Sequential Studies Research Articles

Forecasting the evolution of urban mobility: The influence of anthropomorphism and social responsiveness in the transition from human to automated driving

The transition to automated driving has prompted efforts to anthropomorphize urban transportation, aiming to replicate traditional driver-pedestrian interactions and enhance safety when human drivers are absent. However, prior research on anthropomorphism has shown inconsistency, potentially hindering its practical implementation in pedestrian-vehicle interactions. This study addressed these inconsistencies by examining the contingent role of social responsiveness. Using a 2 × 2 between-subjects experimental design, this study investigated the crossover interaction effects of anthropomorphism and social responsiveness on pedestrian-vehicle interactions at urban crossings. Two sequential studies were conducted: Study 1 examined the crossover interaction effects on cognitive factors and behavioral consequences (responsibility attribution and behavioral intention). Study 2 delved into the underlying mechanisms and contingencies of these interactions. Results reveal: (1) combining anthropomorphism and social responsiveness is crucial for effective pedestrian crossing and communication in the absence of human drivers; (2) the positive effects of this combination on responsibility attribution and behavioral intention are mediated by cognitive factors; and (3) non-responsive humanoid vehicles may not measure up to non-responsive, non-humanoid vehicles, yet responsive humanoid vehicles can outperform responsive, non-humanoid vehicles. These findings support the theory and guide the development of secure, interactive designs for the next generation of urban mobility in the transition to automated driving.

Towards a new generation of fluvial facies models for the interpretation of ancient deposits, based on inter‐annual peak discharge variance of modern rivers

ABSTRACTFluvial facies models based on river planform are flawed and not fully fit for purpose. An alternative approach to classifying fluvial deposits is based on river discharge characteristics. A recent paper showed that the co‐efficient of variance of annual peak discharge (CVQp) correlates well with the characteristics of preserved alluvium for a suite of modern rivers. Here, the database of rivers is expanded and augmented, and the utility of this statistic confirmed. For modern rivers, plotting the running‐value of CVQp for a set interval (for example, 30 years) over a longer discharge record shows that the statistic varies both spatially and temporally. The CVQp can rise abruptly at a given location in response to a single flow event if that event is significantly larger than is common in that river. Such abrupt changes in CVQp are superimposed on longer‐term patterns of more gradual change stimulated by environmental factors or anthropogenic effects such as dam construction. If the period of calculation for CVQp is relatively short, ‘anomalous’ events appear more frequently. Sequential studies of modern rivers indicate that such anomalous events have a high probability of being preserved in the alluvial record of the river, and suggest that, over the timeframes of channel filling and abandonment, they may constitute the dominant (characteristic) portion of the record in high CVQp systems. Since flow events with strongly peaked hydrographs (flashy discharges) are more common in high CVQp systems and leave a record dominated by upper flow regime stratification styles, it follows that the alluvial record of high CVQp rivers will be dominated by upper flow regime stratification. In contrast, in lower CVQp systems the occurrence of an event that changes the running CVQp value significantly may form a distinct event deposit, and the temporarily changed CVQp is unrepresentative for the duration of the channel's life. The dominance of upper flow regime stratification, together with decreased preservation of identifiable macroform structure, increased lateral lithological heterogeneity, and in many cases increased preservation of in situ tree fossils in channel deposits of higher CVQp rivers, forms the basis for a series of new facies models for low, moderate, high and very high/ultra‐high CVQp alluvial systems and deposits. The new models can be applied to ancient successions either in combination with traditional, planform‐based models, or not. These models provide information about ancient palaeoenvironmental conditions, and changes in such conditions over time at various scales via stratigraphic investigations.

