Total Correct Score Research Articles

Cognitive Planning Improved After Cycling Exercise in Older Adults with Down Syndrome

Background/Objectives: Cognitive functions are a crucial part of daily living, especially for adults with Down syndrome (DS) who have a high likelihood of developing Alzheimer’s disease in adulthood. In addition, adults with DS move slower and are not meeting the standard aerobic activity guidelines each week. The aim of this study was to examine if Assisted Cycle Therapy (ACT) would improve cognitive planning as measured by the Tower of London (TOL), set switching as measured by the modified Wisconsin Card Sorting Test, and spatial memory as measured by the Corsi Block Test in adults with DS as compared to self-paced cycling. Methods: Twenty-four participants were randomly assigned to one of two interventions over eight weeks. (1) Thirteen older adults with DS completed the ACT intervention, which is stationary cycling with the assistance of a motor to maintain a cadence at least 35% greater than voluntary cycling. (2) Eleven older adults with DS completed voluntary cycling (VC). Results: Our results showed that cognitive planning as measured by total correct score in the TOL showed improvement for both ACT and VC after 8 weeks of exercise, F(1, 22) = 6.22, p = 0.021. There were no significant differences for spatial memory or set switching. Conclusions: We concluded that cycling exercise has a positive impact on cognitive function, especially problem solving in older adults with DS. Our results are discussed with respect to upregulation of neurotrophic factors that increase functioning in the prefrontal cortex that accompanies exercise and leads to improvements in cognitive planning which is essential to many activities of daily living and quality of life for older adults with DS.

Obesity management in primary care: Are we adequately preparing the next generation of Canadian family physicians?

BackgroundObesity is a chronic disease that affects a large proportion of the population. We examined the preparation of Canadian medical learners for obesity management through three cross-sectional studies exploring the: 1) knowledge of evidence-based obesity management among medical students; 2) perspectives of family medicine residents on the adequacy of obesity management training in their residency programs; and 3) intentions of family medicine residents regarding obesity management when they enter practice. MethodsAn online survey instrument was developed for each study. For Study 1, the survey was developed by HP, VE and JA; the questions mapped onto the ten domains outlined in the 2020 Canadian Clinical Practice Guidelines on the Management of Obesity in Adults. For Study 2, the survey was developed by HP and TMcC; the questions aligned with competencies in the management of other chronic diseases. For Study 3, the survey was developed by MR, HP and MV; the Capability, Opportunity, and Motivation (COM-B) model was used as a framework for the questions. All three surveys met the criterion for face validity and the survey for Study 3 met criteria for content and criterion validity. ResultsStudy 1 enrolled 26 first-year and 22 fourth-year students. Total correct scores were below 50 % for both groups, and patient-centeredness scores differed significantly between the groups. Study 2 enrolled 494 family medicine residents; less than 25 % thought there was sufficient time devoted to training in obesity management during residency and approximately 75 % experienced inconsistent messaging about obesity management from their preceptors. Study 3 enrolled 150 family medicine residents. Few participants believed that they had been well trained or had a clear plan for managing obesity, but most believed that obesity management will form part of their practice and that they will have the time and resources for obesity management. ConclusionCurrent medical education does not reflect the requisite knowledge for contemporary obesity management. Further, family medicine residents identified gaps in mentorship of contemporary principles of obesity management. These findings support the revision of the medical curriculum in Canada to better reflect the science of obesity and its management.

Horse Owners' Knowledge of Fundamental Care and their Perceptions on the Implementation of a Mandatory Certificate of Knowledge.

