Standard Tools Research Articles

Patients Struggle With Severe Symptoms Even After Surviving Esophagectomy for Esophageal Cancer

BackgroundThis prospective study was conducted to determine postesophagectomy symptom severity of esophageal cancer survivors with use of the Upper Digestive Disease (UDD) questionnaire. MethodsA prospective trial included adult esophagectomy patients diagnosed with primary esophageal carcinoma at a single institution from 2000 to 2011. Those who remained alive in 2015 to 2021 were enrolled. Comparison was made between sequential questionnaires. ResultsFrom a prospective registry of 895 patients with esophagectomy for esophageal cancer, 297 (33%) long-term survivors were identified. Of those, 93 (31%) had recent contact data and 66 (71%) consented and completed the UDD questionnaire. Most participants, 77% (51), were men with a mean age of 57 (±7) years. The mean time from esophagectomy was 12 (8-20) years. The 66 enrolled patients completed 127 UDD questionnaires. A total of 27 (41%) completed at least 2 questionnaires. Poor performance was recorded in the 5 domains as follows: reflux, 19 patients (29%); pain, 3 patients (5%); dysphagia, 0 patients; gastrointestinal dumping, 31 patients (47%); and generalized dumping, 17 patients (26%). Between the first and second questionnaires, dysphagia had the most noticeable improvement in domain score (23/27 [85%]), and reflux had the most regression in domain score (7/27 [26%]). ConclusionsPatient-reported outcome data are an integral part of esophageal cancer survivorship care. Having a standardized tool that would enhance research and standardize care pathway symptom management is needed.

DIAGNOSIS AND TREATMENT OF PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH DIABETES MELLITUS

Patients with endocrine disorders often present with concomitant cardiovascular diseases. Peripheral arterial disease (PAD) in individuals with type 2 diabetes exhibits various clinical characteristics and diverse consequences. One of its primary manifestations is macrovascular complications. Although atherosclerosis is the primary cause, other contributory factors come into play. Notably, individuals with diabetes experience a more severe clinical course, marked by higher amputation rates and significant differences in mortality. The ankle-brachial index (ABI) is the standard diagnostic tool for identifying arterial diseases, while angiography is considered the gold standard for assessing anatomical aspects. Effective management of comorbidities including type 2 diabetes, hypertension, and dyslipidemia, has a substantial impact on clinical progression. Atherosclerotic disease manifests through the narrowing of affected vessels, resulting in reduced blood flow. The diagnosis of PAD requires the management of risk factors, medication-based therapies, and interventions for lower extremity issues. Physical exercise is also a valuable approach for alleviating PAD symptoms and extending pain-free walking distances. For patients with refractory conditions, surgical interventions are recommended. In cases where atherosclerotic arterial lesions are minor, pose minimal surgical risk, and have a high likelihood of successful intervention, percutaneous transluminal angioplasty should be considered. Early intervention is recommended in the presence of rest pain, ischemic ulcers, or necrosis. Balloon angioplasty and stent placement have shown efficacy in symptom relief for many PAD patients. Recent technological advancements have expanded the use of endovascular procedures, even before considering traditional "open" methods. Lesion location and length are essential factors for the long-term success of percutaneous vascular interventions.

A sensory lexicon to characterize the quality of fresh and preserved peppers.

Pepper fruits (Capsicum annuum) are economically important commodities worldwide due to their unique sensory profiles and rich antioxidant properties. With ongoing research efforts in optimizing the production and processing of peppers, there is a need for a standardized tool to evaluate the quality of peppers and pepper products. The objective of this work was to develop a sensory lexicon to characterize fresh and preserved peppers. A panel of 10 volunteers was recruited and trained in quantitative descriptive sensory analysis for a total of 37h. Commercially available fresh, pickled, and roasted peppers were used to establish definitions, methods of evaluation, and reference materials for each unique attribute; and attribute intensities were scored on a scale ranging from 0 to 15. Commercially available fresh and preserved pepper samples (n=22) were evaluated by the panel in duplicate to validate the lexicon. Principal component analysis was used to visualize differences among the products, and attribute redundancies were evaluated through analysis of correlations. This lexicon with 46 clearly defined terms that describe fresh, pickled, and roasted pepper products is comprised of 14 aroma, 19 flavor, 9 texture, and 4 chemesthetic attributes. Smoky, burnt, and cooked tomato flavors were typical of roasted red bell peppers, while the floral attribute was characteristic of fresh red bell peppers, and vinegar, pungency, and spicy notes characterized pickled peppers. The lexicon enabled the characterization and differentiation of a wide range of pepper products and lays the framework for quality evaluation and product improvement. PRACTICAL APPLICATION: Breeders and processors are seeking technologies that ensure desirable quality of fresh and processed peppers for an extended shelf life. This sensory lexicon comprised of 14 aroma, 19 flavor, 9 texture, and 4 chemesthetic attributes serves as a basis for evaluating various strategies toward quality improvement, such as novel processing of pepper products.

