Higher Discrepancy Research Articles

25 Biases in Informant Ratings of Functional Abilities in Mild Cognitive Impairment: Predictors of Caregiver-Rated Functional Abilities While Controlling for Patient Objective Cognitive Status

Objective:An understanding of factors that contribute to informant ratings of patients’ functional abilities is crucial, not only because these ratings are used to diagnose individuals with mild cognitive impairment (MCI) versus dementia, but also because these ratings are commonly used as outcome measures in clinical trials. While these ratings are assumed to be largely accurate, research shows they are subject to biases. Caregiver distress, higher caregiver educational attainment, and higher patient age are associated with a higher discrepancy between informant and patient reports of functional abilities. Studies on informant ratings of functional abilities that simultaneously control for patient objective cognitive abilities remain sparse. The current study aims to evaluate caregiver characteristics as predictors of informant-rated functional status while controlling for patient objective cognitive abilities in MCI.Participants and Methods:Individuals with a clinical diagnosis of MCI (Albert, 2011 criteria) were referred to the Cognitive Empowerment Program (CEP), a comprehensive lifestyle program addressing modifiable risk factors associated with progression. This study included cross-sectional data from 118 newly enrolled individuals and their caregivers who served as informants. Patient cognitive functioning was assessed with the Montreal Cognitive Assessment (MoCA). Predictors of interest included caregiver-rated functional abilities (Functional Activities Questionnaire; FAQ), caregiver burden (Zarit Burden Interview; ZBD), caregiver depressive symptoms (Center for Epidemiological Studies Depression scale; CES-D), caregiver stress (Perceived Stress Scale; PSS), and caregivers’ self-rated communicative effectiveness (Communicative Effectiveness Index; CETI). Hierarchical linear regression models were run to predict FAQ while controlling for patient MoCA scores. Separate models were run for the caregiver variables of interest including caregiver age, ZBD, CES-D, PSS, and CETI.Results:Caregivers were 75.6% spouses, 17.1% adult children, 3.3% unmarried partners/cohabitating partners, and 4.1% friends. The mean age of individuals with MCI was 74.7 years (SD: 6.96, mean education = 16.2±2.60 years; 47% female) and the mean age of caregivers was 66.4 (SD: 12.88, mean education = 16.3±2.34; 66% female). Worse ratings of functional abilities on the informant-rated FAQ were found for patients with lower MoCA scores (ß = .242, p = .008). Importantly, while controlling for MoCA scores, worse ratings of functional abilities on the FAQ were found for informants with lower age (ß = -0.269, p = .003), higher perceived stress (ß = 0.267, p = .003), higher caregiver burden (ß = 0.289, p < 0.001), and lower self-rated communication effectiveness (ß = -0.324, p < .001). Caregiver depression (ß = 0.089, p = .084) and education (ß = -0.137, p = .147) were not significant predictors of functional ability ratings while controlling for MoCA scores.Conclusions:Results of the current study highlight the potential for biases in informant ratings regarding functional abilities in MCI. Informant ratings were found to be significantly influenced by caregiver age, stress, burden, and communicative effectiveness. A key finding is that younger caregivers, such as adult children, may report greater functional impairment in individuals with MCI. The current findings have implications for the use of perceived functional ratings, both for diagnostic purposes and as outcome measures in clinical trials.

Chronotype-Dependent Sleep Loss Is Associated with a Lower Amplitude in Circadian Rhythm and a Higher Fragmentation of REM Sleep in Young Healthy Adults.

In modern society, the time and duration of sleep on workdays are primarily determined by external factors, e.g., the alarm clock. This can lead to a misalignment of the intrinsically determined sleep timing, which is dependent on the individual chronotype, resulting in reduced sleep quality. Although this is highly relevant given the high incidence of sleep disorders, little is known about the effect of this misalignment on sleep architecture. Using Fitbit trackers and questionnaire surveys, our study aims to elucidate sleep timing, sleep architecture, and subjective sleep quality in young healthy adults (n = 59) under real-life conditions (average of 82.4 ± 9.7 days). Correlations between variables were calculated to identify the direction of relationships. On workdays, the midpoint of sleep was earlier, the sleep duration was shorter, and tiredness upon waking was higher than on free days. A higher discrepancy between sleep duration on workdays and free days was associated with a lower stability of the circadian rhythm of REM sleep and also with a higher fragmentation of REM sleep. Similarly, a higher tiredness upon waking on free days, thus under intrinsically determined sleep timing conditions, was associated with a lower proportion and a higher fragmentation of REM sleep. This suggests that the misalignment between extrinsically and intrinsically determined sleep timing affects the architecture of sleep stages, particularly REM sleep, which is closely connected to sleep quality.

