Multiple Linear Mixed Effects Research Articles

Distinct Clinical Implications of Patient- Versus Clinician-Rated Motor Symptoms in Parkinson's Disease.

Patient-rated motor symptoms (PRMS) and clinician-rated motor symptoms (CRMS) often differ in Parkinson's disease (PD). Our goal was to investigate the determinants and clinical implications of PRMS compared with CRMS in PD. This retrospective, observational cohort study analyzed the cross-sectional associations and longitudinal impacts of PRMS as assessed by the Movement Disorders Society-sponsored Unified PD Rating Scale (MDS-UPDRS) part 2, while controlling for CRMS measured by MDS-UPDRS part 3. Longitudinal analyses used Cox proportional hazards models and multiple linear mixed-effects random intercepts/slope models, adjusting for many clinical predictors. We conducted propensity score matching (PSM) to reinforce our analyses' robustness and surface-based morphometry to investigate neural correlates. We enrolled 442 patients with early-stage PD. At baseline, regardless of CRMS, PRMS were associated with the severity of postural instability and gait disturbance (PIGD). Notably, PRMS independently and more accurately predicted faster long-term deterioration in motor function than CRMS (Hoehn and Yahr 4, adjusted hazard ratio per +1 point = 1.19 [95% confidence intervals, 1.08-1.32]), particularly in PIGD (PIGD subscore, β-interaction = 0.052 [95% confidence intervals, 0.018-0.086]). PSM confirmed these findings' robustness. Surface-based morphometry suggested that enhanced sensory processing was distinctively associated with PRMS. In early-stage PD, PRMS weighed different aspects of symptoms and more effectively predicted motor deterioration compared to CRMS, with distinctive brain structural characteristics. The superior sensitivity of PRMS to subtle declines in drug-refractory symptoms like PIGD likely underlie our results, highlighting the importance of understanding the differential clinical implications of PRMS to prevent long-term motor deterioration. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Bone health and physical activity in adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study

BackgroundAdolescents with juvenile idiopathic arthritis (JIA) tend to engage in less physical activity than their typically developing peers. Physical activity is essential for bone development and reduced physical activity may detrimentally effect bone health. Thus, we examined differences in total body bone mineral content (BMC) and areal bone mineral density (aBMD) between adolescents with JIA and adolescent controls without JIA. We also examined associations between moderate-to-vigorous physical activity (MVPA), lean mass, and bone outcomes.MethodsParticipants included 21 adolescents with JIA (14 females, 7 males) and 21 sex- and age-matched controls aged 10–20 years. Assessments included: height; weight; triple-single-leg-hop distance (TSLH); MVPA by accelerometry; and total body BMC, aBMD, and lean mass measured using dual X-ray absorptiometry. Height-adjusted z-scores were calculated for BMC and aBMD and used for all analyses. Multiple linear mixed effects models examined group differences in BMC and aBMD, adjusting for sex, maturity, MVPA, TSLH, and lean mass. Participants clusters, based on sex and age (within 18 months), were considered random effects.ResultsAdolescents with JIA had lower total body aBMD z-scores [β (95% CI); -0.58 (-1.10 to -0.07), p = 0.03] and BMC z-scores [-0.47 (-0.91 to -0.03), p = 0.04] compared with controls. Mean daily MVPA was 22.0 min/day lower in adolescents with JIA than controls; however, MVPA was not associated with aBMD [-0.01 (-0.01 to 0.01), p = 0.32] or BMC [0.00 (-0.01 to 0.00), p = 0.39]. Lean mass was positively associated with aBMD [0.05 (0.01 to 0.09) g/cm2, p = 0.03] and BMC [0.06 (0.03 to 0.10) g, p < 0.001].ConclusionAdolescents with JIA had lower total body aBMD and BMC compared with sex- and age-matched controls without JIA. Group differences in bone outcomes were not associated with the lower MVPA participation of adolescents with JIA. Despite this, physical activity should still be encouraged as it promotes physical well-being.