Trends in Invasive Orthopedic Interventions in Patients with Hemophilia Enrolled in the Community Counts Program (2015-2021)

Background Recurrent joint bleeding due to hemophilia often leads to the development of chronic joint disease resulting in chronic pain, decreased joint function and a significant decline in quality of life. Invasive orthopedic interventions (IOI) such as arthroplasty and arthrodesis for end stage joint disease have historically been pursued to decrease pain and improve joint function especially in patients with severe hemophilia and joint disease. Using data collected on patients receiving care in a large network of hemophilia treatment centers in the United States (USHTCN), Tobase et al have previously reported a 5.6% decline in all IOI in patients with hemophilia during the period 2000-2010 (1). Aims The primary objective of the current analysis was to extend those findings using similar data collected during the period 2015-2021 with a focus on IOI indicative of end stage joint disease such as arthrodesis and arthroplasty. Data on IOI were collected annually during the period 2015-2021 from patients who participated in the Community Counts (CC) surveillance project at the 147 member USHTCN using standardized data collection tools. The proportion of patients having IOI in each year was calculated by dividing the total number of patients who reported an IOI by the total number of patients who had a CC visit in that year. Trends in proportions were plotted over time and assessed for statistical significance using the Cochran-Armitage trend test. Results In total, 8,378 CC patients with a diagnosis of hemophilia A or B, over the age of 2 years who completed a subsequent CC visit within last 12 months of last surveillance visit during the years 2015-2021 were included in this study. Enrollees reported a total of 28 arthrodesis and 168 arthroplasty procedures during a total of 21,082 clinic visits over the entire study period. We found that arthroplasty represented 42.6 %, 68.8%, 17.9%, 26.3%, and 7.4% of all procedures reported in the knee, hip, ankle, shoulder, and elbow, respectively (Figure 1). The rate of IOI during the study timeframe remained very low, with only 2.4% of all participants reporting an IOI. During 2015-2021 there was a statistically significant decline in IOI among all patients >=60 years of age (0.59% in 2015 vs. 0.27% in 2021) (p=0.0325) (Figure 2). Similarly, patients with severe hemophilia regardless of age experienced a significant decline in invasive procedures during the study period (1.69% in 2015 vs. 0.88% in 2021) (p=0.021). Conclusions The rates of IOI reported during the years 2015-2021 remained very low (~2.4%). This suggests less joint morbidity and a continued decline in the rates of end stage joint disease during the study period, likely due, at least in part, to improved therapy and early adoption of preventative factor replacement protocols.

