teeth were divided into traumatic group (n =25) and non-traumatic group (n =21) according to the etiology of necrotic pulps. While
depending on whether collagen sponges are used during the apical barrier surgery, the 46 teeth were randomly divided into non-collagen group (n = 23) and collagen group (n = 23). Patients were scheduled for follow-up during 12 months to undergo clinical and radiological examination.
The etiological analysis showed that the failure of both groups were caused by trauma, which indicated that there might be a negative correlation between trauma and success rate of periapical tissue healed (χ2 = 2.696, P = 0.10). Healing results of apical lesions
indicated that 22 affected teeth in collagen group and 21 affected teeth in non-collagen healed well, without clinical and imaging manifestations of failure (χ2 = 0.357, P = 0.55). Assessment results of root sustainable growth suggested that the incomplete tooth
roots in collagen group had different degrees of growth, with an average increase of about 2 mm (P <0.05). The combined application of iRoot-BP and collagen sponge in apical barrier surgery can promote immature roots formation, and make them more similar to normal roots formation.
Conditioning induced placebo-like and nocebo-like effects of thermal discomfort in adults but not in youth
Authors: Weik Ella , Neuenschwander Regula , Edgington Brinn , Jensen Karin , Tipper Christine M , Oberlander Tim F
Published: February 2023

Introduction

Conditioning can be used to modulate the perception of pain, in the form of placebo and nocebo effects. Previous studies show inconsistent results as to whether adolescents show similar, weaker, or non-significant conditioned placebo and nocebo effects compared to effects found in adults. There are suggestions that such differences (if any) may dependent on the cues used in the thermal conditioning paradigms. Therefore, in this current study, we utilized novel, neutral 3D-shaped visual cues to implicitly induce conditioned placebo-like and nocebo-like effects in adolescents and adults.

Methods

During the conditioning paradigm, distinct cues (Fribbles) were paired with low and high temperatures in 24 adults and 20 adolescents (mean age = 25.5 years). In the testing phase, these conditioned cues as well as a neutral (unconditioned) cue were presented with moderate temperatures.

Results

Thermal discomfort of moderate temperatures was lower when presented with the conditioned low heat cue (placebo-like effect) and higher when thermal stimuli were presented with the high heat cue (nocebo-like effect) compared to the neutral cue. The effects were driven by adults, as neither the placebo-like nor the nocebo-like effect was significant in adolescents. The difference between adolescents and adults was not explained by differences in temperature or discomfort levels, as adults and adolescents had comparable calibrated temperatures and levels of discomfort during heat stimuli.

Conclusion

Our findings suggest that thermal perception in adolescents is less influenced by conditioning to an engaging novel visual cue, compared to adults. Our work may have implications for better understanding the scope and limitations of conditioning as a key mechanism of placebo and nocebo effects in youth.
Latina mothers’ perspectives on adverse experiences and protection of Latinx youth in an agricultural community
Authors: Parmar Deepika D. , Minnis Alexandra M. , Caballero Elodia , Zerofsky Melissa , Comfort Megan , Raymond-Flesch Marissa
Published: February 2023

Background

Adverse Childhood Experiences (ACEs) are a measure of childhood toxic stress that have a dose-dependent relationship with many adult health outcomes. While ACEs have been validated across diverse populations to measure neglect, abuse, and family dysfunction, they do not specifically assess trauma related to racism/xenophobia and immigration. 54% of Latinx youth in the United States are immigrants or children of immigrants and a large group with potentially unmeasured trauma. This study looks beyond ACEs to identify adverse and protective factors for healthy development among Latinx youth in an agricultural community through the perspectives of their mothers.

Methods

Twenty mothers of adolescent participants in A Crecer: the Salinas Teen Health Study (a prospective cohort study of 599 adolescents) completed semi-structured interviews in Spanish. Interviews focused on mothers’ perspectives on community resources, parenting strategies, parenting support systems, and their future aspirations for their children. Four coders completed iterative rounds of thematic coding drawing from published ACEs frameworks (original ACEs, community ACEs) and immigrant specific adverse events arising from the data.

