Subcomponent Scores Research Articles

Specific Associations in the Alpha Frequency Between the Subcomponents of Rumination and the Subsystems of the Default Mode Network Among Bipolar I Disorder Patients.

Introduction: Rumination in bipolar disorder (BD) is well documented. Recent neuroimaging studies highlight the role of the default mode network (DMN) in rumination, while few studies have evaluated the DMN activity in BD rumination, particularly the underlying neuroelectrophysiology. Methods: A total of 44 patients with depressed bipolar I disorder (BD-I) and 46 healthy controls underwent resting-state magnetoencephalography. Two core hubs of the DMN, the posterior cingulate cortex (PCC), and anterior medial prefrontal cortex, together with the dorsal medial prefrontal cortex (dmPFC) and the medial temporal lobe (MTL) subsystems, were identified as the regions of interest. The power envelope method was used to determine the alpha band's cross-subsystem functional connectivity (FC). After comparing the rumination and DMN FC between the groups, Spearman partial correlation analysis was performed to evaluate the relationship between aberrant FC and rumination in BD-I patients. Results: BD-I patients demonstrated more global rumination, including higher subcomponent scores of brooding and reflection. In addition, the alpha frequency FC of the PCC-dmPFC and dmPFC-MTL subsystems within the DMN was dramatically increased in the BD-I group. The former was strongly associated with reflection, whereas the latter was related to brooding. Conclusion: The findings suggest that the reflection and brooding components of rumination are selectively related to the alpha frequency FC of the PCC-dmPFC and dmPFC-MTL subsystems, respectively. These associations highlight the significance of DMN activities in rumination among BD-I patients and have implications for future rumination interventions.

What/Why/When/Where/How Framework and Faculty Development Workshop to Improve the Utility of Narrative Evaluations for Assessing Internal Medicine Residents.

Clinical competency committees (CCCs) rely on narrative evaluations to assess resident competency. Despite the emphasis on these evaluations, their utility is frequently hindered by lack of sufficient detail for use by CCCs. Prior resources have sought to improve specificity of comments and use of evaluations by residents but not their utility for CCCs in assessing trainee performance. We developed a 1-hour faculty development workshop focused on a newly devised framework for Department of Medicine faculty supervising internal medicine residents. The what/why/when/where/how framework highlighted key features of useful narrative evaluations: behaviors of strength and growth, contextualized observations, improvement over time, and actionable next steps. Workshop sessions were implemented at a large multisite internal medicine residency program. We assessed the workshop by measuring attendee confidence and skill in writing narrative evaluations useful for CCCs. Skill was assessed through a rubric adapted from literature on the utility of narrative evaluations. Fifty-four participants started the presurvey, and 33 completed the workshop, for a response rate of 61%. Participant confidence improved pre-, post-, and 3 months postworkshop. Total utility scores improved in mock evaluations from 12.4 to 15.5 and in real evaluations from 13.7 to 15.0, but only some subcomponent scores improved, with fewer improving in the real evaluations. A short workshop focusing on our framework improves confidence and utility of narrative evaluations of internal medicine residents for use by CCCs. Next steps should include developing more challenging components of narrative evaluations for continued improvement in trainee performance and faculty assessment.

The effect of reiki on fatigue and sleep quality in individuals with multiple sclerosis: a randomised controlled study

The aim of the study is to investigate the effect of the application of Reiki on fatigue and sleep quality in people with MS. The study is a randomised controlled study. A total of 60 people (control group = 30, intervention group = 30) participated in this study. Personal Information Form, Piper Fatigue Scale (PFS) and Pittsburg Sleep Quality Index (PSQI) were used to collect data. It was found that the PFS and PSQI total and subcomponent scores of the intervention group decreased after Reiki compared to the control group and this was statistically significant (p < 0.05). The study showed that Reiki was significantly effective in improving fatigue and sleep quality in people with MS. As Reiki is a simple, inexpensive and accessible method, it was suggested that its use in the management of MS should be encouraged and maintained in nursing practice.