Relationship between lexicon and grammar in children and youth who use augmentative and alternative communication

The present study investigated the relationship between lexicon and grammar in individuals who use graphic symbol-based aided augmentative and alternative communication (AAC). Data came from 60 transcripts of generalization sessions that were part of two previous intervention studies, aimed at improving the expressive vocabulary and grammar of 12 children and youth who used graphic symbol-based AAC. The specific aims of the current study were to (a) describe vocabulary composition across different levels of expressive vocabulary and (b) analyze the relationship between global measures of expressive vocabulary and the use of grammar in individuals who use aided AAC. A series of multiple linear mixed effect regression analyses showed a positive predictive association between overall vocabulary size and the use of closed-class words, and a positive relationship between the use of verbs and the use of closed-class words. Additionally, the use of verbs had a significant positive association with the use of inflectional morphology, while the use of nouns did not. Theoretical and practical implications of these findings are discussed.

The ISAC Paradigm to Tame Oral Cancer in Saudi Arabia: A Quasi-experimental Study

Late detection of oral cancer (OC) cases in Saudi Arabia is concerning. It reduces survival rate and complicates treatment. The ISAC intervention was developed to bridge the gaps observed in dentists’ practice of OC examination and patient education. The ISAC stands for I, informing patients of OC screenings; S, screening for OC; A, advising high-risk patients to quit risk factors; and C, connecting patients to advanced services. This study tested the potential effect of the ISAC in influencing dentists’ cognitive and behavioral skills, to enhance early detection and prevention of OC. A quasi-experimental study was conducted among dental interns (DIs) at dental setting to test the effect on comprehensive oral cancer examination score (COCE), awareness, self-efficacy, descriptive-norms, and self-reported behavior. Data were collected through triangulation of methods pre and post the intervention at two-months. Multiple linear mixed effects regression models were utilized for data analysis. Between October 2020 and April 2021, 47 DIs participated in the study. The final model showed the significant effects of time (ISAC) on COCE (95% CI = 25.12–29.42, P < .001). DIs had a significant improvement in awareness, self-efficacy, descriptive norms, and self-reported behavior. The findings showed promising effects of the intervention toward the early detection and prevention of OC. Dentists, dental organizations, and policymakers in areas with a high risk of OC could benefit from the current intervention which contributes to capacity building and improved community health. A pragmatic study with a robust design is needed to test the effectiveness of the intervention on a wider scale.

MP48-20 MENTAL WORKLOADS OF SURGEONS IN UROLOGY: A PROSPECTIVE OBSERVATIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP48-20 MENTAL WORKLOADS OF SURGEONS IN UROLOGY: A PROSPECTIVE OBSERVATIONAL STUDY Shigeru Harada, Takashige Abe, Jun Furumido, Keita Takahashi, Kanta Hori, Noriyuki Abe, Masafumi Kon, Sachiyo Murai, Haruka Miyata, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, and Nobuo Shinohara Shigeru HaradaShigeru Harada More articles by this author , Takashige AbeTakashige Abe More articles by this author , Jun FurumidoJun Furumido More articles by this author , Keita TakahashiKeita Takahashi More articles by this author , Kanta HoriKanta Hori More articles by this author , Noriyuki AbeNoriyuki Abe More articles by this author , Masafumi KonMasafumi Kon More articles by this author , Sachiyo MuraiSachiyo Murai More articles by this author , Haruka MiyataHaruka Miyata More articles by this author , Hiroshi KikuchiHiroshi Kikuchi More articles by this author , Ryuji MatsumotoRyuji Matsumoto More articles by this author , Takahiro OsawaTakahiro Osawa More articles by this author , and Nobuo ShinoharaNobuo Shinohara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In urology, new technologies such as laparoscopic and robotic surgery are spreading, and physicians manage to catch up with novel methods. While professional burnout is recently emphasized, the mental and physical costs during surgery are not well understood. Our aim was to clarify the mental workloads (MWLs) of urologists during surgery and predictive factors. METHODS: Urologists in Hokkaido, Japan, joined this study. Between December 2020 and December 2021, after each surgical case, they reported patients’ backgrounds, their role (independent operator, operator under supervision, instructor, 1st, 2nd assistant), surgical outcomes (procedure, operative time, blood loss, complications, near-miss incidents etc.), subjective procedure difficulty, and MWLs, which was assessed by National Aeronautics and Space Administration-Task Load Index (NASA-TLX), via SurveyMonkey®. A multiple linear mixed-effects model was utilized to analyze the factors associated with NASA-TLX. RESULTS: 65 urologists (5 women) joined the study, and 2159 data were collected in 7 days after surgeries (open=250, laparoscopy=315, robotics=407, transurethral surgeries=743, and others=444). A multiple linear mixed-effects model revealed that female surgeons (estimate: +13.90, p=0.035), laparoscopic surgery [+2.54 (reference: transurethral surgery), p=0.035], intraoperative complications (+7.83, p<0.001), near-miss incidents (+3.34, p<0.001), longer operative time (continuous, +0.06, p<0.001), and higher blood loss (continuous, +0.001, p=0.01) were associated with higher MWLs. Operator under supervision (+17.42, p<0.001), independent operator (+8.86, p<0.001), instructor (+4.46, p=0.003), and 1st assistant (+3.90, p=0.01) also showed higher MWLs than 2nd assistant (reference). MWLs correlated with subjective surgical difficulty, with higher scores (+8.05, p<0.001) when the procedure was more difficult, and lower scores (-8.05, p<0.001) when it was less difficult than expected. MWLs was lower as the number of previous surgeries increased (-1.90, p<0.001). CONCLUSIONS: Surgeon MWLs were influenced by multiple factors. Regarding the role of surgery, operators showed higher MWLs, especially under supervision. Instructors should be aware of the high MWLs of operators under their supervision and devise instructional interventions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e663 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shigeru Harada More articles by this author Takashige Abe More articles by this author Jun Furumido More articles by this author Keita Takahashi More articles by this author Kanta Hori More articles by this author Noriyuki Abe More articles by this author Masafumi Kon More articles by this author Sachiyo Murai More articles by this author Haruka Miyata More articles by this author Hiroshi Kikuchi More articles by this author Ryuji Matsumoto More articles by this author Takahiro Osawa More articles by this author Nobuo Shinohara More articles by this author Expand All Advertisement PDF downloadLoading ...

