University Of Colorado Research Articles

Associations between violent and sexual childhood trauma and maladaptive coping in patients with functional seizures.

Functional seizures (FS) are a highly debilitating symptom of functional neurological disorder (FND). FS requires a multi-disciplinary approach to treatment because the patient's initial presentation is to neurology, emergency medicine, or primary care and treatment consists of psychotherapy. People with FS commonly experience severe childhood trauma, particularly sexual trauma. The authors aimed to investigate associations between reported trauma and maladaptive coping mechanisms in the FS population. This retrospective, observational study reports on 137 patients enrolled in the FS Clinic at the University of Colorado between March 2020 - March 2021. Multiple linear regression was used to reveal associations between self-reported childhood sexual and violent trauma and maladaptive coping mechanisms of self-blame and disengagement on the Brief COPE. A quantile regression was generated for each of these outcomes. Results showed that violent and sexual trauma were experienced by 47.5% and 61.6% of the population sample, respectively. Of those exposed to violent trauma, 27.2% perceived it as extremely severe while 43.4% of those exposed to sexual trauma perceived it as extremely severe. Quantile regressions for self-blame and disengagement showed significance for the 25th percentile of those who experienced violent trauma. Self-blame was significantly associated with the 50th and 75th percentile of those exposed to sexual trauma. This evidence supports the value of identifying trauma experienced by individuals with FS as it is associated with specific coping mechanisms that may affect treatment. Identifying prior trauma and resulting coping mechanisms can potentially assist in individualizing care for people with FS.

Development and validation of a pragmatic measure of cocreation in research engagement: a study protocol

IntroductionCocreation, a collaborative process of key interested partners working alongside researchers, is fundamental to community-engaged research. However, the field of community-engaged research is currently grappling with a significant gap: the...

The Prevalence of Sickle Cell Disease in Colorado and Methodologies of the Colorado Sickle Cell Data Collection Program: Public Health Surveillance Study.

Sickle cell disease (SCD) is a genetic blood disorder that affects approximately 100,000 individuals in the United States, with the highest prevalence among Black or African American populations. While advances in care have improved survival, comprehensive state-level data on the prevalence of SCD remain limited, which hampers efforts to optimize health care services. To address this gap, the Colorado Sickle Cell Data Collection (CO-SCDC) program was established in 2021 as part of the Centers for Disease Control and Prevention's initiative to enhance surveillance and public health efforts for SCD. The objectives of this study were to describe the establishment of the CO-SCDC program and to provide updated estimates of the prevalence and birth prevalence of SCD in Colorado, including geographic dispersion. Additional objectives include evaluating the accuracy of case identification methods and leveraging surveillance activities to inform public health initiatives. Data were collected from Health Data Compass (a multi-institutional data warehouse) containing electronic health records from the University of Colorado Health and Children's Hospital Colorado for the years 2012-2020. Colorado newborn screening program data were included for confirmed SCD diagnoses from 2001 to 2020. Records were linked using the Colorado University Record Linkage tool and deidentified for analysis. Case definitions, adapted from the Centers for Disease Control and Prevention's Registry and Surveillance System for Hemoglobinopathies project, classified cases as possible, probable, or definite SCD. Clinical validation by hematologists was performed to ensure accuracy, and prevalence rates were calculated using 2020 US Census population estimates. In 2019, 435 individuals were identified as living with SCD in Colorado, an increase of 16%-40% over previous estimates, with the majority (n=349, 80.2%) identifying as Black or African American. The median age of individuals was 19 years. The prevalence of SCD was highest in urban counties, with concentrations in Arapahoe, Denver, and El Paso counties. Birth prevalence of SCD increased from 11.9 per 100,000 live births between 2010 and 2014 to 20.1 per 100,000 live births between 2015 and 2019 with 58.5% (n=38) of cases being hemoglobin (Hb) SS or HbSβ0 thalassemia subtypes. The study highlighted a 67% (n=26) increase in SCD births over the decade, correlating with the growth of the Black or African American population in the state. The CO-SCDC program successfully established the capacity to perform SCD surveillance and, in doing so, identified baseline prevalence estimates for SCD in Colorado. The findings highlight geographic dispersion across Colorado counties, highlighting the need for equitable access to specialty care, particularly for rural populations. The combination of automated data linkage and clinical validation improved case identification accuracy. Future efforts will expand surveillance to include claims data to better capture health care use and address potential underreporting. These results will guide public health interventions aimed at improving care for individuals with SCD in Colorado.

