Repeat Assessment Research Articles

Noninvasive evaluation of donor and native pancreases following simultaneous pancreas-kidney transplantation using positron emission tomography/computed tomography.

It is crucial to develop practical and noninvasive methods to assess the functional beta-cell mass in a donor pancreas, in which monitoring and precise evaluation is challenging. A patient with type 1 diabetes underwent noninvasive imaging following simultaneous kidney-pancreas transplantation with positron emission tomography/computed tomography (PET/CT) using an exendin-based probe, [18 F]FB(ePEG12)12-exendin-4. Following transplantation, PET imaging with [18 F]FB(ePEG12)12-exendin-4 revealed simultaneous and distinct accumulations in the donor and native pancreases. The pancreases were outlined at a reasonable distance from the surrounding organs using [18 F]FB(ePEG12)12-exendin-4 whole-body maximum intensity projection and axial PET images. At 1 and 2 h after [18 F]FB(ePEG12)12-exendin-4 administration, the mean standardized uptake values were 2.96 and 3.08, respectively, in the donor pancreas and 1.97 and 2.25, respectively, in the native pancreas. [18 F]FB(ePEG12)12-exendin-4 positron emission tomography imaging allowed repeatable and quantitative assessment of beta-cell mass following simultaneous kidney-pancreas transplantation.

Quantifying Hand Strength and Isometric Pinch Individuation Using a Flexible Pressure Sensor Grid.

Modulating force between the thumb and another digit, or isometric pinch individuation, is critical for daily tasks and can be impaired due to central or peripheral nervous system injury. Because surgical and rehabilitative efforts often focus on regaining this dexterous ability, we need to be able to consistently quantify pinch individuation across time and facilities. Currently, a standardized metric for such an assessment does not exist. Therefore, we tested whether we could use a commercially available flexible pressure sensor grid (Tekscan F-Socket [Tekscan Inc., Norwood, MA, USA]) to repeatedly measure isometric pinch individuation and maximum voluntary contraction (MVC) in twenty right-handed healthy volunteers at two visits. We developed a novel equation informed by the prior literature to calculate isometric individuation scores that quantified percentage of force on the grid generated by the indicated digit. MVC intra-class correlation coefficients (ICCs) for the left and right hands were 0.86 (p < 0.0001) and 0.88 (p < 0.0001), respectively, suggesting MVC measurements were consistent over time. However, individuation score ICCs, were poorer (left index ICC 0.41, p = 0.28; right index ICC -0.02, p = 0.51), indicating that this protocol did not provide a sufficiently repeatable individuation assessment. These data support the need to develop novel platforms specifically for repeatable and objective isometric hand dexterity assessments.

Sexual dimorphism in the badlands cricket (Orthoptera, Gryllinae, Gryllus personatus)

Sexual dimorphism (SD) is a common phenomenon in sexual species and can manifest in a variety of ways. Sexual size dimorphism (SSD) is commonly investigated, but it can be confounded with sexual shape dimorphism (SShD) if multivariate measures of size are not used. Univariate studies may also overestimate the prevalence or direction of SSD when the sexes are strikingly different in shape, which may be an issue in taxa such as Orthoptera and other terrestrial arthropods where maximum body size is strongly constrained. Here we tested for the occurrence of both SSD and SShD in the badlands cricket Gryllus personatus (Orthoptera, Gryllinae). We measured four body size dimensions—maxillae span, head width, pronotum length, and mean hind femur length—and used multivariate methods to test whether male and female adult badlands crickets were sexually dimorphic in size and/or shape. All the univariate dimensions were sexually dimorphic, with males having wider heads and maxillae than females and females having longer pronota and hind femora than males, which indicates SShD. However, multivariate methods failed to detect SSD, instead confirming that the sexes primarily differ in body shape. We show how a simple ratio of head width to pronotum length captures SShD in badlands crickets and apply it to iNaturalist, a citizen science platform, to broaden our findings. We propose that orthopterists studying SD minimally measure head width, pronotum length, and hind femur length as a standard that will allow a more repeatable and generalizable assessment of the prevalence and direction of both SSD and SShD.