Reconstructing of the geometry of Atg13 and Atg101 molecules while assembling the complex

Aim. Associated subproteins which constitute the ATG1 multi-protein complex in plants and mammals, including ULK1 in humans, are orchestral protein kinase atg-units in resistance to stress stimuli across their different nature. The goals of this endeavour were to characterize the molecular nature of the interaction of ATG13 with ATG101, followed by in silico docking to catch the plausible ensuing integration into a multimeric complex ULK1/ATG1, which initiates the assembly of a PAS-preautophagosomal structure in the first step of autophagy initiation. Methods. Protein structures were modeled by homology using AlphaFold, and molecular dynamics (MD) was performed using GROMACS 5.0 with the Charmm36. Results. By implementing computer modeling methods, a complex of protein kinase atg-units for both ATG13 and ATG101 proteins, reflecting the interaction interface and conformational properties, was constructed for detailed interpretation while forming the forthcoming assembly of the ULK1/ATG1 multi-protein platform. Conclusions. This study provides a high-quality model platform for further sequential studies of protein-protein docking and protein-protein interactions with the possibility of reconstructing a model of the full ULK1/ATG1 complex to identify ATG8 binding sites.

The usability of a wireless vocal fold vibration switch for individuals with complex communication needs: a caregiver-inclusive iterative home-based evaluation

Purpose: A vocal fold vibration switch is a type of access technology that detects voluntary vibrations of the vocal cords. In two sequential usability studies, we evaluated successive prototypes of a novel wireless vocal fold vibration switch. Methods: Each usability study enroled 7 dyads consisting of individuals with complex communication needs and their caregivers. Each study entailed a 2-week period of independent home use flanked by initial and final usability tests. Each usability test comprised nine tasks including donning and configuration of the switch, connecting it to other devices, and actual activation of the switch. Perceived task difficulty was measured via nine 21-point scales, while caregiver impressions were captured through open-ended questions, both encapsulated within a usability questionnaire. Caregivers described their experience in an open-ended interview in the second usability study. Results: Perceived task difficulty was uniformly low with both prototypes. The vast majority of tasks could be completed either independently or with hints. A small number of contraindications for use were identified with the second prototype, which included episodes of dystonia and heavy breathing, and some aspects of the physical design and robustness were flagged as needing further improvement. Conclusions: The overall qualitative feedback was overwhelmingly positive with caregivers generally desiring to keep and eager to recommend the device to others. Additionally, caregivers expressed that the vocal fold vibration switch expanded the switch user’s capabilities, and they foresaw applications beyond the study setting. Overall, our findings suggest that the wireless vocal fold vibration switch is useable in the home setting.

Enteric methane emissions from zebu cattle are influenced by seasonal variations in rangeland fodder quality and intake

Rangeland fodder resources used to feed ruminants in the Sahel decline considerably in both quantity and quality from the wet to dry seasons. While it is widely assumed worldwide that this seasonality of fodder supply impacts intake levels and therefore enteric methane (eCH4) emissions, there are very few references based on in vivo measurements of eCH4 in this region. The purpose of this study was to test the assumption that the seasonality of fodder supply impacts intake levels and consequently eCH4 in ruminants. Thus, eCH4 was measured in vivo in Sudanese Fulani zebu cattle during three main seasons of the year (wet season: WS, cold dry season: CDS, and hot dry season: HDS). The experiment was carried out on 10 steers aged 32 months with an average (± SD) initial BW of 138 ± 5.8 kg (i.e. 0.55 Tropical Livestock Unit − TLU) and kept in individual pens. Animals were fed with natural rangeland fodder harvested each season following herders’ practices, i.e. green fodder in the WS and dry fodder hay in the CDS and HDS. Different levels of fodder were offered to the animals to reproduce the gradient of fodder availability on rangelands over the year (six trials): 3.3% BW during the CDS; 3.3, 2.3, and 1.4% BW successively during the HDS; and 2.3% in two sequential studies in the WS. Each trial lasted 3 weeks, split into 2 weeks of fodder adaptation and 1 week of data collection. The BW, quantity of voluntary DM intake, digestibility of DM digestibility and of OM digestibility, and eCH4 (GreenFeed® system) were measured for each animal. Fodder composition varied considerably between seasons (P < 0.05). The DM intake (g/kg BW per day) varied from 23.9 in CDS to 15.7 in HDS and 22.3 in WS (P < 0.001). The DM digestibility varied from 0.50 in CDS to 0.46 in HDS and 0.57 in WS. The eCH4 yields (g/kg DM intake per day) varied significantly from 25.2 in the CDS to 31.8 in the HDS and 20.5 in the WS. When extrapolated over a full year and irrespective of season, eCH4 emissions for steers amounted to 68.1 g/d (24.6 g/kg DM intake per day, 46.7 ± 3.34 kg of eCH4/TLU per year). Variations in the various parameters recorded in different areas and during the main seasons must therefore be accounted for in national inventories to refine eCH4 data for ruminants in Sub-Saharan Africa.

