Unique Measures Research Articles

On a Degenerating Limit Theorem of DeMarco–Faber

One of our aims is to complement the proof of DeMarco–Faber’s degenerating limit theorem for the family of the unique maximal entropy measures parametrized by a punctured open disk associated to a meromorphic family of rational functions on the complex projective line, degenerating at the puncture. This complementation is done by our main result, which rectifies a key computation in their argument. We also establish and use a direct and explicit translation from degenerating complex dynamics into quantized Berkovich dynamics, instead of using DeMarco–Faber’s more conceptual transfer principle between those dynamics.

Update on Clinical Trial Endpoints in Gene Therapy Trials for Inherited Retinal Diseases.

Inherited retinal diseases (IRDs) encompass a wide spectrum of rare conditions characterized by diverse phenotypes associated with hundreds of genetic variations, often leading to progressive visual impairment and profound vision loss. Multiple natural history studies and clinical trials exploring gene therapy for various IRDs are ongoing. Outcomes for ophthalmic trials measure visual changes in three main categories-structural, functional, and patient-focused outcomes. Since IRDs may range from congenital with poor central vision from birth to affecting the peripheral retina initially and progressing insidiously with visual acuity affected late in the disease course, typical outcome measures such as central visual acuity and ocular coherence tomography (OCT) imaging of the macula may not provide adequate representation of therapeutic outcomes including alterations in disease course. Thus, alternative unique outcome measures are necessary to assess loss of peripheral vision, color vision, night vision, and contrast sensitivity in IRDs. These differences have complicated the assessment of clinical outcomes for IRD therapies, and the clinical trials for IRDs have had to design novel specialized endpoints to demonstrate treatment efficacy. As genetic engineering and gene therapy techniques continue to advance with growing investment from industry and accelerated approval tracks for orphan conditions, the clinical trials must continue to improve their assessments to demonstrate safety and efficacy of new gene therapies that aim to come to market. Here, we will provide an overview of the current gene therapy approaches, review various endpoints for measuring visual function, highlight those that are utilized in recent gene therapy trials, and provide an overview of stage 2 and 3 IRD trials through the second quarter of 2024.

Climate change exposure and corporate culture: A text-based approach

Utilizing unique measures of climate change vulnerability and corporate culture generated through cutting-edge textual analysis, we explore the effects of firm-specific exposure to climate change on corporate culture. Based on a sample of over 46,000 U.S. observations from 2001 to 2018, our findings demonstrate that firms with greater exposure to climate change have a significantly stronger corporate culture. Companies recognize the value of a strong corporate culture in helping them navigate the unpredictable environment produced by climate change. Therefore, when more exposed to climate change, firms are more driven to promote a robust corporate culture. In particular, an increase in climate change exposure by one standard deviation strengthens corporate culture by 3.12%–37.70%.

Phytoplankton cell-states: multiparameter fluorescence lifetime flow-based monitoring reveals cellular heterogeneity.

Phytoplankton are a major source of primary productivity. Their photosynthetic fluorescence are unique measures of their type, physiological state, and response to environmental conditions. Changes in phytoplankton photophysiology are commonly monitored by bulk fluorescence spectroscopy, where gradual changes are reported in response to different perturbations, such as light intensity changes. What is the meaning of such trends in bulk parameters if their values report ensemble averages of multiple unsynchronized cells? To answer this, we developed an experimental scheme that enables tracking fluorescence intensities, brightnesses, and their ratios, as well as mean photon nanotimes equivalent to mean fluorescence lifetimes, one cell at a time. We monitored three different phytoplankton species during diurnal cycles and in response to an abrupt increase in light intensity. Our results show that we can define specific subpopulations of cells by their fluorescence parameters for each of the phytoplankton species, and in response to varying light conditions. Importantly, we identify the cells undergo well-defined transitions between these subpopulations. The approach shown in this work will be useful in the exact characterization of phytoplankton cell states and parameter signatures in response to different changes these cells experience in marine environments, which will be applicable for monitoring marine-related environmental effects.

