National Institute Research Articles

The NIMH Task Force on Social Work Research Report: Past Accomplishments and Current Challenges

Following the publication of the groundbreaking report by the National Institute of Mental Health Task Force on Social Work Research in 1991, major gains have been made in building a potent infrastructure for social work research. Since then, however, progress has faltered in key areas and complex new challenges have emerged. These developments are examined and suggestions are set forth regarding how best to address the most serious challenges.

Advocating for Generalizability: Accepting Inherent Variability in Translation of Animal Research Outcomes.

Advancing scientific discovery requires investigators to embrace research practices that increase transparency and disclosure about materials, methods, and outcomes. Several research advocacy and funding organizations have produced guidelines and recommended practices to enhance reproducibility through detailed and rigorous research approaches; however, confusion around vocabulary terms and a lack of adoption of suggested practices have stymied successful implementation. Although reproducibility of research findings cannot be guaranteed due to extensive inherent variables in attempts at experimental repetition, the scientific community can advocate for generalizability in the application of data outcomes to ensure a broad and effective impact on the comparison of animals to translation within human research. This report reviews suggestions, based upon work with National Institutes of Health advisory groups, for improving rigor and transparency in animal research through aspects of experimental design, statistical assessment, and reporting factors to advocate for generalizability in the application of comparative outcomes between animals and humans.

Governing Ethical Gaps in Distributed AI Development

Good business practice often leads companies to subdivide into separate functional entities for operational efficiency and specialization. However, these kinds of divisions can generate significant ethical and perhaps even regulatory gaps when they occur in AI companies. In particular, one natural division for an AI company is into separate entities responsible for model development, testing, and cybersecurity (to maintain and protect data). In this paper, we argue that this division can lead to some ethical responsibilities always being “someone else’s job.” For concreteness, we consider the US National Institute of Standards and Technology’s AI Risk Management Framework (NIST AI RMF) as a guide to ethical obligations in a corporate context. We show that a common division of labor in AI development and deployment can lead to specific obligations for which no entity is responsible, even though they apply to the effort as a whole. We propose “Join Accountability Agreements”, a mechanism to ensure that ethical obligations do not slip through the cracks because of the way an effort is structured. We thus aim to highlight the significance of comprehensive examinations of and adaptable strategies for our ethical obligations when developing AI systems in a distributed manner.

Analysis of the health economics portfolio funded by the National Institutes of Health in response to published guidance.

Health services, economics, and outcomes research (referred to as health economics research hereinafter) is one of the interdisciplinary sciences that the National Institutes of Health (NIH) supports in order to pursue its overall mission to improve health. In 2015, NIH guidance was published to clarify the type of health economics research that NIH would continue to fund. This analysis aimed to determine if there were changes in the number of health economics applications received and funded by NIH after the release of the guidance. Health economics applications submitted to NIH both before and after publication of the guidance were identified using a machine learning approach with input from subject matter experts. Application and funding trends were examined by fiscal year, method of application (solicited vs. unsolicited), and activity code. This study found that application and funding rates of health economics research were decreasing prior to guidance. Following publication of this guidance, the application and funding rate of health economics applications increased.

