Repeated Measures General Linear Model Research Articles

CORTICAL INTEGRATIVE THERAPY FOR THE TREATMENT OF MIGRAINES AND HEADACHES

Migraine is a common neurological disorder that is characterized by a host of symptoms including severe throbbing headaches. In this retrospective chart review, the effectiveness of Cortical Integrative Therapy (PedroCIT®) was examined in adults with migraines. Multivariate General Linear Model (M-GLM) was utilized to determine if the emotional, functional, and overall difficulties, as well as the intensity of pain experienced with headaches decreased from before to after PedroCIT® treatment in individuals with mild to complete disability resulting from headaches. Repeated Measures General Linear Model (RM-GLM) was also used to investigate if postural stability increased from pre- to post-treatment. The results of the M-GLM showed that PedroCIT® was effective in reducing emotional, functional, overall disability, and intensity of pain resulting from headaches. Furthermore, RM-GLM indicated that patients who underwent PedroCIT® improved their postural stability from pre- to post-treatment. Finally, the findings also showed that the duration of the treatment did not have any effect among patients with varied degrees of headache disability. This study illustrates the effectiveness of PedroCIT® in the treatment of headaches and postural instability in migraine patients.

The Effect of Different Preparation Times on The Taper and Shape of Simulated Root Canals Using The XP-Endo Shaper Rotary File

ABSTRACT Objective: This study evaluated the effect of different preparation times on the taper and shape of simulated root canals using the XP-endo Shaper rotary file Materials and methods: A total of 54 resin blocks made of clear polyacrylic resin with simulated root canals were used in this study. They were photographed using a stereomicroscope. They were prepared using the XP-endo Shaper instrument up to the working length (WL) according to the manufacturer’s recommendation for 30 seconds (s), 60 s and 90s. Postoperative photographs were performed after canal preparation at each time-point. Then, the registered pre and postoperative datasets were examined to evaluate the canal taper and apical tip diameter. Repeated measures general linear model was used to compare the differences in either the increase or the reduction of the parameters amongst the time-points. Alpha-error was set at 5%. Results: Extending the period of XP-endo Shaper active instrumentation at WL significantly influenced several parameters such as apical tip diameter (P < 0.05) and canal taper (P < 0.05) of the instrumented canal. Conclusions: Extending the activation time of XP endo Shaper instruments at WL resulted in a more comprehensive root canal preparation, increasing the canal taper and the apical tip diameter.

CORTICAL INTEGRATIVE THERAPY EFFECTIVENESS IN THE TREATMENT OF POST-CONCUSSION SYNDROME AND MILD TRAUMATIC BRAIN INJURY

Post-Concussion Syndrome (PCS) is a relatively prevalent condition that emerges after sustaining a head injury. Individuals with PCS experience prolonged impairments and distress associated with the injury which can impact the individuals’ quality of life experiences. In this retrospective chart review of refractory adult patients diagnosed with PCS and mild Traumatic Brain Injury (mTBI), the effectiveness of Cortical Integrative Therapy (PedroCIT®) was investigated by comparing measures of postural stability, brain sequencing and timing, and self-reports of physical and psychosocial symptoms of PCS obtained before and after PedroCIT®. Multivariate and Repeated Measures General Linear Models showed improvements across the measures from before to after treatment in all subjects, highlighting the effectiveness of PedroCIT®. To further underscore the capacity of PedroCIT® to elicit improvements in patients who have been resistant to treatment prior to PedroCIT®, the duration of time that the subjects underwent PedroCIT® was compared to the duration of time since the injury to the subjects’ first PedroCIT® intervention session. The findings of this study showed significant improvements from pre- to post-treatment in postural stability, brain sequencing and timing, and self-reported symptoms for patients affected by PCS and mTBI, and treatment outcomes were largely not contingent upon the severity of the condition at the beginning of treatment. Altogether, this retrospective study suggests that refractory individuals affected by PCS and mTBI can benefit from undergoing PedroCIT® and their treatment outcomes may not be related to the degree of impairment presented at the beginning of treatment.