When virtual others are with me: exploring the influence of social presence in virtual reality wine tourism experiences

PurposeThe purpose of this study is to examine the role of social presence in enhancing positive behaviors in the virtual reality (VR)-based wine tourism context through an innovative approach.Design/methodology/approachTwo sequential experimental studies were conducted to test proposed hypotheses using Web and head-mounted display (HMD) VR formats. Specifically, Study 1 probed the influence of social presence on mental imagery, which subsequently impacted destination visit intention, drinking intent and memorable experience. Study 2 used a field experiment to explore the boundary effects of environmental cues (nature versus social) on social presence and a series of behavioral intentions using an HMD format.FindingsThe findings represent one of the first efforts to unravel the influence of social presence on positive behaviors through mental imagery and the moderating role of environmental cues.Research limitations/implicationsThis research enhances the understanding of wine tourism, drawing upon social presence theory and stimulus-organism-response framework.Practical implicationsThe outcomes provide valuable insights for wine tourism marketers in developing innovative marketing strategies by addressing the usage of social presence and environmental cues in a VR setting.Originality/valueTo the best of the authors’ knowledge, this study is the first to enrich the existing knowledge of wine tourism by exploring the role of social presence and environmental cues in both Web and HMD VR formats.

Adverse event assessment in a parenting programme: experiences from a multisite randomised controlled trial

BackgroundClinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool.MethodsAs part of the RISE project (prevention of child mental health problems in South-eastern Europe—adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted.ResultsThe response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost–benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes.ConclusionThe applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others—with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies.Trial registrationClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730. Registered on 13 January 2021.

The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study.

Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.

Neural network model for prediction of possible sarcopenic obesity using Korean national fitness award data (2010–2023)

Sarcopenic obesity (SO) is characterized by concomitant sarcopenia and obesity and presents a high risk of disability, morbidity, and mortality among older adults. However, predictions based on sequential neural network SO studies and the relationship between physical fitness factors and SO are lacking. This study aimed to develop a predictive model for SO in older adults by focusing on physical fitness factors. A comprehensive dataset of older Korean adults participating in national fitness programs was analyzed using sequential neural networks. Appendicular skeletal muscle/body weight was defined as SO using an anthropometric equation. Independent variables included body fat (BF, %), waist circumference, systolic and diastolic blood pressure, and various physical fitness factors. The dependent variable was a binary outcome (possible SO vs normal). We analyzed hyperparameter tuning and stratified K-fold validation to optimize a predictive model. The prevalence of SO was significantly higher in women (13.81%) than in men, highlighting sex-specific differences. The optimized neural network model and Shapley Additive Explanations analysis demonstrated a high validation accuracy of 93.1%, with BF% and absolute grip strength emerging as the most influential predictors of SO. This study presents a highly accurate predictive model for SO in older adults, emphasizing the critical roles of BF% and absolute grip strength. We identified BF, absolute grip strength, and sit-and-reach as key SO predictors. Our findings underscore the sex-specific nature of SO and the importance of physical fitness factors in its prediction.

Measuring identification with narrative characters: the development and validation of a new scale

During narrative reception, one psychological response audiences may experience toward story characters is identification, which involves a sense of merging between self and character. Given the lack of formally validated measures of this construct in the literature, the current paper introduces a new 12-item scale for measuring identification. Scale development and validation took place over three sequential studies. Exploratory factor analysis in Study 1 (N = 224) indicated four related factors: merging, perspective-taking, understanding, and emotional involvement. In Study 2 (N = 191), confirmatory factor analysis suggested that a second-order four-factor model provided a good fit to the data and a more parsimonious explanation of the scale’s factor structure compared to a first-order model. In addition, the overall scale and subscales demonstrated adequate internal consistency and correlated in the expected directions with theoretically relevant and irrelevant constructs. Using a more demographically diverse sample, Study 3 (N = 290) established measurement invariance of the scale across two narratives in terms of configural, metric, and partial scalar invariance, and provided further support for its factor structure, reliability, and validity.