Comparative analysis of the trueness of linear measurements using direct and indirect scanning protocols compared to actual clinical measurements.

To assess the trueness of digital measurements using direct and indirect scanning approaches compared to the actual clinical measurements. The crown length, width, and width/length ratio were measured in 36 anterior maxillary teeth using three different methods. The first was clinically using a digital caliper, the second was by scanning the teeth using a digital scanner and the third was by making an impression of the teeth, constructing a stone cast in the lab, and scanning it to obtain digital measurements. Bland-Altman test and intraclass correlation were used to assess the data and make comparisons. Measurements taken using both approaches were highly reliable, with intraclass correlations ranging from 0.934 to 0.977 (p ≤ 0.000). Bland-Altman plot reflected a minimal mean difference between measurements especially in crown width measurements. Crown width/crown length measurement displayed the highest mean difference. Both direct and indirect optical surface scans showed similar high trueness in linear measurements of teeth. A higher discrepancy was detected in the crown width/length ratio. Digital dentistry is the new era in patient management. The use of conventional impression techniques and physical dental casts is associated with several disadvantages. Scanning dental casts to convert physical records into digital ones has multiple advantages. Optical surface scans (digital models) of the dentition are currently being more broadly used and advocated in the different dental disciplines including the construction of surgical guides for esthetic crown lengthening procedures. The trueness and reliability of linear measurements are of paramount importance to allow for proper fit and predictable outcomes. In this study, the trueness of these linear measurements obtained using direct and indirect methods was compared to the actual clinical measurements.

Segmentation of X-ray coronary angiography with an artificial intelligence deep learning model: Impact in operator visual assessment of coronary stenosis severity.

Visual assessment of the percentage diameter stenosis (%DSVE ) of lesions is essential in coronary angiography (CAG) interpretation. We have previously developed an artificial intelligence (AI) model capable of accurate CAG segmentation. We aim to compare operators' %DSVE in angiography versus AI-segmented images. Quantitative coronary analysis (QCA) %DS (%DSQCA ) was previously performed in our published validation dataset. Operators were asked to estimate %DSVE of lesions in angiography versus AI-segmented images in separate sessions and differences were assessed using angiography %DSQCA as reference. A total of 123 lesions were included. %DSVE was significantly higher in both the angiography (77% ± 20% vs. 56% ± 13%, p < 0.001) and segmentation groups (59% ± 20% vs. 56% ± 13%, p < 0.001), with a much smaller absolute %DS difference in the latter. For lesions with %DSQCA of 50%-70% (60% ± 5%), an even higher discrepancy was found (angiography: 83% ± 13% vs. 60% ± 5%, p < 0.001; segmentation: 63% ± 15% vs. 60% ± 5%, p < 0.001). Similar, less pronounced, findings were observed for %DSQCA < 50% lesions, but not %DSQCA > 70% lesions. Agreement between %DSQCA /%DSVE across %DSQCA strata (<50%, 50%-70%, >70%) was approximately twice in the segmentation group (60.4% vs. 30.1%; p < 0.001). %DSVE inter-operator differences were smaller with segmentation. %DSVE was much less discrepant with segmentation versus angiography. Overestimation of %DSQCA < 70% lesions with angiography was especially common. Segmentation may reduce %DSVE overestimation and thus unwarranted revascularization.