Prognostic utility of baseline [18F]GTP1 tau PET signal for subsequent cognitive and functional decline in prodromal‐to‐mild Alzheimer's disease

AbstractBackgroundPrior studies of tau PET tracers in participants with normal cognition and/or a broad range of Alzheimer’s disease (AD) severity suggest baseline tau PET signal is associated with subsequent rates of cognitive decline. However, the prognostic utility of tau PET imaging is less well‐established within more homogenous cohorts limited to specific AD stages and for cognitive versus functional decline. We addressed these questions by analyzing baseline [18F]GTP1 tau PET signal and longitudinal changes in cognitive and functional measures in the Phase 2 Tauriel study of semorinemab in prodromal‐to‐mild AD.MethodsWe analyzed data from a subset of Tauriel participants with prodromal AD (pAD; n=127) or mild AD (mAD; n=233) who underwent baseline [18F]GTP1 tau PET and longitudinal assessments with the Clinical Dementia Rating‐Sum of Boxes (CDR‐SB), Alzheimer’s Disease Assessment Scale‐Cognitive Subscale (ADAS‐Cog13), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and/or Alzheimer’s Disease Cooperative Study‐Activities of Daily Living (ADCS‐ADL). As no treatment effects were observed with semorinemab in Tauriel, data were pooled across semorinemab and placebo arms. Associations between baseline [18F]GTP1 SUVRs and annualized longitudinal change on each measure were explored using Pearson correlations and multiple linear mixed effects regression models adjusting for relevant baseline covariates.ResultsBaseline cortical [18F]GTP1 SUVRs and longitudinal decline on clinical measures were significantly greater in mAD relative to pAD cohort. Prognostic associations with baseline cortical [18F]GTP1 were similar in pAD and mAD and more robust for predominantly cognitive measures (ADAS‐Cog13: pAD rs=0.37, mAD rs=0.35; RBANS Total Index: pAD rs=‐0.40, mAD rs=‐0.41) than measures incorporating functional status (CDR‐SB: pAD rs=0.27, mAD rs=0.29; ADCS‐ADL: pAD rs=‐0.12, mAD rs=‐0.26). Analogous results were seen using temporal or Braak stage regions of interest. [18F]GTP1 associations with cognitive decline generally remained significant after adjusting for baseline cognitive score, age, hippocampal volume, and education.ConclusionsHigher baseline [18F]GTP1 tau PET signal was associated with faster subsequent clinical decline in both prodromal and mild AD. More robust associations were seen with cognitive relative to functional measures. These results bolster prior work that suggests a role for tau PET in patient selection/stratification in AD clinical trials.