The aims of this study were to first determine the extent of owners' fundamental knowledge of equine care, second, gain their opinions on the implementation of a mandatory certificate of knowledge and third, to investigate the association of certification on horse owner knowledge. An online survey comprising 23 questions (18 closed, 5 open) was distributed worldwide via snowball sampling, and completed by 1847 horse owners who were all ≥18 years old from 17 different countries. Almost all (96%, n = 1781) completed surveys were usable. Just over half (52%) of participants held a current equine knowledge certification, and 59% believed a mandatory certificate of knowledge should be necessary to buy, own, or sell a horse. Horse owners with an equine certificate of knowledge were more likely to be in favor of a mandatory certificate (Pearson's Chi-squared = 50.79, df = 1, p < 0.0001). The mean correctly answered knowledge questions was 68%, indicating that approximately 1/3 of horse owners lacked fundamental horse care knowledge. Further examination indicated that participating horse owners showed the least understanding in the behavioral interactions domain (ANOVA F(4, 24) = 4.98, p < 0.01), specifically in relation to pain recognition and learning theory terminology. Arguably, this deficit in knowledge and likely correct application increases the risk of owners using misinformed or inappropriate techniques to manage horse behavior and training, predisposing the horse to experiencing a sub-optimal quality of life. Overall no significant difference was found between the total correct scores of horse owners with or without a certificate (ANOVA F(1, 56) = 0.78, p > 0.05); however, a series of Chi-squared tests revealed that for the more complex questions, horse owners with a certificate scored better than those without (all p < 0.05). Further work is needed to develop an evidence-based assessment framework if mandatory certification of horse owners is to become an effective tool for improving horse welfare and quality of life.

Forward versus backward recall: Modality testing

Objectives One of the most frequently applied paradigms in the clinical and experimental fields for assessing working memory is the simple span task, composed of forward and backward recall conditions. However, the utility of the simple span measures and their relation to working memory modalities has yet to be elucidated. The current study aimed to address which of the span measures is more sensitive to the differentiation between forward and backward recall in the tactile, verbal, and visuo-spatial modalities, and to test if working memory modalities differ in the disparity between the two conditions. Methods 134 healthy young adults performed the Tactual, Digit, and Visuo-spatial Span tasks, producing Total Correct scores and Longest Sequence score measures. Results There was an interaction effect for condition and modality type, showing better performance for the forward compared to the backward recall in both measures. However, the effect size of the Longest Sequence score was significantly higher than the Total Correct score in all tasks. Furthermore, the Visuo-spatial Span exhibited a larger difference between forward and backward recall compared to the Digit and Tactual Span, whereas no difference was found between the latter two. Conclusions Forward and backward recall are distinguished in all three modalities, and the Longest Sequence score is more sensitive to differentiate between storage and manipulation components of working memory than the Total Correct score. Additionally, the cognitive demand imposed by manipulation compared to storage is the greatest in the visuo-spatial modality.

Knowledge and Attitudes of Patients About the Rational Use of Antibiotics.

Antimicrobial resistance can lead to morbidity and mortality in serious infections. Therefore, this study aimed to evaluate the knowledge and attitudes of patients admitted to the outpatient clinics of our hospital about the rational use of antibiotics. Patients who applied to Infectious Diseases and Internal Diseases Polyclinics between August 01, 2021 and February 01, 2022 were included. After obtaining written consent from those who agreed to participate in the study, a face-to-face questionnaire was applied to evaluate their knowledge and attitudes about antibiotic use. A total of 735 patients were included in the study; 64.1% were women, and the mean age was 40±15 years. The median of the total correct score on the scale measuring the patients' knowledge level in the study was 5. It was determined that individuals who scored 5 or less did not have sufficient knowledge, and those who scored above 5 had sufficient knowledge. Female gender, being single, being a university graduate, and having a middle income were associated with sufficient knowledge level (p<0.05). The rates of self-starting or using antibiotics until the complaints subsided were higher in the group with insufficient knowledge (p<0.05). The knowledge level of our patients regarding antibiotic use provided better results in all parameters, such as the number of visits to the doctor, self-starting antibiotics, using the antibiotic in the appropriate indication, and complying with the duration. The knowledge level was found to be associated with the appropriate antibiotic use.