Results

Mothers in this study reported adverse experiences captured within community-level ACEs but also distinct experiences related to intergenerational trauma and immigrant-related adversities. The most cited community-level ACEs were housing instability and community violence. Immigrant related adversities included experiences of systemic racism with loss of resources, political instability limiting structural resources, and language-limited accessibility. These were exacerbated by the loss of family supports due to immigration related family-child separation including deportations and staggered parent–child migration. Having experienced intergenerational trauma and systemic oppression, mothers discussed their strategies for building family unity, instilling resilience in their children, and improving socioeconomic opportunities for their family.

Conclusions

Latina mothers shared the impacts of immigrant-related experiences on systemic inequities in the United States which are currently missing from the ACEs framework. Immigrant specific adverse events include language-limited accessibility, or family-child separations, and policies impacting structural resources for immigrant families. Mothers highlighted their capacity to build resilience in their children and buffer impacts of systemic racism. Community-tailored interventions can build on this foundation to reduce health disparities and promote health equity in this population.
Exploring predictors of welfare dependency 1, 3, and 5 years after mental health-related absence in danish municipalities between 2010 and 2012 using flexible machine learning modelling
Authors: Bjerregaard Søren Skotte
Published: February 2023

Background

Using XGBoost (XGB), this study demonstrates how flexible machine learning modelling can complement traditional statistical modelling (multinomial logistic regression) as a sensitivity analysis and predictive modelling tool in occupational health research.

Design

The study predicts welfare dependency for a cohort at 1, 3, and 5 years of follow-up using XGB and multinomial logistic regression (MLR). The models’ predictive ability is evaluated using tenfold cross-validation (internal validation) and geographical validation (semi-external validation). In addition, we calculate and graphically assess Shapley additive explanation (SHAP) values from the XGB model to examine deviation from linearity assumptions, including interactions. The study population consists of all 20–54 years old on long-term sickness absence leave due to self-reported common mental disorders (CMD) between April 26, 2010, and September 2012 in 21 (of 98) Danish municipalities that participated in the Danish Return to Work program. The total sample of 19.664 observations is split geospatially into a development set (n = 9.756) and a test set (n = 9.908).

Results

There were no practical differences in the XGB and MLR models’ predictive ability. Industry, job skills, citizenship, unemployment insurance, gender, and period had limited importance in predicting welfare dependency in both models. On the other hand, welfare dependency history and reason for sickness absence were strong predictors. Graphical SHAP-analysis of the XGB model did not indicate substantial deviations from linearity assumptions implied by the multinomial regression model.

Conclusion

Flexible machine learning models like XGB can supplement traditional statistical methods like multinomial logistic regression in occupational health research by providing a benchmark for predictive performance and traditional statistical models' ability to capture important associations for a given set of predictors as well as potential violations of linearity.

Trial registration

ISRCTN43004323.
COVID-19 vaccine uptake and hesitation among men and women preparing for pregnancy: a cross-section survey based on the theory of planned behavior
Authors: Lei Anjiang , Xi Chunyang , Luo Xiaoxue , Pu Yan , You Huaxuan
Published: February 2023

Background

Given the accelerated speed of COVID-19 vaccine research and administration, the main barriers to herd immunity appear to be concerns about safety and efficacy. Men and women preparing for pregnancy may have the same concerns about COVID-19 vaccination, but few studies have focused on COVID-19 vaccine uptake and hesitation among them.

Methods

A cross-sectional study was conducted among men and women who were preparing for pregnancy in Southwest China. The questionnaire was designed based on the theory of planned behavior (TPB). Multiple logistic regression was used to explore the determinants of the behaviors of COVID-19 vaccination.

Results

A total of 2878 participants completed the survey. A total of 53.89% of participants received at least one dose of the COVID-19 vaccine. A total of 45.21% of participants would receive the COVID-19 vaccine in the future. A total of 0.90% of participants never thought about receiving the COVID-19 vaccine. Multiple logistic regression model 1 showed that female participants (OR:5.497, 95%CI: 4.292–7.041), participants who never received influenza vaccine (OR:2.664, 95%CI: 1.908–3.718), participants who had never been tested for COVID-19 (OR:2.244, 95%CI:1.504–3.349), participants who had higher score of negative attitude (OR:1.448, 95%CI: 1.219–1.719), participants who had lower scores of injunctive norms (OR:0.440, 95%CI: 0.360–0.537) and descriptive norms (OR:0.105, 95%CI: 0.088–0.126) were more likely to delay COVID-19 vaccination. Model 2 showed that participants who had lower scores for positive attitude (OR: 0.406, 95% CI: 0.230–0.716), injunctive norms (OR: 0.283, 95% CI: 0.130–0.614) and descriptive norms (OR: 0.060, 95% CI: 0.038–0.094) were more likely to refuse COVID-19 vaccination.