Standard Risk Assessment Tools Fall Short to Assess Risk in Transplant Patients

Introduction: The HCT-CI (Hematopoietic Cell Transplantation-specific Comorbidity Index) predicts survival after HCT in patients with hematologic malignancies. HCT-CI ≥3 is associated with higher Non-Relapse Mortality (NRM) and lower overall survival in both allogeneic (allo) and autologous (auto)-HCT patients. The Disease Risk Index (DRI) Assessment Tool is a validated tool to categorize patients undergoing allo- transplant into risk categories based on disease status. It was developed to predict overall survival per disease status. This study was done to understand reasons for increased mortality in transplant patients at our center in 2021 compared to 2020 by comparing HCT-CI and DRI of transplant patients between the two years. Methods: The study was approved by our institution's IRB. A retrospective chart analysis of adult patients who underwent auto- or allo-HCT at Henry Ford Hospital in the years 2020 and 2021 was conducted. Relevant patient demographics, comorbidities, disease characteristics, and transplant-related data were collected. HCT-CI scores were calculated on all patients using the online calculator (https://www.mdcalc.com/calc/3980/hematopoietic-cell-transplantation-specific-comorbidity-index-hct-ci). Patients were also risk stratified based on the DRI Assessment Tool (https://cibmtr.org/CIBMTR/Resources/Research-Tools-Calculators/Disease-Risk-Index-DRI-Assignment-Tool). Data was reviewed and collected by investigators and compiled in a confidential platform. Results: A total of 166 patient records between 2020 and 2021 were reviewed. In 2020, 46 patients underwent auto-HCT and 28 underwent allo-HCT. In 2021, 58 patients underwent auto-HCT and 34 patients underwent allo-HCT. The one-year post transplant survival rates for patients are elucidated in Table 1. The median HCT-CI scores amongst the patients who underwent transplant was 3 in 2020 and 4 in 2021(refer Table 2). When assessing the Disease Risk Index, overall, more patients with higher disease risk were transplanted in 2021 compared to 2020 (refer Table 3). 16 patients (12 in 2021 and 4 in 2020) underwent transplant for diseases that are not included in the DRI assessment tool. Of these, 8 patients in 2021 underwent allo-HCT. These included aplastic anemia (AA), inherited bone marrow failure syndromes (BMF), solid tumors, primary CNS lymphomas, mycosis fungoides and hemophagocytic lymphohistiocytosis (HLH). Conclusion: The HCT-CI and the DRI are both tools used in transplant centers to risk stratify patients pre-transplant. The use of both tools can give a good sense of post-transplant outcomes, combining both individual patient characteristics as well as diseases specific variations. These data are also important for monitoring outcomes at transplant centers. In this study, patients who had an HCT-CI >/3 were similar in both years. The DRI however could not be ascertained in 16 patients, as these diseases are not currently included in the DRI. This makes outcome prediction for these particular patients suboptimal especially if they do not have as many comorbidities but still higher risk diseases. Furthermore, this precludes effective outcome monitoring in and amongst transplant centers. The combination of both the HCT-CI and the DRI would perform better if the DRI tool is revised to become more comprehensive or by creating a DRI that is specific for non-malignant disorders like AA, HLA and BMF. We intend to propose this to CIBMTR for further consideration.

Harnessing the benefits of the Nutrition Care Process Quality Evaluation and Standardization Tool: a national auditing initiative to improve quality of documentation.

The Nutrition Care Process Quality Standardization and Evaluation Tool (NCP QUEST) is a validated audit instrument assessing the quality of NCP documentation by Registered Dietitians Nutritionists (RDNs). The present quality improvement project describes change in documentation quality as measured by NCP QUEST and word count of notes after a monthly national digital training provided to Veteran Affairs (VA) RDNs. The training and adoption of NCP QUEST was voluntary. Facilities were recruited among those that had participated during the design and validation study of NCP QUEST. The NCP QUEST score was calculated and the word count was determined for 52 documentation notes (28 from NCP QUEST non-user facilities and 24 from NCP QUEST user facilities) before and after training. The mean pre-training NCP QUEST score for notes from NCP QUEST non-user facilities was 13.71 and 13.88 for NCP QUEST user facilities. The mean post training total NCP QUEST score for non-user facilities was 14.00 and 17.65 for user facilities, with no improvement for the non-user facilities (P=0.69). A significant improvement was identified for the NCP QUEST user facilities (P≤0.001). All facilities experienced a significant reduction in the word count of assessment notes (P=0.04). Use of the electronic NCP terminology website increased 123-fold and was sustained after the training. NCP QUEST users reported that the audit tool is useful. The NCP QUEST should be at the center of RDNs' training and more strategic effort is needed to engage practitioners in the optimal application of the NCP.

43 Application of the Moroccan Arabic Bedside Western Aphasia battery-Revised in Acute Stroke Care

Objective:Despite the prevalence of aphasia in Morocco, standardized quick assessment tools are not available for use with patients in acute stroke care. The present study set out to (1) describe the processes of linguistic adaptation of a Moroccan Arabic (MA) version of the Bedside Western Aphasia Battery-Revised (WAB-R), (2) examine the test’s sensitivity to the detection of aphasia in an acute clinical setting, and (3) measure the instrument’s ability to detect improvement in language ability in the acute period.Participants and Methods:To achieve the first objective, the English Bedside WAB-R was adapted to Moroccan Arabic by a group of linguists. The instrument’s psychometric properties were established by (1) ascertaining the test’s sensitivity to the presence of aphasia, and (2) verifying the tool’s validity and reliability. Participants included a group of age- and education-matched non-brain-damaged individuals (N = 106), a group of right hemisphere brain-lesioned patients (N = 20), and a group of left hemisphere aphasic patients (N = 52). To accomplish the second and third objectives, the Bedside MA-WAB-R was administered to a group of aphasic participants in the acute period (less than three months post-stroke), and a group of age- and education-matched participants (N = 20). Aphasic patients in the acute stage were tested twice on a seven-day interval (3 days and 10 days post-onset). All data were collected from the Neurology department at the University Medical Hospital Hassan II, and the study received approval from the ethics committee of the Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah.Results:Regarding the first objective, the results indicated that the MA-WAB-R is sensitive to the presence of aphasia, as revealed by the significantly worse performance of the aphasic group on all subtests relative to matched normal and right-hemisphere participants (p = .000). Analyses revealed excellent content and construct validity (correlations between subtests and AQ ranging from .5 to .8) as well as high inter-rater reliability, intra-rater reliability and test-retest reliability (ICC (2,1) > .9). For the second and third objectives, the results supported the test’s sensitivity to the detection of aphasia in the acute phase, as confirmed by the significantly worse performance of aphasic patients relative to matched normal controls (p = .000). The instrument also proved as a reliable measure of language improvement in the acute period, as supported by better scores on the second testing point relative to the first across all subtests.Conclusions:The MA-WAB-R is the first standardized assessment tool that can be used for a quick but reliable screening of aphasia in both chronic and acute clinical settings. The test can inform the initial diagnosis of aphasia, and guide a more comprehensive assessment of patients’ spared and impaired linguistic abilities within a context receiving little attention in the aphasia literature.