REPRODUCIBILITY AND PREDICTIVE VALUE OF WHITE COAT HYPERTENSION IN YOUNG TO MIDDLE AGE SUBJECTS

Objective: The reproducibility and the prognostic value of white-coat hypertension (WCH) is still debated. The aim of the study was to investigate the reproducibility of WCH assessed twice within 3 months and its predictive capacity for development of hypertension needing antihypertensive treatment (HT) in young-to-middle-age subjects screened for stage 1 hypertension. Design and method: We investigated 1096, 18-to-45-year old subjects from the HARVEST. Office BP and 24hour BP were measured at baseline and after 3 months. On the basis of BPs measured after 3 months, 132 participants were classified as normotensive, 159 as WCH, 195 as masked hypertensive and 610 as sustained hypertensive. The reproducibility of WCH, office hypertension, and ambulatory hypertension was evaluated with Kappa statistics. The predictive capacity of WCH defined with a single assessment or with double assessment was tested in multivariate Cox models (N = 1054). Results: Baseline WCH was confirmed at 3-month assessment in only 33.3% of participants, whereas 31.6% became normotensive, 8.8% masked hypertensive and 26.3% sustained hypertensive. Reproducibility evaluated with weighted Kappa was fair (0.27, 95%CI 0.20 - 0.37) for WCH, poor (0.14, 95%CI 0.09 - 0.19) for office Hypertension (BP&gt; = 140/90 mmHg), and moderate (0.47, 95%CI 0.41 - 0.53) for ambulatory Hypertension (24hBP&gt; = 130/80 mmHg). During 17.4 years of follow-up, 80.5% of participants developed HT. WCH assessed either at baseline (p = 0.86) or after 3 months (p = 0.16) was not a significant predictor of future HT. However, participants who had WCH both at baseline and after 3 months (N = 76) had an increased risk of HT compared to the normotensives (Hazard ratio, 1.50, 95%CI 1.06 - 2.13, p = 0.022). HRs were 1.35 (95%CI 1.02 - 1.80, p = 0.037) in participants with masked hypertension and 1.52 (95%CI 1.19 - 1.95, p &lt; 0.001) in those with sustained hypertension. Conclusions: These results show that in young-to-middle-age individuals, WCH was confirmed in only one third of people at repeat assessment. This was mainly due to a poor reproducibility of office hypertension. WCH diagnosed with two but not with one BP assessment showed an increased risk of future HT. Our data indicate that people with WCH at first assessment should undergo a second set of ambulatory and office BP measurements before clinical decisions are made.

WED-238 - Repeatability and reproducibility assessment and its acceptable standard error of means for qFibrosis system in multi-site NASH clinical trials

WED-238 - Repeatability and reproducibility assessment and its acceptable standard error of means for qFibrosis system in multi-site NASH clinical trials

Intraobserver Repeatability Assessment of the S390L Firefly WDR Slitlamp in Patients With Dry Eye Disease: Objective, Automated, and Noninvasive Measures.

To assess the intraobserver repeatability of automated, objective, and noninvasive measures obtained with the S390L Firefly WDR slitlamp. This cross-sectional study included 50 eyes of patients with dry eye disease with a mean age of 55.06±12.96 years. Three consecutively repeated measures of the following variables were obtained: first noninvasive break-up time (F-NIBUT), average noninvasive break-up time (A-NIBUT), tear meniscus height, tear meniscus area (TMA), nasal ciliary hyperemia (NCIH), temporal ciliary hyperemia (TCIH), nasal conjunctival hyperemia (NCOH), temporal conjunctival hyperemia (TCOH), upper loss area meibomian gland (U-LAMG), lower loss area meibomian gland (L-LAMG), upper meibomian gland dysfunction grade (U-MGD grade), and lower meibomian gland dysfunction grade (L-MGD grade). Intraobserver repeatability was estimated with coefficient of variation (CoV), intrasubject standard deviation (SD) (S w ), and Bland-Altman plots. All variables showed no statistically significant differences in the repeated-measures analysis except for L-MGD grade ( P =0.045). F-NIBUT and A-NIBUT obtained the highest CoV with an average value of 0.48±0.41 [0.02-1.00] and 0.34±0.25 [0.02-1.00], respectively. The remaining variables showed CoVs between 0.04±0.11 [0.00-0.43] and 0.18±0.16 [0.00-0.75]. A-NIBUT, TMA, NCOH, and L-LAMG obtained an S w of 2.78s, 0.21 mm 2 , <0.001, and 4.11%, respectively. Bland-Altman plots showed a high level of agreement between pairs of repeated measures. The S390L Firefly WDR slitlamp has moderate intraobserver repeatability for F-NIBUT and A-NIBUT, which suggests that F-NIBUT and A-NIBUT are tests with high variability. The remaining variables show satisfactory intraobserver repeatability.