Spinal cord metrics derived from diffusion MRI: improvement in prognostication in cervical spondylotic myelopathy compared with conventional MRI.

A major shortcoming in optimizing care for patients with cervical spondylotic myelopathy (CSM) is the lack of robust quantitative imaging tools offered by conventional MRI. Advanced MRI modalities, such as diffusion MRI (dMRI), including diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help address this limitation by providing granular evaluations of spinal cord microstructure. Forty-seven patients with CSM underwent comprehensive clinical assessments and dMRI, followed by DTI and DBSI modeling. Conventional MRI metrics included 10 total qualitative and quantitative assessments of spinal cord compression in both the sagittal and axial planes. The dMRI metrics included 12 unique measures including anisotropic tensors, reflecting axonal diffusion, and isotropic tensors, describing extraaxonal diffusion. The primary outcome was the modified Japanese Orthopaedic Association (mJOA) score measured at 2 years postoperatively. Extreme gradient boosting-supervised classification algorithms were used to classify patients into disease groups and to prognosticate surgical outcomes at 2-year follow-up. Forty-seven patients with CSM, including 24 (51%) with a mild mJOA score, 12 (26%) with a moderate mJOA score, and 11 (23%) with a severe mJOA score, as well as 21 control subjects were included. In the classification task, the traditional MRI metrics correctly assigned patients to healthy control versus mild CSM versus moderate/severe CSM cohorts, with an accuracy of 0.647 (95% CI 0.64-0.65). In comparison, the DTI model performed with an accuracy of 0.52 (95% CI 0.51-0.52) and the DBSI model's accuracy was 0.81 (95% CI 0.808-0.814). In the prognostication task, the traditional MRI metrics correctly predicted patients with CSM who improved at 2-year follow-up on the basis of change in mJOA, with an accuracy of 0.58 (95% CI 0.57-0.58). In comparison, the DTI model performed with an accuracy of 0.62 (95% CI 0.61-0.62) and the DBSI model had an accuracy of 0.72 (95% CI 0.718-0.73). Conventional MRI is a powerful tool to assess structural abnormality in CSM but is inherently limited in its ability to characterize spinal cord tissue injury. The results of this study demonstrate that advanced imaging techniques, namely DBSI-derived metrics from dMRI, provide granular assessments of spinal cord microstructure that can offer better diagnostic and prognostic utility.

Horospherical dynamics in invariant subvarieties

We consider the horospherical foliation on any invariant subvariety in the moduli space of translation surfaces. This foliation can be described dynamically as the strong unstable foliation for the geodesic flow on the invariant subvariety, and geometrically, it is induced by the canonical splitting of C-valued cohomology into its real and imaginary parts. We define a natural volume form on the leaves of this foliation, and define horospherical measures as those measures whose conditional measures on leaves are given by the volume form. We show that the natural measures on invariant subvarieties, and in particular, the Masur-Veech measures on strata, are horospherical. We show that these measures are the unique horospherical measures giving zero mass to the set of surfaces with horizontal saddle connections, extending work of Lindenstrauss-Mirzakhani and Hamenstädt for principal strata. We describe all the leaf closures for the horospherical foliation.

The fragility index and reverse fragility index of FDA investigational device exemption trials in spinal fusion surgery: a systematic review.