AlignOT: An Optimal Transport Based Algorithm for Fast 3D Alignment With Applications to Cryogenic Electron Microscopy Density Maps.

Aligning electron density maps from Cryogenic electron microscopy (cryo-EM) is a first key step for studying multiple conformations of a biomolecule. As this step remains costly and challenging, with standard alignment tools being potentially stuck in local minima, we propose here a new procedure, called AlignOT, which relies on the use of computational optimal transport (OT) to align EM maps in 3D space. By embedding a fast estimation of OT maps within a stochastic gradient descent algorithm, our method searches for a rotation that minimizes the Wasserstein distance between two maps, represented as point clouds. We quantify the impact of various parameters on the precision and accuracy of the alignment, and show that AlignOT can outperform the standard local alignment methods, with an increased range of rotation angles leading to proper alignment. We further benchmark AlignOT on various pairs of experimental maps, which account for different types of conformational heterogeneities and geometric properties. As our experiments show good performance, we anticipate that our method can be broadly applied to align 3D EM maps.

Implementation of a visual aid to improve disease comprehension in patients with new breast cancer diagnoses.

358 Background: Studies have shown that patients with new cancer diagnoses are overwhelmed due to the large amount of information presented at their initial oncology visit. Inability to meet these high informational demands has been associated with poorer outcomes. Most patient education is done verbally despite data showing that patients only retain 14% of verbal communication compared to 85% of information with visual aids. The aim of this study was to determine if implementation of a visual educational tool on breast cancer diagnosis and treatment would improve comprehension in patients with new diagnoses. Methods: We designed an educational tool to visually depict breast cancer subtype, stage, and treatment plan. We recruited English-speaking patients with new diagnoses of breast cancer who were seen for an initial oncology visit at the Mount Sinai Dubin Breast Center. Patients were randomized to receive the visual aid (intervention) or continue with standard-of-care (control). For patients randomized to the intervention arm, the oncologist used the visual aid to provide education on their diagnosis and treatment plan during the visit. All patients completed a survey at their initial visit and approximately 1 month after diagnosis. The survey included demographic information, patient preferences, and assessment of their understanding of diagnosis and treatment. The worksheet and surveys were piloted with 5 patients with breast cancer and modified based on their feedback. A knowledge score was calculated based on their survey responses with scores ranging from 2 (low knowledge) to 6 (all questions answered correctly). We utilized paired t-test to compare the means of knowledge scores at initial visit and 1 month follow up. Results: Twenty female patients were enrolled from 2022-2023 with a median age of 61 years. Ten patients were randomized to the intervention arm and 10 to the control arm. The initial mean knowledge score of the control group was 4.9 and the follow up mean score was 5.6 (P = 0.11). The initial mean score of the intervention group was 5.3 whereas the follow up mean score was 5.6 (P = 0.84). There was no significant difference between the intervention group and the control group (P = 0.944). An increase in overall scores was noted from initial to follow up survey in all groups. There was a complete elimination of all low scores (< 3) across both groups in the follow up survey. Conclusions: Education at the initial visit improves understanding of breast cancer diagnosis and treatment. Our study demonstrated a standardized informational tool did not improve understanding when compared to individualized teaching with their oncologist. However, our study was limited to a single breast cancer center with a small sample size and English-speaking patients. Next steps include translation of the educational tool into additional languages, as well as expansion of this study to a larger patient population.