Conclusions

The COVID-19 vaccination rate of men and women preparing for pregnancy was significantly lower than the average vaccination rate of China. Gender, protective health behaviors, vaccination attitudes, and subjective norms had effects on the vaccination behaviors of couples preparing for pregnancy.
Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur
Authors: Fan Chongyi , Niu Yingzhen , Wei Maozheng , Kong Lingce , Wang Fei
Published: February 2023

Purpose

Distal femoral torsion is a key factor for poor alignment of patellofemoral joint. This study aims to evaluate the correlation between distal femoral torsion and the severity of patellofemoral arthritis, and to analyze the correlation between distal femoral torsion and the morphology of femoral condyle.

Methods

A retrospective analysis was performed on 125 patients awaiting surgical treatment for knee osteoarthritis from January 2021 to March 2022(79 females, 46 males, average age: 65.78 years, SD 6.61). All patients underwent knee joint radiography, lower-limb digital radiography, and knee joint CT scans. The ratio of length of each distal femoral condyle, TT-TG, patellar tilt, DFL-PCL, DFL-TEA, TEA-PCL and TEA-ACL were measured. The Pearson correlation coefficient was used to evaluate the correlation between distal femoral torsion and ratio of distal femoral condyle, TT-TG and patellar tilt. Logistic regression was used to evaluate the correlation between each parameter and the severity of PFOA.

Results

With the increased severity of PFOA, TT-TG, patellar tilt, DFL-PCL, DFL-TEA and PCA all tended to increase. Patellar tilt was correlated with DFL-PCL (r = 0.243) and TEA-PCL(r = 0.201), but TT-TG had no evident correlation with distal femoral torsion. Compared with Grade I patients of PFOA, DFL-PCL, DFL-TEA, and TEA-PCL were risk factors for increased severity of patellofemoral arthritis in Grade III patients of PFOA, but there was no significant statistic difference in Grade II patients of PFOA.

Conclusions

Distal femoral torsion correlates with the severity of patellofemoral arthritis. Variation of the femoral transepicondylar axis caused by the change of ratio of the femoral condyle is particularly important in the distal femoral torsion. In patients with severe PFOA, abnormal variation of the femoral condyle axis should be not ignored.
Comparison of physicians’ and dentists’ incident reports in open data from the Japan Council for Quality Health Care: a mixed-method study
Authors: Akiyama Naomi , Akiyama Tomoya , Sato Hideaki , Shiroiwa Takeru , Kishi Mitsuo
Published: February 2023

Background

Patient safety is associated with patient outcomes. However, there is insufficient evidence of patient safety in the dental field. This study aimed to compare incidents reported by dentists and physicians, compare the type of errors made by them, and identify how dentists prevent dental errors.

Methods

A mixed-methods study was conducted using open data from the Japan Council for Quality Health Care database. A total of 6071 incident reports submitted for the period 2016–2020 were analyzed; the number of dentists’ incident reports was 144, and the number of physicians’ incident reports was 5927.

Results

The percentage of dental intern reporters was higher than that of medical intern reporters (dentists: n = 12, 8.3%; physicians: n = 180, 3.0%; p = 0.002). The percentage of reports by dentists was greater than that by physicians: wrong part of body treated (dentists: n = 26, 18.1%; physicians: n = 120, 2.0%; p < 0.001), leaving foreign matter in the body (dentists: n = 15, 10.4%; physicians: n = 182, 3.1%; p < 0.001), and accidental ingestion (dentists: n = 8, 5.6%; physicians: n = 8, 0.1%; p < 0.001), and aspiration of foreign body (dentists: n = 5, 3.4%; physicians: n = 33, 0.6%; p = 0.002). The percentage of each type of prevention method utilized was as follows: software 27.8% (n = 292), hardware (e.g., developing a new system) 2.1% (n = 22), environment (e.g., coordinating the activities of staff) 4.2% (n = 44), liveware (e.g., reviewing procedure, double checking, evaluating judgement calls made) 51.6% (n = 542), and liveware-liveware (e.g., developing adequate treatment plans, conducting appropriate postoperative evaluations, selecting appropriate equipment and adequately trained medical staff) 14.3% (n = 150).