SAMHSA names director of OBHE

Rachele C. Espiritu Ph.D. has been named as the Director of the Office of Behavioral Health Equity at the Substance Abuse and Mental Health Services Administration (SAMHSA). Prior to this, she was a founding partner of Change Matrix, where she played a pivotal role in driving and measuring change to promote behavioral health equity and improve the well‐being of individuals and communities. Previously she served as a faculty member in the Department of Pediatrics at Georgetown University Medical Center and as the Director of Evaluation for the Georgetown University Center for Child and Human Development. In these roles, she supported states and communities in building evaluation capacity for children's services and led internal evaluation initiatives for the Center. Esperitu's expertise spans behavioral health, evaluation, workforce development, leadership, systems change, and policy development. She has led numerous state and national initiatives supported by federal agencies and foundations, including the Pacific Southwest Mental Health Technology Transfer Center, the National Network to Eliminate Disparities in Behavioral Health, the Colorado Equity Compass, and Transforming Academia for Equity. Espiritu earned her doctorate in clinical psychology from the University of Colorado at Boulder, where she was honored as a Patricia Robert Harris scholar.

Exploring Patterns and Disparities in E-Consult Referrals: An Analysis of Patient and Community Factors in Colorado Health Care.

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.

First person – Mitchell Leih

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping researchers promote themselves alongside their papers. Mitchell Leih is first author on ‘ Disordered hinge regions of the AP-3 adaptor complex promote vesicle budding from the late Golgi in yeast’, published in JCS. Mitchell is a PhD Student in the lab of Greg Odorizzi at the University of Colorado, Boulder, investigating adaptor protein complexes and their dynamics in membrane trafficking.

Analysis of Complications Associated With Abdominal Incisional Wound Vacuum Assisted Closure Following Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction: A Single Institution Retrospective Study

BackgroundDIEP free flap reconstruction is a preferred breast reconstruction technique due to its muscle-sparing approach and patient satisfaction. However, donor site complications, particularly wound dehiscence, remain a concern. Closed incision negative pressure wound therapy using wound VAC systems may reduce these complications by enhancing perfusion and minimizing edema. This study evaluated the association between postoperative wound VAC use and complications in DIEP flap reconstruction. MethodsA retrospective cohort study was conducted at the University of Colorado, comparing postoperative outcomes in patients who received closed incision negative pressure therapy (VAC) during DIEP flap reconstruction to those who did not (No VAC). Demographic and clinical characteristics, as well as 90-day abdominal complications, were compared between the cohorts. Statistical analyses included t-tests, Wilcoxon rank-sum, Chi-squared, and multivariable logistic regression, with a p-value of ≤0.05 considered significant. ResultsFrom 2021 to 2023, 302 patients were identified, with 114 (38%) receiving a wound VAC. The VAC group was older (mean age 53±10 vs. 50±10, p=0.03) and had longer operative times (534±108 vs. 495±110minutes, p=0.003). No significant differences were observed in BMI, ASA class, or most comorbidities. Complications such as hematoma, seroma, infection, wound dehiscence, bulge, hernia, ED visits, and readmissions showed no significant differences between groups. Multivariable regression indicated a non-significant trend toward fewer complications with VAC use (adjusted OR 0.549, 95% CI 0.277-1.088, p=0.08). ConclusionThe use of incisional VAC did not significantly reduce abdominal complications following DIEP flap reconstruction. However, a non-significant trend toward fewer complications suggests further investigation with larger, multi-institutional studies is warranted.