Knowledge and treatment seeking behaviour for malaria among some undergraduate students of the University of Jos

Background: Malaria remains a major public health problem in Nigeria. Information on clients’ knowledge and treatment seeking behaviour might improve or sustain the rational management of the disease and treatment outcome.&#x0D; Objectives: This study assessed the knowledge and treatment seeking behaviour for the disease among undergraduate students of two Faculties of the University of Jos.&#x0D; Materials and Method: The study employed a cross-sectional strategy in which a self-administered questionnaire was administered to two hundred and two (202) four hundred (400) and five hundred (500) levels Veterinary Medicine and Pharmaceutical sciences Faculty students of the University. The collected data was analyzed using IBM-SPSS® version 23 software.&#x0D; Results: The total possible maximum correct knowledge score of the respondents was 10, and there mean (± SD) knowledge score was 7.77 (± 1.27), with majority (59.9%) having good knowledge of malaria and its management. Most of them either had moderate (38.1%) or good (36.1%) treatment seeking behaviour for the disease. Some factors including religion, level of education, patronage of healthcare facilities, and knowledge of the disease and its management were significant predictors of students’ treatment seeking behaviour for malaria.&#x0D; Conclusion: Despite the fact that a high proportion of the students had good knowledge, their treatment seeking attitudes for the disease were not correspondingly high, implying the existence of a possible gap between the students’ theoretical knowledge on the disease and actual treatment seeking behaviour for the disease.

Effects of Adding Monaural and Binaural Noise to a Dichotic Listening Task.

The Dichotic Digits Test (DDT) evaluates central auditory nervous system (CANS) dysfunction. The DDT is widely used in audiology clinics worldwide, because it is clinically efficient and has good sensitivity and specificity for CANS lesions. However, the DDT shows a strong ceiling effect, which can mitigate its ability to detect subtle CANS dysfunction. This study examines the effects of adding monaural and binaural speech-spectrum noise to the DDT in an effort to make the test more taxing to the CANS and thereby reduce the observed ceiling effect. This was an experimental repeated measures study. The participants were 20 adults aged 18 to 50 years with bilaterally symmetric speech-reception thresholds and pure-tone thresholds (250-8000 Hz) of 25 dB HL or better. Each participant was administered one standard DDT test list (no noise added) and DDT test lists with binaural, monaural right, and monaural left noise added. For each of the noise-added conditions, lists were administered at two different signal-to-noise ratios, for a grand total of seven DDT test lists per participant, presented in randomized order. Monaural and binaural noise effects on DDT scoring indices (Right and Left Ear Percent Correct Scores, Combined Total Percent Correct Scores, and Dichotic Difference Scores), as well as noise effects on the right ear advantage for speech, were examined. Mixed model analyses of variance were used to examine fixed effects and interactions of Noise Condition and Ear. Adding noise to the standard DDT systematically reduced Right and Left Ear Percent Correct Scores and Combined Total Percent Correct Scores. Statistically significant differences on all indices were found between monaural and binaural noise-added conditions, suggesting a possible advantage for binaural listening in noise. These findings suggest that adding noise to tests of dichotic listening increases the difficulty of the task, and that further investigation of dichotic listening patterns in noise could potentially lead to more sensitive clinical evaluations of CANS integrity and function.

Mentalizing in a movie for the assessment of social cognition (MASC): the validation in a taiwanese sample

BackgroundThe present study evaluated the psychometrics properties of a sensitive video-based test used in the evaluation of mentalizing skills, that is, the Movie for the Assessment of Social Cognition-Taiwanese version (MASC-TW).MethodsWe recruited two independent samples of nonclinical participants (N = 167) and adult patients with schizophrenia (N = 41). The MASC-TW and two other social cognition measures, namely the Chinese version of Theory of Mind task (ToM) and the Taiwanese version of the Diagnostic Analysis of Nonverbal Accuracy-2 (DANAV-TW-2), and an executive function measure of the Wisconsin Card Sorting Test (WCST), were administered to both groups.ResultsThe MASC proved to be a reliable measure of mentalizing capacity, high Cronbach’s α value of 0.87. The intraclass correlation coefficient for the MASC-TW total correct scores was 0.85 across three waves of data collection. Across the entire sample, the scores on the MASC-TW were significantly correlated with verbal and nonverbal scores for the ToM task and recognition of facial and prosodic emotion on the DANAV-TW-2. Both executive function and emotion recognition emerged as noteworthy predictors of mentalizing, indicating that these two variables might play crucial roles in the development of mentalizing capacities. Finally, a receiver operating characteristic analysis revealed that in patients with schizophrenia, the MASC was the most accurate discriminator of diagnostic groups, highlighting the validity of the MASC.ConclusionsOverall, the MASC-TW is an ecologically valid and useful tool for assessing mentalizing abilities in a Taiwanese population.