Diagnosis of Sports-Related Concussion Using Symptom Report or Standardized Assessment of Concussion

The Sports Concussion Assessment Tool-5 (SCAT5) has been recommended for concussion evaluation and utilizes both a subjective reported symptom grading scale and objective measures of concussion including a cognitive evaluation: the Standardized Assessment of Concussion (SAC). The SAC includes testing for orientation, immediate memory, concentration, and delayed recall; a 10-word list is used to assess immediate memory and delayed recall. To determine the diagnostic accuracy of components of the SCAT5 and to provide a framework for clinical interpretation. This prospective case-control study of National Collegiate Athletic Association Division I athletes from any sport was conducted from July 2020 to December 2022 at 4 universities. Athletes completed baseline SCAT5 testing using the 10-word list. When an athlete presented acutely with suspected concussion (sideline or within 2 days), the tests were repeated. If a concussion was diagnosed, a control athlete underwent the same tests. Controls were identified and matched on comorbid conditions, sex and gender, sport, season, and baseline scores. Data analysis was conducted from August to October 2023. The primary outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and test-retest reliability of the symptom score; symptom severity score; the total SAC score; and the orientation, immediate memory, concentration, and delayed memory subcomponent scores on the SCAT5 compared with clinical diagnosis of concussion. Baseline and postinjury data were collected on 92 athletes with concussion and 92 matched control athletes (96 men [52%] and 88 women [48%]; 110 who played a sport other than football [59%]). Diagnostic utility was considered excellent for symptom score (AUC, 0.93; 95% CI, 0.89-0.96) and symptom severity score (AUC, 0.94; 95% CI, 0.90-0.97). An increase of 2 points on the symptom score was associated with a sensitivity of 86% (95% CI, 78%-92%), specificity of 80% (95% CI, 70%-87I%), and positive predictive value of 81% (95% CI, 72%-88%). The total SAC score had poor to fair diagnostic utility (AUC, 0.70; 95% CI, 0.63-0.77); however, 41 athletes with concussion (45%) had a total SAC score at or above their baseline score (ie, within normal limits). The diagnostic utility was poor to fair for immediate memory (AUC, 0.68, 95%CI, 0.61-0.75) and delayed recall (AUC, 0.69; 95% CI, 0.62-0.77) and not useful for orientation (AUC, 0.49; 95% CI, 0.43-0.56) and concentration (AUC, 0.52 95% CI, 0.44-0.61). Test-retest reliability was fair for total SAC and poor for immediate memory and delayed recall, orientation, and concentration. In this case-control study of the diagnostic accuracy of reported symptoms and the SAC, reported symptoms were the most accurate indicator of concussion while the 10-word SAC had limited sensitivity. These findings suggest that understanding the properties of the SAC is important when making the diagnosis of concussion.

Multivariate Structural Equation Modeling Techniques for Estimating Reliability, Measurement Error, and Subscale Viability When Using Both Composite and Subscale Scores in Practice

We illustrate how structural equation models (SEMs) can be used to assess the reliability and generalizability of composite and subscale scores, proportions of multiple sources of measurement error, and subscale added value within multivariate designs using data from a popular inventory measuring hierarchically structured personality traits. We compare these techniques between standard SEMs representing congeneric relations between indicators and underlying factors versus SEM-based generalizability theory (GT) designs with simplified essential tau-equivalent constraints. Results strongly emphasized the importance of accounting for multiple sources of measurement error in both contexts and revealed that, in most but not all instances, congeneric designs yielded higher score accuracy, lower proportions of measurement error, greater average subscale score viability, stronger model fits, and differing magnitudes of disattenuated subscale intercorrelations. Extending the congeneric analyses to the item level further highlighted consistent weaknesses in the psychometric properties of negatively versus positively keyed items. Collectively, these findings demonstrate the practical value and advantages of applying GT-based principles to congeneric SEMs that are much more commonly encountered in the research literature and more directly linked to the specific measures being analyzed. We also provide prophecy formulas to estimate reliability and generalizability coefficients, proportions of individual sources of measurement error, and subscale added-value indices for changes made to measurement procedures and offer guidelines and examples for running all illustrated analyses using the lavaan (Version 0.6-17) and semTools (Version 0.5-6) packages in R. The methods described for the analyzed designs are applicable to any objectively or subjectively scored assessments for which both composite and subcomponent scores are reported.