Deep brain stimulation outcomes in the malignant end of Parkinson's disease spectrum

BackgroundHeterogeneity of Parkinson's Disease (PD) phenotype may influence deep brain stimulation (DBS) outcome. However, DBS response in the malignant end of the PD spectrum has been poorly investigated. ObjectiveTo evaluate and compare DBS outcomes in malignant and benign PD patients, defined according to motor and non-motor symptom presentation at the presurgical selection. MethodsWe categorized a cohort of 154 parkinsonian patients fulfilling criteria for subthalamic nucleus (STN)-DBS into malignant, benign, and intermediate subtypes, according to a recently validated clinical PD classification. DBS efficacy on daily living independence (Schwab and England –S&E-score ≥70%), motor symptoms, and motor fluctuations (Unified Parkinson's Disease Rating Scale -UPDRS- part-III and -IV, and Ambulatory Capacity Measure) were compared between malignant and benign patients, using corrected binary logistic regressions and repeated measure general linear model. ResultsOne year after surgery, the probability of losing daily life independence was 16-fold higher in malignant patients, even after adjusting for age at PD onset, PD duration, and percentage of motor improvement after STN-DBS (OR: 16.233; p: 0.035). Conversely, malignant and benign patients showed a similar extent of improvement after STN-DBS (p > 0.05) in motor symptoms, motor fluctuations, and ambulatory capacity, both in medication-ON and medication-OFF conditions. ConclusionDBS candidates in the malignant end of the PD spectrum may profit from a similar improvement of motor symptoms and fluctuations after STN-DBS when compared to benign PD. However, patients of the malignant group have a lower probability of maintaining independence in daily life early after surgery.

The effect of altering routine husbandry factors on sleep duration and memory consolidation in the horse

Sleep is a critically important behaviour for all mammals due to its fundamental role within homeostatic/circadian systems and memory consolidation. As a large and vigilant prey species that is highly sensitive to stimuli at night, the horse sleeps less than other mammalian species. For this reason, the domestic environment has the potential to greatly affect the duration and quality of equine sleep. This study aimed to determine the effect of environmental factors on equine sleep stages, and whether this would influence cognitive performance during a spatial memory task. Ten riding school horses (mixed breed/ height/ sex; average age 14.9 + 2.4 years) were randomly assigned to two groups (n = 5) within a five-week crossover repeated measures design experiment. Each group experienced a combination of one of two light conditions (lights on = Treatment; lights off = Control), and one of two bedding depth treatments (15 cm bed = control; 5 cm bed = treatment) for six days. Duration of sleep stage behaviours (standing Non-Rapid Eye Movement [NREM]), sternal NREM, sternal Rapid Eye Movement [REM] and lateral REM) were measured continuously using CCTV infrared cameras. For the spatial memory task, latency, number of correct responses, and differences between these parameters during training and testing days were measured. A repeated measures general linear model assessed the effects of treatment conditions on duration of sleep stage, and changes in sleep stage over time (bedding and light set as within-subject factors). Wilcoxon Signed-Rank and paired t-tests determined differences in memory task parameters between treatments. Comparing Treatment Bedding with Control Bedding conditions, horses spent on average significantly less time in lateral REM (0.34 ± 0.12 versus 0.46 ± 0.13 h; p = 0.032) and sternal NREM (0.64 ± 0.10 versus 0.80 ± 0.12 h; p = 0.007), and significantly more time in standing NREM (3.69 ± 0.76 versus 3.17 ± 0.77; p = 0.024). Only sternal REM was significantly affected during the Treatment Light condition compared to control conditions (0.53 ± 0.07 versus 0.67 ± 0.11; p = 0.031). Interactions between day and treatment were apparent for specific sleep stage behaviours indicative of acclimatisation. No significant effects (p > 0.05) of Treatment Light or Bedding conditions were detected for performance during the spatial memory test. Overall, horses exposed to sub-optimal conditions tended to display significantly less time in recumbent sleep stages (NREM and REM) and increased time in a standing NREM stage. The impact of reduced sleep on equine cognition requires further study.

Branham sign in dogs undergoing interventional patent ductus arteriosus occlusion or surgical ligation: a retrospective study.