Measurement of the time structure of FLASH beams using prompt gamma rays and secondary neutrons as surrogates

Objective. The aim of this study was to investigate the feasibility of online monitoring of irradiation time (IRT) and scan time for FLASH proton radiotherapy using a pixelated semiconductor detector. Approach. Measurements of the time structure of FLASH irradiations were performed using fast, pixelated spectral detectors based on the Timepix3 (TPX3) chips with two architectures: AdvaPIX-TPX3 and Minipix-TPX3. The latter has a fraction of its sensor coated with a material to increase sensitivity to neutrons. With little or no dead time and an ability to resolve events that are closely spaced in time (tens of nanoseconds), both detectors can accurately determine IRTs as long as pulse pile-up is avoided. To avoid pulse pile-up, the detectors were placed well beyond the Bragg peak or at a large scattering angle. Prompt gamma rays and secondary neutrons were registered in the detectors’ sensors and IRTs were calculated based on timestamps of the first charge carriers (beam-on) and the last charge carriers (beam-off). In addition, scan times in x, y, and diagonal directions were measured. The experiment was carried out for various setups: (i) a single spot, (ii) a small animal field, (iii) a patient field, and (iv) an experiment using an anthropomorphic phantom to demonstrate in vivo online monitoring of IRT. All measurements were compared to vendor log files. Main results. Differences between measurements and log files for a single spot, a small animal field, and a patient field were within 1%, 0.3% and 1%, respectively. In vivo monitoring of IRTs (95–270 ms) was accurate within 0.1% for AdvaPIX-TPX3 and within 6.1% for Minipix-TPX3. The scan times in x, y, and diagonal directions were 4.0, 3.4, and 4.0 ms, respectively. Significance. Overall, the AdvaPIX-TPX3 can measure FLASH IRTs within 1% accuracy, indicating that prompt gamma rays are a good surrogate for primary protons. The Minipix-TPX3 showed a somewhat higher discrepancy, likely due to the late arrival of thermal neutrons to the detector sensor and lower readout speed. The scan times (3.4 ± 0.05 ms) in the 60 mm distance of y-direction were slightly less than (4.0 ± 0.06 ms) in the 24 mm distance of x-direction, confirming the much faster scanning speed of the Y magnets than that of X. Diagonal scan speed was limited by the slower X magnets.

Informant Discrepancy in Report of Parent-adolescent Conflict as a Predictor of Hopelessness among Depressed Adolescents: A Replication Study

AbstractMore knowledge is needed about how family factors influence depression features in adolescents. We aimed to replicate a previous small sample study showing that higher discrepancy between adolescents and caregivers in report of conflict predicted more hopelessness in adolescents with major depression. The current sample comprised 417 adolescent and maternal caregiver dyads. The adolescents were aged between 12 and 17 years (55.4% female, 44.6% male). The sample was drawn from the Treatment of Adolescents with Depression Study (TADS). Analyses were conducted using latent difference score modelling, item response theory, and linear regression in a Bayesian framework. Higher adolescent-perceived conflict relative to caregiver-perceived conflict predicted more adolescent hopelessness. This replicated the original findings in a much larger sample. Adolescent gender did not influence the associations. Addressing divergence in adolescent and parent perceptions of conflict may be relevant to ameliorate hopelessness in treatment of adolescents with depression.

Effect of U.S. Region on the Incidence of In-Hospital Pregnancy Terminations Over Two Decades [ID: 1376691

INTRODUCTION: The overturning of Roe v Wade will result in a patchwork of abortion laws that vary based on where a person lives; however, the current association between geographical region in the United States and abortion is poorly understood. Our objective was to define the effect geographic location has on the incidence of in-hospital pregnancy terminations in the United States. METHODS: The U.S. Nationwide Inpatient Sample (NIS) database was queried for all patients who underwent an in-hospital abortion (termination of pregnancy) from 1997 to 2014. The cohort was divided based on what region in the United States the procedure was performed: Northeast, Midwest, South, and West. ANOVA statistical analysis was used to compare the four groups across the study period. RESULTS: We identified a total of 37,600 patients who underwent an in-hospital pregnancy termination with a significant decrease from 4,113 abortions in 1997 to 1,059 in 2014 (P&lt;.001). Compared to the rest of the United States, the Northeast region experienced a significantly higher incidence of abortions (P&lt;.01), with a mean of 878 abortions per year, and the Midwest experienced a significantly lower incidence of abortions (P&lt;.01), with a mean of 261 abortions per year. CONCLUSION: Our study found that the Northeast and Midwest regions of the United States experience the highest and lowest rates of abortion, respectively. With Roe v Wade overturned, an even higher discrepancy between abortion rate and U.S. region might ensue; however, further study is needed to investigate the etiology of these differences.