Cluster-specific associations between the gut microbiota and behavioral outcomes in preschool-aged children

BackgroundThe gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes.MethodsStool samples were collected from a community sample of 248 typically developing children (3–5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated.ResultsFour different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner.ConclusionsThese data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes.BZUULjYHP9-uSx-sQtCLaZVideo

Graded Motor Imagery and Fall Risk in Older Adults: An Exploratory Case Series

Background: Altered cortical maps can initiate and maintain a pain experience and older adults who move less may be at increased risk for pain, balance and fall risk issues. Purpose: To determine if a brief graded motor imagery (GMI) session to the plantar surface of the foot in older adults can influence self-reported pain, sensitivity of the nervous system and fall risk. Methods: Forty-one older adults (mean age 76.8) received pain neuroscience education, and GMI to the plantar surface of their feet. Measurements pre- and immediately post- intervention included self-reported pain (Numeric pain rating scale), laterality, fall risk (Brief-BESTest), gait speed (40-meter self-paced walk test - SPWT), and nerve sensitivity (Pressure Pain Thresholds - PPT) to the dorsum of the foot and web space dominant hand. Results: Immediately following treatment, mean self-reported pain improved by 1.24 points (p &lt; 0.001), with a large sub-group meeting the minimal clinically important difference (MCID) for self-reported pain (1.7). Gait speed improved significantly (p &lt; 0.001) meeting MCID (0.1 m/s). Left-right judgement task speed (p &lt; 0.001) and accuracy (p = 0.04) improved. None of the PPT measurements improved. While mean composite Briefest test scores did not reach MCID values (9 points), statistically significant improvements were noted in the biomechanical constraints (p = 0.007) and sensory orientation (p = 0.009) subcomponent scores. Conclusion: A brief, one-time GMI session in older adults can decrease pain and improve scores on tests associated with fall risk but fail to decrease sensitivity of the nervous system. More research is needed to validate the results of this exploratory study.

Moving the needle forward in health disparities: An education initiative

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Objective&lt;/title&gt; &lt;p&gt;This paper sought to evaluate the impact of a year-long Health Equity Curriculum (HEC) on the knowledge of health disparities, cross-cultural humility, and empathy among physicians, trainees, and research staff.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Background&lt;/title&gt; &lt;p&gt;There has been an increase in the inclusion of equity, cultural humility, and the social determinants of health into medical education at various levels. However, the frequency of this education is low and not well quantified or defined. The authors report the results of an education program, namely the HEC, on the knowledge of health disparities, cross-cultural humility, and empathy.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Materials and methods&lt;/title&gt; &lt;p&gt;The HEC was delivered between March 2020 and May 2021. It included the following four modules: the social determinants of health, cultural humility, health literacy, and unconscious bias. The participants attended lectures and reviewed articles/videos using online modules and reflection assignments. The Jefferson Scale of Empathy (JSE) and the Cross-Cultural Competence Instrument for Health Care Professionals (CCCHP) were administered pre- and post-HEC. The results were statistically analyzed.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;Of the 102 enrolled participants, 46 completed the entire course. The JSE showed a statistically significant improvement in the empathy scores from pre-HEC to post-HEC (p &amp;lt; 0.01). The CCCHP showed a significant improvement from pre-HEC to post-HEC total scores and in subcomponent scores of Motivation/Curiosity, Attitude, and Knowledge (p &amp;lt; 0.05). There were no significant differences in scores for the Skills and Emotions/Empathy subcomponents.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusions&lt;/title&gt; &lt;p&gt;Enrollment and completion in the HEC were associated with statistically significant improvements in the validated measures of cultural competence and empathy. Scaling this type of content and curriculum can educate professionals on equity and serving diverse communities. A further study is warranted.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Mediterranean diet is associated with better gastrointestinal health and quality of life, and less nutrient deficiency in children/adolescents with disabilities.