A novel approach for standardizing clinical laboratory categorical test results using machine learning and string distance similarity

Standardizing clinical laboratory test results is critical for conducting clinical data science research and analysis. However, standardized data processing tools and guidelines are inadequate. In this paper, a novel approach for standardizing categorical test results based on supervised machine learning and the Jaro-Winkler similarity algorithm is proposed. A supervised machine learning model is used in this approach for scalable categorization of the test results into predefined groups or clusters, while Jaro-Winkler similarity is used to map text terms into standard clinical terms within these corresponding groups. The proposed method is applied to 75062 test results from two private hospitals in Bangladesh. The Support Vector Classification algorithm with a linear kernel has a classification accuracy of 98%, which is better than the Random Forest algorithm when categorizing test results. The experiment results show that Jaro-Winkler similarity achieves a remarkable 99.93% success rate in the test result standardization for the majority of groups with manual validation. The proposed method outperforms previous studies that concentrated on standardizing test results using rule-based classifiers on a smaller number of groups and distance similarities such as Cosine similarity or Levenshtein distance. Furthermore, when applied to the publicly available MIMIC-III dataset, our approach also performs excellently. All these findings show that the proposed standardization technique can be very beneficial for clinical big data research, particularly for national clinical research data hubs in low- and middle-income countries.

11 Contributions of Cardiovascular Burden, Peripheral Inflammation, and Brain Integrity on Digital Clock Drawing Performance in Non-Demented Older Adults

Objective:Higher cardiovascular burden and peripheral inflammation are associated with small vessel vascular disease, a predominantly dysexecutive cognitive profile, and a higher likelihood of conversion to vascular dementia. The digital clock drawing test, a digitized version of a standard neuropsychological tool, is useful in identifying cognitive dysfunction related to vascular etiology. However, little is known about the specific cognitive implications of vascular risk, peripheral inflammation, and varying levels of overall brain integrity. The current study aimed to examine the role of cardiovascular burden, peripheral inflammation, and brain integrity on digitally acquired clock drawing latency and graphomotor metrics in non-demented older adults.Participants and Methods:The final prospectively recruited IRB-consented participant sample included 184 non-demented older adults (age: 69±6 years, education: 16±3 years, 46% female, 94% white) who completed digital clock drawing, vascular assessment, blood draw, and brain MRI. Digital clock drawing variables of interest included: total completion time (TCT), pre-first hand latency (PFHL), digit misplacement, hour hand distance from center, and clock face area (CFA). Cardiovascular burden was calculated using the revised version of the Framingham Stroke Risk Profile (FSRP-10). Peripheral inflammation was operationalized using interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-a), and high sensitivity C-reactive protein (hsCRP). The brain integrity composite was comprised of bilateral entorhinal cortex volume, bilateral ventricular volume, and whole brain leukoaraiosis.Results:Over and above age and cognitive reserve, hierarchical regressions showed FSRP-10, inflammatory markers, and brain integrity explained an additional 13.3% of the variance in command TCT (p< 0.001), with FSRP-10 (p=0.001), IL-10 (p= 0.019), and hsCRP (p= 0.019) as the main predictors in the model. FSRP-10, inflammatory markers, and brain integrity explained an additional 11.7% of the variance in command digit misplacement (p= 0.009), with findings largely driven by FSRP-10 (p< 0.001).Conclusions:Overall, in non-demented older adults, subtle behavioral nuances seen in digital clock drawing metrics (i.e., total completion time and digit misplacement) are partly explained by cardiovascular burden, peripheral inflammation, and brain integrity over and above age and cognitive reserve. These nuanced behaviors on digitally acquired clock drawing may associate with an emergent disease process or overall vulnerability.Funding sources: Barber Fellowship; K07AG066813; R01 AG055337; R01 NR014810; American Psychological Foundation Dissertation Award; APA Dissertation Research Award

Dyslexia: An invisible disability or different ability.

With a global dyslexia prevalence of at least 10%, significant numbers of students with dyslexia go undiagnosed and their symptoms unaddressed, but with timely intervention, 90% of dyslexic children can be educated in regular inclusive classrooms. This study aimed to estimate the prevalence of dyslexia among primary schoolchildren in government and private schools. A cross-sectional study on 128 primary schoolchildren attending selected government and private schools in Western Maharashtra was conducted and evaluated using the Search tool, which is a standardized study tool for screening dyslexia. Microsoft Excel and MedCalc version 3.1 were used for data entry and analysis. The prevalence of dyslexia was estimated, and differences between groups were evaluated using appropriate tests. Of the total sample size of 128 children, findings showed 10.9% of students as dyslexic, 9.3% as vulnerable, and the remaining 79.8% as non-dyslexic. Of 14 dyslexic children, 10 were found to be from government schools and the remaining four were from private schools. The high prevalence of dyslexia even in a small study sample size is a matter of concern and emphasizes the need for extensive research and initiatives, including awareness campaigns among teachers, parents, and school authorities, and the importance of detection of undiagnosed dyslexic children as early as possible and providing them with appropriate interventions.

