bluuebunny/crossref_metadata_2025 huggingface dataset:
A-12 Racial Differences in Performance Validity Test Failure Rates
Authors: Davis Jeremy , Rolin Summer , Hromas Gabrielle
Published: August 2021

Objective

Embedded performance validity tests (PVTs) may show increased false positive rates in racially diverse examinees. This study examined false positive rates by race in an older adult sample.

Method

The project involved secondary analysis of a deidentified dataset (N = 22,688) from the National Alzheimer’s Coordinating Center (NACC). Participants were included if their identified race was African American or white. Exclusion criteria included diagnosis of mild cognitive impairment (MCI; n = 5160) or dementia (n = 5550). The initial sample included 11,114 participants grouped as cognitively normal (89.9%) or impaired but not MCI of whom 16.4% identified as African American. Propensity score matching was conducted by diagnostic group to match African American and white participants on age, education, gender, and MMSE score. The final sample included 3024 and 482 participants in normal and impaired groups, respectively, with 50% of participants identifying as African American in each group. Failure rates on five embedded PVTs in the NACC cognitive test battery were examined by race and by diagnosis.

Results

Age, education, gender, and MMSE score were not significantly different by race in either diagnostic group. In the normal group, 4.7% of African American and 1.9% of white participants failed two or more PVTs (p < 0.001). In the impaired group, 9.5% of African American and 5.8% of white participants failed two or more PVTs (n.s.).

Conclusions

PVT failure rates were significantly higher among African American participants in the normal group but not in the impaired group. Failure rates remained below a common false positive threshold of 10%.
A-113 Evaluation of a Recognition Trial for the Symbol Digit Modalities Test as a Performance Validity Measure in Monolingual and Bilingual Traumatic Brain Injury Survivors
Authors: Munoz Isabel , Lopez-Hernandez Daniel W , Rugh-Fraser Rachel A , Bichlmeier Amy , Baez Abril J , Nordberg Bethany A , Saravia Sarah , Litvin Pavel Y , Budding Deborah , Vespa Paul M , Hovda David A , Fuster Joaquin M , Woo Ellen , Hardy David J , Victor Tara L , Boone Kyle B , Wright Matthew J
Published: August 2021

Objective

Research shows that traumatic brain injury (TBI) patients perform worse than healthy comparisons (HC) on the Symbol Digit Modalities Test (SDMT). We evaluated cut-off scores for a newly developed recognition trial of the SDMT as a performance validity assessment in monolingual and bilingual TBI survivors and HC adults.

Method

The sample consisted of 43 acute TBI (ATBI; 24 monolinguals; 19 bilinguals), 32 chronic TBI (CTBI; 13 monolinguals; 19 bilinguals), and 57 HC (24 monolinguals; 33 bilinguals) participants. All participants received standardized administration of the SDMT. None of the participants displayed motivation for feigning cognitive deficits.

Results

The HC group outperformed both TBI groups on the demographically adjusted SDMT scores, p = 0.000, ηp2 = 0.24. An interaction emerged in SDMT scores where monolingual ATBI outperformed bilingual ATBI and bilingual CTBI outperformed monolingual CTBI, p = 0.017, ηp2 = 0.06. No differences were found in the SDMT recognition trial. Both Bichlmeier and Boone’s suggested cut-off scores had different failure rates in ATBI (Bichlmeier: 77%; Boone: 37%), CTBI (Bichlmeier: 69%; Boone: 19%), and HC (Bichlmeier: 56%; Boone: 26%). For the monolingual group (Bichlmeier: 66%; Boone: 36%) and the bilingual group (Bichlmeier: 66%; Boone: 21%). Finally, chi-squared analysis revealed monolingual TBI had greater failure rates than the bilingual ATBI.

Conclusion

Bichlmeier’s proposed cut-off score resulted in greater failure rates in TBI survivors compared to Boone’s suggested cut-off score. Furthermore, monolingual ATBI were influenced more by Bichlmeier’s cut-off score than the bilingual ATBI group, although the reason for this finding is unclear and requires additional study with a larger sample size.
A-122 Verbal Fluency Switching and Clustering Performance in Retired Professional Football Players
Authors: Nordberg Bethany , Lopez-Hernandez Daniel W , Bueno Alexis , Victor Tara L , Saravia Sarah , Baez Abril J , Sidhu Jasman , Munoz Isabel , Cantu Robert C , Guskiewicz Kevin M , Kelly Daniel F , Swerdloff Ronald , Hardy David J , Woo Ellen , Litvin Pavel Y , Wright Matthew J
Published: August 2021

Introduction

Repeated sports-related concussion has been associated with cognitive deficits, like other forms of traumatic brain injury. Football speed players (FSP; e.g., quarterbacks) are at greater risk of cognitive impairment compared to football non-speed players (FNP). Verbal fluency is typically comprised of two tasks: letter fluency (LF) and semantic fluency (SF). Verbal clustering (production of continuous words belonging to the same category or subcategory) and switching (abandoning an exhausted semantic cluster to a new one in order to produce more words) reflect executive control and strategy use. We examined LF, SF, as well as LF and SF switching and clustering performance in retired FSP, FNP, and healthy comparison (HC) participants.

Methods

The sample consisted of 28 HC, 17 retired FSP, and 53 retired FNP. ANOVAs were conducted to determine group differences on LF, SF, switching, and clustering. FSP and FNP did not differ in concussion frequency.