Children and adolescents with disabilities face various nutritional problems. This study aimed to examine dietary characteristics, nutritional status and problems, gastrointestinal health, and quality of life in children and adolescents with disabilities. This study included 5-18 years old children and adolescents (n = 1,991) with disabilities. We used the Mediterranean Diet Quality Index (KIDMED), the Gastrointestinal Symptom Rating Scale (GSRS), and the Pediatric Quality of Life Inventory (PedsQL) to assess diet characteristics, gastrointestinal problems, and life quality. We collected retrospective 24-h food record to assess energy and nutrient intakes. The rate of stunting in children with disabilities varies between 16.5% and 19.8%. When comparing disability types, more children with physical disabilities were underweight (8.8% vs. 6.7%) and stunted (19.8% vs. 16.5%), while more children with intellectual disabilities were tall (7.9% vs. 5.5%) and overweight/obese (21.1 vs. 17.2%; p < 0.05). Wasting (9.3%) and overweight/obesity (23.8%) were more common in children with disabilities aged 5-7 years (p < 0.001). Eating problems such as loss of appetite, food refusal, food neophobia, and food selectivity were more common in children aged 5-7 years, and problems with fast eating and overeating were more common in adolescents aged 13-18 years (p < 0.05). Among children and adolescents with disabilities, the nutrients with inadequate intakes were vitamin E, vitamin B1, folate, potassium, calcium, and iron, while the nutrients with intakes above the requirements were proteins, carbohydrates, vitamins A, B2, B6, B12, and C, phosphorus, zinc, and sodium. Participants with good Mediterranean diet quality had higher energy and nutrient intakes and higher percentages of meeting nutrient requirements (p < 0.05). KIDMED scores were negatively correlated with GSRS total (r = -0.14, p < 0.001) and subcomponent scores (abdominal pain, diarrhea, reflux, indigestion, and constipation; p < 0.05), and significantly and positively correlated with PedsQL total (r = 0.12, p < 0.001). A one-unit increase in the GSRS score resulted in a 14.4 times decrease in the PedsQL score, and a one-unit increase in the KIDMED score resulted in a 10.8 times increase in the PedsQL score (p = 0.001). Overweight/obesity, stunting/wasting, nutritional problems, and deficiencies are common among disabled children and adolescents. Mediterranean diet is associated with a better quality of life, and gastrointestinal health in children with disabilities.

Actigraphy: An Adjunctive Method to Measure Irritability in Opioid-Exposed Newborns.

Background and purpose: Conventional measures of withdrawal in newborns with prenatal opioid exposure (POE) rely on nursing assessments, including the subjective judgment of infant irritability. This study investigated limb movement actigraphy as a tool for providing an objective, quantifiable measure of underlying distress. Methods: Correlational analyses compared continuous physiological-detected movement actigraphy and clinical intervallic-scored symptomology (modified Finnegan system) obtained from a control cohort of 37 term neonates with POE studied in their crib in the newborn unit (1-8 days). Results: Infants spent 15% crib time in high movement activity (>100 movements/minute; index irritability) and 38% crib time in low activity (0-5 movements/minute; index calm). There was a significant positive association between actigraphy and Finnegan composite score (r = .28, P = .001) and between actigraphy and subcomponent scores (i.e., central nervous system, gastrointestinal, and metabolic-vasomotor-respiratory). Conclusion: Movement activity via actigraphy captures underlying distress and calm not measured by conventional assessments. Such objective, quantifiable measures can serve to promote equitable assessment and treatment of hospitalized newborns with POE.