Objective quantification of responses to the clinical pull-test in people with Parkinson’s disease

BackgroundPostural instability can occur in the later-stages of Parkinson’s disease (PD). The clinical pull-test is scored on a 0–4 scale on the Unified Parkinson’s disease rating scale (UPDRS), with postural instability scored 2 or higher. This ordinal scale does not adequately track progression in early-PD or predict development of postural instability. Research QuestionTo develop a test that quantifiably measured the backward stepping response on the pull-test in early-PD. MethodsParticipants (35 controls and 79 PD participants) were prospectively enrolled in this study. Participants stepped backwards with each shoulder pull at four strengths on an instrumented gait mat. Four spatiotemporal parameters (reaction-time, step-back-time, step-back-distance, step-back-velocity) were quantified using Protokinetics Movement Analysis Software. Spatiotemporal pull-test parameters were compared to standard PD measures using linear regression and correlation coefficients. Repeated measures analysis was used to determine group differences in pull-test parameters. In a subset of participants repeated testing was performed and Bland-Altman plots were used to determine reproducibility of the pull-test parameters. ResultStep-back-distance and step-back-velocity were inversely related to motor UPDRS and freezing of gait questionnaire scores. PD participants had shorter step-back-distance than controls adjusted for age and sex. Repeat assessments in 16 participants, on average 0.7 years apart, showed good agreement on most of the quantified parameters. SignificanceThe backward stepping response in PD participants was quantifiable, reproducible, and related to disease severity and could be used to quantify progression towards postural instability in early-PD.

Development of a high fidelity, multidisciplinary, crisis simulation model for robotic surgical teams.

Immediate access to the patient in crisis situations, such as cardiac arrest during robotic surgery, can be challenging. We aimed to present a full immersion simulation module to train robotic surgical teams to manage a crisis scenario, enhance teamwork, establish clear lines of communication, improve coordination and speed of response. Start time of cardiopulmonary resuscitation (CPR), first defibrillator shock and robotic de-docking time from the first 'cardiac arrest call' were recorded. Observational Teamwork Assessment for Surgery (OTAS) scores were used in control and test simulations to assess performance along with a participant survey. Repeat scenarios and assessment were conducted at a 6-month interval for the same team to validate knowledge retention and an additional scenario was run with a new anaesthetic team to validate modular design. OTAS scores improved across all specialty teams after training with emergency algorithm and at retention validity re-test (p = 0.0181; p = 0.0063). There was an overall reduction in time to CPR (101-48s), first defibrillator shock (> 302s to 86s) and robot de dock time (86-25s) Improvement remained constant at retention validity re-test. Replacing the anaesthetic team showed improvement in time to CPR, first shock and robotic de-dock times and did not affect OTAS scores (p = 0.1588). The module was rated highly for realism and crisis training by all teams. This high-fidelity simulation training module is realistic and feasible to deliver. Its modular design allows for efficient assessment and feedback, optimising staff training time and making it a valuable addition to robotic team training.

A New Questionnaire to Assess Respiratory Symptoms (The Respiratory Symptom Experience Scale): Quantitative Psychometric Assessment and Validation Study.

Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. The Respiratory Symptom Experience Scale (RSES)was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores -0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers' RSES scores were significantly higher than former smokers' scores (P<.001). Switchers' RSES scores were significantly lower than smokers' scores (P<.001) and no different from former smokers' scores (P=.34). The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health.