Factors affecting the discrepancy between patient and physician global assessment in early rheumatoid arthritis: The Ontario Best Practices Research Initiative.

We aimed to assess the prevalence and factors affecting the discrepancy between patient global assessment (PtGA) and physician global assessment of disease activity (PhGA) in patients with early rheumatoid arthritis (RA) at enrolment and after one year. Patients from the Ontario Best Practices Research Initiative (OBRI) were included. The discrepancy between PtGA and PhGA was calculated by simple subtraction (PtGA-PhGA). An absolute value ≥30 was considered discordant. Linear regression analysis was used to assess factors affecting PtGA, PhGA, and PtGA-PhGA discrepancy at enrolment and 1-year follow-up. A total of 531 patients with mean disease duration of 0.3 years were analysed. The discordance prevalence was 22.4% at enrolment and 20.3% after one year. PtGA was higher in the majority of the discordant cases. Multivariable regression analysis showed higher PtGA was significantly associated with higher pain score, tender joint counts (TJC28), ESR, and fatigue at enrolment and 1-year follow-up while PtGA was associated with higher swollen joint counts (SJC28) only at enrolment. Similar associations were found for PhGA, with the exception of fatigue, which was not a significant factor at one year. Multivariable analysis showed that higher discrepancy between PtGA-PhGA was associated with lower SJC28 and higher pain score at enrolment and lower SJC28 and higher pain and fatigue score at 1-year follow-up. Significant PtGA-PhGA discrepancy was found in approximately one-quarter of early RA patients. In the majority of these patients, PtGA was higher than PhGA. The main predictors of PtGA and PhGA remained the same after one year.

Added Value of Next Generation over Sanger Sequencing in Kenyan Youth with Extensive HIV-1 Drug Resistance.

HIV-1 drug resistance testing in children and adolescents in low-resource settings is both important and challenging. New (more sensitive) drug resistance testing technologies may improve clinical care, but evaluation of their added value is limited. We assessed the potential added value of using next-generation sequencing (NGS) over Sanger sequencing for detecting nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRMs). Participants included 132 treatment-experienced Kenyan children and adolescents with diverse HIV-1 subtypes and with already high levels of drug resistance detected by Sanger sequencing. We examined overall and DRM-specific resistance and its predicted impact on antiretroviral therapy and evaluated the discrepancy between Sanger sequencing and six NGS thresholds (1%, 2%, 5%, 10%, 15%, and 20%). Depending on the NGS threshold, agreement between the two technologies was 62% to 88% for any DRM, 83% to 92% for NRTI DRMs, and 73% to 94% for NNRTI DRMs, with more DRMs detected at low NGS thresholds. NGS identified 96% to 100% of DRMs detected by Sanger sequencing, while Sanger identified 83% to 99% of DRMs detected by NGS. Higher discrepancy between technologies was associated with higher DRM prevalence. Even in this resistance-saturated cohort, 12% of participants had higher, potentially clinically relevant predicted resistance detected only by NGS. These findings, in a young, vulnerable Kenyan population with diverse HIV-1 subtypes and already high resistance levels, suggest potential benefits of more sensitive NGS over existing technology. Good agreement between technologies at high NGS thresholds supports their interchangeable use; however, the significance of DRMs identified at lower thresholds to patient care should be explored further. IMPORTANCE HIV-1 drug resistance in children and adolescents remains a significant problem in countries facing the highest burden of the HIV epidemic. Surveillance of HIV-1 drug resistance in children and adolescents is an important public health strategy, particularly in resource-limited settings, and yet, it is limited due mostly to cost and infrastructure constraints. Whether newer and more sensitive next-generation sequencing (NGS) adds substantial value beyond traditional Sanger sequencing in detecting HIV-1 drug resistance in real life settings remains an open and debatable question. In this paper, we attempt to address this issue by performing a comprehensive comparison of drug resistance identified by Sanger sequencing and six NGS thresholds. We conducted this study in a well-characterized, vulnerable cohort of children and adolescents living with diverse HIV-1 subtypes in Kenya and, importantly, failing antiretroviral therapy (ART) with already extensive drug resistance. Our findings suggest a potential added value of NGS over Sanger even in this unique cohort.