Results

We found the HC group outperformed the FSP group in LF, p = 0.042, ηp2 = 0.07. For SF, the HC and FNP groups outperformed the FSP group, p = 0.013, ηp2 = 0.09. Furthermore, we found the HC group outperformed both football groups in SF switching, p = 0.000, ηp2 = 0.17.

Conclusion

As expected, the HC group outperformed the FSP group on LF and SF. Also, the FNP group outperformed the FSP group on SF. Interestingly, FSP displayed generally worse performances, supporting the notion that their experience of sub-concussive blows puts them at greater risk for cognitive impairment. Further investigation is needed with larger sample sizes to evaluate SF and other cognitive deficits in the FSP participants.
A-14 Mechanisms and Neuropsychological Correlates of Sleep Disruption in Concussed College Athletes
Authors: Riegler Kaitlin E , Guty Erin T , Thomas Garrett A , Bradson Megan , Arnett Peter A
Published: August 2021

Objective

First, to explore demographic/injury characteristics associated with increased sleep disruption post-concussion. Second, to examine the association between sleep disruption post-concussion and symptom reporting and cognitive variability.

Method

124 athletes (M = 103, F = 21) completed neuropsychological testing within 14 days of concussion. Athletes were categorized as sleep-disrupted (n = 52) or not sleep-disrupted (n = 72). Athletes in the sleep-disrupted group endorsed one or more of the following from the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) Post-Concussion Symptom Scale (PCSS): trouble falling asleep, sleeping more than usual, and sleeping less than usual. Loss of consciousness (LOC) and concussion history were explored. Two neurocognitive variability measures were derived from the neuropsychological battery: intraindividual standard deviation (ISD) and maximum discrepancy score (MDS). Variability in memory and attention/processing speed (APS) composites were explored. Total PCSS symptom score, without sleep items, was calculated.

Results

A significantly greater proportion of sleep-disrupted athletes experienced LOC (30%) compared to not sleep-disrupted athletes (13%), χ2(1,N = 118) = 4.99, p < 0.03, φ = 0.21. Sleep-disrupted athletes reported more symptoms, t(122) = −5.42, p < 0.001, d = 0.98, and demonstrated more memory variability (memory ISD, t(122) = −2.22, p = 0.03, d = 0.40, and memory MDS, t(122) = −2.29, p = 0.02, d = 0.41) than not sleep-disrupted athletes. Groups did not differ in APS variability or concussion history.

Conclusions

Given the higher rate of LOC in sleep-disrupted athletes, it is possible that LOC is a mechanism leading to post-concussion sleep difficulties. Furthermore, sleep disruption following concussion results in more variable memory performance and higher symptom reporting. Symptom reporting and/or return to baseline cognitive functioning are often decision-making tools in concussion management. The difficulties experienced by sleep-disrupted athletes may complicate recovery.
A-165 Normative Data for the Rivermead Behavioral Memory Test (RBMT) in Collegiate Athletes
Authors: Thomas Garrett A , Guty Erin T , Riegler Kaitlin E , Bradson Megan L , Arnett Peter A
Published: August 2021

Objective

The Rivermead Behavioral Memory Test (RBMT) Story subtest has four alternate forms. While the use of different forms allows for greater test–retest reliability, it is unclear whether these forms are comparable in terms of difficulty and expected performance. Thus, this study aimed to evaluate performance on the different forms of the RBMT in college athletes.

Method

Our sample consisted of 602 (M = 450, F = 152) college athletes tested at baseline. We evaluated performance differences on the four different RBMT forms for immediate and delayed recall.

Results

Independent samples t-tests revealed significant differences between all forms at immediate recall, except when comparing Form A to Form B. There were also significant differences between all forms at delayed recall. Among males, there was a significant difference among most forms at immediate recall, with the exception of Form A compared to Form B. Additionally, among males, there was a significant difference among most forms at delayed recall, with the exception of Form A compared to Form D. Among females, findings indicate that Form A and Form B were comparable and not statistically different at immediate and delayed recall. Additionally, Form C and Form D were comparable and not significantly different at immediate and delayed recall among females.

Conclusions

The significant differences found between many of the RBMT forms at both immediate and delayed recall were further illuminated when accounting for sex differences. Therefore, we recommend using normative data that accounts for form and sex differences when using the RBMT, especially in cases where baseline testing is not available.
A-174 Diurnal Preference Relation to Need for Cognition and Cognitive Reflection
Authors: Pizer Jasmin H , Myers Melissa A , Hawley Nanako A , Harrell Murphy N , Hill Benjamin D
Published: August 2021

Objective

This study evaluated the effect of individual differences in diurnal preferences on a problem-solving test of intelligence and a measure of a personality trait of how much someone enjoys thinking.

Method

Archival data from 85 participants who had completed measures online were utilized in this study. The sample was 51.8% female, 71.8% Caucasian, and mean age was 19.5. Participants completed the Morningness-Eveningness Questionnaire (MEQ), Composite Morningness Questionnaire (CMQ), Cognitive Reflection Test (CRT), and Need for Cognition Scale-Short Form (NFC). Raw score totals were utilized. Diurnal preferences were later grouped for morning, evening, or in between based on published MEQ and CMQ cutoffs. Lower scores indicate evening types, and higher scores indicate morning types.

Results

Scores on measures of diurnal preference were significantly positively related to NFC (MEQ r = 0.28, p = 0.011; CMQ r = 0.36, p = 0.001) meaning that morning types tend to enjoy effortful mentation more. Diurnal preferences were not significantly related to CRT performance. One-way ANOVA was performed with diurnal preferences as the group factor and NFC and CRT as dependent variables. Significant main effects were not found for MEQ and NFC nor MEQ and CRT. Significant main effects were found for CMQ and NFC F(2,77) = 5.33, p = 0.007, but not for CMQ and CRT.