Experimental assessment of the ice protection effectiveness of icephobic coatings for a hovering drone rotor

A new installation at the Anti-Icing Materials International Laboratory was developed to study the effects of icing on the degradation of a hovering drone rotor aerodynamic performance and to test different potential ice protection solutions. Following a study on icing parameters effects on aerodynamic performance, this paper studies a methodology developed to assess the performances of coatings as a potential ice protection system under severe icing conditions and rotor speeds up to 4950 RPM. Four different coatings, commercial or under development, were applied to the rotor blades and their effect on the resulting ice accumulation and aerodynamic degradation were measured and compared to those previously obtained on similar, uncoated blades. Results show that passive icephobic coatings in general are a promising solution to limit the negative effect of icing conditions for drone applications, without any additional energy consumption from the system. Moreover, the repeatability assessment of tests under similar conditions and for the same coating showed agreement within ±5% between repetitions, showing no signs of ice protection efficiency degradation for any of the tested coatings.

The effect of classroom environment on literacy development

The physical characteristics of a child’s learning environment can affect health, wellbeing and educational progress. Here we investigate the effect of classroom setting on academic progress in 7–10-year-old students comparing reading development in “open-plan” (multiple class groups located within one physical space) and “enclosed-plan” (one class group per space) environments. All learning conditions (class group, teaching personnel, etc.) were held constant throughout, while physical environment was alternated term-by-term using a portable, sound-treated dividing wall. One hundred and ninety-six students underwent academic, cognitive and auditory assessment at baseline and 146 of these were available for repeat assessment at the completion of 3 school terms, allowing within-child changes across an academic year to be calculated. Reading fluency development (change in words read-per-minute) was greater for the enclosed-classroom phases (P < 0.001; 95%CI 3.7, 10.0) and the children who showed the greatest condition difference (i.e. slower rate of development in the open-plan) were those with the worst speech perception in noise and/or poorest attention skills. These findings highlight the important role classroom setting plays in the academic development of young students.

CNV-Net: Segmentation, Classification and Activity Score Measurement of Choroidal Neovascularization (CNV) Using Optical Coherence Tomography Angiography (OCTA)

This paper aims to present an artificial intelligence-based algorithm for the automated segmentation of Choroidal Neovascularization (CNV) areas and to identify the presence or absence of CNV activity criteria (branching, peripheral arcade, dark halo, shape, loop and anastomoses) in OCTA images. Methods: This retrospective and cross-sectional study includes 130 OCTA images from 101 patients with treatment-naïve CNV. At baseline, OCTA volumes of 6 × 6 mm2 were obtained to develop an AI-based algorithm to evaluate the CNV activity based on five activity criteria, including tiny branching vessels, anastomoses and loops, peripheral arcades, and perilesional hypointense halos. The proposed algorithm comprises two steps. The first block includes the pre-processing and segmentation of CNVs in OCTA images using a modified U-Net network. The second block consists of five binary classification networks, each implemented with various models from scratch, and using transfer learning from pre-trained networks. Results: The proposed segmentation network yielded an averaged Dice coefficient of 0.86. The individual classifiers corresponding to the five activity criteria (branch, peripheral arcade, dark halo, shape, loop, and anastomoses) showed accuracies of 0.84, 0.81, 0.86, 0.85, and 0.82, respectively. The AI-based algorithm potentially allows the reliable detection and segmentation of CNV from OCTA alone, without the need for imaging with contrast agents. The evaluation of the activity criteria in CNV lesions obtains acceptable results, and this algorithm could enable the objective, repeatable assessment of CNV features.

On the Design of Aqueous Emulsions of Colophony Resin.

Companies regularly face market pressure to develop products faster but they also need to simultaneously incorporate technological constraints, sustainability trends, and customer requirements into their designs, which requires the use of systematic procedures. Firms that exploit natural resources and convert them into high-value products are among them. However, the literature on the application of such systematic approaches to products of this type remains scarce, as they often requrire extensive experimental plans involving the testing and optimization of multiple formulations. Here, we propose a systematic approach to the design of pine-resin-in-water emulsions, which can be used to fabricate pressure-sensitive adhesives. The strategy is customer-centric in the sense that the customers' specifications are integrated into the decision-making tool used to assess the quality of the formulations obtained through experiments. This tool uses loss functions to assess satisfaction with individual quality characteristics and multi-attribute decision-making methods to integrate them into an overall quality metric. Our framework is aligned with industrial practices and consists of three sequential stages: (i) screening of primary factors; (ii) optimization of secondary factors; and (iii) assessment of the experimental repeatability of the formulations. In each of these stages, the decision-making tool is used to "drive" the process of finding the optimal formulation.