Optimising verbal fluency analysis in neurological patients with dysarthria: examples from Parkinson’s disease and hereditary ataxia

ABSTRACT Background Verbal fluency tests (VFTs) are widely used to assess cognitive-linguistic performance in neurological diseases. However, the influence of dysarthria on performance in tests requiring oral responses is unclear in ataxia and Parkinson’s disease. Objectives To determine the impact of dysarthria on VFT performance and evaluate the validity and reliability of alternative methods for analyzing VFT data. Method Trained raters evaluated dysarthria using VFT recordings in people with ataxia (N = 61) or Parkinson’s disease (PD; N = 69). Total Correct Items scores and qualitative parameters (intrusions, ambiguous verbalizations, perseverations, and interjections) were compared across semantic, phonemic, and alternating fluency tasks. Disease severity was considered as a covariate in the regression model. Results VFT dysarthria ratings correlated with the benchmark (ground truth) dysarthria scores derived from a monologue. Ambiguous responses resulting from unclear speech impeded the rater’s ability to determine if a response was correct. Regression analysis indicated that more severe dysarthria ratings predicted diminished scores in all three tasks (semantic fluency, phonemic fluency and alternating fluency) in the ataxia group. The contribution of disease severity to semantic, phonemic and alternating fluency was reduced substantially in the ataxia group after accounting for dysarthria severity in the model in both groups. Conclusions Dysarthria severity can be estimated based on speech samples derived from VFT. Dysarthria can lead to lower total correct items and is associated with more ambiguous verbalizations in VFT. Dysarthria severity should be considered when interpreting VFT performance in common movement disorders.

Effect of central auditory processing disorders on contralateral routing of offside signals (CROS) hearing aids performance

Objectives The aim of this study was to assess central auditory processing (CAP) tests in patients with single sided deafness (SSD)and to study the effect of central auditory processing disorders(CAPD) on the contralateral routing of signal (CROS) hearing aid performance in these subjects. Design This case-control study was performed in Audiovestibular unit, ENT Department. The study included 20 children with SSD and 20 healthy control children. All participants were subjected to CAP tests including pitch pattern sequence (PPS), gap in noise (GIN) and speech intelligibility in noise (SPIN) tests. The child was fitted with CROS and evaluated by SPIN test and bern benefit in single - sided deafness (BBSS) questionnaire. Results There were lower SPIN, PPS, and GIN total correct scores in children with SSD than the control group. The group with normal central test battery has higher SPIN score and significant performance with questionnaire when fitted with CROS. Conclusions Children with normal central auditory processing test battery performed better when fitted with CROS than those with abnormal test battery.

Association of PPP1R1B polymorphisms with working memory in healthy Han Chinese adults.

The dopamine- and cAMP-regulated phosphoprotein (DARPP-32), which is encoded by the PPP1R1B gene, plays a converging regulatory role in the central nervous system by mediating the actions of dopamine, serotonin, and glutamate. Previous studies have demonstrated that variations in genes related to the dopamine system influence working memory. The present study thus investigated whether polymorphisms in PPP1R1B gene were associated with working memory. A sample of 124 healthy Han Chinese were genotyped for three single nucleotide polymorphisms of PPP1R1B gene, namely rs12601930C/T, rs879606A/G, and rs3764352A/G, using polymerase chain reaction and restriction fragment length polymorphism analysis. Working memory performance was assessed using the Wisconsin Card Sorting Test (WCST). Significant differences were observed in the Total Correct (TC), Total Errors (TE), and Conceptual Level Responses (CLR) scores of the WCST among the three rs12601930C/T genotypes (p = 0.044, 0.044, and 0.047, respectively); in TC, TE, Non-Perseverative Errors (NPE), and CLR scores between participants with the CC and (CT + TT) rs12601930C/T polymorphism genotypes (p = 0.032, 0.032, 0.019, and 0.029, respectively); in TC, TE, Perseverative Errors (PE), NPE, and CLR scores between participants with the (CT + CC) and TT rs12601930C/T polymorphism genotypes (p = 0.001, 0.001, 0.011, 0.004, and 0.001, respectively); and in NPE and CLR scores between participants with the GG and (AG + AA) genotypes of the rs3764352A/G polymorphism (p = 0.011 and 0.010). Furthermore, for males only, there were significant differences in TC, TE, PE, NPE, and CLR scores among the rs12601930C/T genotypes (p = 0.020, 0.020, 0.037, 0.029, and 0.014, respectively) and NPE and CLR scores among the rs3764352 genotypes (p = 0.045 and 0.042). PPP1R1B gene polymorphisms rs12601930C/T and rs3764352A/G might be associated with working memory assessed by the WCST in healthy Chinese adults, especially among males.