FDA investigational device exemption (IDE) studies are considered a gold standard of assessing safety and efficacy of novel devices through RCTs. The fragility index (FI) has emerged as a means to assess robustness of statistically significant study results and inversely, the reverse fragility index (RFI) for non-significant differences. Previous authors have defined results as fragile if loss to follow up is greater than the FI or RFI. The aim of this study was to assess the FI, RFI, and robustness of data supplied by IDE studies in spinal surgery. This was a systematic review of the literature. Inclusion criteria included randomized controlled trials with dichotomous outcome measures conducted under IDE guidelines between 2000 and 2023. FI and RFI were calculated through successively changing events to non-events until the outcome changed to non-significance or significance, respectively. The fragility quotient (FQ) and reverse fragility quotient (RFQ) were calculated by dividing the FI and RFI, respectively, by the sample size. Thirty-two studies met inclusion criteria with a total of 40 unique outcome measures; 240 outcomes were analyzed. Twenty-six studies reported 96 statistically significant results. The median FI was 6 (IQR: 3-9.25), and patients lost to follow up was greater than the FI in 99.0% (95/96) of results. The average FQ was 0.027. Thirty studies reported 144 statistically insignificant results and a median RFI of 6 (IQR: 4-8). The average RFQ extrapolated was 0.021, and loss to follow up was greater than the RFI in 98.6% (142/144) of results. IDE studies in spine surgery are surprisingly fragile given their reputations, large sample sizes, and intent to establish safety in investigational devices. This study found a median FI and RFI of 6. The number of patients lost to follow-up was greater than FIand RFI in 98.8% (237/240) of reported outcomes. FQ and RFQ tell us that changes of two to three patients per hundred can flip the significance of reported outcomes. This is an important reminder of the limitations of RCTs. Analysis of fragility in future studies may help clarify the strength of the relationship between reported data and their conclusions.

Is the Hamilton regression filter really superior to Hodrick–Prescott detrending?

Abstract An article published in 2018 by J.D. Hamilton gained significant attention due to its provocative title, “Why you should never use the Hodrick-Prescott filter.” Additionally, an alternative method for detrending, the Hamilton regression filter (HRF), was introduced. His work was frequently interpreted as a proposal to substitute the Hodrick–Prescott (HP) filter with HRF, therefore utilizing and understanding it similarly as HP detrending. This research disputes this perspective, particularly in relation to quarterly business cycle data on aggregate output. Focusing on economic fluctuations in the United States, this study generates a large amount of artificial data that follow a known pattern and include both a trend and cyclical component. The objective is to assess the effectiveness of a certain detrending approach in accurately identifying the real decomposition of the data. In addition to the standard HP smoothing parameter of $\lambda = 1600$ , the study also examines values of $\lambda ^{\star }$ from earlier research that are seven to twelve times greater. Based on three unique statistical measures of the discrepancy between the estimated and real trends, it is evident that both versions of HP significantly surpass those of HRF. Additionally, HP with $\lambda ^{\star }$ consistently outperforms HP-1600.

The civilian's dilemma: Civilians exhibit automatic defensive responses to the police.

Interactions between police officers and civilians incur for both police and civilians the possibility of danger due to a nonzero likelihood of encountering a physical threat. A body of work examining the implications of threat processes during police-civilian interactions focuses almost exclusively on the perspective of police officers, under the auspice that police use-of-force decisions stem from perceptions and misperceptions of threat (e.g., research on the shooter bias). Almost no research has examined these dynamics from the perspective of civilians whose encounter with police involves interacting with an armed and potentially dangerous individual. In the current work, we advance the idea that just as police may respond to civilians as threats, civilians may respond to the police as threats. That is, among civilians, encountering the police may evoke a combination of defensive bodily and behavioral responses. Across three studies (N = 603) each utilizing unique measures of defensive behavioral and physiological responding, we found that people more rapidly avoid police than nonpolice, demonstrate enhanced defensive freeze responses to police than nonpolice, and evince larger defensive physiological preparation toward police than nonpolice. In light of these patterns, we discuss the implications of defensive responses for shaping civilian behavior in real-world encounters with the police. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome: The Need for a Standardized Approach.