Tackling Health Inequalities in Times of Crisis

Abstract Across Europe, people are grappling with a multitude of challenges, spanning from the cost of living to housing, food insecurity, climate change, conflicts, and social unrest. These adversities significantly impact individuals’ health and wellbeing, and create the conditions for persisting health inequalities. At the root of these crises are unjust economic systems, in which the privileged few benefit while the majority face difficulties on a daily basis. Societies across Europe are witnessing rising polarisation and discrimination. Competitiveness and security are emerging as key priorities in the new European political landscape, with health and wellbeing pushed to the sidelines. Tackling health inequalities in times of crisis requires urgent, targeted action across societal sectors and levels. Education emerges as a crucial equaliser, alongside income and social safety nets. Moreover, effective climate strategies must prioritise the needs of the most vulnerable population groups. This plenary session lays the groundwork for understanding our contemporary, rapidly evolving landscape and its implications for addressing health inequalities. What lessons can we draw from new approaches across sectors that meet social and health needs, and how can we navigate these challenges – and sail those waves of innovation – to ensure equitable health and social justice for all? Moderators Caroline Costongs Director EuroHealthNet Cristina Abreu Santos Vice-President Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Portugal Keynote speakers Fran Baum The Stretton Institute, The University of Adelaide, Australia (by video message) Katarina Ivanković Knežević Director for Social Rights and Inclusion, Directorate-General Employment, Social Affairs and Inclusion, European Commission Panellists Didier Jourdan UNESCO Chair and WHO Collaborating Centre ‘Global Health and Education’, University of Clermont-Auvergne, France Jill Litt Professor of Environmental Health in the Environmental Studies Programme, University of Colorado, USA and Senior researcher, Barcelona Institute of Global Health (ISGlobal), Spain

Structured Debriefing to Assess Performance of Entrustable Professional Activities.

Background The medical workplace presents challenges for workplace-based learning. Structured debriefing of shared clinical experiences has been proposed as a way to take advantage of workplace-based learning in a setting that facilitates deep learning conversations. Objective To investigate faculty and learner acceptance of private, face-to-face, structured debriefing of performance of entrustable professional activities (EPAs). Methods During the 2020-2021 academic year, faculty at the University of Colorado (CU) and the University of Utah (UU) debriefed fellow performance of jointly selected EPAs in neonatal-perinatal medicine pertinent to shared 1- to 3-week clinical rotations. Private face-to-face debriefing was structured by a comprehensive EPA-specific list of behavioral anchors describing 3 levels of entrustment/accomplishment. Sessions ended with joint decisions as to level of entrustment/accomplishment and goals for improvement. We used thematic analysis of semistructured fellow interviews and faculty focus groups to identify themes illustrated with representative quotations. Results We interviewed 17 fellows and 18 faculty. CU participants debriefed after clinical rotations; UU usually debriefed during rotations. Debriefing sessions for 1 to 2 EPAs lasted 20 to 40 minutes. Themes represented in fellow interviews and faculty focus groups suggested that debriefing facilitated formative feedback along with shared understanding of clinical performance and assessment criteria. The standardized format and private conversations supported assessment of aspects of performance for which review might otherwise have been overlooked or avoided. The conversations also provided valuable opportunities for formative discussion of other matters of importance to fellows. Conclusions Structured debriefing of recently shared clinical experiences fostered formative assessment viewed positively by teachers and learners.

Sex Differences Across the Lifespan: A Focus on Cardiometabolism.