Studi Literatur Intensitas Nyeri Pada Orang Dengan HIV/AIDS

Pain is one of the most commonly reported symptoms in people living with HIV / AIDS (PLWHA). There are three main reasons why people with HIV / AIDS experience pain: as a symptom of HIV infection, as a result of other illnesses or opportunistic infections, and as a side effect of ARV treatment. This literature review aims to determine the intensity of pain and the location of pain with HIV/AIDS. It uses research articles that include quantitative data. The search for articles used four databases, namely PubMed, Science Direct, SpringerLink, and Google Scholar, using the deadline from January 2015 to August 2020. The search terms chosen are "pain intensity" or "pain level" or "pain" and "People Living with HIV/AIDS" or "PLWHA." After a full-text review, ten studies meet the inclusion criteria. The results of the identification of the article show that people living with HIV who have an older age tend to experience more intense pain than the younger age. The six articles that have been identified show that people with HIV/AIDS experience pain mildly to moderate. In contrast, four other studies show that pain experienced by PLWHA is moderate to severe, with the head as the most predominantly experiencing pain. The pain in PLWHA can reduce individuals' quality of life and interfere with their ability to carry out daily activities. Nurses are required to perform routine and repeated pain assessments in HIV patients to determine appropriate pain management. Keywords: pain intensity; HIV / AIDS; literature review.

Ten Questions Concerning Indoor Environmental Quality (IEQ) Models: The Development and Applications

In the past two decades, with advances in data collection and in analytical techniques and tools, there has been a significant increase in research on indoor environmental quality (IEQ) assessment. To better understand the relationships between the overall IEQ performance and individual IEQ aspects, namely, indoor air quality, thermal comfort, acoustic quality, and visual quality, IEQ models have been developed by many previous studies. In this paper, the IEQ models proposed in the literature in the period from 2001 to 2022 are examined and summarized into ten questions, including but not limited to indicator selection, data collection, analysis methods, interpretation, and implication. The proposed answers aim to provide insight into current studies on IEQ models and identify gaps for future research. It has been found that the existing IEQ models differed for different building types or occupants. To compare the IEQ performance of various buildings in other countries, standardized data collection protocols are necessary, including the selection of IEQ aspects/indicators and their corresponding objective measurement strategies and standardized subjective survey methods. In addition, the data analysis approaches used to develop the IEQ models must be unified. Moreover, criteria for overall IEQ performance and the individual IEQ aspects should be provided. This study is the first comprehensive investigation of all the steps involved in IEQ model development. The answers to these ten questions can be seen as practical instructions for establishing an improved, standardized, and repeatable IEQ assessment model.

A contribution to the debate on measurement uncertainty when using X-ray computing tomography

Currently, XCT metrological capabilities require further enhancement, due to the absence of a full traceability chain and the presence of different scan parameters that can significantly influence the process. In the last 10 years, substantial progress has been made towards an XCT standardised process for dimensional inspection. However, AM surface measurement and porosity characterisation have been shown to be different from dimensional inspection presenting differing problems. The scanned object for dimensional inspection is affected by XCT measurement uncertainties. These are controlled by the scan voxel size (magnification) and scan parameters and to a lesser extent the surface determination; however, porosity characterisation and surface measurement are greatly affected by the surface determination, in addition to the material type, magnification and scan parameters. To address some of these issues artefacts are used for performance verification of the measuring system and the identification of contributing errors; this is considered one of the essential steps in the metrological process, where true traceability is elusive. Measurement uncertainty is the key to evaluation of the quality of the measurement. In order to ensure measurement traceability, every result should be accompanied by an uncertainty statement. However, several diverse sources can cause uncertainty in the XCT measurements, making it very difficult to establish the overall uncertainty. Furthermore, because the XCT system is a multi-purpose device that can be used for internal and external and material measurements, the uncertainty can vary significantly. The current study evaluates the precision of XCT measurement of internal defects in additively manufactured components through the assessment of reproducibility and repeatability of the internal feature characterisation process. Several sources of variability were assessed: two different XCT machines, three different operators and four different surface determination thresholds. The main aim of the repeatability study was to identify the confidence in successive measurements when scanning under the same conditions. The reproducibility study was used to find the relationship between results when conditions are varied. The results of the repeatability study have a deviation from the reference value within 0.8 voxel, and for the reproducibility study has shown the deviation from the reference value is within 1.6 voxels, with some operators’ results’ less than one voxel from the reference value. The use of different scan parameters and specifically different spot sizes result in the result output deviation. All the operators chose an optimum ISO threshold value for surface determination based on a previously published methodology which was more than 50%, the closest results to the reference value were obtained from a 61% surface determination threshold. The custom ISO threshold method for surface determination could detect the cavities between the powder particles.