Conclusion

These findings indicate that diurnal preference was not associated with performance on the problem-solving intelligence test used in this study. However, morning types appear to be higher for personality traits related to motivation to engage in thinking and would be expected to do better on some cognitive tests that demand more test engagement.
A-176 Undercover Performance Validity Testing: Proposed Embedded Validity Indicators for Pediatric Neuropsychological Assessment
Authors: Kaswan Naomi R , Thompson Ryan C , Markiv Yelena , Deenen Aubrey , Pilavjian Haig V , Hirst Rayna B
Published: August 2021

Objective

Literature supports the use of the Delis-Kaplan Executive Function System Trail Making Test Conditions 4/2 ratio (TMT 4/2) and Stroop Color Word Test Word Reading (WR) as embedded validity indicators (EVIs) with adults (Erdodi et al., 2018; Guise et al., 2012) and the Wechsler Abbreviated Scale of Intelligence, 2nd Edition Matrix Reasoning (MR) as an EVI with children (Sussman et al., 2017). This study assessed the utility of these measures as EVIs in healthy children, compared to the Test of Memory Malingering Trial 1 (TOMM1 < 45; Perna & Loughan, 2013) and Reliable Digit Span (RDS).

Method

Participants (n = 99, 68.7% male, Mage = 11.9) completed baseline neuropsychological evaluations for sport participation, including the aforementioned measures. Receiver operator characteristic curve analysis was used to determine whether TMT 4/2, MR, and WR accurately categorized valid performance.

Results

TMT 4/2 yielded adequate sensitivity (0.83–1.00) but poor specificity (0.07–0.09) when predicting TOMM1 and RDS pass/fail performances. MR yielded adequate sensitivity (1.00) and specificity (0.92) when predicting RDS pass/fail performance and adequate specificity (0.92) and poor sensitivity (0.18) when predicting TOMM1 pass/fail performance. The only EVI that produced better than chance accuracy was MR when predicting RDS pass/fail performance (area under the curve [AUC] = 0.98). All participants failed the WR cutoff, suggesting poor specificity.

Conclusion

Results suggest that MR was the only EVI that achieved minimally acceptable specificity (≥0.90) in children. MR performed adequately when detecting valid performances but variably when detecting invalid performances; therefore, MR may be used alongside well-established performance validity tests with children but not independently.
A-183 Base Rates of Performance and Symptom Validity Test Failures in Active Duty and Veteran Samples Referred for Attention-Deficit/Hyperactivity Disorder Evaluation
Authors: Shura Robert D , Armistead-Jehle Patrick , Cooper Douglas B
Published: August 2021

Objective

To evaluate base rates of abnormal MMPI-2-RF symptom validity test (SVT) and stand-alone performance validity test (PVT) scores in active duty (ad) service member and Veterans Affairs clinical samples referred for neuropsychological assessment of ADHD.

Method

MMPI-2-RF SVT scores and various PVTs were evaluated in two samples referred specifically for assessment of ADHD: service members (N = 82) and Veterans (N = 355). SVT and PVT outcomes were then compared to published data establishing invalid base rates in larger, more general samples.

Results

Elevated MMPI-2-RF overreport scales (F-r ≥ 79; FS, RBS, and FBS-r ≥ 80; & Fp-r ≥ 70) ranged from 14.6% (FBS-r) to 40.0% (RBS) in the ad sample and 12.0% (FBS-r) and 28.9% (RBS) in the veteran sample. MMPI-2-RF profiles that were invalidated due to overreport (e.g., F-r = 120, all others ≥100) were under 5% on the veteran sample and no greater than 6.1% in the ad sample. Elevations on underreport scales were higher in the veteran sample (L-r = 12.9%, K-r = 2.0%) than the ad sample (L-r = 3.7%, K-r = 1.2%). In the ad sample, 21.5% failed one PVT and 6.3% failed two. In the Veteran sample, 23.4% failed one PVT.

Conclusions

Elevated MMPI-2-RF overreport scales were relatively common on ad and Veterans referred for ADHD evaluations. However, frequencies of elevated and invalidated scales were diminished relative to overall base rates reported in national data. Regarding PVT failure, both samples were lower than national average invalid rates. Despite the incentive inherent in ADHD exams, invalidity in both samples were consistently lower for both SVTs and PVTs.
A-23 Positive Associations between Cognition and Openness in HIV+ Individuals with Detectable Viral Loads
Authors: Martin Karli M , Del Bene Victor A , Triebel Kristen , Wheeler Pariya , Vance David
Published: August 2021

Objective

High rates of medication non-adherence with the advent of combination antiretroviral therapy (cART) in the HIV+ population persist at approximately 50%. Consequences of non-adherence include higher mortality and transmission risk. As the population of older adults with HIV-associated neurocognitive disorder (HAND) increases, the relationship between cognition, personality, and medication adherence requires further study. We explore whether the five main personality traits were related to cognition and serostatus outcomes.

Method

186 HIV+ individuals completed a neuropsychological battery and the Big Five Inventory to measure personality. Viral load was dichotomized as undetectable (< 19; n = 128) and detectable (≥20; n = 58). Pearson correlations were used to evaluate the relationship between cognition and openness in undetectable and detectable groups.