Women's health and sex differences research remain understudied. In 2022, to address the topic of sex differences, the Ludeman Family Center for Women's Health Research (LFCWHR) at the University of Colorado (LudemanCenter.org) held its third National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism." The research presentations and discussions from the 2022 conference addressed cardiometabolic sex differences across the lifespan and included sessions focusing on scientific methods with which to study sex differences, effects of estrogen on metabolism, and sex differences in cardiovascular disease-implications for women and policy among others. Over 100 participants, including basic scientists, clinical scientists, policymakers, advocacy group leaders, and federal agency leadership participated. The meeting proceedings reveal that although exciting advances in the area of sex differences have taken place, significant questions and gaps remain about women's health and sex differences in critical areas of health. Identifying these gaps and the subsequent research that will result may lead to important breakthroughs.

Does dissection influence weight bias among doctor of physical therapy students?

Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety-seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias-the Modified Weight Bias Internalized Scale (M-WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale-and open-ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M-WBIS, or BMI between the two universities. The mean scores on both the ATOP and M-WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M-WBIS scores (p = 0.428). BMI had a low correlation with initial M-WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students.

Gaining a new angle on pancreas cancer: A pre-operative thrombelastographic parameter predicts recurrence and survival among patients with resected periampullary and pancreatic adenocarcinoma

BackgroundIt has previously been demonstrated that Thrombelastography(TEG) angle may be associated with recurrence and survival in pancreas cancer in a cohort of patients operated on at the University of Colorado in 2016–2017. Now approaching 10 years of follow-up, we revisit these associations and strengthen these claims with multivariate analysis. MethodsRetrospective chart review was performed. Statistical analysis was conducted using STATA. Receiver operating characteristic(ROC) curves identified the performance of angle for predicting recurrence&survival. Unadjusted and adjusted cox regression models were used to identify significant predictors of these outcomes. Results47 patients were included with median follow-up of 29.6 months. ROC curves for angle predicting recurrence and survival identified a cutoff of 44.5°. KM curves demonstrated that patients above the cutoff were more likely to recur(90%vs46 ​%,p ​= ​0.001) and less likely to survive(16%vs56 ​%,p ​= ​0.001). Angle remained significant on multivariate analyses (HR recurrence:3.64[1.32–10.25],HR survival:3.80[1.38–10.46]). ConclusionsTEG angle is independently associated with disease recurrence and overall survival in pancreas cancer. This may be identifying virulent tumor biology, but further studies are required. A prospective study is underway.

Uncertainty and Communication Preferences Among Patients Undergoing Lung Transplant Evaluation: A Mixed-Methods Study.

Higher uncertainty is associated with poorer quality of life and may be impacted by clinician communication about the future. We determined how patients undergoing lung transplant evaluation experience uncertainty and communication about the future from clinicians. We performed a convergent parallel mixed-methods study using a cross-sectional survey and semistructured interviews. Patients undergoing lung transplant evaluation at the University of Colorado and the University of Washington answered questions about future communication and completed the Mishel Uncertainty in Illness Scale-Adult (MUIS-A; range 33-165, higher scores indicate more uncertainty). Interviews were analyzed using content analysis. Integration of survey and interview results occurred during data interpretation. A total of 101 patients completed the survey (response rate: 47%). Twelve survey participants completed interviews. In the survey, most patients identified changing family roles as important (76%), which was infrequently discussed with clinicians (31%). Most patients (86%) worried about the quality of their life in the future, and 74% said that not knowing what to expect in the future prevented them from making plans. The mean MUIS-A score was 85.5 (standard deviation 15.3). Interviews revealed three themes: (1) uncertainty of the future distresses participants; (2) participants want practical information from clinicians; and (3) communication preferences vary among participants. Participants experienced distressing uncertainty and wanted information about the future. Communication topics that were important to participants were not always addressed by physicians. Clinicians should address how chronic lung disease and lung transplant can directly impact patients' lives and support patients to cope with uncertainty.

High PD-L1 expression among patients with ALK rearranged non–small cell lung cancer and response to first line ALK tyrosine kinase inhibitors.