Development and validation of a novel scoring system for acute ischemic stroke

BackgroundThis study aimed to assess the clinical application of the Artery Occlusion Image Score (AOIS), a new metric based on computed tomographic angiography (CTA) that reflects the severity of occlusive changes in the main intracranial arteries.Materials and MethodsPatients diagnosed with acute ischemic stroke (AIS) were divided into three groups: anterior circulation infarcts (ACI group), posterior circulation infarcts (PCI group), and both anterior and posterior circulation infarcts (ACI + PCI group). The sensitivity and specificity of AOIS were evaluated using the Basilar Artery on Computed Tomography Angiography (BATMAN) score, the Clot Burden Score (CBS), and the National Institutes of Health Stroke Scale (NIHSS) as comparators through receiver-operating characteristic (ROC) curve analysis.ResultsThe final analysis included 439 consecutive patients. In the ACI group, AOIS demonstrated high sensitivity (86.3%) and specificity (85.0%) and outperformed CBS in predicting patient prognosis. In the PCI group, AOIS also showed high sensitivity (88.9%) and specificity (90.0%) and outperformed BATMAN in predicting patient prognosis. In the ACI + PCI group, AOIS positively correlated with the NIHSS score (Spearman’s ρ = 0.602, P < .001). Additionally, the scoring time of AOIS did not significantly differ from CBS and BATMAN.ConclusionAOIS is a convenient and reliable method for guiding treatment and predicting outcomes in patients with ACI or/and PCI. Furthermore, AOIS is the first CTA-based scoring system that covers both the anterior and posterior circulation, providing a convenient and reliable evaluation for patients with concurrent acute ischemic stroke in both circulations.

Feasibility of Biofilm Biofertilizer in Halving Nitrogen Waste in Paddy Cultivation

In an attempt to achieve the target of the Colombo Declaration in 2019, we, the Centre for Advanced Research on Nitrogen Management in Agriculture (CARNMA) at the National Institute of Fundamental Studies (NIFS) conducted 112 field trials in 13 districts of Sri Lanka. Here, two practices being used extensively by the farmers were compared for the Nitrogen (N) fertilizer use efficiency in paddy; (a) chemical fertilizer (CF) practice [340 kg CF/ha (Urea 225, TSP 55 and MOP 60 kg/ha) and, as recommended by the Department of Agriculture] (b) Biofilm biofertilizer (BFBF) practice [2.5 L of BFBF/ha split into two applications, at two and six weeks after sowing, together with 225 kg CF/ha (Urea 150, TSP 40 and MOP 35 kg/ha), a reduction of CF by 34% because of the ability of the BFBF in increasing fertilizer use efficacy via microbial turnover]. Results showed that the BFBF application cut down N-fertilizer use by 33%, and hence the waste is also by the same amount with a simultaneous increase in grain yield by 23% (i.e., the average of all the 112 trials: the BFBF practice 5,860 kg/ha, and the CF practice 4,748 kg/ha). Moreover, the N fertilizer use efficiency by paddy crop increased by 6% in the BFBF practice indicating a higher N uptake, and hence lower N waste compared to the CF practice. The fertilizer cut down and the increased N uptake collectively reduced N waste by over 50%. In conclusion, the BFBF practice can be considered as a promising approach to meet the target of the Colombo Declaration in 2019 i.e., halving N waste in agriculture by 2030.&#x0D; &#x0D; Keywords: Biofilm biofertilizer, Colombo declaration, N-waste, Paddy

Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60?

Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population. We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection(ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002). PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.

Multi-kilowatt cw laser power measurement comparison between national standards

We present here the first comparison between National Metrology Institutes of high accuracy continuous wave optical power measurements in the kilowatt regime. The National Institute of Standards and Technology (NIST) performed measurements with a power meter relying on photon momentum. The Physikalisch-Technische Bundesanstalt (PTB) performed measurements with a modified off-the-shelf thermal power meter. The non-absorbing photon momentum measurement approach permits the two power meters to measure the same laser beam optical path simultaneously, resulting in a direct comparison of the meters supported by an optical system to accommodate differences in instrument settling times. The results show agreement within the expanded uncertainties for each instrument. NIST and PTB illustrate a degree of equivalence of 0.49% with an expanded uncertainty of 1.37% (k = 2) for an average result across all power levels.