Results

Global cognition was positively associated with openness in both undetectable, r(126) = 0.24, p = 0.006, and detectable viral load groups, r(56) = 0.46, p < 0.001, with a moderate association observed in those with detectable viral loads. A moderate, positive relationship was found in the detectable group between openness and verbal ability (r(56) = 0.420, p = 0.001), immediate recall (r(56) = 0.404, p = 0.002), delayed recall (r(56) = 0.418, p = 0.001) and working memory (r(56) = 0.444, p < 0.001). In the undetectable group, openness was correlated with verbal ability, (r(126) = 0.296, p = 0.001), and processing speed (r(126) = 0.275, p = 0.002).

Conclusion

In HIV+ individuals with detectable viral loads, increased openness is moderately associated with higher cognitive functioning. These associations were weaker in the undetectable group. HIV+ people who are open to new experiences have better cognitive functioning, which may be a viable intervention target to increase medication adherence.
A-42 Examining the Utility of the DREFs: Does it Correlate to HbA1c Levels
Authors: Calcagno-davi Briana , Powell Sarah , Ilkowitz Jeniece , Gonzalez Juana , Gallagher Marypat
Published: August 2021

Objective

Previous research suggests that kids with T1D are at higher risk for attention and executive weaknesses, which are the exact skills necessary for proper management of their diabetes (Gaudieri, Chen, Greer et al., 2008; Lin, Northam, Rankins, Werther, et al., 2010; McNally, Rohan, Pendley et al., 2010; American Diabetes Association, 2018). In an attempt to quantify the specific executive skills that impact poor glycemic control in youth, Duke, Raymond & Harris (2014) created the Diabetes Related Executive Functioning Scale (DREFS) (Parent version, Cronbach’s alphas α =0.97). The current study expands on the one published research article on the DREFs, by examining the link between Parent DREFs and child’s HbA1c levels in a northeast population.

Method

HbA1c levels and scores on parent DREFs of 23 youth (10–17 years-old; 10 males) in ongoing research at the NYU Diabetes Center were reviewed. All participants were English speaking.

Results

The sample as a whole had relatively high HbA1c level, which is above the American Diabetes Associations recommended upper limit of 7% (M = 7.92, SD = 1.38) with DREF total score (M = 276, SD = 44). Spearman’s Correlations revealed a significant positive correlation between emotional control and higher HbA1c (rs [23] = −0.482, p = 0.020).

Conclusion

In our sample in the north east, urban clinic, poor emotional regulation was strongly correlated with poorer diabetes control. Unlike the initial study on the DREFS, many aspects of executive functioning were not strongly correlated to blood glucose control. This highlights the need for better understanding psychosocial functioning in children with chronic health conditions.
A-56 Mild Cognitive Impairment in a Patient with a History of COVID-19 Positivity and co-Morbid Cerebrovascular Disease
Authors: Lapitan Franchezka , Wisinger Amanda , Fink Joseph
Published: August 2021

Objective

Neurocognitive complaints have been observed in severe cases of post-COVID-19 diagnosis. However, limited information exists regarding specific neurocognitive deficits of patients reporting mild infection symptoms and persistent memory problems after infection. We report on a patient referred for worsening memory complaints 7-months after testing positive.

Method

Patient was a 74-year-old Caucasian female with a history of COVID-19. Relevant history was significant for sleep apnea, pulmonary embolism, hypertension, hyperlipidemia, and type-2 diabetes. Imaging pre-infection revealed mild cerebrovascular disease. Patient underwent a tele-neuropsychological evaluation to assess the extent of cognitive difficulties.

Results

Results indicated prominent difficulties were in the domains of immediate and delayed memory and executive functioning. Patient denied anxiety and depression on self-report measures, however, collateral information suggested she experienced a substantial increase in psychiatric symptoms following COVID-19. Activities of daily living (ADLs) were preserved, but she required increased assistance with complex ADLs. Post-infection cerebrovascular disease on imaging was documented as unchanged.

Conclusions

Although specific cognitive impairments were noted, discernment of direct residual effects of COVID-19 is limited in cases without a pre-COVID-19 neurocognitive baseline and with pre-existing conditions affecting the brain, such as cerebrovascular disease. This case illustrates the rising conundrum of clinical cases with stable underlying medical conditions but presence of cognitive deficits post-infection. Caution is needed to avoid over-interpretation of cognitive test results and necessity for a thorough clinical history that includes duration and clinical characteristics of COVID-19. Future research is needed on larger group studies comparing pre and post-COVID-19 neurocognitive results of patients with varying levels of vascular risk factors.
A-57 The Neuropsychological Impact of Antiphospholipid Antibody Syndrome: A Case Study
Authors: Del Pozzo Jill , Weiss Erica F , Bronshteyn Diana , Masur David M , McGinley John J , Facchini Ronda F
Published: August 2021

Objective

Antiphospholipid Antibody Syndrome (APS), also known as Hughes Syndrome, is an autoimmune condition linked to various adverse medical and neurological outcomes affecting 5 in 100,000. APS results from antibodies (aPL) that attack blood proteins that bind to phospholipids (e.g., 2-glycoprotein I and prothrombin), which can cause blood flow problems, increased risk of blood clots, and recurrent vascular thrombotic events. Research suggests APS may lead to various neurologic/medical issues including memory loss, visual disturbances, and dementia.

Method

Neuropsychological evaluation of 48-year-old female with triple-positive APS and history of bilateral superior parietal chronic ischemic infarctions, multiple bilateral lacunar infarctions, and bilateral encephalomalacia. Reports progressive cognitive changes (< 1 year).