Omics Analysis and Quality Control Pipelines in a High-Performance Computing Environment.

Data quality is often an overlooked feature in the analysis of omics data. This is particularly relevant in studies of chemical and pathogen exposures that can modify an individual's epigenome and transcriptome with persistence over time. Portable, quality control (QC) pipelines for multiple different omics datasets are therefore needed. To meet these goals, portable quality assurance (QA) metrics, metric acceptability criterion, and pipelines to compute these metrics were developed and consolidated into one framework for 12 different omics assays. Performance of these QA metrics and pipelines were evaluated on human data generated by the Defense Advanced Research Projects Agency (DARPA) Epigenetic CHaracterization and Observation (ECHO) program. Twelve analytical pipelines were developed leveraging standard tools when possible. These QC pipelines were containerized using Singularity to ensure portability and scalability. Datasets for these 12 omics assays were analyzed and results were summarized. The quality thresholds and metrics used were described. We found that these pipelines enabled early identification of lower quality datasets, datasets with insufficient reads for additional sequencing, and experimental protocols needing refinements. These omics data analysis and QC pipelines are available as open-source resources as reported and discussed in this article for the omics and life sciences communities.

2 Clinical Validity and Cut-Off Scores of a Brief Neuropsychological Battery for a Large Rural Population in Community Setting

Objective:There is a dearth of an appropriate standardized tool to assess neuropsychological functions in rural population, which has low literacy rates, are culturally diverse, and have limited access to healthcare resources. The NIREH Neuropsychological Battery for Rural Population (NINB-RP) is a relatively brief and easy-to-administer battery comprising multiple tests that are modified or adopted as per rural community settings to evaluate verbal learning, fine coordination, attention efficiency, executive task, concentration, and visual attention, mental flexibility, and motor coordination in rural populations. The present study aimed to examine the clinical validity and establish cut-off scores for impairment of neuropsychological functions for different age, gender, and education levels of NINB-RP in a rural community in central India.Participants and Methods:This was a prospective cross-sectional study conducted in participants aged > 18 years (n=2952, M: F=1407:1545) recruited through a stratified sampling technique from 23 randomly selected villages from central India. The data of nine neuropsychological tests [(Finger and Tweezer dexterity test (FDT, TDT); Digit Forward and Backward test (DFT, DBT); Serial subtraction test (SST); Trail Making-A and B; Finger Tapping test (FTT); and Letter Digit Substitution test, LDST)] from 215 cognitively impaired and 2737 healthy control subjects were analyzed. The tests were performed in a village school/community hall or an outdoor camp. Independent sample t-test, Chi-square test, and Receiver Operating Characteristic (ROC) curve were used to calculate the area under the curve (AUC), cut-off scores, and sensitivity (ST)/specificity (SP) values for seven conditions, i.e., gender (male vs. female), age groups (up to 49 years and above 50 years); and educational levels (illiterate, intermediate and college). For those variables where ST/SP values were lower than 0.70, a unique cut-off score was calculated for the entire sample, adjusting by age and educational levels.Results:A significant difference in mean (median) scores between the healthy control and cognitively impaired groups were observed in all tests except Trail Making A and B and LDST. The AUC for most of the tests ranged from 0.70 to 0.81, and the ST/SP values ranged from 69-73% and 65-75%, respectively. The results showed that most tests of NINB-RP reached moderate to good sensitivity and specificity for gender, age and education levels, except for DBT for females, above 50 years, and illiterate and intermediate education groups. FDT for males [AUC: 0.85 (95%CI0.80-0.91], ST/SP=76/82%] and females [(AUC=0.78 (95%CI0.74-0.82), ST/SP=71/70%], TDT for intermediate education group [AUC=0.82 (95%CI0.60-1.00), ST/SP=86/83%] and FTT for less than 49 years age group [AUC=0.75 (95%CI0.67-0.84), ST/SP=71/76%] were the most useful tests to discriminate among healthy control and cognitively impaired rural population.Conclusions:The present study is an attempt to establish the cut-off scores of a neuropsychological battery for a large rural population in the community setting. The proposed cut-off values might be helpful in clinical assessment in rural areas where clinical neuropsychology services are not readily available. NINB-RP can be a valuable tool for clinical research studies in rural communities. Further studies on similar samples in other countries need to be undertaken.