Background:The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical ductal closure, a direct comparison of the Branham sign elicited by these two techniques has not been made.Aim:Since closure with an Amplatz canine ductal occluder (ACDO) occurs over 10 minutes and surgical ligation (SL) is more rapid, we hypothesized that the Branham sign following occlusion of a PDA with an ACDO would be less severe than following SL.Methods:Clinical records of dogs diagnosed with left-to-right shunting PDA between 2008 and 2018 were retrospectively reviewed. Of 139 dogs undergoing PDA occlusion, only 41 dogs (ACDO n = 32, SL n = 9) were included after applying exclusion criteria. Heart rate (HR) and blood pressure (BP) from occlusion time (T0) until 30 minutes post occlusion (T30) were recorded. Signalment and anesthetic protocol were also recorded. The influence of age and weight on the hemodynamic variations was assessed. Hemodynamic variables and calculations were compared between and within groups using a repeated measures general linear model, and post hoc tests were applied if significance was identified.Results:A mild Branham sign was present in both groups, and hemodynamic changes were not significantly different between groups. In both groups, there was a significant decrease in HR (11 bpm, 5.3–16.3; p < 0.001) (10.4%, 5.4–15.5; p < 0.001) and increase in diastolic BP (9.5 mmHg, 3–16; p = 0.002) (23.5%, 7.1–39.9; p = 0.002), but systolic BP did not change significantly (p = 0.824). Age and weight did not influence Branham sign.Conclusion:The Branham sign in dogs is mild in both groups, lasts for at least 30 minutes, and is independent of the method of PDA closure.

Rapid eye movement sleep behavior disorder: A proof-of-concept neuroprotection study for prodromal synucleinopathies.

To explore the feasibility of a neuroprotection trial in prodromal synucleinopathy, using idiopathic rapid eye movement sleep behavior disorder (iRBD) as the target population and 123 I-FP-CIT-SPECT as a biomarker of disease progression. Consecutive iRBD patients were randomly assigned to a treatment arm receiving selegiline and symptomatic rapid eye movement sleep behavior disorder treatment, or to a control arm receiving symptomatic treatment only. Selegiline was chosen because of a demonstrated neuroprotection effect in animal models. Patients underwent 123 I-FP-CIT-SPECT at baseline and after 30months on average. The clinical outcome was the emergence of parkinsonism and/or dementia. A repeated-measures general linear model (GLM) was applied using group (control and treatment) as "between" factor, and both time (baseline and follow-up) and regions (123 I-FP-CIT-SPECT putamen and caudate uptake) as the "within" factors, adjusting for age. Thirty iRBD patients completed the study (68.2±6.9years; 29 males; 21% dropout rate), 13 in the treatment arm, and 17 in the control arm. At follow-up (29.8±9.0months), three patients in the control arm developed dementia and one parkinsonism, whereas two patients in the treatment arm developed parkinsonism. Both putamen and caudate uptake decreased over time in the control arm. In the treatment arm, only the putamen uptake decreased over time, whereas caudate uptake remained stable. GLM analysis demonstrated an effect of treatment on the 123 I-FP-CIT-SPECT uptake change, with a significant interaction between the effect of group, time, and regions (p=0.004). A 30-months neuroprotection study for prodromal synucleinopathy is feasible, using iRBD as the target population and 123 I-FP-CIT-SPECT as a biomarker of disease progression.

The acute effect of atropine eye drops on the human full-field electroretinogram.

Atropine eye drops are a common and effective treatment for slowing myopia progression, but the site and mode of action of atropine in controlling myopia are unclear. We investigated the early retinal sites of action of atropine by examining its effects on the human full-field electroretinogram (ffERG). Baseline ffERGs were recorded in both eyes of 24 healthy subjects (mean ± SD: 21.0 ± 2.3years; spherical equivalent refraction, range: + 1.63 to - 0.75 D) using 6 standard ISCEV protocols, 30min after bilateral pupil dilation with 1% Tropicamide. Atropine (1 drop, 0.1%) was then instilled into the non-dominant eye. 24h later, ffERGs were again recorded in both eyes. Ratios (post-atropine: pre-atropine) of dark-adapted (DA) and light-adapted (LA) ffERGs were compared between atropine-treated and control eyes using multivariate repeated measures general linear models. Atropine-treated eyes responded with 14% lower DA3.0 OP (oscillatory potential) amplitude (p = 0.003) and 4% delay in the DA10.0 a-wave peak time (p = 0.00099) compared with control eyes. Amplitudes and peak times were not different between atropine-treated and control eyes for DA0.01, LA3.0, and LA3.0 flicker ERGs. While atropine caused a small (1.26mm2, p = 0.03) extra increase in pupil area in the treated eye, atropine-induced changes in ffERG responses bore no relationship with changes in pupil area (R2 = 2-5%, p > 0.05). The observed changes in oscillatory potentials corroborate previous findings that atropine affects neural activity in the inner retina. However, observed changes to the a-wave suggest that atropine also affects activity in photoreceptors.