Results

Neuropsychological evaluation evidenced low average premorbid functioning and currently, extremely low overall cognitive ability. Memory was variable with significant visual and working memory impairment but preserved delayed recall of contextual information. While verbal abilities were intact, deficits were noted in executive functioning, attention, processing speed, visuomotor, visual–spatial, and fine motor skills.

Conclusion

This 48-year-old woman’s cognitive profile is consistent with findings in the APS literature and is indicative of an early onset major vascular neurocognitive disorder. Retrospective studies suggest that cognitive deficits often precede somatic symptoms of APS and abnormal neuroimaging findings; she presents atypically, as somatic symptoms and abnormal neuroimaging preceded cognitive decline. This case adds to the limited body of neuropsychological data regarding the effects of APS on cognitive functioning, as the pathogenesis of cognitive impairment in APS is unclear and leads to questions regarding differences in, and trajectories of, cognitive deficits in APS.
A-67 Measuring Regional Cerebral Blood Flow with Single-Photon Emission Computed Tomography (SPECT) in Obsessive–Compulsive Disorder
Authors: Perez Sophia G , McDonald Bailey , Spagna Samantha , Golden Charles J , Willeumier Kristen , Amen Daniel
Published: August 2021

Objective

To identify regional cerebral blood flow (rCBF) differences between individuals with Obsessive–Compulsive Disorder (OCD) and healthy controls. Mehtods: Healthy controls (n = 81, Mage = 41.9, 53.0% female, 42.0% Caucasian) and persons diagnosed by psychiatric examination with OCD (n = 1020, Mage = 34.8, 33.6% female, 66.3% Caucasian) were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha = 0.001) were found for age [t(1099) = −4.4], gender [χ2(2) = 25.7], and race [χ2(12) = 30.1] between groups and therefore were controlled for. Significant rCBF differences were noted in the cerebellum [left:F(1,1096) = 21.6; right:F(1,1096) = 18.3], limbic system [left:F(1,1096) = 12.2; right:F(1,1096) = 10.4], and basal ganglia [left:F(1,1096) = 18.6; right:F(1,1096) = 18.3].

Results

Group means comparisons indicated higher perfusion in the cerebellum for the OCD group. Lower perfusion was found in the limbic system and basal ganglia in the OCD group. This study found higher perfusion in the cerebellum among the OCD group. Previous research found increased rCBF in the left cerebellum in OCD before pharmacotherapy. In the right cerebellum, increased rCBF was found among participants with early-onset OCD.

Conclusion

Overall, there is limited research on the cerebellum because of its use as a reference point. No research was found regarding the limbic system in OCD using SPECT; however, other neuroimaging found increased amygdala reactivity to emotional face stimuli. This study found lower perfusion in the basal ganglia among the OCD group. Previous research found hypoperfusion in the right; however, hypoperfusion in the left was not significant. Updated OCD and rCBF research with SPECT are needed. Limitations included the inclusion of comorbidities and use of DSM-IV-TR rather than DSM-5 diagnosis criteria.
A-76 Coping Style Moderates the Effect of Pain on Depression in Multiple Sclerosis
Authors: Bradson Megan L , Cadden Margaret H , Guty Erin T , Riegler Kaitlin E , Thomas Garrett A , Arnett Peter A
Published: August 2021

Objective

The present study examined coping style as a possible moderator in the relationship between pain and depression in persons with multiple sclerosis (PwMS).

Method

Fifty-four PwMS (38 female) completed a comprehensive neuropsychological test battery and psychosocial questionnaires. Pain was measured using the Brief Pain Inventory (BPI), and indices of pain severity and pain interference were derived. Active coping and avoidant coping scores were derived from the COPE Questionnaire. The Beck Depression Inventory-Fast Screen (BDI-FS) was used to measure depression.

Results

Regression analyses revealed that the interactions between pain severity and both avoidant (p = 0.005) and active (p = 0.004) coping composites significantly predicted depression. Simple effects tests revealed that pain severity predicted depression in PwMS with low active coping (p < 0.001) and high avoidant coping (p < 0.001), but not high active coping or low avoidant coping. The interactions between pain interference and both avoidant (p = 0.02) and active (p = 0.008) coping composites also significantly predicted depression. Simple effects tests revealed that pain interference predicted depression in PwMS with low active coping (p < 0.001), high active coping, (p = 0.048), and high avoidant coping (p < 0.001), but not low avoidant coping.

Conclusions

We found that coping style moderated the relationship between pain and depression in MS. Pain severity and pain interference predicted depression in PwMS who exhibited less active and more avoidant coping. Interventions that aim to reduce avoidant coping and increase active coping skills may be useful in improving affective outcomes in PwMS.
Interictal high frequency background activity as a biomarker of epileptogenic tissue
Authors: Stovall Truman , Hunt Brian , Glynn Simon , Stacey William C , Gliske Stephen V
Published: August 2021