Systematic review. To identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures. SCS is a surgical procedure used in patients with tethered cord syndrome (TCS)-characterized by abnormal attachment of neural components to surrounding tissues-to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms. PubMed and EMBASE searches captured SCS literature published between 1950 and 2023. Prospective/retrospective cohort studies and case series were included without age limit or required follow-up period. Review articles without new patient presentations, meta-analyses, systematic reviews, conference abstracts, and letters were excluded. Studies included adult and pediatric patients. The 29 identified studies represented 278 patients (age 5-76y). In 24.1% of studies, patients underwent primary TCS intervention via SCS. In 41.4% of studies, patients underwent SCS after failed previous primary detethering (24.1% of studies were mixed and 10.3% were unspecified). The most commonly reported non-genitourinary/bowel surgical indications were back pain (55.2%), lower-extremity pain (48.3%), lower-extremity weakness (48.3%), lower-extremity numbness (34.5%), and lower-extremity motor dysfunction (34.5%). Genitourinary/bowel symptoms were most often described as nonspecific bladder dysfunction (58.6%), bladder incontinence (34.5%), and bowel dysfunction (31.0%). After SCS, non-genitourinary/bowel outcomes included lower-extremity pain (44.8%), back pain (31.0%), and lower-extremity sensory and motor function (both 31.0%). Bladder dysfunction (79.3%), bowel dysfunction (34.5%), and bladder incontinence (13.8%) were commonly reported genitourinary/bowel outcomes. In total, 40 presenting surgical indication categories and 33 unique outcome measures were reported across studies. Seventeen of the 278 patients (6.1%) experienced a complication. The SCS surgical literature displays variability in operative indications and postoperative outcomes. The lack of common reporting mechanisms impedes higher-level analysis. A standardized outcomes measurement tool, encompassing both patient-reported outcome measures and objective metrics, is necessary. Level 4.

The use of private regulatory measures to create healthy food retail environments: a scoping review.

Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these. Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework. Food retail. Food retail settings using private regulatory measures to create healthier food retail environments. In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35). We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.

Comparative analysis of lithium-ion and flow batteries for advanced energy storage technologies

This research does a thorough comparison analysis of Lithium-ion and Flow batteries, which are important competitors in modern energy storage technologies. The goal is to clarify their unique characteristics and performance measures. Lithium-ion batteries demonstrate superior energy density (200 Wh/kg) and power density (500 W/kg) in comparison to Flow batteries (100 Wh/kg and 300 W/kg, respectively), indicating their ability to store more energy per unit mass and provide higher power outputs. Flow batteries have a competitive advantage in terms of cycle life, providing a longer duration of 1000 cycles compared to Lithium-ion batteries, which only offer 500 cycles. In addition, although Lithium-ion batteries have a higher efficiency of 90% compared to 80% in Flow batteries, the latter exhibit a lower environmental impact with decreased CO2 emissions (30 g/kWh) and a lower toxicity rating. Lithium-ion batteries have lower material costs, amounting to $200 per kilowatt-hour (kWh). However, they entail higher installation costs of $5000 and maintenance costs of $200, when compared to Flow batteries, which have material costs of $150/kWh, installation costs of $8000, and maintenance costs of $300. In addition, Lithium-ion batteries demonstrate superior charging capabilities of 50 kW and discharging rates of 70 kW, surpassing Flow batteries which have charging rates of 30 kW and discharging rates of 40 kW, respectively. The findings of this study highlight the subtle advantages and compromises of Lithium-ion and Flow batteries in terms of different performance parameters. This information is crucial for making well-informed decisions when choosing energy storage technologies that meet specific application needs in a wide range of sectors, including portable electronics and grid-scale applications.

Board of directors, COVID-19, and corporate social responsibility monetary performance: direct and interaction effects analysis

Purpose This study aims to provide archival evidence on the impact of board characteristics on corporate social responsibility (CSR) monetary performance and how they interact with the COVID-19 pandemic in the context of CSR monetary performance. Design/methodology/approach This study analyzes listed companies in Oman’s capital market from 2016 to 2021, using pooled ordinary least squares and unique CSR performance measures such as budgeting and spending. Findings The study finds that companies with more expertise and frequent meetings are more likely to allocate a larger budget for CSR activities. However, this does not apply to larger boards or to independent directors. During the COVID-19 pandemic, the effect of independent directors on CSR budgeting and spending is more pronounced, and boards with more expertise and meetings show a negative interaction with the pandemic. The interaction of board characteristics with COVID-19 in terms of CSR monetary performance varies depending on company size. Board independence and expertise show a significant reaction to COVID-19 infection and death cases when setting CSR budgeting and spending. Research limitations/implications The findings of this study are stimulating, but stem from an emerging country with unique cultural and institutional characteristics. Methodological issues were also encountered during the analysis, so readers should exercise caution when applying the results to other settings. Practical implications This study highlights board involvement in deciding a company’s CSR investment, as it was believed that chief executive officers are considered responsible for CSR activities. Additionally, this research underscores the significance of incorporating the financial aspects of CSR into reporting. Originality/value This study examines the seldom explored relationship between corporate boards and CSR monetary aspects during regular and irregular times, offering theoretical and practical insights that benefit multiple stakeholders.