Ageing shift workers' sleep and working-hour characteristics after implementing ergonomic shift-scheduling rules.

We studied whether implementing binding ergonomic shift‐scheduling rules change ageing (≥45 years) social and healthcare employees’ (mean age 52.5 years, 95% women) working‐hour characteristics (e.g. weekly working hours, number and length of night shifts, and short shift intervals) and sleep. We compared an intervention group (n = 253) to a control group (n = 1,234) by survey responses (baseline 2007/2008, follow‐up 2012) and objective working‐hour characteristics (intervention group n = 159, control group n = 379) from 91 days preceding the surveys. Changes in working‐hour characteristics were analysed with repeated measures general linear models. The fully adjusted model (sociodemographics and full‐/part‐time work) showed that proportion of short shift intervals (<11 hr, p = .033) and weekend work (p = .01) decreased more in the intervention than in the control group. Changes in sleep outcomes were analysed with generalised logit model to binomial and multinomial variables. The fully adjusted model (sociodemographics, full‐/part‐time work, job strain, health behaviours, and perceived health) revealed higher odds in the intervention group for long sleep (≥9 hr; odds ratio [OR] 5.53, 95% confidence interval [CI] 2.21–13.80), and lower odds of short sleep (<6 hr; OR 0.72, 95% CI 0.57–0.92), having at least two sleep difficulties often (OR 0.55, 95% CI 0.43–0.70), and more specifically difficulties in falling asleep (OR 0.56, 95% CI 0.41–0.77), waking up several times per night (OR 0.43, 95% CI 0.34–0.55), difficulties in staying asleep (OR 0.64, 95% CI 0.49–0.82), and non‐restorative sleep (OR 0.70, 95% CI 0.54–0.90) than the control group. In conclusion, implementation of ergonomic shift‐scheduling rules resulted in minor changes in ageing employees’ objective working hours and a consistent buffering effect against worsening of sleep.

Comparison of Dexmedetomidine and Ketamine for Managing Postoperative Symptoms After Third-Molar Surgery

Lower-impacted third-molar surgery is the most common oral-maxillofacial surgery procedure and involves a considerable degree of soft- and bony-tissue trauma. This study measured and compared postoperative sequalae between patients receiving dexmedetomidine or ketamine after third-molar surgery. This study was a randomized double-blind prospective trial. The patients were divided into 2 groups: ketamine and dexmedetomidine. Pain, swelling, and trismus outcomes were evaluated before and 2 and 7days after surgery. In addition, patients were asked to record the number and timing of oral analgesic tablets they required during the postoperative period. Data were analyzed using the Mann-Whitney U test and a repeated-measures general linear model. The significance level was set at P<.05. The study included 66 patients (38 women and 28 men) undergoing extraction of impacted mandibular third molars. Significant differences were found between the groups in visual analog scale pain scores at 1, 6, and 12hours after surgery (P<.001, P=.010, and P=.030, respectively). Trismus and swelling did not differ significantly between the 2 groups (P>.05). Ketamine resulted in less postoperative pain than dexmedetomidine during the first 12hours after third-molar surgery.

Psychophysiological correlates of anxious apprehension: Trait worry is associated with startle response to threat

Worry is a form of repetitive negative thought that is closely associated with anxiety disorders. Worry has been described as anxious apprehension and conceptualized as reflecting heightened anticipation of potentially threatening future events. However, it is unclear whether people who tend to worry show heightened physiological reactivity when anticipating threat, especially if the threat is uncertain. In the current study, community participants (n = 52) completed a threat anticipation task featuring uncertain threat, certain threat, and safety while the startle response to auditory probes was measured. Self-reported tendency to worry was assessed using the Penn State Worry Questionnaire, and anxiety disorder status was assessed via a clinical interview. A repeated-measures general linear model showed a main effect of threat level on the startle response, as well as a significant three-way interaction among threat level, worry, and anxiety disorder status. Follow-up tests showed that higher worry was associated with blunted startle responses to threat but particularly to uncertain threat among participants with a history of anxiety disorders. Worry did not moderate startle responding in participants without a history of anxiety disorders. These results indicate that psychophysiological correlates of worry depend on clinical status and suggest that trait worry is associated with physiological blunting to threat in individuals with a history of anxiety disorders, particularly when threat is uncertain. Implications for theoretical models of worry are discussed.