Prognostic utility of baseline [18F]GTP1 tau PET signal for subsequent cognitive and functional decline in prodromal‐to‐mild Alzheimer's disease

AbstractBackgroundPrior studies of tau PET tracers in participants with normal cognition and/or a broad range of Alzheimer’s disease (AD) severity suggest baseline tau PET signal is associated with subsequent rates of cognitive decline. However, the prognostic utility of tau PET imaging is less well‐established within more homogenous cohorts limited to specific AD stages and for cognitive versus functional decline. We addressed these questions by analyzing baseline [18F]GTP1 tau PET signal and longitudinal changes in cognitive and functional measures in the Phase 2 Tauriel study of semorinemab in prodromal‐to‐mild AD.MethodsWe analyzed data from a subset of Tauriel participants with prodromal AD (pAD; n=127) or mild AD (mAD; n=233) who underwent baseline [18F]GTP1 tau PET and longitudinal assessments with the Clinical Dementia Rating‐Sum of Boxes (CDR‐SB), Alzheimer’s Disease Assessment Scale‐Cognitive Subscale (ADAS‐Cog13), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and/or Alzheimer’s Disease Cooperative Study‐Activities of Daily Living (ADCS‐ADL). As no treatment effects were observed with semorinemab in Tauriel, data were pooled across semorinemab and placebo arms. Associations between baseline [18F]GTP1 SUVRs and annualized longitudinal change on each measure were explored using Pearson correlations and multiple linear mixed effects regression models adjusting for relevant baseline covariates.ResultsBaseline cortical [18F]GTP1 SUVRs and longitudinal decline on clinical measures were significantly greater in mAD relative to pAD cohort. Prognostic associations with baseline cortical [18F]GTP1 were similar in pAD and mAD and more robust for predominantly cognitive measures (ADAS‐Cog13: pAD rs=0.37, mAD rs=0.35; RBANS Total Index: pAD rs=‐0.40, mAD rs=‐0.41) than measures incorporating functional status (CDR‐SB: pAD rs=0.27, mAD rs=0.29; ADCS‐ADL: pAD rs=‐0.12, mAD rs=‐0.26). Analogous results were seen using temporal or Braak stage regions of interest. [18F]GTP1 associations with cognitive decline generally remained significant after adjusting for baseline cognitive score, age, hippocampal volume, and education.ConclusionsHigher baseline [18F]GTP1 tau PET signal was associated with faster subsequent clinical decline in both prodromal and mild AD. More robust associations were seen with cognitive relative to functional measures. These results bolster prior work that suggests a role for tau PET in patient selection/stratification in AD clinical trials.

1365Does pain self-efficacy influence initial bending following exercise in adults with chronic low back pain?

Abstract Background Differences in pain self-efficacy between individuals with chronic low back pain (CLBP) may partly explain why response to exercise varies. The aim of this study was to determine if pain self-efficacy influences initial forward bending following an exercise intervention in adults with CLBP. Methods A total of 69 adults (18-65 years old) with moderate-severe CLBP-related disability who presented to a primary care physiotherapy clinic in Melbourne, Australia underwent baseline assessment of pain self-efficacy, pain intensity and kinesiophobia, prior to participation in one of two 12-week exercise interventions. Two outcome measures (lumbar and hip flexion range of motion (ROM) over the first quarter of forward bending from stance), were assessed at baseline, 6 and 12-weeks. Multiple linear mixed-effects modelling was performed for each outcome measure. Results For every 10-point increase in baseline pain self-efficacy, lumbar flexion ROM during initial bending decreased by an estimated mean 0.51 (95% CI: -1.41, 0.39) and 0.94 (95% CI: -1.75, -0.13) degrees at 6 and 12-weeks, respectively. Similarly, hip flexion ROM during initial bending decreased by an estimated mean 1.64 (95% CI: -3.70, 0.41) and 1.43 (95% CI: -3.34, 0.48) degrees at 6 and 12-weeks, respectively, per 10-point increase in baseline pain self-efficacy. Conclusions Pain self-efficacy did not influence initial forward bending following a 12-week exercise intervention. As the exercises were not targeted to improve bending, further research is required to verify these findings. Key message Pain self-efficacy may not explain variations in initial forward bending following an exercise intervention in adults with CLBP.