Democratizing Health Care in the Metaverse: How Video Games can Monitor Eye Conditions Using the Vision Performance Index: A Pilot Study

In a world where digital media is deeply engrained into our everyday lives, there lies an opportunity to leverage interactions with technology for health and wellness. The Vision Performance Index (VPI) leverages natural human-technology interaction to evaluate visual function using visual, cognitive, and motor psychometric data over 5 domains: field of view, accuracy, multitracking, endurance, and detection. The purpose of this study was to describe a novel method of evaluating holistic visual function through video game-derived VPI score data in patients with specific ocular pathology. Prospective comparative analysis. Patients with dry eye, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration, and healthy individuals. The Vizzario Inc software development kit was integrated into 2 video game applications, Balloon Pop and Picture Perfect, which allowed for generation of VPI scores. Study participants were instructed to play rounds of each video game, from which a VPI score was compiled. The primary outcome was VPI overall score in each comparison group. Vision Performance Index component, subcomponent scores, and psychophysical inputs were also compared. Vision Performance Index scores were generated from 93 patients with macular degeneration (n= 10), cataract (n= 10), DR (n= 15), dry eye (n= 15), glaucoma (n= 16), and no ocular disease (n= 27). The VPI overall score was not significantly different across comparison groups. The VPI subcomponent "reaction accuracy" score was significantly greater in DR patients (106 ± 13.2) versus controls (96.9 ± 11.5), P= 0.0220. The VPI subcomponent "color detection" score was significantly lower in patients with DR (96.8 ± 2.5; p=0.0217) and glaucoma (98.5 ± 6.3; P= 0.0093) compared with controls (101 ± 11). Psychophysical measures were statistically significantly different from controls: proportion correct (lower in DR, age-related macular degeneration), contrast errors (higher in cataract, DR), and saturation errors (higher in dry eye). Vision Performance Index scores can be generated from interactions of an ocular disease population with video games. The VPI may offer utility in monitoring select ocular diseases through evaluation of subcomponent and psychophysical input scores; however, future larger-scale studies must evaluate the validity of this tool. Proprietary or commercial disclosure may be found after the references.

The COPD Assessment Test (CAT) and Depression: A Longitudinal Analysis During the COVID-19 Pandemic.

Chronic obstructive pulmonary disease (COPD) is multifaceted, with some patients experiencing anxiety and depression. Depression in COPD has been associated with worse total scores for the COPD assessment test (CAT). Also, CAT score worsening has been observed during the COVID-19 pandemic. The relationship between the Center for Epidemiologic Studies Depression Scale (CES-D) score and CAT sub-component scores has not been evaluated. We investigated the relationship between CES-D score and CAT component scores during the COVD-19 pandemic. Sixty-five patients were recruited. Pre-pandemic (baseline) was defined as 23rd March 2019-23rd March 2020, CAT scores and information related to exacerbations were collected via telephone at 8-week intervals between 23rd March 2020-23rd March 2021. There were no differences in CAT scores pre- compared to during the pandemic (ANOVA p = 0.97). Total CAT scores were higher in patients with symptoms of depression compared to those without both pre- (p < 0.001) and during-pandemic (eg, at 12 months 21.2 versus 12.9, mean difference = 8.3 (95% CI = 2.3-14.2), p = 0.02). Individual CAT component scores showed significantly higher chest tightness, breathlessness, activity limitation, confidence, sleep and energy scores in patients with symptoms of depression at most time points (p < 0.05). Significantly fewer exacerbations were observed during- compared to pre-pandemic (p = 0.04). We observed that COPD patients with symptoms of depression had higher CAT scores both pre- and during the COVID-19 pandemic. Presence of depressive symptoms was selectively associated with individual component scores. Symptoms of depression may potentially influence total CAT scores.