Fit for purpose and for practice? The self-perception of Serbian nurses

Abstract Background Nursing competencies are paramount to the quality of care outcomes and patient satisfaction. Serbia is lagging behind developed countries in the number of highly educated nurses. The study objective was to examine how well hospital nurses' competency fit for purpose (fit the needs of patients) and fit for practice (fit the needs of job requirements). Methods In the 2016 survey, 356 nurses in a general hospital have self-assessed how well their competencies fit for purpose and how well they fit for practice. In total 29 competencies that were classified as a health care professional competencies and managerial competencies were analyzed. Similar to the literature, we used educational standards and curriculum to construct a survey instrument - a two-dimensional questionnaire with two sub-scales. The paired-samples t-test and repeated measure general linear model were used to calculate the effect size of parameter estimates. The bivariate correlation analysis was also used, namely Pearson's and Spearman's rho correlation coefficient, and the effect size of the estimated correlation coefficients was calculated as well as their 95% confidence interval based on 1000 simulated samples via the bootstrap procedure. Results The survey instrument had Cronbach alpha 0.889 and 0.908 for health care and management competencies, respectively. Competency compliance rate was 69% (competency ratio 20 for purpose v 29 for practice). More fit for purpose were collaborating with external professionals and motivating patients for a healthy lifestyle, while prevention of intrahospital infections and the use of information technology better fit for practice. Low-income nurses have better-complied competencies. The nurses value teaching method the most. Conclusions In Serbia, nurses' competencies are moderately fitted for purpose and for practice. Managerial competencies are insufficiently acknowledged in nursing practice. Key messages Hospital nurses in Serbia have more competencies that are fit for purpose than is required for their current position. The development of higher education for nurses and the revision of job descriptions should be strategically oriented towards meeting the needs of patients.

Personality Pathology among Adults with History of Childhood Sexual Abuse: Study of the Relevance of DSM-5 Proposed Traits and Psychobiological Features of Temperament and Character.

Background:The main aim of this study was to determine whether childhood sexual abuse (CSA) is reflected in the pathological traits of the alternative model of personality disorders (AMPD) in section-III of DSM-5 and Cloninger’s temperament and character profiles.Methods:The Persian versions of Personality Inventory for DSM-5 (PID-5), Temperament and Character Inventory (TCI-125), and Structured Clinical Inventory for DSM-IV-TR-Axis II-Screening Questionnaire (SCID-II-SQ) were administered to 43 Iranian college students who reported a history of CSA and 390 participants who did not. Bivariate Pearson correlations and general linear model repeated measures (GLMRM) were used to compare results.Results:Bivariate correlations indicated that both the PID-5 and TCI-125 were significantly associated with their relevant personality disorders. Profile analysis showed that the pathological trait domains of the PID-5, except for negative affectivity, were significantly greater in those with an experience of CSA. Of the seven dimensions of TCI-125, novelty seeking and persistence were higher in those with an experience of CSA, but reward dependence, self-directedness, and cooperativeness were lower.Conclusions:These results confirmed a correlation between CSA and personality dysfunction. The pattern of dysfunction was complex and somewhat different from the two facet measures used.