Cognitive, psychological, and physiological effects of a web-based mindfulness intervention in older adults during the COVID-19 pandemic: an open study

BackgroundThe development of effective strategies to maintain good mental health of older adults is a public health priority. Mindfulness-based interventions have the potential to improve psychological well-being and cognitive functions of older adults, but little is known about the effect of such interventions when delivered through internet. During the COVID-19 pandemic we evaluated short- and long-term cognitive, psychological, and physiological effects of a mindfulness-based intervention (MBI) delivered via web-based videoconference in healthy older adults.MethodsFifty older adults participated in an 8-week MBI, which comprised structured 2-h weekly group sessions. A comprehensive evaluation encompassing cognitive (verbal memory, attention and processing speed, executive functions) and psychological assessments (depression and anxiety symptoms, mindfulness, worries, emotion regulation strategies, well-being, interoceptive awareness and sleep) was conducted. Additionally, electroencephalography (EEG) data were recorded before and after the MBI and at the 6-month follow-up (T6). Data were analyzed using an intention-to-treat approach, using linear mixed models adjusted for age. The effect size for time was computed as omega squared.ResultsWe observed significant improvements from pre-MBI to post-MBI and at the T6 across several measures. These improvements were notable in the areas of verbal memory (California Verbal Learning Test, p ≤ .007), attention and executive functions (Trail Making Test A and BA, p < .050), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness, p = .0002 for self-regulation and p < .05 for noticing, body listening, and trusting dimensions), and rumination (Heidelberg Form for Emotion Regulation Strategies, p = .018). These changes were associated with low to medium effect size. Moreover, we observed significant changes in EEG patterns, with a decrease in alpha1 (p = .004) and an increase in alpha2 (p < .0001) from pre-MBI to T6. Notably, improvements in TMTBA and rumination were correlated with the decrease in alpha1 (p < .050), while improvements in TMTA were linked to the increase in alpha2 (p = .025).ConclusionsThe results of our study show that a web-based MBI in older adults leads to improvements in cognitive and psychological measures, with associated modulations in specific brain rhythms. While these findings are promising, further controlled studies are required to validate these preliminary results.Trial registrationThe trial has been registered with the United States National Library of Medicine at the National Institutes of Health Registry of Clinical Trials under the code NCT05941143 on July 12, 2023.

Integrative medicine for hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS): a feasibility study

Purpose Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are multisystem conditions marked by dysfunctional connective tissue. This feasibility study evaluated a 9-week integrative medicine program in this population. Methods Using a single-arm study design, adults with HSD or EDS were given recommendations for an anti-inflammatory Mediterranean diet and self-management with additional behavioral and psychosocial support. Preliminary data on feasibility based on recruitment and retention, adherence to the diet, mobile app tracking, changes to perceived well-being via health outcomes, and satisfaction with care were obtained. Results Thirteen participants were enrolled within a 4-month timeframe. Eight participants completed the study. Three participants met dietary tracking requirement in at least 4 of 8 intervention weeks and met the macronutrient requirements in at least half of the weeks tracked. No decreases in VAS pain scores after 5 and 9 weeks were noted; however, 62.5% (n = 5) of participants had decreased pain at 9 weeks, compared to baseline. There were significant improvements (p<.05) in six of twelve measurements of satisfaction with care at the end of the intervention. Conclusion This study provides a foundation for future research on patient experience and introduces a novel treatment paradigm focused on nutrition and self-management. Trial Registration: National Institutes of Health clinicaltrials.gov; identifier: NCT04734041. Implications for rehabilitation Lifestyle and dietary interventions are relatively safe and well tolerated in the hypermobility spectrum disorder (HSD) and Ehlers-Danlos disorder (EDS) population. Participants in our 9-week integrative medicine program actively engaged in self-management of their condition and showed promising adherence to dietary and tracking requirements. Effective treatment of the intricacies and dynamics of these highly variable and clinically heterogeneous disorders may require a network of healthcare providers, integrative healthcare, as well as behavioral and psychosocial support. Dietary tracking through mobile apps might help promote self-efficacy and adherence to dietary changes. Symptom tracking might be an effective way for patients to track changes to their health and could provide valuable information for health professionals engaged in managing the disorders.