From social categorization to implicit citizenship theories: Advancing the socio‐cognitive foundations of state–citizen interactions

AbstractPublic administration research has recently paid increasing attention to public employees' social categorization of citizens and the consequences thereof for administrative decision‐making. We advance this line of scholarship by theorizing the concept of implicit citizenship theories (ICTs) and elaborating it in four sequential empirical studies. ICTs are implicit assumptions about citizens' typical or ideal characteristics that emerge freely and associatively in the minds of public employees and guide cognitive categorization. We investigate the content and structure of these ICTs and extract a taxonomy of six distinctive, yet interrelated, prototypes of citizens that public employees bring to their jobs. As implicit theories influence attitudes and behaviors, ICTs are relevant to the quality of public services delivered to citizens. This is particularly evident where negative prototypes give rise to unequal treatment. Practical interventions to change those prototypes might target their individual beholders or the social context that makes ICTs accessible.

Influences of past moral behavior on future behavior: A review of sequential moral behavior studies using meta-analytic techniques.

Experimental research on sequential moral behavior (SMB) has found that engaging in an initial moral (or immoral) behavior can sometimes lead to moral balancing (i.e., switching between positive and negative behavior) and sometimes to moral consistency (i.e., maintaining a consistent pattern of positive or negative behavior). In two meta-analyses, we present the first comprehensive syntheses of SMB studies and test moderators to identify the conditions under which moral balancing and moral consistency are most likely to occur. Meta-Analysis 1 (k = 217 effect sizes, N = 31,242) revealed that engaging in an initial positive behavior only reliably resulted in moral licensing (i.e., balancing) in studies that measured engagement in negative target behaviors (Hedges' g = 0.25, 95% CI [0.16, 0.44]) and only resulted in positive consistency in foot-in-the-door studies using prosocial requests (Hedges' g = -0.44, 95% CI [-0.59, -0.29]). Meta-Analysis 2 (k = 132 effect sizes, N = 14,443) revealed that engaging in an initial negative behavior only reliably resulted in moral compensation (i.e., balancing) in studies that measured engagement in positive target behaviors (Hedges' g = 0.27, 95% CI [0.18, 0.37]). We found no evidence for reliable negative consistency effects in any conditions. These results cannot be readily explained by current theories of SMB effects, and so further research is needed to better understand the mechanisms that drive moral balancing and consistency under the conditions observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sustainable treatment scheme for in-situ remediation of contaminated drains using engineered natural systems

Ensuring water security in resource-constrained, densely populated regions is a significant challenge globally. Due to insufficient treatment infrastructure, untreated sewage discharge into drainage channels is prevalent, especially in developing countries. This leads to the pollution of already dwindling water bodies and threatens future water availability. In this context, in-situ treatment within drains using nature-based systems is an attractive option. This study evaluates microbial bioremediation and phytoremediation as engineered natural solutions for in-stream treatment of municipal wastewater. A three-stage treatment system consisting of anoxic biofilm, aerobic biofilm, and hydroponic floating wetlands was adopted. Each stage was optimized for operational parameters through batch and continuous flow studies. The anoxic biofilm system using autoclaved aerated concrete (AAC) as the attachment media, at an optimized hydraulic retention time (HRT) of 2 h, showed the best performance with respect to COD removal. Comparable COD removal was observed in both externally aerated and non-aerated aerobic biofilm systems with coir fibre at 6 h HRT. However, aerated system outperformed non-aerated system at low HRTs. The hydroponic system with Canna indica effectively removed residual ammonia-N with an HRT of 2 h. The sequential continuous flow studies employing the optimized conditions showed significant removals of COD (86%) and ammonia-N (97.6%). The results highlight that locally available materials having a high specific surface area can be used as biofilm supports for COD removal, and floating wetlands employing indigenous macrophytes can be an ideal choice for in-situ nutrient removal. The Life Cycle Assessment (LCA) showed that the developed system did not have direct significant impacts on freshwater eco-toxicity and eutrophication. The proposed hybrid treatment system can be implemented as modular units without major drainage modifications or energy-intensive operations. The study, therefore, finds potential application in densely populated settlements in low-income countries where systematic sewage treatment options remain inadequate.