The effects of using participatory working time scheduling software on working hour characteristics and wellbeing: A quasi-experimental study of irregular shift work

BackgroundStudies in the health care sector indicate that good work time control is associated with better perceived wellbeing but also with non-ergonomic work schedules, such as compressed work schedules. Participatory working time scheduling is a collaborative approach to scheduling shift work. Currently, there is a lack of information on whether working hour characteristics and employees’ wellbeing in irregular shift work change after implementing participatory working time scheduling. ObjectiveTo investigate the effects of using digital participatory working time scheduling software on working hour characteristics and well-being among Finnish hospital employees. Participants and methodsWe compared changes in objective working hour characteristics and wellbeing between 2015 and 2017 among employees (n = 677, mainly nurses and practical nurses) when using participatory working time scheduling software (participatory scheduling, n = 283) and traditional shift scheduling (traditional scheduling, n = 394). The statistical analyses were conducted using the repeated measures general linear model and the generalized logit model for binomial and multinomial variables adjusted for age, sex, education, shift work experience, control over scheduling of shifts at baseline (where applicable) and hospital district. ResultsThe proportion of long work shifts (≥ 12 h) increased to a greater extent (F = 4.642, p = 0.032) with the participatory scheduling than with the traditional scheduling. In comparison to traditional scheduling, the perceived control over scheduling of shifts increased (OR 3.24, 95% CI 1.73-6.06) and excessive sleepiness in connection with evening shifts decreased (OR 0.40, 95% CI 0.16-0.99) significantly with participatory scheduling. None of the other wellbeing variables showed statistically significant changes in the adjusted models. ConclusionsThe proportion of long work shifts and perceived control over scheduling of shifts increased more among employees using participatory working time scheduling than among those using traditional scheduling. Otherwise, using participatory working time scheduling software had little effect on both objectively measured working hour characteristics and perceived wellbeing in comparison to traditional scheduling. The results merit confirmation in a larger sample with a longer follow-up.Tweetable abstractParticipatory working time scheduling combines individual flexibility and staffing requirements in shift work.

Consider BMI Change When Evaluating Nutrition Intervention Impact on Eating Competence: Findings from an Intervention with Eating Competence Constructs for Adults

Abstract Objectives Examine change in adult eating competence (EC) over a 12 month period following participation in a controlled 7-month nutrition education intervention with EC constructs. Methods Parents of 4th grade youth in a cluster randomized impact assessment of a 7 month school-based culinary and physical activity intervention were assigned to 1 of 4 incrementally complex treatments that included components congruent with EC tenets. An online survey included validated measures of EC (ecSI 2.0TM), physical activity, stress, diet quality, healthful modeling, self-efficacy (SE) to offer fruits and vegetables to youth, and self-reported height/weight. EC was defined as ecSI 2.0TM ≥32. Measures were completed at baseline (BL), post-intervention (FU) and 5 months later (FU2). SPSS 24.0 analyses included repeated measures general linear modeling, means testing, chi square, Pearson correlation. Results Mean age of the mostly female (86%) sample (n = 418) was 39.1 ± 6.0 y; at FU2 126 were intervention and 96 control parents. BL analyses supported EC tenets with greater ecSI 2.0TM scores associated with less stress, lower BMI, less overweight/obesity, greater physical activity, greater SE and modeling behaviors (all P &amp;lt; 0.01). These relationships persisted at FU (n = 220) and FU2 (n = 221) for BMI, SE, modeling, and stress measures (all P &amp;lt; 0.01) and physical activity (P = 0.001 FU and 0.09 FU2). EC was denoted for 53% and 57% at BL and FU2 respectively. BL to FU2 ecSI 2.0TM change was not significant when controlling for changes in stress or physical activity. However, compared to those with increased FU2 BMI, ecSI 2.0TM tended (P = 0.06) to increase when BMI was decreased or unchanged, even when controlling for BL BMI. BL to FU2 ecSI 2.0 change was inversely related to BMI change (P = 0.01). ecSI 2.0TM tended to decrease for control, but increase for intervention parents (P = 0.07; –0.34 vs. 1.05), but not when controlling for BMI change. Conclusions An intervention with attention to EC congruent tenets showed modest effect on ecSI 2.0TM suggesting that successful programs require attributes that directly align with EC, which may be uniquely different from traditional nutrition education. Accurate EC intervention assessment required consideration of BMI change. Funding Sources USDA, NIFA.