School-Based Screening of Social Determinants of Health: A Scoping Review

School-based screening instruments have traditionally focused on assessing within-child factors, such as a student’s academic, social, emotional, behavioral, or physical development. This emphasis in school-based screening may be a missed opportunity to assess and ameliorate contextual factors (i.e., social determinants of health) influencing child development. In this scoping review, we aim to describe the current landscape of screening for social determinants of health (SDOH) in school settings. Following established practices for scoping reviews, we searched PsycInfo, ERIC, and CINAHL Plus in December 2022 for articles describing the development or use of an SDOH measure in a school setting. From each eligible article, two coders independently extracted (1) study characteristics, (2) measure characteristics, (3) available psychometric or usability information, and (4) reported outcomes of measure implementation. Descriptive and content analyses were used to examine data. We identified six articles describing the development or use of SDOH measures in elementary, high school, or university settings. These articles yielded six unique SDOH measures, intended for either adolescent or young adult self-report, caregiver proxy-report, or both. Measures included 6–25 SDOH items, with additional items assessing demographics, health behaviors, or mental health (e.g., depression). Reported outcomes included increased referrals to services and implementation of school-based supports to reduce social risk (e.g., school food pantry). We discuss next steps for research evaluating the feasibility and social consequences of school-based SDOH screening.

Physical distancing and its association with travel behavior in daily pre-pandemic urban life: An analysis utilizing lifelogging images and composite survey and mobility data

This study analyzed physical distancing in people’s daily lives and its association with travel behavior and the use of transportation modes before the COVID-19 outbreak. We used data from photographic images acquired automatically by lifelogging devices every 5 seconds, on average, from 170 participants of a 2-day wearable camera study, in order to identify their physical distancing status throughout the day. Using deep-learning computer vision algorithms, we developed three measures which provided a near-continuous quantification of the proportion of time spent without anyone else within a distance of approximately 13 meters, as well as the proportion of time spent without others within approximately 2 meters. These measures are then used as outcomes in beta regression and multinomial logit models to explore the association between the participant’s physical distancing and travel behavior and transportation choices. The multidisciplinary research approach to understand these associations accounted for a number of social, economic, and cultural factors that potentially influenced their physical isolation levels. We found that participants spend a significant amount of time physically separated from others, without anyone else within 2 meters. The use of public transportation, automobiles, active travel, and an increase in trip frequency, including trips to transportation facilities, reduced the extent of physical distancing, with public transportation having the most significant impact. Higher incomes, strong social networks, and a sense of belonging to the community reduced the tendency for physical distancing. In contrast, factors such as age, obesity, dog ownership, intensive use of the Internet, and being knowledgeable about climate change issues increased the likelihood of physical distancing. The paper addresses a crucial gap in our understanding of how these factors intersect to create the dynamics of physical distancing in non-emergency situations and highlights their planning and operational implications while showcasing the use of unique person-based physical distancing measures derived from autonomously collected image data.

Quantum Information-Assisted Complete Active Space Optimization (QICAS).