Abstract A015: Novel genetic driver for the genesis of muscle invasion in bladder cancer

Abstract Non-muscle invasive bladder cancer (NMIBC) is a heterogeneous type of urothelial carcinoma with a substantial risk (&amp;gt;50%) of tumor progression and muscle invasion. Our sequential studies uniquely unveiled the availability of Retinal Degeneration Protein 3 (RD3) in human adult/fetal tissues and recognized its functional significance in tumor evolution. Herein, we investigated the relevance of RD3 in coordinating de novo MIBC from NMIBC. Compared to the low-grade tumor, RD3 is significantly lost (mRNA, qPCR; protein, ELISA) in grade III and IV patient derived NMIBC cells. In a cohort of (n=55) NMIBC patients, RD3-loss associated with increased tumor invasive potential (complete loss in highly invasive T4), metastasis (vs. primary tumors), therapy pressure (insignificant levels in progressive disease that defies therapy), disease recurrence, and death (custom archived TMA with automated RD3 IHC).Crucially, we observed a significant low-is-worse association to overall survival (p=7.30E-03, hazard ratio (HR) of 5.161), relapse-free survival (p=4.464E-02, HR = 2.328), and progression-free survival (p=7.00E-0.4, HR = 3.264). Further, radio-resistant cells exposed to fractionated irradiation (FIR, 2Gy/Day for 5 days) to a total dose of 10 or 20Gy displayed a dose dependent loss of RD3 recognizing an ongoing acquisition of RD3-loss with therapy pressure. More interestingly, Grade I or III bystander cells (BSE) co-cultured with FIR-exposed cells displayed anew acquisition of RD3-loss and displayed tumor grade-dependent increase (vs. mock-irradiated) in NFkB transcriptional activity (EMSA) and the activation of NFkB trans-activated pro-survival molecules (QPCR profiling of 89 NFkB targets). Together, these results clearly depict that RD3 regulates NMIBC disease pathogenesis, dissemination, acquired loss of RD3 with therapy pressure and further implies its role in the evolution of de novo MIBC from NMIBC. Funding: DOD CA-210339, OCAST-HR19-045, NIH-P20GM103639, NIH-NCI-P30CA225520 and TSET-R23-03. Citation Format: Sreenidhi Mohanvelu, Poorvi Subramanian, Sabir Salim, Dinesh Babu Somasundaram, Sheeja Aravindan, Natarajan Aravindan. Novel genetic driver for the genesis of muscle invasion in bladder cancer [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr A015.

Radiographic analysis in Thoroughbreds reveals morphological changes in healthy maturing stifle joints and possible association between subchondral lesions and femoral condyle width.

Assess femorotibial features in foals with and without medial femoral condyle (MFC) subchondral radiolucencies (SR+ and SR-). 3 independent, sequential radiographic studies were performed. Study 1 retrospectively measured femorotibial morphological parameters in repository radiographs (SR- and SR+). Study 2 qualitatively compared drawings of intercondylar notch shape in postmortem radiographs (SR-). Study 3 prospectively measured femorotibial parameters in 1-month-old foals (SR-). In studies 1 and 3, 13 morphologic parameters were measured. Limb directional asymmetry was assessed in 2 age groups (< 7 or ≥ 7 months). Study 1 (SR- group; n = 183 radiographs) showed increased femoral measurements with maturation, except the distal femoral intercondylar notch width (FINwal), which decreased. In contrast, in SR+ stifles (53 radiographs), 3 femoral parameters (MFC width [MFCwpf], MFC height, or FINwal) showed no changes. Tibial plateau width alone increased with maturation in both groups. Interobserver reliability was good to excellent. Study 2 (n = 53 radiographs) confirmed a distal FINw decrease in SR- foals. In study 1, left SR- stifles in greater than or equal to 7-month-old fillies had significantly larger femoral bicondylar width and FINw, while right SR+ stifles in fillies greater than or equal to 7 months had a significantly larger MFCw. In study 3 of 1-month-old foals (n = 94 SR- radiographs), the MFCw, femoral condyle bicondylar width, and lateral femoral condyle height were all greater on the left, whereas the intercondylar intereminence space width was larger on the right. In SR+ stifles, the distal femur exhibited divergent maturation, indicating a wider MFC in the right stifle in older foals. As SR lesions are more common on the right, this suggests a potential association with MFC morphology.