Effect of guide sleeve material, region, diameter, and number of times drills were used on the material loss from sleeves and drills used for surgical guides: An in vitro study

Statement of problemHow material loss from sleeves and drills is affected when different guide sleeve materials and different sizes of implant drills are used for different regions of surgical guides is unclear. PurposeThe purpose of this in vitro study was to compare the amount of material loss from different guide sleeves (zirconia and cobalt-chromium) and drills of different diameters during osteotomy preparation in different regions. Material and methodsThree tooth-supported surgical guides with sleeve holes positioned in the first premolar and second molar sites were prepared. Guide sleeves (Ø 2.20 mm, 3.40 mm, and 4.05 mm) were milled from zirconia (n=60) and cobalt-chromium (n=60) blocks. A total of 12 titanium nitride-coated stainless steel twisted drills (n=6 per sleeve material) of different diameters (Ø 2.00, 3.20, 3.85 mm) were used with corresponding sleeves during the drilling. The weight loss from the drills and the volume loss from the guide sleeves after drilling were analyzed by using multiple linear mixed effect models (α=.05). ResultsAccording to the 4-way ANOVA for volume loss from sleeves, no significant interaction was found among the 4 main effects (number of times a drill was used, region, diameter, and material), but interactions between the number of times a drill was used and diameter (P=.001) and between the number of times the drill was used and material were significant (P<.001). For weight loss from the drills, a significant interaction was detected between the number of times the drill was used and diameter (P=.024). ConclusionsLess sleeve material was lost when zirconia sleeves were used. All sleeves had more material loss in the molar region than in the premolar region. The diameter had varying effects on the amount of material loss from drills and sleeves. The sleeve material and the region did not affect the material loss from drills.

Relationship of common hemodynamic and respiratory target parameters with brain tissue oxygen tension in the absence of hypoxemia or hypotension after cardiac arrest: A post-hoc analysis of an experimental study using a pig model.

Brain tissue oxygen tension (PbtO2)-guided care, a therapeutic strategy to treat or prevent cerebral hypoxia through modifying determinants of cerebral oxygen delivery, including arterial oxygen tension (PaO2), end-tidal carbon dioxide (ETCO2), and mean arterial pressure (MAP), has recently been introduced. Studies have reported that cerebral hypoxia occurs after cardiac arrest in the absence of hypoxemia or hypotension. To obtain preliminary information on the degree to which PbtO2 is responsive to changes in the common target variables for PbtO2-guided care in conditions without hypoxemia or hypotension, we investigated the relationships between the common target variables for PbtO2-guided care and PbtO2 using data from an experimental study in which the animals did not experience hypoxemia or hypotension after resuscitation. We retrospectively analyzed 170 sets of MAP, ETCO2, PaO2, PbtO2, and cerebral microcirculation parameters obtained during the 60-min post-resuscitation period in 10 pigs resuscitated from ventricular fibrillation cardiac arrest. PbtO2 and cerebral microcirculation parameters were measured on parietal cortices exposed through burr holes. Multiple linear mixed effect models were used to test the independent effects of each variable on PbtO2. Despite the absence of arterial hypoxemia or hypotension, seven (70%) animals experienced cerebral hypoxia (defined as PbtO2 <20 mmHg). Linear mixed effect models revealed that neither MAP nor ETCO2 were related to PbtO2. PaO2 had a significant linear relationship with PbtO2 after adjusting for significant covariates (P = 0.030), but it could explain only 17.5% of the total PbtO2 variance (semi-partial R2 = 0.175; 95% confidence interval, 0.086–0.282). In conclusion, MAP and ETCO2 were not significantly related to PbtO2 in animals without hypoxemia or hypotension during the early post-resuscitation period. PaO2 had a significant linear association with PbtO2, but its ability to explain PbtO2 variance was small.

Longitudinal neural exposure to local anesthetic and nerve block duration: a retrospective analysis of experimental data from healthy volunteer trials

Background and objectivesCharacteristics of a nerve block depend on the distribution of local anesthetic (LA) close to the nerve. The relationship between longitudinal distribution of LA and nerve block characteristics...

Initial third molar development is delayed in jaws with short distal space: An early impaction sign?

IntroductionThe multifactorial aetiology of third molar (M3) impaction remains puzzling. While short retromolar jaw space is a well-established risk factor in young adults, space alone does not explain how impaction develops. Here we investigated in children and adolescents a potential new factor, delayed M3 development. We hypothesized that two important impaction correlates – lack of jaw space, and delayed M3 development – are also positively correlated with each other, and may together help suggest from early ages subsequent possible M3 impaction. Material and methodsWe studied 689 M3 regions on retrospective CBCT images of 179 Canadian patients aged 8–13 years, using multiple linear mixed-effects (LME) modeling to predict M3 development (using Demirjian’s stages) in both upper and lower jaws based upon available distal jaw space while also accounting for age, sex, jaw, and oral quadrant. ResultsLack of distal jaw space was associated with less-developed M3s in upper and lower jaws (t = 3.209, p = .001). If space availability fell below a given threshold, absence of M3 development was predicted. Upper M3s developed more than lower M3s for each additional millimetre of retro-M1 space gained. Between-sex differences were not found. ConclusionRetromolar jaw space and M3 development are two positive correlates of M3 impaction that co-associate as early as childhood. Our results suggest that delayed initial M3 development merits investigation as a potential prognosticator for late M3 eruption relative to when jaw growth ceases – an outcome known to increase the likelihood of impaction.