Outcome Evaluation of a Transnational Postgraduate Capacity-Building Program Using the Objective Structured Clinical Examination.

Previous studies have applied interview-oriented self-reported or peer-centered evaluation methods, rather than an objective and quantitative method, to evaluate outcome of a postgraduate capacity-building program and have mainly focused on the cognitive level. To investigate the feasibility of the objective structured clinical examination (OSCE) in an international setting and report the results of the outcome evaluation for the behavioral aspect. A case-control study. Ninety examinees divided into 2 case-control groups: 17 program-experienced doctors and 17 control doctors in the first group, and 28 mentees of the program-experienced doctors and 28 control doctors in the second group. A six-station OSCE was implemented. The OSCE scores were measured to evaluate (1) the direct educational effect regarding learning in the first group and (2) the indirect educational effects regarding transfer in the second group. Written questionnaire and interview data were collected for qualitative analysis. The quantitative results of the overall or subcomponent OSCE scores indicated no significant differences in the comparisons of the first and second case-control groups. The qualitative data indicated that the program improved participants' medical knowledge, skills, and self-confidence, however, it also revealed limited learning environment provided by the program. This transnational study has demonstrated the process for introducing and successfully completing the testing of an OSCE in Laos. Discrepancy in the goals of the OSCE and the education program limited the usefulness of OSCE as an assessment tool, leading to the lack of significant differences in its results.

Comparison of Four Dietary Pattern Indices in Australian Baby Boomers: Findings from the Busselton Healthy Ageing Study.

The assessment of dietary patterns comprehensively represents the totality of the diet, an important risk factor for many chronic diseases. This study aimed to characterise and compare four dietary pattern indices in middle-aged Australian adults. In 3458 participants (55% female) from the Busselton Healthy Ageing Study (Phase Two), a validated food frequency questionnaire was used to capture dietary data between 2016 and 2022. Four dietary patterns [Australian Dietary Guideline Index 2013 (DGI-2013); the Mediterranean Diet Index (MedDiet); the Literature-based Mediterranean Diet Index (Lit-MedDiet); and the EAT-Lancet Index], were calculated and compared by measuring total and sub-component scores, and concordance (𝜌c). Cross-sectional associations between the dietary indices and demographic, lifestyle, and medical conditions were modelled with linear regression and restricted cubic splines. Participants had the highest standardised scores for the DGI-2013 followed by the EAT-Lancet Index and the MedDiet, with the lowest standardised scores observed for the Lit-MedDiet. The DGI-2013 had the lowest agreement with the other scores (𝜌c ≤ 0.47). These findings indicate that the diets included in this Australian cohort align more closely with the Australian Dietary Guidelines than with the other international dietary patterns, likely due to the wide variation of individual food group weightings in the construction of these indices.

The Surgical Learning Curve: Does Robotic Technical Skill Explain Differences in Operative Performance?

Background: Prior studies on technical skills use small collections of videos for assessment. However, there is likely heterogeneity of performance among surgeons and likely improvement after training. If technical skill explains these differences, then it should vary among practicing surgeons and improve over time. Materials and Methods: Sleeve gastrectomy cases (n = 162) between July 2018 and January 2021 at one health system were included. Global evaluative assessment of robotic skills (GEARS) scores were assigned by crowdsourced evaluators. Videos were manually annotated. Analysis of variance was used to compare continuous variables between surgeons. Tamhane's post hoc test was used to define differences between surgeons with the eta-squared value for effect size. Linear regression was used for temporal changes. A P value <.05 was considered significant. Results: Variations in operative time discriminated between individuals (e.g., between 2 surgeons, means were 91 and 112 minutes, Tamhane's = 0.001). Overall, GEARS scores did not vary significantly (e.g., between those 2 surgeons, means were 20.32 and 20.6, Tamhane's = 0.151). Operative time and total GEARS score did not change over time (R2 = 0.0001-0.096). Subcomponent scores showed idiosyncratic temporal changes, although force sensitivity increased among all (R2 = 0.172-0.243). For a novice surgeon, phase-adjusted operative time (R2 = 0.24), but not overall GEARS scores (R2 = 0.04), improved over time. Conclusions: GEARS scores showed less variability and did not improve with time for a novice surgeon. Improved technical skill does not explain the learning curve of a novice surgeon or variation among surgeons. More work could define valid surrogate metrics for performance analysis.