We propose an effective quantum information-assisted complete active space optimization scheme (QICAS). What sets QICAS apart from other correlation-based selection schemes is (i) the use of unique measures from quantum information that assess the correlation in electronic structures in an unambiguous and predictive manner and (ii) an orbital optimization step that minimizes the correlation discarded by the active space approximation. Equipped with these features, QICAS yields, for smaller correlated molecule, sets of optimized orbitals with respect to which the complete active space configuration interaction energy reaches the corresponding complete active space self-consistent field (CASSCF) energy within chemical accuracy. For more challenging systems such as the chromium dimer, QICAS offers an excellent starting point for CASSCF by greatly reducing the number of iterations required for numerical convergence. Accordingly, our study validates a profound empirical conjecture: the energetically optimal nonactive spaces are predominantly those that contain the least entanglement.

HPB P42 Case Report: Laparoscopic Cholecystectomies in patients with a Ventriculoperitoneal shunt: key considerations for surgeons

Abstract Background Laparoscopic surgery has evolved to become the preferred mode of access for intraperitoneal surgery and is the gold standard approach to cholecystectomy. With the high prevalence of laparoscopic procedures to definitively treat gallstones and their associated complications, an increasing number of patients with co-morbidities are undergoing these procedures, including patients with cerebrospinal fluid (CSF) shunts in situ. These shunts pose unique challenges due to the paucity of guidelines, research and data to optimally manage these patients. Methods We report a case of a patient who underwent a successful, but technically challenging laparoscopic cholecystectomy whilst having a Ventriculoperitoneal (VP) shunt present. Important considerations are necessary, including the additional risks of: shunt failure and impaired CSF drainage, retrograde insufflation leading to increased intracranial pressure and herniation, and the risk of bile leak which could result in ascending meningitis (thereby making intra-operative cholangiogram a relative contraindication). We will discuss what unique measures were implemented pre-operatively, peri-operatively and post-operatively to prevent these complications, in consultation with both the patient and the wider multidisciplinary healthcare team. Results A 39-year-old female with gallstone pancreatitis, underwent an ERCP, and was subsequently listed for elective laparoscopic cholecystectomy. From childhood, she had a VP shunt in place for an Arnold Chiari II malformation. A literature review was conducted and a CT scan was arranged. Her case was discussed with neurosurgery, radiology, microbiology and anaesthetics, with multiple safety recommendations proposed; including US guided marking of the shunt tubing on the skin, appropriate pre-operative antibiotics, lower than normal pneumoperitoneum pressures, no attempt at intra-operative cholangiogram or bile duct exploration, avoidance of gallbladder perforation, minimal washout, neuro-observations in the post-operative period and post-operative antibiotics. Conclusions Our report shows that with thorough pre-operative planning involving communication with multidisciplinary team and with informed consent, laparoscopic cholecystectomy can be performed in this patient sub-group with relative safety without the need for shunt manipulation or peri-operative intracranial pressure monitoring. It is however, technically challenging, and should be considered by experienced laparoscopic surgeons, and perhaps reserved for those with subspecialty biliary interests.

Comparative Analysis of the Monetary Policy Practices: A Case Study of China and the United States

Currency policy plays a crucial role in macroeconomic management and is of significant importance for the economic stability and development of countries and regions. Understanding and evaluating the choices and consequences of different countries' currency policy practices are essential. This paper aims to compare and analyze the currency policy practices of China and the United States, two important economic entities, and explore their core elements, policy objectives, and impact on economic stability and growth. China, as the world's second-largest economy, has implemented a series of unique monetary policy measures to address domestic and external challenges. The United States, as the largest economy in the world, has a long-standing tradition of stable monetary policy and faces challenges and responsibilities consistent with its economic status.

Immunological Misfiring and Sex Differences/Similarities in Early COVID-19 Studies: Missed Opportunities of Making a Real IMPACT.