One-carbon metabolism gene polymorphisms are associated with cognitive trajectory among African-American adults

The sex-specific link between longitudinal annual rate of cognitive change (LARCC) and polymorphisms in one-carbon metabolism enzymatic genes remains unclear, particularly among African-American adults. We tested associations of 14 single nucleotide polymorphisms (SNPs) from MTHFR, MTRR, MTR, and SHMT genes and select MTHFR haplotypes and latent classes (SNPHAP/SNPLC) with LARCC. Up to 797 African-American participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study (age: 30–64 y, 52% women) had 1.6–1.7 (i.e., 1 or 2) repeated measures (follow-up time, mean = 4.69 y) on 9 cognitive test scores, reflecting verbal and visual memory, verbal fluency, psychomotor speed, attention, and executive function: California Verbal Learning Test–immediate recall (CVLT-List A), CVLT-DFR (delayed free recall), Benton Visual Retention Test (BVRT), Animal Fluency (AF), Digits Span Forward and Backward tests, and Trail Making Test parts A and B (Trails A and B). Multiple linear mixed-effects and multiple linear regression models were conducted. Overall, MTHFR SNPs rs4846051(A1317G, G>A) and rs1801131(A1298C, G>T) were associated with slower and faster declines on AF, respectively, whereas rs2066462(C1056T, A>G) was related to slower decline on Trails B (executive function). Among men, rs4846051(A1317G, G>A) was linked to faster decline on BVRT (visual memory), whereas rs2066462(C1056T, A>G) and rs9651118(C>T) were associated with slower decline on CVLT-List A and rs9651118(C>T) with faster decline on CVLT-DFR. Among women, a slower decline on the domain “verbal memory/fluency” was observed with rs1801133(C677T, A>G). MTHFR2SNPHAP [rs1801133(C677T, A>G)/rs1801131(A1298C, G>T): GG] was associated with slower decline on AF among women, whereas MTHFR3SNPHAP(AT) was linked with slower decline on CVLT-List A among men but faster decline on “verbal memory/fluency” among women. Similar patterns were observed for MTHFR SNPLCs. In sum, MTHFR gene variations can differentially impact longitudinal changes in multiple cognitive domains among African-American adults.

Effects of childhood setting and interaction with nature on academic performance in introductory college-level courses in the environmental sciences

This study explored the relationships between student background and academic performance in college introductory environmental science (ES) courses at a large U.S. research university with the premise that this analysis may inform teaching practices, curricula, and efforts to increase retention. We surveyed over 700 students across eleven introductory ES courses and used multiple linear mixed-effects regressions to model the data. We found that students who grew up in rural settings or who had frequent childhood interactions with natural environments earned higher grades, on average, than students from urban settings or with fewer childhood interactions with natural environments. Our results indicate that students reporting frequent childhood interactions with forests, for example, were projected to earn grades up to 1.5 letter grades higher in these courses than students with no such interactions. In addition, students with frequent childhood interactions with nature were likelier to report that such interactions helped them in their ES course, suggesting that these students may recognize the value of these experiences. Greater interest in the subject matter also correlated with higher ES course grades, whereas amount of prior ES coursework did not. We discuss the possible implications of these correlations for ES academic performance and educational practice.

Atrial fibrillation, antithrombotic treatment, and cognitive aging: A population-based study.

