Category: Nevin Manimala

JMIR Res Protoc. 2024 Jun 6;13:e56271. doi: 10.2196/56271.

ABSTRACT

BACKGROUND: Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts-which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients.

OBJECTIVE: We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for “adult immunosuppression.”

METHODS: Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses.

RESULTS: This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024.

CONCLUSIONS: This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record-compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56271.

PMID:38842925 | DOI:10.2196/56271

Am J Orthopsychiatry. 2024 Jun 6. doi: 10.1037/ort0000753. Online ahead of print.

ABSTRACT

Despite the importance of the school environment for mental health outcomes, there is little research on how the school context during adolescence may impact depressive symptoms among Asian Americans (AAs) over time. The purpose of this study was to investigate (a) the long-term effects of perceived prejudice from peers and teachers on school belonging and depressive symptoms in adolescence, early young adulthood, and young adulthood among AAs and (b) the mediating effects of school belonging and two early depressive symptoms on the associations between perceived prejudice from peers and teachers and young adulthood depressive symptoms. The data came from the National Longitudinal Study on Adolescent Health. The present study used a subsample of 689 AAs who completed interviews during adolescence, young adulthood, and adulthood. The major data analysis strategy was structural equation modeling. The structural equation modeling results indicated that the major path coefficients from school context to depressive symptoms at the three time points for AAs were statistically significant, except for the path from adolescent depressive symptoms to young adulthood depressive symptoms. There were three significant mediating effects of school belonging and two early depressive symptoms on the association between perceived prejudice from teachers and young adulthood depressive symptoms in AAs. The results emphasize the importance of identifying school contextual risk factors leading to mental health disparities and developing culturally appropriate intervention strategies for AAs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38842898 | DOI:10.1037/ort0000753

Psychol Rev. 2024 Jun 6. doi: 10.1037/rev0000463. Online ahead of print.

ABSTRACT

A central goal of research into language acquisition is explaining how, when learners generalize to new cases, they appropriately restrict their generalizations (e.g., to avoid producing ungrammatical utterances such as *the clown laughed the man; “*” indicates an ungrammatical form). The past 30 years have seen an unresolved debate between statistical preemption and entrenchment as explanations. Under preemption, the use of a verb in a particular construction (e.g., *the clown laughed the man) is probabilistically blocked by hearing that other verb constructions with similar meanings only (e.g., the clown made the man laugh). Under entrenchment, such errors (e.g., *the clown laughed the man) are probabilistically blocked by hearing any utterance that includes the relevant verb (e.g., by the clown made the man laugh and the man laughed). Across five artificial-language-learning studies, we designed a training regime such that learners received evidence for the (by the relevant hypothesis) ungrammaticality of a particular unattested verb/noun + particle combination (e.g., *chila + kem; *squeako + kem) via either preemption only or entrenchment only. Across all five studies, participants in the preemption condition (as per our preregistered prediction) rated unattested verb/noun + particle combinations as less acceptable for restricted verbs/nouns, which appeared during training, than for unrestricted, novel-at-test verbs/nouns, which did not appear during training, that is, strong evidence for preemption. Participants in the entrenchment condition showed no evidence for such an effect (and in 3/5 experiments, positive evidence for the null). We conclude that a successful model of learning linguistic restrictions must instantiate competition between different forms only where they express the same (or similar) meanings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38842892 | DOI:10.1037/rev0000463

Psychol Addict Behav. 2024 Jun 6. doi: 10.1037/adb0001015. Online ahead of print.

ABSTRACT

OBJECTIVE: A propensity for aggression or alcohol use may be associated with alcohol-related aggression. Previous research has shown genetic overlap between alcohol use and aggression but has not looked at how alcohol-related aggression may be uniquely influenced by genetic risk for aggression or alcohol use. The present study examined the associations of genetic risk for trait aggression, alcohol use, and alcohol use disorder (AUD) with alcohol-related aggression using a polygenic risk score (PRS) approach.

METHOD: Using genome-wide association study summary statistics, PRSs were created for trait aggression, alcohol consumption, and AUD. These PRSs were used to predict the phenotype of alcohol-related aggression among drinkers in two independent samples: the University of California at San Francisco (UCSF) Family Alcoholism Study (n = 1,162) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 4,291).

RESULTS: There were significant associations between the AUD PRS and lifetime alcohol-related aggression in the UCSF study sample. Additionally, the trait aggression PRS was associated with three or more experiences of hitting anyone else and getting into physical fights while under the influence of alcohol, along with a composite score of three or more experiences of alcohol-related aggression, in the UCSF study sample. No significant associations were observed in the Add Health sample. Limited sex-specific genetic effects were observed.

CONCLUSIONS: These results provide preliminary evidence that genetic influences underlying alcohol use and aggression are uniquely associated with alcohol-related aggression and suggest that these associations may differ by type and frequency of alcohol-related aggression incidents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:38842867 | DOI:10.1037/adb0001015

J Vis. 2024 Jun 3;24(6):5. doi: 10.1167/jov.24.6.5.