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey.

With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.

INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC): An NIA and VA-sponsored initiative to increase veteran participation in aging and dementia research.

Older military veterans often present with unique and complex risk factors for Alzheimer's disease (AD) and related dementias. Increasing veteran participation in research studies offers one avenue to advance the field and improve health outcomes. To this end, the National Institute on Aging (NIA) and Department of Veterans Affairs (VA) partnered to build infrastructure, improve collaboration, and intensify targeted recruitment of veterans. This initiative, INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC), provided funding for five sites and cross-site organizing structure. Diverse and innovative recruitment strategies were used. Across five sites, 172 veterans entered registries, and 99 were enrolled into ADRC studies. Of the enrolled, 39 were veterans from historically underrepresented racial and ethnic groups. This initiative laid the groundwork to establish sustainable relationships between the VA and ADRCs. The partnership between both federal agencies demonstrates how mutual interests can accelerate progress. In turn, efforts can help our aging veterans.

Using climate financing wisely to address multiple crises

A convergence of several risk drivers creates the compound crises we see across the globe today. At the same time, the global humanitarian community and national institutions in affected countries are increasingly resource constrained. In this context, existing financing mechanisms should be evaluated for their potential to create synergies between social protection, peace, and inclusion objectives on the one hand and climate resilience outcomes on the other. The existing international architecture of climate change mitigation and adaptation policy and financing holds, in principle, the potential to address not only its main purpose of climate action, but also to contribute to development outcomes and address multiple risk drivers. Examples of this exist, but for these mutual benefits to emerge, and for climate finance to contribute more significantly to crises prevention, the agendas must become more aligned. Aligning several factors may enable coherence: i) Timeframes, from short-term response to multi-year programming; ii) Planning and targeting, moving towards conflict-sensitive area-based approaches and universal access to services; iii) Institutional arrangements and partnerships, coordinated national planning and jointly implemented local action.

A machine learning approach for early identification of patients with severe imported malaria

BackgroundThe aim of this study is to design ad hoc malaria learning (ML) approaches to predict clinical outcome in all patients with imported malaria and, therefore, to identify the best clinical setting.MethodsThis is a single-centre cross-sectional study, patients with confirmed malaria, consecutively hospitalized to the Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy from January 2007 to December 2020, were recruited. Different ML approaches were used to perform the analysis of this dataset: support vector machines, random forests, feature selection approaches and clustering analysis.ResultsA total of 259 patients with malaria were enrolled, 89.5% patients were male with a median age of 39 y/o. In 78.3% cases, Plasmodium falciparum was found. The patients were classified as severe malaria in 111 cases. From ML analyses, four parameters, AST, platelet count, total bilirubin and parasitaemia, are associated to a negative outcome. Interestingly, two of them, aminotransferase and platelet are not included in the current list of World Health Organization (WHO) criteria for defining severe malaria.ConclusionIn conclusion, the application of ML algorithms as a decision support tool could enable the clinicians to predict the clinical outcome of patients with malaria and consequently to optimize and personalize clinical allocation and treatment.

Highlighting the NIAID Radiation and Nuclear Countermeasures Program's Commitment to Training and Diversifying the Radiation Workforce.