Measuring bilingual language dominance: An examination of the reliability of the Bilingual Language Profile

Measuring language dominance, broadly defined as the relative strength of each of a bilingual’s two languages, remains a crucial methodological issue in bilingualism research. While various methods have been proposed, the Bilingual Language Profile (BLP) has been one of the most widely used tools for measuring language dominance. While previous studies have begun to establish its validity, the BLP has yet to be systematically evaluated with respect to reliability. Addressing this methodological gap, the current study examines the reliability of the BLP, employing a test–retest methodology with a large ( N = 248), varied sample of Spanish–English bilinguals. Analysis focuses on the test–retest reliability of the overall dominance score, the dominant and non-dominant global language scores, and the subcomponent scores. The results demonstrate that the language dominance score produced by the BLP shows “excellent” levels of test–retest reliability. In addition, while some differences were found between the reliability of global language scores for the dominant and non-dominant languages, and for the different subcomponent scores, all components of the BLP display strong reliability. Taken as a whole, this study provides evidence for the reliability of BLP as a measure of bilingual language dominance.

Does Surgeon Experience Correlate with Crowd-Sourced Skill Assessment in Robotic Bariatric Surgery?

The Global Evaluative Assessment of Robotic Skills (GEARS) rubric provides a measure of skill in robotic surgery. We hypothesize surgery performed by more experienced operators will be associated with higher GEARS scores. Patients undergoing sleeve gastrectomy from 2016 to 2020 were analyzed. Three groups were defined by time in practice: less than 5, between 5 and 15, and more than 15years. Continuous variables were compared with ANOVA and multivariable regression was performed. Fourteen operators performing 154 cases were included. More experienced surgeons had higher GEARS scores and shorter operative times. On multivariable regression, operative time (P = 0.027), efficiency (P = .022), depth perception (P = 0.033), and bimanual dexterity (P = 0.047) were associated with experience. In our video-based assessment (VBA) model, operative time and several GEARS subcomponent scores were associated with surgical experience. Further studies should determine the association between these metrics and surgical outcomes.

Impact of Long-Term Evoked Compound Action Potential Controlled Closed-Loop Spinal Cord Stimulation on Sleep Quality in Patients With Chronic Pain: An EVOKE Randomized Controlled Trial Study Subanalysis

ObjectiveSpinal cord stimulation (SCS) is considered an effective interventional nonpharmacologic treatment option for several chronic pain conditions. Here we present the effects of the novel evoked compound action potential (ECAP) controlled closed-loop (ECAP-CL) SCS system on long-term sleep quality outcomes from the EVOKE study. Materials and MethodsThe EVOKE study is a double-blind, randomized, controlled clinical trial conducted at 13 sites in the United States (N = 134 patients). The clinical trial utilized SCS to manage chronic pain and compared novel ECAP-CL technology to open-loop SCS. Additionally, sleep quality data was collected using the Pittsburgh Sleep Quality Index (PSQI) at baseline and all study visits. ResultsThe mean PSQI global score for ECAP-CL patients at baseline was 14.0 (n = 62; ± 0.5, SD 3.8), indicating poor sleep quality. Clinically meaningful and statistically significant reductions (p < 0.001) in the global PSQI scores were noted at 12 months (n = 55; 5.7 ± 0.6, SD 4.2). A total of 76.4% of ECAP-CL patients met or exceeded Minimal Clinically Important Difference from baseline in PSQI at 12 months. Additionally, 30.9% of ECAP-CL patients achieved “good sleep quality” scores (PSQI ≤ 5), and 29.1% achieved sleep quality remission. “Normative” sleep scores were observed in 29.6% of ECAP-CL patients at 12 months, and these scores were better than the US general population. Additionally, ECAP-CL patients achieved statistically significant changes from baseline (p < 0.01) across all seven subcomponent scores of PSQI at 12 months. ConclusionsECAP-CL SCS elicits consistent neural activation of the target leading to less variability in long-term therapy delivery. In the EVOKE study, this resulted in ECAP-CL patients demonstrating clinically superior and sustained pain relief. Results from this study provide new evidence of long-term improvement in sleep quality and quantity in patients with chronic pain resulting from the use of this novel ECAP-CL SCS technology. Clinical Trail RegistrationThe Clinicaltrials.gov registration number for the study is NCT02924129.