Prognostic nomogram for uncontrolled type 2 diabetes using Thailand nation-wide cross-sectional studies.

Uncontrolled type 2 diabetes (T2DM) and limited hemoglobin A1c (HbA1c) levels examination are a burden in community hospitals in Thailand. The nomogram from the patients' information might be a practical solution to identify a high-risk group of diabetic complications. Thus, this study aimed to establish an effective prognostic nomogram for patients with uncontrolled T2DM. Sequential nationwide cross-sectional studies of T2DM patients in 2018 and 2015 were utilized for development and validation groups, respectively, with this chronological order aiming to capture recent trends during development and assess the nomogram's robustness across diverse timeframes. The predictive outcome was uncontrolled T2DM, defined as HbA1c ≥9%. The model was determined by multivariable regression analysis and established an effective prognostic nomogram. The receiver operating characteristic curve, Hosmer-Lemeshow goodness of fit test, and decision curve analysis (DCA) was applied to evaluate the performance of the nomogram. In 2018, 24% of the 38,568 participants in the development group had uncontrolled T2DM (defined as Hba1c ≥9%). The predictive nomogram of uncontrolled diabetes consisted of demographic characteristics, prescription medications, history of diabetic complications, and laboratory results (C-statistic of 0.77). The goodness of fit test and DCA showed good agreement between the result and clinical application for T2DM. The predictive nomogram demonstrates simplicity, accuracy, and valuable prediction to enhance diabetic care in resource-limited countries, including Thailand.

Serial repetitive nerve stimulation studies in organophosphorus poisoning indicate two distinct pathophysiological processes occur at the neuromuscular junction in the intermediate syndrome

Introduction Intermediate syndrome is an important cause of respiratory failure following acute organophosphorus pesticide poisoning. The objective of this study was to examine the pathophysiology of this syndrome by analysis of sequential repetitive nerve stimulation studies in patients with acute organophosphorus pesticide poisoning. Methods Thirty-four consenting symptomatic patients with acute organophosphorus pesticide poisoning with intermediate syndrome (n = 10) or a milder forme fruste intermediate syndrome (n = 24) were assessed prospectively with daily physical examination and repetitive nerve stimulation done on the right and left median and ulnar nerves. The compound muscle action potential at 1, 3, 10, 15, 20 and 30 Hertz was measured with a train of ten stimuli. The amplitudes of the resulting stimuli were normalized to the first stimulus (100 per cent) and plotted against time. The decrease in the area under the curve of all the second stimulus compound muscle action potentials in the first 0.3 seconds was measured as a means of quantifying the refractory block. The decrease in the area under the curve under the 10, 15, 20 and 30 Hertz compound muscle action potentials relative to this pooled second stimulus compound muscle action potentials-area under the curve indicated the extent of additional rate-dependent block (decreasing compound muscle action potential-area under the curve over the first 0.3 seconds after the first stimulus with increasing Hertz). Results These new measurements strongly correlated with the severity of weakness. Refractory block was seen in most patients but was more severe in those with intermediate syndrome than those with forme fruste (partial) intermediate syndrome (median 55 per cent versus 16 per cent, P = 0.0001). Similar large differences were found for rate-dependent block (30 per cent versus 7 per cent, P = 0.001), which was uncommon in forme fruste intermediate syndrome but found in nine out of 10 patients with intermediate syndrome. Rate dependent block was generally only observed after 24 hours. The simplest strong predictor was total block at 30 Hertz repetitive nerve stimulation (89 per cent [interquartile range 73 to 94 per cent] versus 21 per cent [4 to 55 per cent]; P < 0.0001), which was very similar to total block calculated by summing other calculations. Discussion These findings likely represent depolarization and desensitization block from prolonged excessive cholinergic stimulation but it is not clear if these are from pre- or post-synaptic pathology. An animal model of intermediate syndrome with repetitive nerve stimulation studies might enable a better pathophysiological understanding of the two types of block. Limitations The limited number of repetitive nerve stimulation studies performed were sufficient to demonstrate proof-of-concept, but further studies with more patients are needed to better define the correlates, clinical relevance and possible diagnostic/prognostic roles for the use of this technique. Conclusion There are two easily distinguishable pathophysiological abnormalities in the neuromuscular block in intermediate syndrome. While they often coincide, both may be observed in isolation. The total and rate-dependent block at 30 Hertz are strongly associated with more severe weakness.