8626 Background: Patients with ALK rearrangements are highly responsive to ALK tyrosine kinase inhibitors (TKIs). Negative prognostic markers to ALK TKIs include TP53 alterations and ALK Variants 3a/b. The prognostic role that PD-L1 expression plays in first line ALK TKI outcomes is less clear. Methods: Retrospective review of patients with metastatic ALK-rearranged NSCLC seen between 2015 - 2022 at the University of Colorado who received first line ALK TKIs was performed. PD-L1 expression was denoted as high (≥50%) or low (< 1% or 1-49%) based on pre-treatment biopsies. Clinicopathologic features, treatment outcomes, and genomic data were collected. Survival outcomes were assessed using Kaplan Meier methods. Multivariate modeling adjusted for brain metastases, TP53 mutations, ALK variant status, and ALK TKI. PD-L1 was overexpressed in EML4-ALK murine cell lines with lentiviruses. In vitro and in vivo response to ALK TKIs were compared to non-infected cell lines. Neutrophils and lymphocytes were quantified on pre-treatment H&E slides. Results: Baseline characteristics of 130 patients are shown. Median PFS was significantly (p < 0.001) longer in the PD-L1 low cohort than the PD-L1 high cohort (21 vs 11 mos, HR 0.44, 95% CI 0.29 – 0.66). There was no difference in OS between the PD-L1 low and PD-L1 high cohort (p = 0.4, 107 vs 91 mos, HR 0.86, 95% CI 0.46 – 1.61). In an alectinib sub-group analysis (n = 89), PD-L1 high expressers had a higher rate of CNS progression (93.0 vs 73.9%, p = 0.022). Forced overexpression of PD-L1 in murine EML4-ALK cell lines exerted no difference to in vitroor in vivo response to alectinib. Pre-treatment biopsies from the PD-L1 high cohort (n = 19) revealed significantly more neutrophils (p = 0.021), but not lymphocytes (p = 0.904). Conclusions: High PD-L1 expression (≥50%) is associated with worse PFS and higher intracranial progression rate among those receiving ALK TKIs. Induced PD-L1 expression in ALK cell lines did not alter in vitro or in vivo ALK TKI sensitivity. Higher neutrophil counts track with high PD-L1 expression (≥50%), suggesting that differences within the immune tumor microenvironment may be relevant. [Table: see text]

Potential of near real-time detection of cancer and immuno-oncology failure, within weeks of initiating therapy.

e14555 Background: For most areas of internal medical practice, biochemical and/or clinical tests rapidly allow physicians to evaluate if a drug being administered has activity in that patient. Unfortunately, for most of oncology, measuring response is by imaging after delay of months. Methods: In 2018 the Trau lab published that the pan-cancer DNA methylation pattern (general hypomethylation with specific hypermethylation) resulted in physico-chemical alteration in purified circulating tumor DNA (ctDNA) as well as genomic DNA. Detecting these changes were not sequence dependent, but rather the epigenetic alterations resulted in altered binding to a specific electrode, easily and quickly measured by differential pulse voltammetry. In 2022 our group using the “aiElectrode” method showed significantly improved ability to cleanly separate cfDNA from people with cancer and those without, as well as anecdotal success in using the method to separate progression from regression. The improved method is used here. Results: Here we present analysis of samples from 18 cancer patients from 3 small series with cfDNA taken before and after treatment; 20 pairs could be analyzed. The Scripps Clinic Bio-Repository supplied samples from 8 lymphoma patients before and after treatment with chemotherapy and a bone marrow transplant; all showed initially clinical improvement and decrease in the ctDNA by the aiElectrode. Subsequently 2 relapsed and in both cases ctDNA analysis showed increased ctDNA. The Drammen Hospital in Norway supplied 18 samples from 7 patients (2 or 3 time points each) with NSCLC treated with pembrolizumab immunotherapy. One responded and 6 had progression. The aiElectrode ctDNA results were concordant for all but one of the 7 patients. The University of Colorado provided before and after therapy specimens from three patients. In total, 20 pairs of specimens were analyzed and 19 were concordant, generating an accuracy of 95%. Some of the post treatment samples from Drammen were as early as 2 weeks after therapy initiation. Conclusions: As IO may result in cures, but also may result in pseudoprogression or hyperprogression, a simple, rapid turnaround, inexpensive, blood test to aid clinicians in the early detection of failing IO, and thus individualized switching to an alternative therapy (which typically costs much less) may be beneficial, even life saving for that patient, while reducing direct as well as indirect costs. Unlike other ctDNA technologies, this can eventually be offered in a small, point-of-care device that is simple and inexpensive enough for use at every oncologist office visit to provide near real-time tracking of treatment response. [Table: see text]