Abstract P543: Longitudinal Change in Perceived Loneliness Among Older Adults During the COVID-19 Pandemic: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: We and others observed that social distancing enforced early in the COVID-19 pandemic led to an increase in loneliness, a social condition associated with adverse mental and physical health outcomes. Here, we examine longitudinal changes in perceived loneliness over the first two years of the COVD-19 pandemic among older adults participating in the Atherosclerosis Risk in Communities (ARIC) Study. Hypothesis: Perceived loneliness decreased over the course of the pandemic. Methods: The UCLA 3-item Loneliness questionnaire, which assesses lack of companionship, feeling left out, and feeling isolated, to classify level of perceived loneliness, was administered to ARIC participants in March-October 2020 and again in August 2020-March 2022 as part of the Colllaborative Cohort of Cohorts for COVID-19 Research (C4R). Prepandemic measures (Jan-March 2020) were available in a subset. For each item, response categories “hardly ever”, “some of the time” and “often” were scored from 1 to 3, respectively, and added to create a final score ranging from 3 to 9 (higher scores indicating greater loneliness). T-tests were used to compare mean loneliness score values between the measurement periods. Mixed effects linear regression models were fit to examine predictors of change in the loneliness score. Results: Among 2,335 ARIC cohort participants with repeat assessments of loneliness during the COVID-19 pandemic (mean age 82.4 (SD 4.4) years, 64.8% female, 18.5% Black), mean perceived loneliness score decreased from 4.40 (SD 1.51) to 3.78 (SD 1.25) (p-value &lt;0.01) over median follow-up of 10.7 (SD 3.8) months. In 516 participants with pre-pandemic measures, the mean perceived loneliness score was 3.63 (SD 1.13). In analyses adjusted for age, the decrease in the loneliness score during the pandemic was greater by 0.65 (95% CI: 0.46, 0.84) units among Black, as compared to White participants. Male sex was likewise associated with a 0.89 (95% CI: 0.77, 1.02) unit decrease in the loneliness score. No differences were observed by educational attainment, age, or levels of the Area Deprivation Index. Conclusion: Despite reporting greater loneliness during the first six months of the COVID-19 pandemic compared to the time prior to the pandemic, older adults reported similar levels of perceived loneliness in the second year of the pandemic compared to pre-pandemic levels. In particular, Black race and and male sex were associated with greater reductions in loneliness over the pandemic period. These results suggest that older adults were psychologically resilient with respect to the extreme social changes associated with the COVID-19 pandemic.

Kinetic tremor analysis using wearable sensors and fuzzy inference systems in Parkinson's disease

BackgroundComputer systems for evaluating Parkinson's disease (PD) have recently increased. Many existing methods allow the quantification of tremors and extraction of some characteristics of the acquired signals by analysing manoeuvres established in the MDS-UPDRS. Some of these current methods interpret the finger-to-nose test, which includes kinetic tremors of the hands; however, an evaluation strictly based on the guidelines of the MDS Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is not performed, in addition to not using additional biomechanical indicators that make more robust and accurate monitoring of the patient's evolution. New methodThe proposed method consists of a fuzzy logic system that evaluates PD patients in a range based on the MDS-UPDRS. The system evaluates by taking biomechanical features extracted from signals recorded with inertial measurement units (IMUs), which were previously processed for obtaining meaningful characteristics according to the MDS-UPDRS and other additional ones. Comparison with existing methodsIn addition to the characteristics established by the MDS-UPDRS for the classification, this method uses other procedures that were considered necessary for the achievement of an accurate evaluation, such as the amplitude of the tremors in the different stages of the finger-to-nose manoeuvre, the tremors frequency and the voluntary movement frequency. Conclusionskinetic tremors were measured based on a sensor network formed by IMUs. A Fuzzy Logic system obtains an accurate and repeatable biomechanical assessment of PD patients. This system will permit physicians to follow up on each patient with objective assessments improving medical treatments.