Developing and maintaining a robust and diverse scientific workforce is crucial to advance knowledge, drive innovation, and tackle societal issues that impact the economy and human health. The shortage of trained professionals in radiation and nuclear sciences derives from many factors, such as scarcity of specialized coursework, programming, professional development, and experiential learning at educational institutions, which significantly disrupt the training pipeline. Other challenges include small numbers of faculty and educators with specialized radiation/nuclear expertise that are continually overextended professionally and scientifically, with the burden of training falling on this subset of individuals. Even more alarming is the recent loss of radiobiologists due to increased retirements and deaths, leaving the radiobiology community with a void of mentors and knowledge. Lastly, inconsistency in acquiring stable grant funding to recruit and retain scientists is a major hurdle to training the next generation of radiation and nuclear scientists. Recommendations from the scientific community and the National Academies of Sciences, Engineering, and Medicine describe the need to bolster educational resources and provide more hands-on training experiences. Of equal importance was the suggestion that funding agencies provide more opportunities for training and tracking the radiation workforce. The Radiation and Nuclear Countermeasures Program (RNCP), and the Office of Research Training and Special Programs (ORTSP), both within the National Institute of Allergy and Infectious Diseases (NIAID) are committed to helping to develop and sustain the radiation research workforce. This commentary illustrates the importance of addressing radiation workforce development and outlines steps that the RNCP is taking to help mitigate the issue. In addition, the role for Diversity, Equity, Inclusion, and Accessibility (DEIA) in helping to increase the number of students trained in the radiation sciences is discussed, and the NIH's DEIA priorities and RNCP efforts to improve DEIA in the research community are highlighted. One of the main goals of this commentary is to provide awareness of available educational (i.e., development of a radiation biologist eBook) and funding resources. A summary of available awards targeting early- to mid-stage investigators and diversity candidates is given, and it is hoped that this list, although not exhaustive and not specific for all focus areas in radiation (e.g., cancer research), will encourage more radiation biologists to explore and apply to these under-utilized opportunities.

Mortality trends during the first three waves of the COVID-19 pandemic at an urban district hospital in South Africa: A retrospective comparative analysis

Background. Severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) is the virus responsible for the COVID‐19 (C19) pandemic. South Africa (SA) experienced multiple periods of increased transmission. Tertiary, regional and central hospitals were overwhelmed, resulting in low acceptance rates. Objectives. To compare mortality trends of patients who died in hospital from SARS‐CoV‐2 infection during the first three waves of infection as defined by the National Institute of Communicable Diseases of South Africa. Methods. This was a retrospective cohort study at a district level hospital of 311 adults who died within the first three waves of COVID‐19. The study analysed case and crude fatality rates, baseline characteristics, symptomatology, clinical presentation and management of patients. Results. Waves 1, 2 and 3 yielded case fatality rates of 14.5%, 27.6% and 6.3%, respectively, and crude fatality rates of 16.7%, 33.0% and 12.2%, respectively. Black Africans were less likely to die during the third wave (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.31 ‐ 0.94). Patients in the second wave had clinical frailty scores of &lt;5 (OR 2.51; 95% CI 1.56 ‐ 4.03). Obesity was most prevalent in the second wave (OR 1.87; 95% CI 1.01 ‐ 3.46), and dyslipidaemia (OR 3.03; 95% CI 1.59 ‐ 5.77) and ischaemic heart disease (OR 3.77; 95% CI .71 ‐ 8.33) were most prevalent during the third wave. Severe ground glass appearance was most common during the second wave (OR 2.37; 95% CI 1.49 ‐ 3.77). Renal impairment was most prevalent during the first wave (OR 3.28; 95% CI 1.59 ‐ 6.77), and thrombo‐ embolic phenomena were less common during wave three (OR 0.12; 95% CI 0.02 ‐ 0.91). Conclusion. The Beta variant was the most virulent, with the highest case and crude fatality rates in wave 2.