Isothermal Quenching of As-Cast Medium Carbon, High-Silicon AR Steel.

Medium carbon high-silicon abrasion resistant (AR) steel was examined by performing dilatometry, light optical microscopy (LOM), scanning electron microscopy (SEM), and hardness measurements after isothermal bainitization and modified martempering and compared to direct quenching technology. A commercial thermodynamic tool was used for hardness prediction and compared to the measured one and revealed a rather good agreement for direct quenching, as was the case for isothermal holdings near to the martensite start (Ms). The predicted martensite start temperatures were in good agreement with the experimental data, the experimental value was 321 °C, while the predicted values were 324 and 296 °C. However, a higher discrepancy appeared for isothermal holding much above the martensite transition in the bainite region resulting in lower measured hardness compared to the predictions related to the actual kinetics and complexity of the formed final volume percentages of phase constituents such as bainite, martensite, and rest austenite, later as a part of unfinished bainite transformation at studied temperature. The predicted hardness values for quenching, isothermal holding at 280, 300 and 350 °C were 50.6, 50.6, 49.4 and 49.4 HRC, while the measured values were 53.3, 48.3, 48 and 43 HRC, respectively. A very good agreement between the thermodynamic prediction was achieved by comparing the measured Ms concerning prior austenite grain size as one of the crucial parameters for setting a proper heat treatment strategy of various isothermal quenchings making thermodynamic predictions for low alloyed steels a powerful tool for optimizing the heat-treating operations.

Induction of mastitis by cow-to-mouse fecal and milk microbiota transplantation causes microbiome dysbiosis and genomic functional perturbation in mice

BackgroundMastitis pathogenesis involves a wide range of opportunistic and apparently resident microorganims including bacteria, viruses and archaea. In dairy animals, microbes reside in the host, interact with environment and evade the host immune system, providing a potential for host-tropism to favor mastitis pathogenesis. To understand the host-tropism phenomena of bovine-tropic mastitis microbiomes, we developed a cow-to-mouse mastitis model.MethodsA cow-to-mouse mastitis model was established by fecal microbiota transplantation (FMT) and milk microbiota transplantation (MMT) to pregnant mice to assess microbiome dysbiosis and genomic functional perturbations through shotgun whole metagenome sequencing (WMS) along with histopathological changes in mice mammary gland and colon tissues.ResultsThe cow-to-mouse FMT and MMT from clinical mastitis (CM) cows induced mastitis syndromes in mice as evidenced by histopathological changes in mammary gland and colon tissues. The WMS of 24 samples including six milk (CM = 3, healthy; H = 3), six fecal (CM = 4, H = 2) samples from cows, and six fecal (CM = 4, H = 2) and six mammary tissue (CM = 3, H = 3) samples from mice generating 517.14 million reads (average: 21.55 million reads/sample) mapped to 2191 bacterial, 94 viral and 54 archaeal genomes. The Kruskal–Wallis test revealed significant differences (p = 0.009) in diversity, composition, and relative abundances in microbiomes between CM- and H-metagenomes. These differences in microbiome composition were mostly represented by Pseudomonas aeruginosa, Lactobacillus crispatus, Klebsiella oxytoca, Enterococcus faecalis, Pantoea dispersa in CM-cows (feces and milk), and Muribaculum spp., Duncaniella spp., Muribaculum intestinale, Bifidobacterium animalis, Escherichia coli, Staphylococcus aureus, Massilia oculi, Ralstonia pickettii in CM-mice (feces and mammary tissues). Different species of Clostridia, Bacteroida, Actinobacteria, Flavobacteriia and Betaproteobacteria had a strong co-occurrence and positive correlation as the indicator species of murine mastitis. However, both CM cows and mice shared few mastitis-associated microbial taxa (1.14%) and functional pathways regardless of conservation of mastitis syndromes, indicating the higher discrepancy in mastitis-associated microbiomes among lactating mammals.ConclusionsWe successfully induced mastitis by FMT and MMT that resulted in microbiome dysbiosis and genomic functional perturbations in mice. This study induced mastitis in a mouse model through FMT and MMT, which might be useful for further studies- focused on pathogen(s) involved in mastitis, their cross-talk among themselves and the host.Graphical