The Effects of Tai Chi on the Executive Functions and Physical Fitness in Middle-Aged Adults with Depression: A Randomized Controlled Trial.

Objective The present study examined the effects of Tai Chi exercise on the executive functions (EFs) and physical fitness of middle-aged adults with depression. Methods A total of 39 middle-aged adults with depression (Mage = 50.59, SD = 7.38) were randomly assigned to the Tai Chi group (n = 20) or the waiting-list control group (n = 19). The Tai Chi group engaged in two 90 min sessions of Tai Chi exercise per week for 12 weeks; the waiting-list control group was asked to maintain their usual daily routines for 12 weeks. Depression symptoms, EFs (i.e., inhibitory control, planning, working memory, and cognitive flexibility), and physical fitness (i.e., cardiovascular fitness, muscular strength, muscular endurance, power, and flexibility) were evaluated at the baseline (pretest), 6-week (mid-test), and 12-week (post-test) marks. Results Both groups showed decreased depression symptoms over time. Compared with the control group, the Tai Chi group showed decreased reaction times for incongruent conditions in the Stroop test from pretest to mid- and post-test, and shorter reaction time for incongruent conditions in the Stroop test than the control group at post-test; the Tai Chi group performed significantly better than the control group in overall total move score of Tower of London (TOL). The Tai Chi group also showed increased total correct scores of TOL from pretest to mid- and post-test, and greater total correct scores of TOL than the control group at post-test. Additionally, results indicated that Tai Chi exercise comprehensively improved physical fitness from pretest to mid- and post-test. Greater performance in terms of cardiovascular fitness, muscular strength, and power was also found in the Tai Chi group at post-test than in the control group. Conclusions These findings suggest that the 12-week Tai Chi exercise improved inhibitory control, planning and working memory aspects of executive functions, and physical fitness in middle-aged adults with depression.

Extended High Frequency Hearing, but Not Tinnitus, Is Associated With Every-Day Cognitive Performance.

Research into the potential associations between tinnitus and cognition has investigated specific cognitive domains in laboratory settings despite adults with tinnitus reporting broad cognitive difficulties in every-day life. To address this limitation, the present study compared performance and perceived exertion on a visual office-like task in 38 adults with tinnitus (19 with normal hearing and 19 with hearing loss) and 38 adults without tinnitus (19 with normal hearing and 19 with hearing loss) matched for age, sex and educational background. All participants were also assessed for hearing, anxiety and depression, and participants with tinnitus were also assessed for tinnitus handicap. No associations were found between presence of tinnitus and cognitive performance (mean total rate correct score on the visual office-like task being 2.9 for the tinnitus group, 2.8 for the control group, p = 0.612) and perceived exertion (mean ratings of perceived exertion on the Borg CR10-scale being 5.8 for the tinnitus group, 6.5 for the control group, p = 0.063) on the visual office-like task when corrected for standard (0.125 to 8 kHz) and extended high frequency (10 to 16 kHz) hearing thresholds, anxiety, and depression. The correction for extended high frequency average (10, 12.5, 14, and 16 kHz) hearing threshold was significant for performance (p = 0.009) but not perceived exertion on the visual office-like task. Overall, the results showed extended high frequency hearing, but not tinnitus, was associated with every-day cognitive performance. This indicates clinical testing of hearing thresholds above 8 kHz could support clinicians’ identification and management of cognitive difficulties. One management method suggested by the current findings would include provision of auditory stimulation at frequencies exceeding the frequency response of many current hearing aids.