Maternal Tobacco Use During Pregnancy and Child Neurocognitive Development

Maternal tobacco use during pregnancy (MTDP) persists across the globe. Longitudinal assessment of the association of MTDP with neurocognitive development of offspring at late childhood is limited. To examine whether MTDP is associated with child neurocognitive development at ages 9 to 12 years. This cohort study included children aged 9 and 10 years at wave 1 (October 2016 to October 2018) and aged 11 to 12 years at a 2-year follow-up (wave 2, August 2018 to January 2021) across 21 US sites in the Adolescent Brain Cognitive Development (ABCD) Study. Data were analyzed from June 2022 to December 2023. MTDP. Outcomes of interest were neurocognition, measured by the National Institutes of Health (NIH) Toolbox Cognition Battery, and morphometric brain measures through the region of interest (ROI) analysis from structural magnetic resonance imaging (sMRI). Among 11 448 children at wave 1 (mean [SD] age, 9.9 [0.6] years; 5990 [52.3%] male), 1607 children were identified with MTDP. In the NIH Toolbox Cognition Battery, children with MTDP (vs no MTDP) exhibited lower scores on the oral reading recognition (mean [SE] B = -1.2 [0.2]; P < .001), picture sequence memory (mean [SE] B = -2.3 [0.6]; P < .001), and picture vocabulary (mean [SE] B = -1.2 [0.3]; P < .001) tests and the crystallized cognition composite score (mean [SE] B = -1.3 [0.3]; P < .001) at wave 1. These differential patterns persisted at wave 2. In sMRI, children with MTDP (vs no MTDP) had smaller cortical areas in precentral (mean [SE] B = -104.2 [30.4] mm2; P = .001), inferior parietal (mean [SE] B = -153.9 [43.4] mm2; P < .001), and entorhinal (mean [SE] B = -25.1 [5.8] mm2; P < .001) regions and lower cortical volumes in precentral (mean [SE] B = -474.4 [98.2] mm3; P < .001), inferior parietal (mean [SE] B = -523.7 [136.7] mm3; P < .001), entorhinal (mean [SE] B = -94.1 [24.5] mm3; P < .001), and parahippocampal (mean [SE] B = -82.6 [18.7] mm3; P < .001) regions at wave 1. Distinct cortical volume patterns continued to be significant at wave 2. Frontal, parietal, and temporal lobes exhibited differential ROI, while there were no notable distinctions in the occipital lobe and insula cortex. In this cohort study, MTDP was associated with enduring deficits in childhood neurocognition. Continued research on the association of MTDP with cognitive performance and brain structure related to language processing skills and episodic memory is needed.

The impact of biomass power plants on Brazilian workers’ income: a synthetic difference-in-differences approach

PurposeThis research assesses the economic impact of biomass plant installations on Brazilian municipalities, focusing on (1) labor income, (2) sectoral labor income and (3) income inequality.Design/methodology/approachMunicipal data from the Annual Social Information Report, the National Electric Energy Agency and the National Institute of Meteorology spanning 2002 to 2020 are utilized. The Synthetic Difference-in-Differences methodology is employed for empirical analysis, and robustness checks are conducted using the Doubly Robust Difference in Differences and the Double/Debiased Machine Learning methods.FindingsThe findings reveal that biomass plant installations lead to an average annual increase of approximately R$688.00 in formal workers' wages and reduce formal income inequality, with notable benefits observed for workers in the industry and agriculture sectors. The robustness tests support and validate the primary results, highlighting the positive implications of renewable energy integration on economic development in the studied municipalities.Originality/valueThis article represents a groundbreaking contribution to the existing literature as it pioneers the identification of the impact of biomass plant installation on formal employment income and local economic development in Brazil. To the best of our knowledge, this study is the first to uncover such effects. Moreover, the authors comprehensively examine sectoral implications and formal income inequality.

The UK Divide: Does Having a Pembrolizumab–Chemotherapy Option in Head and Neck Cancer Matter? Real-world Experience of First-line Palliative Pembrolizumab Monotherapy and Pembrolizumab–Chemotherapy Combination in Scotland