The Functional Relationship of Sediment Transport under Various Simulated Rainfall Conditions

Sediment removed in the detachment process is transported by overland flow. Previous experimental and field works studied that sediment transport is influenced by hydraulic properties of flow, physical properties of soil, and surface characteristics. Several equations in predicting sediment transport have been developed from previous research. The objective of this paper was to establish the selected parameters that contribute to the sediment transport capacity in overland flow conditions under different rainfall pattern conditions and to evaluate their significance. The establishment of independent variables was performed using the dimensional analysis approach that is Buckingham’s π theorem. The final results obtained are a series of independent parameters; the Reynolds number (Re), dimensionless rainfall parameter iLν, hydraulic characteristics QLν that related to the dependent parameters; and dimensionless sediment transport qsρv. The relationship indicates that 63.6% to 72.44% of the variance in the independent parameters is in relation to the dependent parameter. From the iteration method, the estimation of constant and regression coefficient values is presented in the form of the general formula for linear and nonlinear model equations. The linear and nonlinear model equations have the highest model accuracy of 93.1% and 81.5%, respectively. However, the nonlinear model equation has the higher discrepancy ratio of 54.9%.

Direct Quantification of Droplet Activation of Ambient Black Carbon Under Water Supersaturation

AbstractUnderstanding the droplet activation of black carbon (BC) under water supersaturation (SS) conditions is crucial to estimate its lifetime (through activation scavenging) and indirect radiative impacts. However, directly probing the droplet activation of ambient BC is challenging because of the difficulty in discriminating the BC‐containing particles (BCc) from other components. Here, we coupled the measurements of number concentrations between size‐resolved cloud condensation nuclei (CCN) and individual BCc, achieving a direct quantification of droplet activation for ambient BCc. The activation diameters of BCc (D50_BCc), determined as the dry diameter at which 50% of BCc were activated, were 144 ± 21 nm under SS 0.2% corresponding to activated number fraction of total BCc of 60% ± 10%. D50_BCc was determined as a function of the coating hygroscopicity, and the organic content was observed as a limiting factor in controlling BCc activation. The activated BCc number concentration was predicted using the volume‐weighted compositions within particle. The predicted CCN agreed well with the measurements for all particles, while overestimating the activated BCc number concentration by 71%, 27%, and 27% at SS = 0.1%, 0.2%, and 0.3%, respectively. The higher discrepancy under lower SS may result from the higher non‐sphericity of BCc at large sizes. Therefore, only knowing the hygroscopicity distribution of bulk compositions may not be sufficient for estimating the activation of BCc, but considering additional factors such as the non‐sphericity of BCc is necessary to estimate droplet activation.

Mandibular range of motion in children with juvenile idiopathic arthritis with and without clinically established temporomandibular joint involvement and in healthy children; a cross-sectional study

BackgroundRecognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA.The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children.MethodsThis cross-sectional study included children with JIA and healthy children of age 6–18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement.ResultsA total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children.ConclusionAll mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.