Characterizing the response of Timepix solid state detectors to dust impacts

Timepix Solid State Detectors (TSSDs) are used in a range of applications, including high energy particle physics, x-ray imaging spectroscopy, medical imaging, radiation monitors and compact dosimeters. In space sciences, such detectors have been used for characterizing the radiation environments of the Earth and lunar surface. This study is a pilot investigation of the response of TSSDs to high-velocity dust impacts. The setup used for the measurements is a silicon slab with 500μm thickness combined with the Timepix 2 read-out chip with a pixel size of 55×55 μm2. The outer surface of the SSD is coated with a 150 nm thick layer of aluminum to eliminate the sensitivity to light. The dust accelerator facility operated at the University of Colorado is used to expose the TSSD to micron- and sub-micron sized iron particles in a velocity range of 1–10 km/s. A fraction (5%) of the impacting dust particles were detected by the TSSD. The primary mechanism of the detection is through the light generated upon the impact and the charge signal spreads over multiple pixels. The fraction of dust particles kinetic energy that is converted to detectable charge on the TSSD is small, in the range of 10−3−10−6. The largest craters generated by the dust impacts were examined using a scanning electron microscope (SEM). The SEM images confirm that the particles penetrated the aluminum layer and the craters contain iron residue from the dust material. Over the investigated impact parameter range, the TSSD does not suffer a permanent damage from the dust impacts. Due to their small size and relatively low sensitivity to dust impacts, TSSDs could be used as dust detectors only in environments with high dust fluxes (e.g., in cometary trails), or where the precision measurements of the impact location are desired.

Fair evaluation of federated learning algorithms for automated breast density classification: The results of the 2022 ACR-NCI-NVIDIA federated learning challenge

The correct interpretation of breast density is important in the assessment of breast cancer risk. AI has been shown capable of accurately predicting breast density, however, due to the differences in imaging characteristics across mammography systems, models built using data from one system do not generalize well to other systems. Though federated learning (FL) has emerged as a way to improve the generalizability of AI without the need to share data, the best way to preserve features from all training data during FL is an active area of research. To explore FL methodology, the breast density classification FL challenge was hosted in partnership with the American College of Radiology, Harvard Medical Schools’ Mass General Brigham, University of Colorado, NVIDIA, and the National Institutes of Health National Cancer Institute. Challenge participants were able to submit docker containers capable of implementing FL on three simulated medical facilities, each containing a unique large mammography dataset. The breast density FL challenge ran from June 15 to September 5, 2022, attracting seven finalists from around the world. The winning FL submission reached a linear kappa score of 0.653 on the challenge test data and 0.413 on an external testing dataset, scoring comparably to a model trained on the same data in a central location.

Longitudinal study of immunity to SARS-CoV2 in ocrelizumab-treated MS patients up to 2 years after COVID-19 vaccination.