Factors Associated with Obstetric Violence Implicated in the Development of Postpartum Depression and Post-Traumatic Stress Disorder: A Systematic Review.

Postpartum depression (PPD) and post-traumatic stress disorder (PTSD) continue to be prevalent, and disabling women with mental disorders and obstetric violence (OV) may be a trigger for them, particularly during maternity. We aimed to analyze the association between manifestations of OV with the development of PPD and PTSD during pregnancy, childbirth, and postpartum. This systematic review was based on the PRISMA 2020 statement and explored original articles published between 2012 and 2022. A total of 21 articles were included in the analysis, and bias was assessed by the Effective Public Health Practice Project's Quality Assessment Tool. The highest rate of PPD symptoms appeared in women under 20 years old, multiparous, and with low education levels. The higher PTSD ratio was present in women under 35 years, primiparous, and with secondary studies. The mode of labor (instrumental or C-section) was identified as a major risk factor of PPD, being mediator variables of the informal coercion of health professionals and dissatisfaction with newborn healthcare. Instead, partner support during labor and high satisfaction with healthcare during birth were protective factors. Regarding PTSD, the mode of labor, several perineal tears, and the Kristeller technique were risk factors, and loss of autonomy and coercion modulated PTSD symptomatology. The protective factors for PTSD were respect for the labor plan, adequate communication with health professionals, social support during labor, and the skin-to-skin procedure. This systematic review provides evidence that OV contributes to PPD and PTSD, being important in developing standardized tools to prevent it. This study recommends changes in maternal healthcare policies, such as individualized healthcare assistance, humanized pregnancy protocols, and women's mental health follow-up, and improvements in the methodological quality of future research.

Comparison of the diagnostic value of 18F-NaF PET/CT and 99mTc-MDP SPECT for bone metastases: a systematic review and meta-analysis.

Bone scintigraphy, the standard tool for detecting bone metastases has some insufficiencies; thus, supplementary imaging techniques are needed. This study is a comprehensive meta-analysis of studies reporting and comparing the diagnostic efficacy of 18F-sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) and 99mTc-MDP single-photon emission computed tomography (SPECT) for bone metastases. Literature related to the diagnosis of bone metastases using 18F-NaF PET/CT and 99mTc-MDP SPECT was searched on PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang databases, and VIP. Evaluation of study quality was performed according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Pooled sensitivity (SEN) and specificity (SPE) were assessed along with heterogeneity. The subject operating characteristic curve was plotted, the area under the curve (AUC) was calculated, and the pre- and post-test probabilities were compared. Finally, 11 articles, consisting of 1,085 patients and 1,782 lesions, were included. At the patient level (11 articles), the results were pooled SEN =0.92 and SPE =0.96 for PET/CT, SEN =0.80 and SPE =0.90 for SPECT. The AUC of PET/CT [0.98 (0.96-0.99)] was higher than that of SPECT [0.92 (0.89-0.94), P<0.05]. At the lesion level (6 articles), the results were pooled SEN =0.96 and SPE =0.98 for PET/CT, SEN =0.76 and SPE =0.94 for SPECT. The AUC of PET/CT [0.99 (0.98-1.00)] was higher than that of SPECT [0.94 (0.92-0.96); P<0.05]. Statistical heterogeneity existed, and meta-regression showed that, at patient-based level, the study design type, tumor character, and the selection blinding method were the main sources of heterogeneity. Furthermore, both PET/CT and SPECT had superior SEN for osteogenic metastases than non-osteogenic metastases (P=0.01). At the lesion level, tumor character was a source of heterogeneity accompanied by an increased SEN for osteogenic metastases, and the SEN for SPECT combined with CT was improved [SEN =0.87 (0.68-1.00), P=0.03]. 18F-NaF PET/CT has a higher SEN and SPE than 99mTc-MDP SPECT in diagnosing bone metastases, nevertheless, it is necessary to fully understand the primary tumor and the characteristics of the imaging protocol to choose suitable modality for individuals. Combining SPECT with CT improves the diagnostic efficacy than having SPECT alone and can be a powerful supplement to PET/CT for suspected osteogenic bone metastases.