Mechanical and Gamma-Ray Interaction Studies of PbO–MoO3–Li2O–B2O3 Glass System for Shielding Applications in The Low Energy Region: A Theoretical Approach

The mechanical and radiation shielding properties for the PbO–MoO3–Li2O–B2O3 glass system were theoretically investigated in this paper. The PbO–MoO3–Li2O–B2O3 glass system (coded as investigated glasses) was fabricated using the melt quenching mechanism. The optical packing density (OPD) increases from 75.563 to 84.366, and oxygen molar volume (OMV) decreases from 13.234 to 11.853 cm3/mol when increasing the PbO concentration. The values of elastic moduli decreased from 47.06 to 39.67 GPa for Young, from 33.51 to 32.41 GPa for bulk, from 19.82 to 16.29 GPa for shear and from 59.94 to 54.14 GPa for longitudinal moduli as the PbO is increased. The radiation attenuation characteristics were reported at the photon energies used in diagnostic radiology. The mass attenuation coefficient (MAC) was evaluated using the three photoatomic data libraries EPICS2017, EPDL97, and XCOM, available in the EpiXS and Phy-X programs. The MAC for the five investigated glasses at 20 keV was much higher than the MAC at 40, 60 and 80 keV. The MAC for investigated glasses increased with the addition of PbO, with Pb-S1 demonstrating the lowest MAC, and Pb-S5 demonstrating the highest MAC. Additionally, the rate of the increment of MAC at 20 keV as the concentration of PbO increased was higher than that at 40, 60 and 80 keV. The effective atomic number (EAN) was determined using Phy-X program. The EAN follows the trend: Pb-S5 &gt; Pb-S4 &gt; Pb-S3 &gt; Pb-S2 &gt; Pb-S1. The EAN results proved that the glass with low amounts of B2O3 and higher amounts of PbO had good attenuation features. The EAN had the maximum values of 73.55–76.67 at 20 keV, whereas the lowest values occurred at 80 keV and varied between 53.63 and 63.39. The half-value layer (HVL) results showed that the Pb-S1 glass had the greatest HVL, while Pb-S5 had the least. There is a higher discrepancy between the tenth-value layer values at 80 keV than at 20 keV. At 20 keV, the difference between the highest and lowest TVL values (Pb-S1 and Pb-S5) was only 0.004 cm, while the difference at 80 keV was 0.152 cm. Pb-S5 is the most space-efficient radiation shield.

A Two-Parameter Corresponding States Method for Calculating the Steady-State Evaporation Rate of C2\u2013C9 n-Alkane Droplets in Air for Elevated Pressures and Temperatures

Advanced gas turbine and internal combustion engine combustion chambers operate at highly elevated pressures and temperatures. Therefore, spray vaporization analysis cannot be limited to the atmospheric environment since evaporation strongly depends on ambient conditions. Presently, the effect of air pressure and temperature on droplet evaporation rate was investigated by using both a transient and a steady-state approach. A corresponding states model was derived for the steady-state evaporation rate for n-alkanes in the range of C2–C9 with an excellent fit quality and < 1% model uncertainty, considering the thermophysical data uncertainties. The model was tested for C1, C10, and C12 n-alkanes as well with low success. The ambient conditions were evaluated in terms of reduced pressures and temperatures, covering the range of 0.02–0.5 and 1.2–1.5, respectively. However, the applicability of the model was limited to reduced temperature of 1.3–1.5, as higher discrepancy was observed between the trends of the different n-alkanes at lower temperatures. Since the heat-up phase of practical sprays in combustion chambers is often short, the present model might significantly reduce the computational effort required for liquid evaporation calculations.

Compress the curve: a cross-sectional study of variations in COVID-19 infections across California nursing homes

ObjectiveNursing homes’ residents and staff constitute the largest proportion of the fatalities associated with COVID-19 epidemic. Although there is a significant variation in COVID-19 outbreaks among the US nursing homes,...

Assessment of CMIP6 models' skill for tropical Indian Ocean sea surface temperature variability