Evaluating the amount of knowledge about palliative care concepts among health professionals and medical students in the Gaza Strip: a cross-sectional study

BackgroundImprovements in diagnostic facilities and health-care services result in increased numbers of patients with end-stage disease being diagnosed and improvements in medical care for these patients resulting in longer life expectancy. This result generates the need to develop an integrative care system covering patient's physical, psychological, social, and spiritual needs. In the Gaza Strip, the scarcity of palliative care professionals reveals the necessity to develop such care systems. This study evaluated the knowledge of physicians, nurses, and medical students in the Gaza Strip hospitals about palliative care concepts. MethodsA cross-sectional study was conducted in five hospitals in the Gaza Strip, occupied Palestinian territory. Eligible to participate were all physicians, nurses, and medical students who were willing to participate. In total, 352 participants completed the self-administered, validated Palliative Care Knowledge Test. The primary outcome was participant's amount of knowledge on palliative care concepts (including 20 questions on five subscales). The sample size was chosen on the basis of the Epi-Info tool (with a confidence level of 0·95). Results were analysed using SPSS version 23, a one-way ANOVA, and post-hoc tests. Ethical approval was obtained from the Palestinian Health Research Council Helsinki Committee and consent was obtained from the participants. FindingsPatients were recruited from Sept 1 to Dec 31, 2019. The mean age of the 352 participants was 31·9 years (SD 9·5). 210 (59·7%) participants were male, 142 (40·3%) were female, 97 (27·6%) were physicians, 162 (46·0%) were nurses, and 93 (26·4%) were students. The overall average total correct score (of which 100% indicated all questions were answered correctly and reflected the maximum level of knowledge) of the subscales was 47·0%. The average scores across all participants were: 68·9% for philosophy, 41·3% for pain, 37·2% for dyspnoea, 48·5% for psychiatric problems, and 39·2% for gastrointestinal problems. Men scored higher than women, but the difference was not significant (p>0·05). There was a statistically significant difference between physicians, nurses, and students in two subscales (philosophy and dyspnoea) as established by a one-way ANOVA (F=7·17, p=0·001 for philosophy; F=4·67, p=0·010 for dyspnoea). A Bonferroni post-hoc test revealed that physicians’ knowledge in philosophy was significantly higher than that of nurses, with a mean difference in questionnaire scores of 25·2%; but notably, the students’ knowledge was significantly higher than that of nurses, with a mean difference of 32·6%. Additionally, physicians’ knowledge in dyspnoea was significantly higher than nurses’ by a mean difference of 0·386 and higher than students’ by a mean difference of 22·7%. Other subscales did not show any significant differences. Significant differences were found in the subscale scores between different hospitals, except for gastrointestinal problems. InterpretationThe overall low Palliative Care Knowledge Test scores indicate large knowledge gaps. Although philosophy and psychiatric problems were better understood than other concepts, the results were still substantially less than the ideal percentage of 100%. Poor knowledge is likely to reflect poor practice and care for patients with end-stage disease. Students undergo intensive palliative care training at one university, as reflected in their significantly better scores for some subscales, suggesting the effectiveness of educational measures. Palliative care integration is a joint responsibility of professionals and decision makers and should be strengthened by building palliative care teams as well as staff education across all hospitals. FundingNone.

Are neurocognitive abilities and social cognition related to social and role functioning in familial high risk group for psychosis?