HLA-G14bp ins/del polymorphism and post-transplant weight gain in kidney transplantation: potential implications beyond tolerance

BackgroundHuman leukocyte antigen (HLA)-G is a non-classical HLA molecule with immunomodulant and immunosuppressive functions, involved in transplantation tolerance. HLA-G14bp ins/del polymorphism in exon 8 has been associated with allograft rejection and kidney transplant outcome, with controversial results. We investigated associations of HLA-G14bp ins/del polymorphism on onset of some of the main post-transplant risk factors, like excess body weight, lipid abnormalities, increased fasting plasma glucose. Polymorphisms of cytokines with both immunosuppressive and metabolic effects were also assessed for comparisons and associated analysis.MethodsThe present study involved kidney transplant recipients (n = 173) in which body mass index, cholesterol, triglycerides, fasting plasma glucose were registered in the first years after transplantation and analyzed in association with genotypes. Presence of hypertension and smoking habits, demographic, transplant-related and therapeutic data of patients were also recorded. Polymerase chain reaction, sequence-specific primer amplification and Taqman allelic discrimination techniques were used for genotyping of HLA-G14bp ins/del, interleukin (IL)-10(−1082G > A,-819 T > C,–592A > C), transforming growth factor-β(+ 869 T > C,+915C > G), IL-6(−174G > C), tumor necrosis factor-α(−308G > A) and IL-18(−137G > C,-607C > A). Effects of genotypes on clinical markers at each time point (pre-transplant and 1 to 5 years after transplant) were analyzed using a repeated-measures general linear model analysis; adjustment for potential confounders was performed.ResultsResults showed that HLA-G14bp ins/ins was significantly associated with obesity, in particular after transplantation (3 years, p = 0.002, OR = 4.48, 95% CI:1.76–11.41). Post-transplant body mass index was significantly increased in HLA-G14bp ins/ins carriers (3 and 4 years, p = 0.033 and p = 0.044); effects of HLA-G14bp genotypes on post-transplant BMI were confirmed by using repeated-measures analysis and after controlling for confounding variables. Cytokine genotypes did not associate with the examined factors.ConclusionsThe study of transplanted patients allowed to evidence a potential relationship between post-transplant weight gain and HLA-G14bp ins/del polymorphism, previously involved in rejection for its immunosuppressive/tolerogenic activity. This novel association could widen the knowledge of the role and functions of HLA-G molecules in diseases and transplantation.

Family Perceptions of Quality of Life for Pediatric Home Ventilator Patients

Home mechanical ventilation is an alternative to institutional management for some children with chronic or degenerative respiratory and neuromuscular disorders. Over the past 20 years, Children’s Hospital of Philadelphia has enhanced its Home Care Home Ventilator Program, designed to transition hospitalized children requiring long-term mechanical ventilation safely home. Program goals include supporting patient safety, medical stability, and caregiver competence while promoting quality of life. This longitudinal quality improvement project examined perceived quality of life for families with children discharged home for the first time on mechanical ventilation. We sought to identify unmet needs related to this transition. A self-report quality-of-life survey adapted from several validated tools was completed by the primary caregiver at 3 specific times over 6 months. Repeated-measures general linear modeling examined changes over time in caregivers’ perceptions of quality of life and confidence in meeting their child’s ongoing healthcare needs. After completing the inpatient portion of the program, followed by 6 months caring for their child at home with support from the hospital’s Home Care Department and Technology Dependence Center, caregivers reported more time to attend to their own needs and family activities, less financial burden, less anxiety, and perceived improvements in their child’s health and quality of life compared with hospitalization. Based on our findings, one program change was implemented: the Home Care social worker now meets with the family prior to discharge.

A Novel Experiential Quality Improvement Training Program During Residency Improves Quality Improvement Confidence and Knowledge: a Prospective Cohort Study.

The Accreditation Council for Graduate Medical Education (ACGME) mandates resident quality improvement (QI) training to improve patient safety, cost control, and efficiency. Thus, understanding this topic is crucial for early career physicians. This manuscript describes an enhanced, experiential QI curriculum for psychiatry residents and its outcomes. Two cohorts of 12 third-year residents completed the curriculum, which included didactics, external resources, and expert guidance through small group project design, implementation, and analysis/presentation. A survey on resident confidence in QI principles and the quality improvement knowledge assessment tool-revised (QIKAT-R) was used before and after curriculum participation. Data were analyzed using parametric descriptive tests and repeated measures general linear models with Benjamini-Hochberg correction for multiple comparisons. Resident confidence in performing seven of the ten steps of QI and QIKAT-R scores significantly improved for both cohorts (p = .011). Eighty-nine percent of residents felt that the curriculum met their goals. The QI curriculum effectively improved resident QI confidence and knowledge. Residents reported that experiential engagement in the design, implementation, and analysis/presentation of their project was crucial to these achievements. This experiential QI curriculum with resident-generated QI projects addressed ACGME training requirements while integrating QI training directly into the residents' clinical activities, making the QI efforts relevant and meaningful while also achieving ACGME goals.