AbstractThe present study examines the ability of Coupled Model Inter‐comparison Project phase 6 (CMIP6) models in representing the dominant modes of tropical Indian Ocean (TIO) sea surface temperature (SST) variability on the interannual and decadal time scale. Historical simulations from 27 CMIP6 models are assessed against Extended Reconstructed SST over the period of 1854 to 2014. Spectrum analysis reveals that many models reproduce interannual and decadal variability of TIO SST but underestimate the amplitude of variability with some disparity in the periodicity. All models can reproduce the dominant basin‐wide mode of interannual and decadal variability of TIO SST reasonably well. Skill score analysis of TIO SST variability reveals that KACE‐1‐0‐G has highest skill, followed by FGOALS‐f3‐L, EC‐Earth3‐Veg‐LR, ACCESS‐ESM1‐5, CanESM5‐CanOE on the interannual timescale and FGOALS‐f3‐L, CanESM5‐CanOE, KACE‐1‐0‐G and CanESM5, respectively, showed highest skills for decadal variability. It is found that variations in radiation and latent heat flux are primarily responsible for interannual variability in TIO SST, the basin‐wide warming, in the observations. Taylor diagram analysis reveals that all the models exhibit better skill for the radiative flux; however, skill for the latent heat and momentum flux varies from model to model. It is important to note that the models in which the latent heat flux and zonal wind are better represented have produced better TIO SST variability compared to other models. A higher discrepancy in latent heat and zonal momentum flux leads to improper wind‐evaporation‐SST and wind‐circulation‐SST feedback, which in turn restricts the model skill. Besides, model that has realistic central and eastern Pacific SST variability show better skill for TIO SST variability in both interannual and decadal time scales. The present study advocates that better representation of latent heat flux and zonal wind in coupled models is important for the accurate simulation of interannual and decadal variability in TIO SST.

Cell-free DNA profiling in patients with lupus nephritis.

Increased level of cell-free DNA (cf-DNA) is associated with systemic lupus erythematosus (SLE) and might be related to disease activity. The aim of this study was to evaluate whether cfDNA integrity, size distribution and concentration of different cfDNA fractions is associated with lupus activity and kidney involvement. Blood samples were collected from 43 SLE patients and 50 healthy controls. Nuclear and mitochondrial fractions of cfDNA and intracellular DNA were quantified by real-time qPCR. Sizing and quantification of total cfDNA level was performed on Bioanalyzer. We determined four parameters that characterized cfDNA profile: fragmentation index, ratio of intra- to extracellular mtDNA copy number, cfDNA concentration, and presence of 54-149 bp and 209-297 bp fragments. Patients with healthy-like cfDNA profile had higher eGFR (P = 0.009) and more often no indications for kidney biopsy or less advanced lupus nephritis (LN) (P = 0.037). In contrary, SLE patients with distinct cfDNA profile (characterized by increased cfDNA concentration and fragmentation, higher discrepancy between intra- to extracellular mtDNA copy number, and the presence of 54-149 bp and 209-297 bp fragments) had lower eGFR (P = 0.005) and more often advanced LN or history of renal transplantation (P = 0.001). We showed that cfDNA profiling may help to distinguish SLE patients with renal involvement and severe disease course from patients with more favorable outcomes. We suggest cfDNA profile a promising SLE biomarker.

Is HIV disease associated with a discrepancy between premorbid verbal IQ and neurocognitive functions?

ABSTRACT Introduction: There is debate about the optimal approach to diagnose neurocognitive impairment in people with HIV disease. The current “gold-standard” uses normative data to determine whether performance is below that of demographically comparable peers. This study investigated the utility of a discrepancy analysis approach, which compares normative neurocognitive performance directly to estimated premorbid intellectual functioning. Method: A total of 570 adults with and without HIV disease completed a comprehensive neurocognitive battery and the Wechsler Test of Adult Reading (WTAR), an oral word reading measure that was used to estimate premorbid verbal IQ. Normative scores for six neurocognitive domains were subtracted from the WTAR standardized score to calculate discrepancy scores where higher scores indicated greater discrepancies. Results: In models adjusting for relevant confounds, an interaction between HIV serostatus and domain discrepancy scores emerged such that persons with HIV had significantly higher discrepancy scores than seronegative participants, specifically in the domains of attention and episodic memory. Of clinical relevance, persons with HIV were two to three times more likely than their seronegative counterparts to have clinically discordant performance relative to premorbid verbal IQ in these domains. Additionally, the standard normative approach and discrepancy analysis method had fair to moderate agreement for classifying attention and episodic memory impairment in the participants with HIV disease. Conclusions: HIV disease is associated with discrepancies between premorbid IQ estimates and the domains of attention and memory, consideration of which may be a clinically useful complement to standard normative approaches to diagnosing HIV-associated neurocognitive disorders.