In this study, we aimed to compare neurocognitive abilities and social cognitive features among adolescent offspring of psychotic individuals and healthy controls. The study sample was composed of offspring of patients with psychotic disorders (n=30), the high risk group (HR), and age and sex matched healthy controls (n=32) the Control Group (CG). The psychiatric diagnoses were established by using the KD-SADS. Strengths and Difficulties Questionnaire adolescent and parent forms (SDQ-A, SDQ-P) were used. General functioning status were evaluated by The Children's Global Assessment Scale (CGAS) and Global Functioning Scale: Social and Role Functioning. Wisconsin Cart Sorting Test, Controlled Oral Word Association Test, California Verbal Learning Test, Stroop Colour and Word Test and Trail Making Tests A and B were used to assess neurocognitive abilities; to assess social cognition and empathy skills DANVA-2 and Bryant Empathy Scale were used, respectively. Among HR 53.33% had at least one psychopathology. SDQ-A, SDQ-P scores were significantly higher, and CGAS, social and role functioning scores were significantly lower in HR. Neurocognitive test scores were significantly worse except for SCWT scores in the HR. No significant differences were obtained in social cognition. A variety of the neurocognitive abilities were significantly correlated with the role functioning. In regression analyses, the most predictive scores were WCST total correct scores and role functioning score. HR group showed more impairments in neurocognition, social, role and overall functioning, whereas there was no significant difference in terms of social cognition. Disturbances in neurocognition were correlated with impairments in role functioning.

Validation of Discrete and Regression-Based Performance and Cognitive Fatigability Normative Data for the Paced Auditory Serial Addition Test in Multiple Sclerosis.

Cognitive fatigability is an objective performance decrement that occurs over time during a task requiring sustained cognitive effort. Although cognitive fatigability is a common and debilitating symptom in multiple sclerosis (MS), there is currently no standard for its quantification. The objective of this study was to validate the Paced Auditory Serial Addition Test (PASAT) discrete and regression-based normative data for quantifying performance and cognitive fatigability in an Ontario-based sample of individuals with MS. Healthy controls and individuals with MS completed the 3″ and 2″ versions of the PASAT. PASAT performance was measured with total correct, dyad, and percent dyad scores. Cognitive fatigability scores were calculated by comparing performance on the first half (or third) of the task to the last half (or third). The results revealed that the 3″ PASAT was sufficient to detect impaired performance and cognitive fatigability in individuals with MS given the increased difficulty of the 2″ version. In addition, using halves or thirds for calculating cognitive fatigability scores were equally effective methods for detecting impairment. Finally, both the discrete and regression-based norms classified a similar proportion of individuals with MS as having impaired performance and cognitive fatigability. These newly validated discrete and regression-based PASAT norms provide a new tool for clinicians to document statistically significant cognitive fatigability in their patients.

Nutritional Knowledge and Eating Habits of the National Brazilian Futsal Team

Introduction: Futsal is a sport that requires nutritional support to support the high-energy expenditure and significant loss of fluids and electrolytes during training and matches. It is important that high-level athletes follow appropriate, evidence-based nutrition. To our knowledge, there is a lack of data on the eating habits and nutrition knowledge of Futsal players. Therefore, this study aims to describe the nutritional knowledge and eating habits of players of the national Brazilian Futsal Team. A secondary aim was to translate the Abridged Nutrition for Sport Questionnaire into Portuguese for use in Portuguese-speaking athletes. Material and methods: This is a cross-sectional and descriptive study. The evaluations were carried out during the preparation period of the Brazilian Futsal Team for the FIFA Futsal World Cup 2020 qualifiers. We evaluated anthropometry (weight, height, body mass index) nutritional knowledge (assessed using a translated version of the Abridged Nutrition for Sport Knowledge Questionnaire) and eating habits (assessed using a validated Brazilian FFQ), as well as supplement use. The translation of the ANSKQ was undertaken using previous validated forward-backward translation procedures. Results: The mean total correct score on the ANSKQ was 12 out of a possible 35 (34.45%). The mean total correct score on the ANSKQ was 12 out of a possible 35 (34.45%). Players had a statistically significantly higher score for “General Nutrition” knowledge than Sports Nutrition Knowledge (47.27% vs 28.53%, p&lt;0.005). Futsal players had infrequent consumption of the food group "Milk and dairy products", and frequent consumption of "Snacks" as well as fruits. Regarding dietary supplements, 46% of athletes said they consume, or previously consumed, with Whey Protein being the most common supplement. Conclusions: There is room from improvement in athletes nutrition knowledge, especially sports specific knowledge. Futsal players may also require education on appropriate supplement use and dietary intake.

COVID-19 health awareness among the United Arab Emirates population.