Reliability and validity of an adapted Arabic version of Scoliosis Japanese Questionnaire-27 in Saudi Arabia

BackgroundThe Scoliosis Research Society SRS-22 questionnaire is a standard tool to assess the Health-Related Quality of Life (HRQoL) in scoliosis patients but, because of cultural differences limited use among Arabic patients. The aim is to perform a cross-cultural adaptation and validation of Arabic version of Scoliosis Japanese Questionnaire-27 and test it on Saudi patients with adolescent idiopathic scoliosis (AIS). MethodsThis a cross sectional study run between July 2021 and December 2022 recruited 194 patients. The cross-cultural adaptation process was performed using the American Association of Orthopedic Surgeons (AAOS) Outcomes Committee method. All patients had completed the Arabic version of Scoliosis Japanese Questionnaire-27 and SF-12 preoperatively and 3-month postoperatively. The validity and internal consistency were tested using the Intraclass correlation coefficient (ICC), Cronbach alpha, Pearson correlation coefficient, and confidence interval (CI). ResultsWe analyzed the result of 194 female adolescent patients. The average age is 14 ± 2.4 years (range from 10 to 21 years). The majority of patients have a Lenke type 1 curve (54 %). The overall Cronbach alpha (CA) of all domains of Scoliosis Japanese Questionnaire-27 is 0.92. However, the Cronbach alpha for the mental health (Q17,18,20,21,23,24) and, self-image (Q12-14,22,25,26) are 0.93 and 0.84 respectively. ConclusionThe Arabic version of Scoliosis Japanese Questionnaire-27 is a reliable and valid instrument and can be applied to evaluate the quality of life in patients with AIS.

CentralBankRoBERTa: A fine-tuned large language model for central bank communications

Central bank communications are an important tool for guiding the economy and fulfilling monetary policy goals. Natural language processing (NLP) algorithms have been used to analyze central bank communications. These outdated bag-of-words methods often ignore context and cannot distinguish who these sentiments are addressing. Recent research has introduced deep-learning-based NLP algorithms, also known as large language models (LLMs), which take context into account. This study applies LLMs to central bank communications and constructs CentralBankRoBERTa, a state-of-the-art economic agent classifier that distinguishes five basic macroeconomic agents and binary sentiment classifier that identifies the emotional content of sentences in central bank communications. The absence of large-language models in the central bank communications literature may be attributed to a lack of appropriately labeled datasets. To address this gap, we introduce our model, CentralBankRoBERTa, offering an easy-to-use and standardized tool for scholars of central bank communications.

ВЕСТИБУЛЯРНЫЙ НЕЙРОНИТ: КЛИНИЧЕСКИЙ ПРИМЕР ТЕЧЕНИЯ ЗАБОЛЕВАНИЯ С ИСПОЛЬЗОВАНИЕМ БИОЛОГИЧЕСКИ ОБРАТНОЙ СВЯЗИ (БОС)

The examination was conducted with the consent of patient P., born in 1961, who was undergoing treatment in the neurological department of the Federal State Budgetary Health Care Institution "Clinical Hospital No. 8 of the Federal Medical and Biological Agency" (FGBUZ KB No. 8 FMBA of Russia). The patient was examined for viral and bacterial infections: Herpes simplex virus 1,2 IgM, herpes simplex virus 1,2 IgG, cytomegalovirus IgM, Epstein-Barr virus IgM to AG capsid, SARS-CoV-2 coronavirus, IgM antibodies, meningococcus, haemophilus bacillus, streptococcus (Neisseria meningitidis, heamophilus influenzae, streptococcus pneumoniae, PCR), influenza type B virus. It should be noted that all analyses were performed with quantitative evaluation in order to observe the course of the disease in dynamics. This list of analyses was determined not only to monitor the dynamics of the disease, but also to perform differential diagnosis (e.g. with labyrinthitis, as this disease has a similar clinical picture). In the course of the study, as a result of a rational evaluation, it was identified and decided to focus the study on herpes simplex virus 1, 2 IgG analyses in the dynamics - accordingly, the analyses were taken on day 5 of the disease, on day 14, and then on day 21. The patient underwent instrumental diagnostics: audiometry, SCT study, MRI study to exclude other similar pathological phenomena. In addition to laboratory tests, the patient underwent diagnostic and rehabilitation tests on a stabilisation platform with biofeedback based on StabMed 2-"Stabilan-01-2" software, both at the beginning of treatment and at the end (the main diagnostic test performed was a stabilography test. Various variants of the Romberg test are a standard tool in the arsenal of a modern doctor, for example, clinical recommendations on differential diagnosis of peripheral vertigo include it in the list of mandatory procedures during physical examination of a patient with complaints of dysfunction of the vestibular apparatus ).

Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years’ experience

The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis. The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I2 statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality. The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P<0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P<0.001 in CFNG compared with MNM, P=0.013 for CLFN compared with MNM, P<0.001 for DI compared with MNM). DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.