High frequency oscillations (HFOs) are very brief events that are a well-established biomarker of the epileptogenic zone (EZ) but are rare and comprise only a tiny fraction of the total recorded EEG. We hypothesize that the interictal high frequency ‘background’ data, which has received little attention but represents the majority of the EEG record, also may contain additional, novel information for identifying the EZ. We analysed intracranial EEG (30–500 Hz frequency range) acquired from 24 patients who underwent resective surgery. We computed 38 quantitative features based on all usable, interictal data (63–307 h per subject), excluding all detected HFOs. We assessed association between each feature and the seizure onset zone (SOZ) and resected volume (RV) using logistic regression. A pathology score per channel was also created via principle component analysis and logistic regression, using hold-out-one-patient cross-validation to avoid in-sample training. Association of the pathology score with the SOZ and RV was quantified using an asymmetry measure. Many features were associated with the SOZ: 23/38 features had odds ratios >1.3 or <0.7 and 17/38 had odds ratios different than zero with high significance (P < 0.001/39, logistic regression with Bonferroni Correction). The pathology score, the rate of HFOs, and their channel-wise product were each strongly associated with the SOZ [median asymmetry ≥0.44, good surgery outcome patients; median asymmetry ≥0.40, patients with other outcomes; 95% confidence interval (CI) > 0.27 in both cases]. The pathology score and the channel-wise product also had higher asymmetry with respect to the SOZ than the HFO rate alone (median difference in asymmetry ≥0.18, 95% CI >0.05). These results support that the high frequency background data contains useful information for determining the EZ, distinct and complementary to information from detected HFOs. The concordance between the high frequency activity pathology score and the rate of HFOs appears to be a better biomarker of epileptic tissue than either measure alone.
Pathology and Pathogenesis of Lassa Fever: Novel Immunohistochemical Findings in Fatal Cases and Clinico-pathologic Correlation
Authors: Shieh Wun-Ju , Demby Austin , Jones Tara , Goldsmith Cynthia S , Rollin Pierre E , Ksiazek Thomas G , Peters Clarence J , Zaki Sherif R
Published: August 2021

Background

Lassa fever is a zoonotic, acute viral illness first identified in Nigeria in 1969. An estimate shows that the “at risk” seronegative population (in Sierra Leone, Guinea, and Nigeria) may be as high as 59 million, with an annual incidence of all illnesses of 3 million, and fatalities up to 67 000, demonstrating the serious impact of the disease on the region and global health.

Methods

Histopathologic evaluation, immunohistochemical assay, and electron microscopic examination were performed on postmortem tissue samples from 12 confirmed Lassa fever cases.

Results

Lassa fever virus antigens and viral particles were observed in multiple organ systems and cells, including cells in the mononuclear phagocytic system and other specialized cells where it had not been described previously.

Conclusions

The immunolocalization of Lassa fever virus antigens in fatal cases provides novel insightful information with clinical and pathogenetic implications. The extensive involvement of the mononuclear phagocytic system, including tissue macrophages and endothelial cells, suggests participation of inflammatory mediators from this lineage with the resulting vascular dilatation and increasing permeability. Other findings indicate the pathogenesis of Lassa fever is multifactorial and additional studies are needed.
Universal Lifelong Fungal Prophylaxis and Risk of Coccidioidomycosis in Lung Transplant Recipients Living in an Endemic Area
Authors: Truong Clover N , Nailor Michael D , Walia Rajat , Cherrier Lauren , Nasar Aasya , Goodlet Kellie J
Published: August 2021

Background

Lung transplant recipients residing in the endemic region are vulnerable to severe morbidity and mortality from Coccidioides. As infection risk persists beyond the first posttransplant year, investigations evaluating extended prophylaxis durations are needed. The purpose of this study is to assess the incidence of coccidioidomycosis among lung transplant recipients receiving universal lifelong azole antifungal prophylaxis.

Methods

Patients receiving transplants from 2013–2018 and initiated on azole antifungal prophylaxis at a lung transplant center in Arizona were included and followed through 2019 or until death, second transplant, or loss to follow-up. Recipients who died or received treatment for coccidioidomycosis during the transplant admission, or who had received a previous transplant, were excluded. The primary outcome was proven or probable coccidioidomycosis with new asymptomatic seropositivity assessed secondarily.

Results

A total of 493 lung transplant recipients were included, with 82% initiated on itraconazole prophylaxis, 9.3% on voriconazole, and 8.5% on posaconazole. Mean age at transplant was 62 years, 77% were diabetic, and 8% were seropositive for Coccidioides pretransplant. After a median follow-up of 31 months, 1 proven infection and 1 case of new asymptomatic seropositivity (1/493 each, 0.2% incidence) occurred during the study period. The single coccidioidomycosis case occurred 5 years posttransplant in a patient who had azole prophylaxis stopped several months prior. Although within-class switches were common throughout the study period, permanent discontinuation of azole prophylaxis was rare (1.4% at end of follow-up).

Conclusions

Universal lifelong azole prophylaxis was associated with a low rate of coccidioidomycosis among lung transplant recipients residing in endemic regions.
Latino Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Martinez Diego A , Klein Eili Y , Parent Cassandra , Prieto Diana , Bigelow Benjamin F , Saxton Ronald E , Page Kathleen R
Published: August 2021

We assessed temporal changes in the household secondary attack rate of severe acute respiratory syndrome coronavirus 2 and identified risk factors for transmission in vulnerable Latino households of Baltimore, Maryland. The household secondary attack rate was 45.8%, and it appeared to increase as the alpha variant spread, highlighting the magnified risk of spread in unvaccinated populations.
Opposing functions of the Hda1 complex and histone H2B mono-ubiquitylation in regulating cryptic transcription inSaccharomyces cerevisiae
Authors: Shirra Margaret K , Kocik Rachel A , Ellison Mitchell A , Arndt Karen M
Published: August 2021