COVID-19-associated intensive care unit (ICU) admissions were recognized as critical health issues that contributed to morbidity and mortality in SARS-CoV-2-infected patients. Severe symptoms in COVID-19 patients are often accompanied by cytokine release syndrome. Here, we analyzed publicly available data from the Yale IMPACT cohort to address immunological misfiring and sex differences in early COVID-19 patients. In 2020, SARS-CoV-2 was considered far more pathogenic and lethal than other circulating respiratory viruses, and the inclusion of SARS-CoV-2 negative patients in IMPACT cohorts confounds many findings. We ascertained the impact of several important biological variables such as days from symptom onset (DFSO); pre-existing risk factors, including obesity; and early COVID-19 treatments on significantly changed immunological measures in ICU-admitted COVID-19 patients that survived versus those that did not. Deceased patients had 19 unique measures that were not shared with ICU patients including increased granzyme-B-producing GzB+CD8+ T cells and interferon-γ. Male COVID-19 patients in ICU experienced many more changes in immunological and clinical measures than female ICU patients (25% vs. ~16%, respectively). A total of 13/124 measures including CCL5, CCL17, IL-18, IFNα2, Fractalkine, classical monocytes, T cells, and CD4Temra exhibited significant sex differences in female vs. male COVID-19 patients. A total of nine measures including IL-21, CCL5, and CD4Temra differed significantly between female and male healthy controls. Immunosuppressed patients experienced the most decreases in CD4Temra and CD8Tem cell numbers. None of the early COVID-19 treatments were effective in reducing levels of IL-6, a major component of the cytokine storm. Obesity (BMI >30) was the most impactful risk factor for COVID-19-related deaths and worst clinical outcomes. Our analysis highlights the contribution of biological sex, risk factors, and early treatments with respect to COVID-19-related ICU admission and progression to morbidity and mortality.

2 The Role of Flexibility in Learning in Autistic Teens

Objective:Autistic youth have impaired executive functioning (EF) and these challenges increase throughout adolescence. Deficits in EF have been associated with poor adult outcomes, decreased availability for learning, and linked to academic outcomes. Specifically, flexible problem solving is greatly reduced in autistic youth. We aim to investigate how flexibility contributes to learning in autistic youth and their typically developing peers.Participants and Methods:Participants included 44 teens with (n=22) and without (n=22) ASD. All teens were 14-18 years old (ASD M = 15.77, SD = 1.05; TD M = 15.73, SD = .96) with FSIQ 3 70 (ASD M = 105.92, SD= 16.17; TD M = 107.93, SD = 10.14). Teens with ASD met DSM-5 criteria for autism supported by the SCQ and/or ADOS-2. All participants completed the California Verbal Learning Task (Child or Third Edition) over zoom. Parents reported on their child’s flexibility skills on the Flexibility Questionnaire (FQ) which encompasses 5 subscales: routines/rituals, transitions, special interests, social flexibility, and generativity. Independent samples t-tests examined group differences in performance on the CVLT, measured by the long delay recall and learning slope. Bivariate correlations examined the relationship between learning and flexibility in the autistic group. Linear regression was used to determine how flexibility contributes to learning above and beyond age, gender, and diagnosis.Results:Autistic youth had significantly lower scores on the CVLT long-delay recall (t = 2.311, p = .026) and the learning slope (t = 1.186, p = .038) than their typically developing peers. Special interests on the FQ were related to both performance on the first trial of the CVLT (r = -.482 p = .023) and the short delay cued recall (r = -.469 p = .028) in the autistic group. Fewer transition related problems were predictive of higher scores on the CVLT above and beyond age, gender, and diagnosis (R2 = .366, B = - .088, p = .030).Conclusions:Learning was significantly lower in autistic teens compared to their typically developing peers. Additionally, autistic youth had a less steep learning slope than their typically developing peers. Autistic youth may focus on the first group of words only and don’t flexibly update their list to add new words as the trials go on. Autistic youth with more restricted interests have difficulty with the first trial due to the shifting required when starting a new unfamiliar task. Additionally, youth with a greater focus on their own interests had more difficulty on cued recall indicating that these youth may have had trouble shifting when prompted to use semantic categories. Fewer challenges with transitions were a significant predictor of learning above and beyond age, gender, and diagnosis. Previous research has shown large discrepancies between parent-report and laboratory-based tasks in autistic youth. This project highlights two unique measures of different modalities that show similarities in their ratings emphasizing their potential as good representations of overall skills. Future research should utilize a larger sample size to continue to examine the role of flexible problem solving in working memory and learning in autistic youth.