(1) To plot the trajectory of humoral and cellular immune responses to the primary (two-dose) COVID-19 mRNA series and the third/booster dose in B-cell-depleted multiple sclerosis (MS) patients up to 2 years post-vaccination; (2) to identify predictors of immune responses to vaccination; and (3) to assess the impact of intercurrent COVID-19 infections on SARS CoV-2-specific immunity. Sixty ocrelizumab-treated MS patients were enrolled from NYU (New York) and University of Colorado (Anschutz) MS Centers. Samples were collected pre-vaccination, and then 4, 12, 24, and 48 weeks post-primary series, and 4, 12, 24, and 48 weeks post-booster. Binding anti-Spike antibody responses were assessed with multiplex bead-based immunoassay (MBI) and electrochemiluminescence (Elecsys®, Roche Diagnostics), and neutralizing antibody responses with live-virus immunofluorescence-based microneutralization assay. Spike-specific cellular responses were assessed with IFNγ/IL-2 ELISpot (Invitrogen) and, in a subset, by sequencing complementarity determining regions (CDR)-3 within T-cell receptors (Adaptive Biotechnologies). A linear mixed-effect model was used to compare antibody and cytokine levels across time points. Multivariate analyses identified predictors of immune responses. The primary vaccination induced an 11- to 208-fold increase in binding and neutralizing antibody levels and a 3- to 4-fold increase in IFNγ/IL-2 responses, followed by a modest decline in antibody but not cytokine responses. Booster dose induced a further 3- to 5-fold increase in binding antibodies and 4- to 5-fold increase in IFNγ/IL-2, which were maintained for up to 1 year. Infections had a variable impact on immunity. Humoral and cellular benefits of COVID-19 vaccination in B-cell-depleted MS patients were sustained for up to 2 years when booster doses were administered.

Tracing the contribution of cattle farms to methane emissions through bibliometric analyses

Methane contributes to global warming, and livestock is one of the sources of methane production. However, methane emission studies using bibliometric tools in livestock are lacking. Given the negative impact of climate change on the ecosystem and the rise in methane emissions, it is essential to conduct a bibliometrics study to provide an overview and research trends. We used the Bibliometrix package and VOSviewer to decipher bibliometric indices for methane emissions in cattle farms (MECF). Current dataset were collected from the Web of Science (Core Collection) database, and 8,998 publications were analyzed. The most co-occurring keywords scientists preferred were methane (1528), greenhouse gas (443), methane emissions (440), and cattle (369). Methane was the most frequently used keyword in the published scientific literature. Thematic evolution of research themes and trend results highlighted carbon dioxide, methane, dairy cattle, cattle, and risk factors during 1999-2017. Chinese Academy of Sciences ranked on top with 485 publications, followed by Agriculture & Agri-Food Canada, University of Colorado, National Oceanic and Atmospheric Administration, and Aarhus University. Chinese Academy of Sciences was also the most cited organization, followed by the University of Colorado, Agriculture & Agri-Food Canada, National Oceanic and Atmospheric Administration, and United States Geological Survey. Source analysis showed that the Science of the Total Environment was cited with the highest total link strength. “Science of the Total Environment” ranked first in source core 1 with 290 citation frequencies, followed by “Journal of Dairy Science” with 223 citation frequencies. Currently, no bibliometric study has been conducted on MECF, and to fill this knowledge gap, we carried out this study to highlight methane emissions in cattle farms, aiming at a climate change perspective. In this regard, we focused on the research productivity of countries authors, journals and institutions, co-occurrence of keywords, evolution of research trends, and collaborative networking. Based on relevance degree of centrality, methane emissions and greenhouse gases appeared as basic themes, cattle, and dairy cattle appeared as emerging/declining themes, whereas, methane, greenhouse gas and nitrous oxide appeared to fall amongst basic and motor themes. On the other hand, beef cattle, rumen and dairy cow seem to be between motor and niche themes, and risk factors lie in niche themes. The present bibliometric analysis provides research progress on methane emissions in cattle farms. Current findings may provide a framework for understanding research trends and themes in methane emissions in cattle farms (MECF) research.

Albumin versus crystalloids for AKI in the cirrhotic patient

University of Colorado (University Hospital) Program (Founding), Aurora, Colorado The corresponding author is Emily Sue Spencer, MD; [email protected] The authors declare no conflicts of interest.