Evaluation of a Workflow to Define Low Specific Absorption Rate MRI Protocols for Patients With Active Implantable Medical Devices.

MRI exams for patients with MR-conditional active implantable medical devices (AIMDs) are contraindicated unless specific conditions are met. This limits the maximum specific absorption rate (SAR, W/kg). Currently, there is no general framework to guide meeting a lower SAR limit. To design and evaluate a workflow for modifying MRI protocols to whole-body SAR (WB-SAR ≤0.1 W/kg) and local-head SAR (LH-SAR ≤0.3 W/kg) limits while mitigating the impact on image quality and exam time. Prospective. Twenty healthy volunteers on head (n = 5), C-spine (n = 5), T-spine (n = 5), and L-spine (n = 5) with IRB consent. Vendor-provided head, C-spine, T-spine, and L-spine protocols (SARRT ) were modified to meet both low SAR targets (SARLOW ) using the proposed workflow. in vitro SNR and CNR were evaluated with a T1 -T2 phantom. in vivo image quality and clinical acceptability were scored using a 5-point Likert scale for two blinded readers. 1.5T/spin-echoes, gradient-echoes. In vitro SNR and CNR values were evaluated with a repeated measures general linear model. in vivo image quality and clinical acceptability were evaluated using a generalized estimating equation analysis (GEE). The two reader's level of agreement was analyzed using Cohen's kappa statistical analysis. Using the workflow, SAR limits were met. 0.12 ± 0.02 W/kg, median (SD) values for LH-SAR were 0.12 (0.02) W/kg and WB-SAR: 0.09 (0.01) W/kg. Examination time did not increase ≤2x the initial time. SARRT SNR values were higher and significantly different than SARLOW (P < 0.05). However, no significant difference was observed between the CNR values (value = 0.21). Median (IQR) CNR values were 14.2 (25.0) vs. 15.1 (9.2) for head, 12.1 (16.9) vs. 25.3 (14.2) for C-spine, 81.6 (70.1) vs. 71.0 (26.6) for T-spine, and 51.4 (52.6) vs. 37.7 (27.3) for L-spine. Image quality scores were not significantly different between SARRT and SARLOW (median [SD] scores were 4.0 [0.01] vs. 4.3 [0.2], P > 0.05). The proposed workflow provides guidance for modifying routine MRI exams to achieve low SAR limits. This can benefit patients referred for an MRI exam with low SAR MR-conditional AIMDs. 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;52:91-102.

Depressive symptoms moderate cannabis use for young adults in a Text-Delivered randomized clinical trial for cannabis use disorder

BackgroundThe importance and complexity of addressing both substance use and mood disorders such as depression within traditional treatment settings is well established. However, little is known about this issue within the context of mHealth treatment. Research is needed to determine if depression interacts with mHealth delivered cannabis use disorder treatment similarly compared traditional treatments. ObjectiveWe examined the moderating effect of depressive symptoms on cannabis use with 96 young adults (ages 18 to 25) enrolled in a text-delivered randomized clinical trial for cannabis use disorder. Participants were followed for three months. MethodWe used a repeated measures general linear model to test if depressive symptoms moderated the treatment’s effect on cannabis use. Self-report of past 30-day use and urinalysis of THC metabolites were the outcome measures. Depressive symptoms were measured using the PHQ-2, with scores >3 serving as the clinical cut-point, indicating likely depression disorder. ResultsParticipants with sub-threshold depression scores significantly reduced the number of days they used cannabis across all three months of the study. For participants with scores above the clinical cut-point, treatment had no effect on cannabis use. Similarly, participants with sub-threshold depression scores reduced the number of positive urinalysis results at three months. Effect sizes ranged from small to medium. ConclusionResults support the importance of simultaneously addressing depressive symptoms and cannabis use when treating young adults using text-delivered counseling. As mHealth interventions continue to demonstrate efficacy in addressing substance use disorders, the integration of mood disorder treatments appears warranted.