Watermelon Intake Is Associated with Increased Nutrient Intake and Higher Diet Quality in Adults and Children, NHANES 2003-2018.

Watermelon is a nutrient-dense, low energy food that provides vital nutrients and contributes to overall fruit intake. Previous studies have found positive associations between watermelon and nutrient intake but few focused on raw watermelon intake or had small sample sizes. Therefore, the objective of this study was to utilize a large, nationally representative sample to determine associations between watermelon intake and nutrient intake and diet quality. Data from children (2-18 y) and adults (19+ y) who participated in the National Health and Nutrition Examination Survey (NHANES) cycles 2003-2018 were utilized in the current study. Watermelon intake was 7.51 and 7.29 g/d per capita in children and adults, respectively. In watermelon consumers, usual intake was 125 and 161 g/d in children and adults, respectively. Total diet quality was higher in watermelon consumers as compared to non-consumers as well as several subcomponent scores. Children and adult watermelon consumers had greater than 5% higher intake of dietary fiber, magnesium, potassium, and vitamin A as well as more than 5% lower intake of added sugars and total saturated fatty acids as well as higher intake of lycopene and other carotenoids. This study suggests watermelon can increase nutrient intake as well as diet quality in both children and adult Americans.

Abstract 12058: The Impact of Cardiovascular Health Intervention on Plasma Metabolomic Profiles

Introduction: Previously, we used plasma metabolomics profiling to identify metabolites underlying cardiovascular health (CVH) in participants of the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Herein, we explored whether a health intervention could alter plasma concentrations of metabolites associated with CVH in MECA participants with poor CVH. Methods: 71 Black adults without known cardiovascular disease and with poor CVH, defined as AHA Life’s Simple 7 (LS7) score &lt;8, were given a technology-enabled behavioral intervention platform (Health360x) for 6 months with or without access to a health coach. Metabolites were assessed pre- and post-intervention by untargeted high-resolution metabolomics profiling. Metabolome wide association study (MWAS) was conducted to identify differentially expressed metabolites and Mummichog was used to identify metabolic pathways that were differentially enriched after the intervention. Annotations were performed by matching to an in-house library of confirmed metabolites. Paired t-test and Wilcoxon signed-rank test were used to compare clinical metrics. Results: Mean age was 55 + 9.0 years, 69% female. Total LS7 scores improved from 6.2 ( + 1.49) to 6.5 ( + 1.74) with the intervention. While total and subcomponent LS7 scores and clinical metrics (BMI, blood pressure, glucose and cholesterol levels) trended toward improvement, the changes were not statistically significant. MWAS identified 18 metabolites that were significantly changed after intervention, including glutamine and glutamate. Pathway analysis demonstrated 30 metabolic pathways that were significantly changed with intervention, including glutamate, aspartate, asparagine, arginine and proline metabolism. Conclusions: Six-months of lifestyle intervention altered activity of 30 metabolic pathways without significant alterations in the clinical metrics. These metabolites and pathways appear to be indicators of a healthier lifestyle in the Black population, potentially supporting their use as markers of CVH and possible therapeutic targets.