Level of Supervision for the Entrustable Professional Activities Common to General Pediatrics and the Subspecialties Decreases from Residency to Fellowship

ObjectivesTo compare level of supervision (LOS) ratings of graduating pediatric residents with their assessments as fellows for the five Entrustable Professional Activities (EPAs) common to general pediatrics and the subspecialties and to determine if the difference between ratings from residency to fellowship is less for the QI and Practice Management EPAs, since the skills needed to perform these may be less context-dependent. MethodsWe compared ratings of graduating residents with their assessments as fellows using LOS data from two sequential EPA studies. ResultsThere were 65 ratings from 41 residents at the first fellow assessment. At graduation, most residents needed little to no supervision for all EPAs with 94% (61/65) of ratings level four or five. In contrast, only 5/65 (8%) of the first fellow assessments were level four or five. The ratings difference for the QI and Practice Management EPAs was similar to the others. ConclusionsLOS ratings for the EPAs common to generalists and subspecialists reset as residents become fellows. There was no evidence that the QI and Practice Management EPAs are less context-dependent. This study provides additional validity evidence for using these LOS scales to assess trainees in pediatric residency and fellowship.

Exploring Public Schools as a Primary Setting for Early Prevention in Rural Areas: A Qualitative Approach to Strengthening the Trauma-Informed Elementary Schools (TIES) Program

Abstract Trauma-Informed Elementary Schools (TIES) is a pilot program designed to bring trauma-informed services to early elementary schools in a rural state. Although two sequential TIES pilot studies found significantly positive outcomes in cultivating a trauma-sensitive school climate and culture, the program has been limited to a few schools and has not yet been assessed for broader impact on primary stakeholders. The current study explored stakeholders’ input in development of a comprehensive intervention plan by identifying the benefits and challenges of implementing the program and contributing their perspectives on strengthening the program. The study also explored the challenges of implementing the TIES program during the COVID-19 pandemic to optimize the program for its unique rural environment. Fourteen semistructured interviews were conducted via Zoom or in person. Two coauthors primarily used thematic analysis to categorize findings from transcribed interviews with NVivo. The participants identified positive impact of the program on children’s socioemotional learning and support with special attention to children in need and the overall improvement of general educational tasks for all children as a whole classroom. The results highlight the importance of the program as perceived by primary stakeholders and provide specific suggestions for improvement.

Preliminary Results from Retrospective Correlation of Circulating Tumor DNA (ct-DNA) with Imaging for HPV-Positive Oropharyngeal Squamous Cell Carcinoma.

The role of molecular markers is increasingly being recognized for head and neck tumors, ranging from benign lesions like paragangliomas to malignancies like squamous cell carcinomas. Multiple studies have recently validated blood tests for circulating tumor tissue-modified viral human papillomavirus DNA (HPV ct-DNA) for posttreatment surveillance of HPV-driven oropharyngeal squamous cell carcinomas. This technology quantifies fragments of circulating DNA that are shed into the blood stream with very high (>95%) positive and negative predictive values and are also highly sensitive in distinguishing tumor HPV-DNA from a noncancerous source. This study has a cohort of 34 patients with HPV-driven oropharyngeal squamous cell carcinomas, having at least 3 sequential imaging studies and ct-DNA values. The study showed a strong positive correlation between the imaging findings and the ct-DNA level in recurrent HPV-positive oropharyngeal squamous cell carcinomas. Findings also include the 100% negative predictive value of HPV ct-DNA tests to rule out tumor recurrence. At our institution, we are now routinely performing the ct-DNA assay for surveillance of treated HPV oropharyngeal squamous cell carcinomas. Correlation among clinical, radiologic, and biomarker findings are now part of routine discussions during the multidisciplinary tumor boards.