In response to the global COVID-19 epidemic, the United Arab Emirates (UAE) government is taking precautionary action to mitigate the spread of the virus. The aim of this study was to evaluate the knowledge and practices toward COVID-19 among the general public in the UAE during the current outbreak. A cross-sectional online survey of 1356 respondents in the UAE was conducted during the epidemic outbreak between 9th to 24th June-2020. The questionnaire consisted of three sections: Socio-demographic, knowledge, practices. Independent-samples t-test, one-way analysis of variance (ANOVA), chi-square and binary logistic regression was used. A p-value of (p < 0.05) was considered statistically significant. The total correct score of knowledge and practice questions was high 85% and 90%, respectively. Male’s sex, other marital status, and illiterate/primary educational levels had a lower level of knowledge and practices than others. Participants aged 18–29 had little higher knowledge than other ages but had a lower level in practices, people who live in Abu Dhabi had better knowledge and practices than other emirates, employed people had a lower level of knowledge but higher in practices. Binary logistic regression analysis presented that females, 18–29 years, and married participants significantly associated with a higher score of knowledge, while female, over 30 years old, the martial status of singles, college-level and higher, unemployed, were significantly associated with high mean practices score. This study provided a full screening of the knowledge and practices among a sample of residents in The UAE toward COVID-19, continuing to implement the health education programs pursued by the UAE is highly important to maintain the appropriate level of awareness among the public.

What do Emergency Physicians Know About Immune Checkpoint Inhibitor-Related Toxicities: A Brief Report

Background: Cancer types eligible for treatment with immune checkpoint inhibitors (ICI) have increased over the past decade thus simultaneously growing the number of patients presenting to emergency departments (ED) with immune mediated toxicities. Objectives: The objective of this study was to ascertain information regarding the knowledge and management of immune checkpoint inhibitor mediated toxicities amongst emergency department physicians. Methods: A multiple-choice questionnaire was developed assessing the understanding of ICI usage and management of immune mediated toxicities, amongst ED physicians in 6 major ED departments in London. Participating clinicians included all levels of trainees and ED physicians. Questionnaires were distributed during weekly ED educational sessions, followed by training on immune-mediated toxicities. Results: Between March 2019 and September 2019, the questionnaire was delivered to 126 participants (80% junior grade, 20% specialist ED consultants). There was no significant association between clinician's seniority and overall score reached on the questionnaire. Amongst all participants, 56, 49, and 36% identified correctly ICIs as the first-line treatment regimen for melanoma, renal cell carcinoma, and non-small cell lung cancer, respectively. Overall, 90% of the participants recognized correctly cisplatin as a chemotherapy agent and 77% pembrolizumab as an ICI agent. Generally, there was a good understanding of chemotherapy related toxicities, however, the participants scored less well on questions relating to ICIs. Ten months following the initial audit and educational intervention, a single site re-audit was performed. The total average correct score was similar pre- and post-intervention (8, 13%, respectively). Conclusions: Knowledge and management of immune mediated toxicities is inferior compared to chemotherapy across physicians working in major ED departments in London. This survey highlights the need for increased education on ICI amongst ED clinicians.

Providers’ assignment of NYHA functional class in patients with heart failure: A vignette study

BackgroundAccuracy of New York Heart Association Functional Classification (NYHA-FC) I-IV assessment is critical to promoting guideline directed care. ObjectiveExamine providers’ accuracy when diagnosing NYHA-FC I-IV in patients with heart failure (HF). MethodsA web-based survey using validated vignettes was conducted with 244 physicians, nurse practitioners (NP), clinical nurse specialists (CNS) and physician assistants (PA) who provide care to patients with HF. ResultsProviders comprised of 65% NPs, 19% physicians, 14% CNSs, 2% PAs with an average of 15 years working with HF patients. Accuracy ranged from 36.9% for Class IV to 78.7% for Class I. Increased HF patient volume seen (p=0.024), physician vs. NP/PA/CNS (p=0.021), and typically assigned a HF stage (p<0.001) were associated with increased total correct score accuracy in multivariable modeling. ConclusionIt is critical that NYHA-FC is accurately assigned to promote optimal outcomes. Research in the future should focus on improving accuracy in assigning NYHA-FC.