Does the current state of biomarker discovery in autism reflect the limits of reductionism in precision medicine? Suggestions for an integrative approach that considers dynamic mechanisms between brain, body, and the social environment.

Over the past decade, precision medicine has become one of the most influential approaches in biomedical research to improve early detection, diagnosis, and prognosis of clinical conditions and develop mechanism-based therapies tailored to individual characteristics using biomarkers. This perspective article first reviews the origins and concept of precision medicine approaches to autism and summarises recent findings from the first "generation" of biomarker studies. Multi-disciplinary research initiatives created substantially larger, comprehensively characterised cohorts, shifted the focus from group-comparisons to individual variability and subgroups, increased methodological rigour and advanced analytic innovations. However, although several candidate markers with probabilistic value have been identified, separate efforts to divide autism by molecular, brain structural/functional or cognitive markers have not identified a validated diagnostic subgroup. Conversely, studies of specific monogenic subgroups revealed substantial variability in biology and behaviour. The second part discusses both conceptual and methodological factors in these findings. It is argued that the predominant reductionist approach, which seeks to parse complex issues into simpler, more tractable units, let us to neglect the interactions between brain and body, and divorce individuals from their social environment. The third part draws on insights from systems biology, developmental psychology and neurodiversity approaches to outline an integrative approach that considers the dynamic interaction between biological (brain, body) and social mechanisms (stress, stigma) to understanding the origins of autistic features in particular conditions and contexts. This requires 1) closer collaboration with autistic people to increase face validity of concepts and methodologies; (2) development of measures/technologies that enable repeat assessment of social and biological factors in different (naturalistic) conditions and contexts, (3) new analytic methods to study (simulate) these interactions (including emergent properties), and (4) cross-condition designs to understand which mechanisms are transdiagnostic or specific for particular autistic sub-populations. Tailored support may entail both creating more favourable conditions in the social environment and interventions for some autistic people to increase well-being.

Secondaries from retromolar trigone carcinoma leading to orbital apex disorders

Orbital apex disorders (OADs) are uncommon and they include – orbital apex syndrome (OAS), superior orbital fissure syndrome (SOFS), and cavernous sinus syndrome (CSS). They all share similar etiologies, diagnostic evaluation, and management strategies. These syndromes can occur isolated or combined – where SOFS progresses and develops into OAS or CSS. Combined presentation has been reported with infective etiologies, but no literature is available for neoplasms. OAD secondary to head and neck cancer is exceptionally rare. A 44-year-old male post left hemi-mandibulectomy with modified neck dissection, radiotherapy, and chemotherapy for left retromolar trigone carcinoma presented with complaints of inability to open left eye (LE) and defective vision in the same eye. On examination of LE, visual acuity was 6/24 NIP with complete ptosis, extraocular movements were restricted in all gaze, corneal sensation was diminished, and pupil was 5 mm and not reacting to light. LE fundus examination showed blurring of disk margins. The primary diagnosis was made as OAS. Contrast enhanced-MRI neck showed features suggestive of recurrence with intracranial extend involving left cavernous sinus, orbital apex, and left orbit. Later considering the extend of spread in MRI and the clinical presentation, diagnosis was made to be OAD. The patient was given third cycle of chemotherapy – injection paclitaxel, injection cisplatin, and injection fluorouracil, along with injection dexamethasone. The patient was provided temporary eye crutch glasses and asked to review after 3 weeks for repeat assessment. Although individual syndromes of OAD are rare, they are closely related entity. Hence, it is important to know that SOFS can progress to OAS causing visual dysfunction or to CSS, leading to systemic ailments. Or else, they can present as combined syndromes also.