Maintenance of chromatin structure under the disruptive force of transcription requires cooperation among numerous regulatory factors. Histone post-translational modifications can regulate nucleosome stability and influence the disassembly and reassembly of nucleosomes during transcription elongation. The Paf1 transcription elongation complex, Paf1C, is required for several transcription-coupled histone modifications, including the mono-ubiquitylation of H2B. In Saccharomyces cerevisiae, amino acid substitutions in the Rtf1 subunit of Paf1C greatly diminish H2B ubiquitylation and cause transcription to initiate at a cryptic promoter within the coding region of the FLO8 gene, an indicator of chromatin disruption. In a genetic screen to identify factors that functionally interact with Paf1C, we identified mutations in HDA3, a gene encoding a subunit of the Hda1C histone deacetylase (HDAC), as suppressors of an rtf1 mutation. Absence of Hda1C also suppresses the cryptic initiation phenotype of other mutants defective in H2B ubiquitylation. The genetic interactions between Hda1C and the H2B ubiquitylation pathway appear specific: loss of Hda1C does not suppress the cryptic initiation phenotypes of other chromatin mutants and absence of other HDACs does not suppress the absence of H2B ubiquitylation. Providing further support for an appropriate balance of histone acetylation in regulating cryptic initiation, absence of the Sas3 histone acetyltransferase elevates cryptic initiation in rtf1 mutants. Our data suggest that the H2B ubiquitylation pathway and Hda1C coordinately regulate chromatin structure during transcription elongation and point to a potential role for a HDAC in supporting chromatin accessibility.
Genomic signatures of inbreeding in a critically endangered parrot, the kākāpō
Authors: Foster Yasmin , Dutoit Ludovic , Grosser Stefanie , Dussex Nicolas , Foster Brodie J , Dodds Ken G , Brauning Rudiger , Van Stijn Tracey , Robertson Fiona , McEwan John C , Jacobs Jeanne M E , Robertson Bruce C
Published: August 2021

Events of inbreeding are inevitable in critically endangered species. Reduced population sizes and unique life-history traits can increase the severity of inbreeding, leading to declines in fitness and increased risk of extinction. Here, we investigate levels of inbreeding in a critically endangered flightless parrot, the kākāpō (Strigops habroptilus), wherein a highly inbred island population and one individual from the mainland of New Zealand founded the entire extant population. Genotyping-by-sequencing (GBS), and a genotype calling approach using a chromosome-level genome assembly, identified a filtered set of 12,241 single-nucleotide polymorphisms (SNPs) among 161 kākāpō, which together encompass the total genetic potential of the extant population. Multiple molecular-based estimates of inbreeding were compared, including genome-wide estimates of heterozygosity (FH), the diagonal elements of a genomic-relatedness matrix (FGRM), and runs of homozygosity (RoH, FRoH). In addition, we compared levels of inbreeding in chicks from a recent breeding season to examine if inbreeding is associated with offspring survival. The density of SNPs generated with GBS was sufficient to identify chromosomes that were largely homozygous with RoH distributed in similar patterns to other inbred species. Measures of inbreeding were largely correlated and differed significantly between descendants of the two founding populations. However, neither inbreeding nor ancestry was found to be associated with reduced survivorship in chicks, owing to unexpected mortality in chicks exhibiting low levels of inbreeding. Our study highlights important considerations for estimating inbreeding in critically endangered species, such as the impacts of small population sizes and admixture between diverse lineages.
Antigen Testing for COVID-19 Asymptomatic Screening: Why it Should be Preferred Over PCR Insights From Navy Region Japan’s Experience With a Comprehensive Antigen Testing Strategy
Authors: Mullinax Ross A
Published: August 2021

Polymerase chain reaction (PCR) is commonly used in asymptomatic screening testing, but is suboptimal for this purpose as it will identify many old persistent positives that are no longer infectious. This can result in placement of individuals that are not infectious to others into isolation. This results in substantial adverse impact to military manning and operations, without any benefit to public health. Antigen testing does not have this same drawback. Antigen testing, while less sensitive than PCR, will identify the vast majority of infectious positives, especially those with higher viral loads that are more likely to transmit to others. Importantly, use of antigen testing will also greatly increase the certainty of benefit from isolation, reducing the risk of isolating those individuals who are beyond their infectious period and pose no threat to public health. The literature on this topic is reviewed, with particular focus on studies that perform viral culture in addition to PCR and antigen testing. This allows for determination of sensitivity for infectious virus. Also, Navy Region Japan’s experience with a comprehensive antigen testing strategy is described. The challenges presented by persistent positive PCR test results are examined, as well as the real-world benefits from implementing widespread use of antigen testing.
Cepheid metallicity in the Leavitt law (C-metall) survey – I. HARPS-N@TNG spectroscopy of 47 classical Cepheids and 1 BL Her variables
Authors: Ripepi V , Catanzaro G , Molinaro R , Gatto M , De Somma G , Marconi M , Romaniello M , Leccia S , Musella I , Trentin E , Clementini G , Testa V , Cusano F , Storm J
Published: August 2021