Conclusion

Hardware and software and environment components accounted for a small percentage of the errors made, while the components of liveware and liveware-liveware errors were larger. Human error cannot be prevented by individual efforts alone; thus, a systematic and holistic approach needs to be developed by the medical community.
Leveraging process mining for modeling progression trajectories in amyotrophic lateral sclerosis
Authors: Tavazzi Erica , Gatta Roberto , Vallati Mauro , Cotti Piccinelli Stefano , Filosto Massimiliano , Padovani Alessandro , Castellano Maurizio , Di Camillo Barbara
Published: February 2023

Background

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease whose spreading and progression mechanisms are still unclear. The ability to predict ALS prognosis would improve the patients’ quality of life and support clinicians in planning treatments. In this paper, we investigate ALS evolution trajectories using Process Mining (PM) techniques enriched to both easily mine processes and automatically reveal how the pathways differentiate according to patients’ characteristics.

Methods

We consider data collected in two distinct data sources, namely the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) dataset and a real-world clinical register (ALS–BS) including data of patients followed up in two tertiary clinical centers of Brescia (Italy). With a focus on the functional abilities progressively impaired as the disease progresses, we use two Process Discovery methods, namely the Directly-Follows Graph and the CareFlow Miner, to mine the population disease trajectories on the PRO-ACT dataset. We characterize the impairment trajectories in terms of patterns, timing, and probabilities, and investigate the effect of some patients’ characteristics at onset on the followed paths. Finally, we perform a comparative study of the impairment trajectories mined in PRO-ACT versus ALS–BS.

Results

We delineate the progression pathways on PRO-ACT, identifying the predominant disabilities at different stages of the disease: for instance, 85% of patients enter the trials without disabilities, and 48% of them experience the impairment of Walking/Self-care abilities first. We then test how a spinal onset increases the risk of experiencing the loss of Walking/Self-care ability as first impairment (52% vs. 27% of patients develop it as the first impairment in the spinal vs. the bulbar cohorts, respectively), as well as how an older age at onset corresponds to a more rapid progression to death. When compared, the PRO-ACT and the ALS–BS patient populations present some similarities in terms of natural progression of the disease, as well as some differences in terms of observed trajectories plausibly due to the trial scheduling and recruitment criteria.

Conclusions

We exploited PM to provide an overview of the evolution scenarios of an ALS trial population and to preliminary compare it to the progression observed in a clinical cohort. Future work will focus on further improving the understanding of the disease progression mechanisms, by including additional real-world subjects as well as by extending the set of events considered in the impairment trajectories.
Machine learning for early prediction of acute myocardial infarction or death in acute chest pain patients using electrocardiogram and blood tests at presentation
Authors: de Capretz Pontus Olsson , Björkelund Anders , Björk Jonas , Ohlsson Mattias , Mokhtari Arash , Nyström Axel , Ekelund Ulf
Published: February 2023

Aims

In the present study, we aimed to evaluate the performance of machine learning (ML) models for identification of acute myocardial infarction (AMI) or death within 30 days among emergency department (ED) chest pain patients.

Methods and results

Using data from 9519 consecutive ED chest pain patients, we created ML models based on logistic regression or artificial neural networks. Model inputs included sex, age, ECG and the first blood tests at patient presentation: High sensitivity TnT (hs-cTnT), glucose, creatinine, and hemoglobin. For a safe rule-out, the models were adapted to achieve a sensitivity > 99% and a negative predictive value (NPV) > 99.5% for 30-day AMI/death. For rule-in, we set the models to achieve a specificity > 90% and a positive predictive value (PPV) of > 70%. The models were also compared with the 0 h arm of the European Society of Cardiology algorithm (ESC 0 h); An initial hs-cTnT < 5 ng/L for rule-out and ≥ 52 ng/L for rule-in. A convolutional neural network was the best model and identified 55% of the patients for rule-out and 5.3% for rule-in, while maintaining the required sensitivity, specificity, NPV and PPV levels. ESC 0 h failed to reach these performance levels.

Discussion

An ML model based on age, sex, ECG and blood tests at ED arrival can identify six out of ten chest pain patients for safe early rule-out or rule-in with no need for serial blood tests. Future studies should attempt to improve these ML models further, e.g. by including additional input data.