ObjectiveTo examine the association of atrial fibrillation (AF) with cognitive decline and dementia in old age, and to explore the cognitive benefit of antithrombotic treatment in patients with AF.MethodsThis population-based cohort study included 2,685 dementia-free participants from the Swedish National Study on Aging and Care in Kungsholmen, who were regularly examined from 2001–2004 to 2010–2013. AF was ascertained from clinical examination, ECG, and patient registry. Global cognitive function was assessed using the Mini-Mental State Examination. We followed the DSM-IV criteria for the diagnosis of dementia, the NINDS-AIREN (National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences) criteria for vascular dementia, and the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer disease. Data were analyzed using multiple linear mixed-effects and Cox regression models.ResultsWe identified 243 participants (9.1%) with AF at baseline. During the 9-year follow-up period, 279 participants (11.4%) developed AF and 399 (14.9%) developed dementia. As a time-varying variable, AF was significantly associated with a faster annual Mini-Mental State Examination decline (β coefficient = −0.24, 95% confidence interval [CI]: −0.31 to −0.16) and an increased hazard ratio (HR) of all-cause dementia (HR = 1.40, 95% CI: 1.11–1.77) and vascular and mixed dementia (HR = 1.88, 95% CI: 1.09–3.23), but not Alzheimer disease (HR = 1.33, 95% CI: 0.92–1.94). Among people with either prevalent or incident AF, use of anticoagulant drugs, but not antiplatelet treatment, was associated with a 60% decreased risk of dementia (HR = 0.40, 95% CI: 0.18–0.92).ConclusionAF is associated with a faster global cognitive decline and an increased risk of dementia in older people. Use of anticoagulant drugs may reduce dementia risk in patients with AF.

Apical root displacement is a critical risk factor for apical root resorption after orthodontic treatment.

To identify risk factors for apical root resorption (ARR) of maxillary and mandibular incisors using mathematical quantification of apical root displacement (ARD) and multiple linear mixed-effects modeling. Periapical radiographs of maxillary and mandibular incisors and lateral cephalograms of 135 adults were taken before and after orthodontic treatment. ARR was measured on the periapical radiographs, and movement of central incisors was evaluated on the superimposed pre- and posttreatment lateral cephalograms. ARD was mathematically calculated from pretreatment tooth length, inclination change, and movement of the incisal edge. Linear mixed-effects model analysis was performed to identify risk factors for ARR, and standardized coefficients (SCs) were calculated to investigate the relative contribution of the risk factors to ARR. Vertical ARD showed the highest SCs for both maxillary and mandibular incisors. Horizontal ARD showed the second highest SC for mandibular incisors but was not significantly correlated with the ARR of maxillary incisors. When horizontal and vertical ARDs were included in the mixed-effects model, the use of self-ligating brackets was significantly correlated with increased ARR of mandibular incisors. ARD is a critical factor for ARR after orthodontic treatment. Careful monitoring of ARR is recommended for patients requiring significant ARD of incisors.

Expression of inflammatory markers in women with perinatal depressive symptoms.

Perinatal depression affects 10-20% of women and is associated with poor outcomes for mother and child. Inflammation is associated with depression in non-pregnant adults. Perinatal depression and inflammation in pregnancy are independently associated with morbidities including obesity, gestational diabetes, preeclampsia, and preterm birth. The role of inflammation in perinatal depression has received little attention. We hypothesized an association between self-reported perinatal depressive symptoms and serum inflammatory biomarkers TNF-α, IL-6, IL-1β, and CRP. 110 healthy gravidas were recruited in third trimester from an academic medical center, with a baseline study visit at a mean of 32.5 (SD ± 1.8) weeks gestational age. Sixty-three participants completed the Edinburgh Postnatal Depression Scale (EPDS) and provided demographic information and serum samples upon enrollment and at 3 and 6months postpartum. Serum inflammatory markers were quantified by multiplex array. Multiple linear mixed effects models were used to evaluate trends of biomarkers with the EPDS score in the third trimester of pregnancy and the postpartum period. Elevated serum TNF-α was associated with lower EPDS total score (β= - 0.90, p = 0.046) after adjusting for demographics and medication use. In contrast, IL-6, CRP, and IL-1β did not demonstrate statistically significant associations with depressive symptoms by the EPDS in either crude or adjusted models. Study findings showed no association or an inverse (TNF-α) association between inflammatory markers and perinatal depressive symptoms. Relevant literature evaluating a role for inflammation in depression in the unique context of pregnancy is both limited and inconsistent, and further exploration is merited.

Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock

The haemodynamic consequences of fluid resuscitation in septic shock have not been fully elucidated. Therefore, we assessed circulatory effects in the first 24 h of restriction of resuscitation fluid as compared to standard care in intensive care unit (ICU) patients with septic shock. This was a post-hoc analysis of the multicentre CLASSIC randomised trial in which patients with septic shock, who had received the initial fluid resuscitation, were randomised to a protocol restricting resuscitation fluid or a standard care protocol in nine ICUs. The highest plasma lactate, highest dose of noradrenaline, and the urinary output were recorded in five time frames in the first 24 h after randomisation. We used multiple linear mixed effects models to compare the two groups. We included all 151 randomised patients; the cumulated fluid resuscitation volume in the first 24 h after randomisation was median 500 ml (Interquartile range (IQR) 0-1500) and 1250 ml (500-2500) in the fluid restriction group and standard care group, respectively. The estimated differences in the fluid restriction group vs. the standard care group were 0.1 mM (95% confidence interval -0.7 to 0.9; P = 0.86) for lactate, 0.01 μg/kg/min (-0.02 to 0.05; P = 0.48) for dose of noradrenaline, and -0.1 ml/kg/h (-0.3 to 0.2; P = 0.70) for urinary output during the first 24 h after randomisation. We observed no indications of worsening of measures of circulatory efficacy in the first 24 h of restriction of resuscitation fluid as compared with standard care in adults with septic shock who had received initial resuscitation.

Changes in Maternal Plasma Adiponectin from Late Pregnancy to the Postpartum Period According to the Mode of Delivery: Results from a Prospective Cohort in Rio de Janeiro, Brazil.

IntroductionMaternal plasma adiponectin is inversely related to insulin resistance, atherosclerosis and child health. However, little is known about its concentrations in the perinatal period, especially according to mode of delivery. Our aim is to evaluate the association between mode of delivery and changes in maternal plasma adiponectin from 3rd trimester of pregnancy to 30–45 days postpartum.MethodsA cohort was recruited in Rio de Janeiro, Brazil, with four waves of follow-up: 5-13th, 22-26th, 30-36th gestational weeks and 30–45 days postpartum. Eligible subjects should be between 20–40 years of age, be free of chronic and infectious diseases and presenting with a singleton pregnancy. The mode of delivery was classified as vaginal (VD) or cesarean (CS). Plasma adiponectin concentration (μg/mL) was measured using commercial ELISA kits. Statistical analyses included the Wilcoxon rank-sum test and the multiple linear mixed effects model.ResultsA total of 159 participated in the study. Median adiponectin concentrations were higher for the VD group (n = 99; 8.25, IQR: 5.85–11.90) than for the CS group (n = 60; 7.34, IQR: 4.36–9.76; p = 0.040) in the postpartum samples but were not different between the two groups in the 3rd trimester. Women who underwent CS had a lower rate of increase in adiponectin concentration from the 3rd trimester to 30–45 days postpartum compared to those who underwent VD (β = -.15, 95% CI: -.28-.02, p = 0.030).ConclusionThe CS procedure was associated with lower maternal circulating concentrations of adiponectin at 30–45 days postpartum, compared to the VD.

Influence of plant community composition on biomass production in planted grasslands.

United States energy policy mandates increased use of renewable fuels. Restoring grasslands could contribute to a portion of this requirement through biomass harvest for bioenergy use. We investigated which plant community characteristics are associated with differences in biomass yield from a range of realistic native prairie plantings (n = 11; i.e., conservation planting, restoration, and wildlife cover). Our primary goal was to understand whether patterns in plant community composition and the Floristic Quality Index (FQI) were related to productivity as evidenced by dormant season biomass yield. FQI is an objective measure of how closely a plant community represents that of a pre-European settlement community. Our research was conducted in planted fields of native tallgrass prairie species, and provided a gradient in floristic quality index, species richness, species diversity, and species evenness in south-central Wisconsin during 2008 and 2009. We used a network of 15 randomly located 1 m2 plots within each field to characterize the plant community and estimate biomass yield by clipping the plots at the end of each growing season. While plant community composition and diversity varied significantly by planting type, biomass yield did not vary significantly among planting types (ANOVA; P >0.05). Biomass yield was positively correlated with plant community evenness, richness, C4 grass cover, and floristic quality index, but negatively correlated with plant species diversity in our multi-season multiple linear mixed effects models. Concordantly, plots with biomass yield in the lowest quartile (biomass yield < 3500 kh/ha) had 8% lower plant community evenness and 9% lower FQI scores than those in the upper quartile (biomass yield > 5800 kh/ha). Our results suggest that promoting the establishment of fields with high species evenness and floristic quality may increase biomass yield, while simultaneously supporting biodiversity.