Classical Cepheids (DCEPs) are the most important primary indicators of the extragalactic distance scale. Establishing the dependence on metallicity of their period–luminosity and period–Wesenheit (PLZ/PWZ) relations has deep consequences on the calibration of secondary distance indicators that lead to the final estimate of the Hubble constant (H0). We collected high-resolution spectroscopy for 47 DCEPs plus 1 BL Her variables with HARPS-N@TNG and derived accurate atmospheric parameters, radial velocities, and metal abundances. We measured spectral lines for 29 species and characterized their chemical abundances, finding very good agreement with previous results. We re-determined the ephemerides for the program stars and measured their intensity-averaged magnitudes in the V, I, J, H, Ks bands. We complemented our sample with literature data and used the Gaia Early Data Release 3 (EDR3) to investigate the PLZ/PWZ relations for Galactic DCEPs in a variety of filter combinations. We find that the solution without any metallicity term is ruled out at more than the 5σ level. Our best estimate for the metallicity dependence of the intercept of the PLKs, PWJKs, PWVKs, and PWHVI relations with three parameters is −0.456 ± 0.099, −0.465 ± 0.071, −0.459 ± 0.107, and −0.366 ± 0.089 mag dex−1, respectively. These values are significantly larger than the recent literature. The present data are still inconclusive to establish whether or not also the slope of the relevant relationships depends on metallicity. Applying a correction to the standard zero-point offset of the Gaia parallaxes has the same effect of reducing by ∼22 per cent the size of the metallicity dependence on the intercept of the PLZ/PWZ relations.
Management of Mycobacterium tuberculosis Prosthetic Joint Infection: 2 Cases and Literature Review
Authors: Lo Carson K L , Chen Lina , Varma Sonal , Wood Gavin C A , Grant Jennifer , Wilson Evan W
Published: August 2021

Prosthetic joint infection caused by Mycobacterium tuberculosis (TBPJI) is uncommon but can be encountered in immunocompromised patients or those from tuberculosis-endemic regions. A lack of clinical suspicion and experience with TBPJI often leads to a delay in diagnosis. We report 2 cases of TBPJI in a Hungarian-Canadian and Iranian-Canadian immigrant, respectively. Both were treated with concurrent surgical and medical therapy. We also performed a literature review on TBPJI case reports, outlining their diagnosis and management.
Association Between SARS-CoV-2 Cycle Threshold Values and Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis
Authors: Shah Vishal P , Farah Wigdan H , Hill James C , Hassett Leslie C , Binnicker Matthew J , Yao Joseph D , Murad M Hassan
Published: August 2021

Cycle threshold (CT) values are correlated with the amount of viral nucleic acid in a sample and may be obtained from some qualitative real-time polymerase chain reaction tests used for diagnosis of most patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, CT values cannot be directly compared across assays, and they must be interpreted with caution as they are influenced by sample type, timing of sample collection, and assay design. Presently, the correlation between CT values and clinical outcomes is not well understood. We conducted a systematic review and meta-analysis of published studies through April 19, 2021, that reported an association between CT values and hospitalization, disease severity, and mortality in patients ≥18 years old with SARS-CoV-2. A meta-analysis of 7 studies showed no significant difference in mean CT values between hospitalized and nonhospitalized patients. Among hospitalized patients, those with CT values <25 had a high risk of more severe disease and mortality than patients with CT values >30 (odds ratio [OR], 2.31; 95% CI, 1.70 to 3.13; and OR, 2.95; 95% CI, 2.19 to 3.96; respectively). The odds of increased disease severity and mortality were less pronounced in patients with CT values of 25–30 compared with >30.
Diagnosis of Histoplasmosis Using the MVista Histoplasma Galactomannan Antigen Qualitative Lateral Flow–Based Immunoassay: A Multicenter Study
Authors: Abdallah Wassim , Myint Thein , LaRue Richard , Minderman Melissa , Gunn Suphansa , Wheat L Joseph , Hage Chadi A
Published: August 2021

Background

Accurate and timely methods for the diagnosis of histoplasmosis in resource-limited countries are lacking. Histoplasma antigen detection by enzyme immunoassay (EIA) is widely used in the United States (US) but not in resource-limited countries, leading to missed or delayed diagnoses and poor outcomes. Lateral flow assays (LFAs) can be used in this setting.

Methods

Frozen urine specimens were submitted to MiraVista diagnostics for antigen testing from 3 medical centers in endemic areas of the US. They were blinded and tested for the MVista Histoplasma LFA. Patients were classified as controls or cases of histoplasmosis. Cases were divided into proven or probable; pulmonary or disseminated; immunocompetent or immunosuppressed; and mild, moderate, or severe.

Results

Three hundred fifty-two subjects were enrolled, including 66 cases (44 proven, 22 probable) and 286 controls. Most of the cases were immunocompromised (71%), and 46 had disseminated and 20 had pulmonary histoplasmosis. Four cases were mild, 42 moderate, and 20 severe. LFA and EIA were highly concordant (κ = 0.84). Sensitivity and specificity of the LFA were 78.8% and 99.3%, respectively. LFA sensitivity was higher in proven cases (93.2%), patients with disseminated (91.3%), moderate (78.6%), and severe disease (80%), and those with galactomannan levels >1.8 ng/mL (97.8%). Specificity was 99.3% in proven cases, 99.3% in patients with moderate or severe disease, and 96.8% in those with galactomannan levels >1.8 ng/mL. Cross-reactivity was noted with other endemic mycoses.

Conclusions

The MVista Histoplasma LFA meets the need for accurate rapid diagnosis of histoplasmosis in resource-limited countries, especially in patients with high disease burden, potentially reducing morbidity and mortality.
Dark Pool Trading and Information Acquisition
Authors: Brogaard Jonathan , Pan Jing
Published: August 2021

Theory suggests that dark pools may facilitate or discourage information acquisition. We find that more dark pool trading leads to greater information acquisition. We measure information acquisition using stock price dynamics around earnings announcements. To overcome endogeneity concerns, we exploit a large exogenous decrease to dark pool trading that results from the implementation of the Security and Exchange Commission’s (SEC’s) Tick Size Pilot Program. The results cannot be explained by lit venue liquidity, algorithmic trading, or informational efficiency. A battery of additional tests, such as documenting a shift in SEC EDGAR searches, supports the information acquisition interpretation.