AimsThe Scottish Medical Consortium recently approved first-line pembrolizumab monotherapy or in combination with chemotherapy for head and neck squamous cell carcinoma in the palliative setting, contrasting with the decision made by the National Institute for Health and Care Excellence, who approved monotherapy alone in England and Wales. The aim of this study was to provide real-world performance data for first-line pembrolizumab-containing treatments for head and neck squamous cell carcinoma in the palliative setting in Scotland. Materials and methodsWe analysed the electronic records of patients who started pembrolizumab-containing treatment between 1 March 2020 and 30 September 2021. Outcomes included overall survival, progression-free survival (PFS), the duration of response and the disease control rate. Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival. ResultsOur cohort included 91 patients (median follow-up 10.8 months). Patient characteristics were similar to those in the KEYNOTE-048 study, although our cohort had a higher proportion of patients with newly diagnosed, non-metastatic disease. For patients receiving monotherapy (n = 76), 12- and 24-month overall survival were 45% and 27%, respectively. For patients receiving pembrolizumab–chemotherapy (n = 15), 12-month overall survival was 60% (24-month overall survival had not yet been reached). Experiencing one or more immune-related adverse event (irAE; versus no irAEs), of any grade, was associated with favourable overall survival and PFS for patients receiving monotherapy in both univariable Log-rank analysis (median overall survival 17.4 months versus 8.6 months, respectively, P = 0.0033; median PFS 10.9 months versus 3.0 months, respectively, P < 0.0001) and multivariable analysis (Cox proportional hazards regression: overall survival hazard ratio 0.31, P = 0.0009; PFS hazard ratio 0.17, P < 0.0001). ConclusionOur real-world data support the KEYNOTE-048 study findings and the value of combination treatment options. Additionally, our data show that irAEs of any grade, as reported in routine clinical records, are associated with better outcomes in this patient group, adding to the growing body of evidence showing that irAEs are generally a positive marker of programmed death-ligand 1 (PD-L1) inhibitor response.

Postprocedural delirium following mechanical thrombectomy for acute ischemic stroke: a retrospective study

IntroductionNational representative estimates on in-hospital delirium after acute ischemic stroke are not well established and there is limited data on the impact of delirium on clinical outcomes following mechanical thrombectomy. We evaluated risk factors for delirium and the impact on outcomes following mechanical thrombectomy for acute ischemic stroke.MethodsThis is a retrospective study of patients who underwent mechanical thrombectomy for acute ischemic stroke at a single tertiary comprehensive stroke center between April 2011 and December 2019. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Patient characteristics, comorbidities, laboratory data, elapsed times, tissue plasminogen activator use, duration of the procedure, type of anesthesia, National Institute of Health stroke scores (NIHSS), sedation scores, reperfusion grades, complications, length of hospital stay, discharge disposition, and 90-day mortality were evaluated.ResultsFive hundred and two patients were evaluated, and post-procedural delirium was identified in 24/467 (5.1%) patients. Thirty-five patients could not be assessed for delirium due to excessive sedation. The incidence of delirium in white vs. non-white patients &amp;lt;65 years was 5/137 (3.6%) compared to 0/91 (0%), and 7/176 (4.0%) compared to 12/63 (19%) in patients ≥65 years, P = 0.006. Bias reduction multi-variable analysis identified low postprocedural hemoglobin level odds ratio of 0.76 (95% CI 0.61–0.92, P = 0.006), greater age (odds ratio 1.04, 95% CI 1.01–1.009, P = 0.024), and non-white race odds ratio of 2.52 (95% CI 1.06–6.38, P = 0.030) as factors associated with delirium [Brier score = 0.045, C-index = 0.800, and Akaike Information Criterion (AIC) = 174]. General anesthesia was not associated with an increased delirium risk. NIHSS at 24 and 48 h and discharge, length of stay, and 90-day mortality were not different between delirium and no-delirium groups. Delirium patients had a reduced odds ratio of 0.13 (05% CI 0.01–1.00, P = 0.02) for home discharge.DiscussionDelirium following mechanical thrombectomy for acute ischemic stroke primarily affected older patients and was associated with reduced odds of home discharge following hospitalization. Changes in NIHSS during hospitalization and 90-day mortality were not adversely affected by the presence of delirium. General anesthesia was not associated with an increased delirium risk following mechanical thrombectomy.