ABSTRACT

Ensemble processing allows the visual system to condense visual information into useful summary statistics (e.g., average size), thereby overcoming capacity limitations to visual working memory and attention. To examine the role of attention in ensemble processing, we conducted three experiments using a novel paradigm that merged the action effect (a manipulation of attention) and ensemble processing. Participants were instructed to make a simple action if the feature of a cue word corresponded to a subsequent shape. Immediately after, they were shown an ensemble display of eight ovals of varying sizes and were asked to report either the average size of all ovals or the size of a single oval from the set. In Experiments 1 and 2, participants were cued with a task-relevant feature, and in Experiment 3, participants were cued with a task-irrelevant feature. Overall, the task-relevant cues that elicited an action influenced reports of average size in the ensemble phase more than the cues that were passively viewed, whereas task-irrelevant cues did not bias the reports of average size. The results of this study suggest that attention influences ensemble processing only when it is directed toward a task-relevant feature.

PMID:38842835 | DOI:10.1167/jov.24.6.5

Invest Ophthalmol Vis Sci. 2024 Jun 3;65(6):11. doi: 10.1167/iovs.65.6.11.

ABSTRACT

PURPOSE: To evaluate microvascular intereye differences in diabetic patients with same-stage diabetic retinopathy (DR) in both eyes as assessed using optical coherence tomography angiography (OCTA).

METHODS: In this cross-sectional study, fovea-centered swept-source 6 × 6 mm OCTA scans were acquired using a 200 kHz OCTA device. Vessel density (VD) and fractal dimension were calculated on binarized, vessel-segmented images in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Foveal avascular zone (FAZ) area (FAZA) and perimeter (FAZP) was measured and FAZ circularity (FAZC) calculated. Absolute difference (δabs) and asymmetry index between eyes was assessed and compared across DR stages. Differences of VD, FD, and FAZ parameters between left and right eye were evaluated using linear mixed models.

RESULTS: A total of 336 eyes of 168 diabetic patients without DR and with DR stages ranging from mild nonproliferative to proliferative DR were included for analysis. The intereye comparison revealed significantly lower VD in the SCP (estimate [95% CI] = -0.009 [-0.01; -0.006], P < 0.01), as well as a significantly lower FD in the SCP (-0.007 [-0.009; -0.005], P < 0.01) of the left compared to the right eye. FAZC of the left compared to the right eye was lower in eyes without DR, moderate DR, and PDR (P < 0.05). FAZ δabs and asymmetry index were higher in more advanced disease stages (P < 0.05).

CONCLUSIONS: OCTA metrics provide important information on the retinal microvasculature in systemic diseases such as DR. Our results reveal a significant intereye difference with lower VD and FD in the SCP as well as higher FAZ impairment of the left compared to the right eye.

PMID:38842830 | DOI:10.1167/iovs.65.6.11

JAMA Ophthalmol. 2024 Jun 6. doi: 10.1001/jamaophthalmol.2024.1808. Online ahead of print.

ABSTRACT

IMPORTANCE: National estimates regarding the frequency of presentations and patterns of care for eye pain are unknown. This information could guide research and clinical efforts to optimize outcomes.

OBJECTIVE: To estimate eye pain visits in the US in the outpatient and emergency department (ED) settings.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study of National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (2008-2019) analyzed a population-based sample of visits to outpatient clinics and EDs. The sample consisted of patients presenting with eye pain. Data were analyzed from September 2023 to April 2024.

MAIN OUTCOMES AND MEASURES: Weighted sample data estimated outpatient and ED eye pain presentations including patient and clinician characteristics, diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10]), and disposition.

RESULTS: From 2008 through 2019, 4.6 million (95% CI, 3.9 million to 5.3 million) outpatient and 1.0 million (95% CI, 0.8 million to 1.1 million) ED eye pain visits occurred annually. Patients were predominantly women (63.2% [95% CI, 59.4%-67.0%]) and older than 60 years (46.6% [95% CI, 42.4%-51.0%]) in the outpatient setting. Patients presenting to the ED were more often men (51.8% [95% CI, 48.7%-55.0%]) and aged younger than 45 years (aged <15 years: 16.4% [95% CI, 13.9%-18.8%]; 15-24 years: 19.2% [95% CI, 16.6%-21.7%]; and 25-44 years: 35.6% [95% CI, 32.7%-38.5%]). In nearly half of outpatient eye pain visits, the major problem was classified as nonacute (2.0 million [95% CI, 1.6 million to 2.3 million]). Eye pain was the primary reason for the visit (RFV) in 42.0% (95% CI, 37.8%-46.2%) of outpatient visits and 66.9% (95% CI, 62.9%-70.9%) of ED eye pain visits. It was the only RFV in 18.3% (95% CI, 15.0%-21.7%) of outpatient and 32.7% (95% CI, 29.0%-36.4%) of ED eye pain encounters. Ophthalmologists evaluated the largest number of outpatient visits (45.3% [95% CI, 38.8%-51.7%). The primary diagnosis was non-vision threatening for most outpatient (78.5% [95% CI, 56.8%-100%]) and ED (69.9% [95% CI, 62.1%-77.7%]) visits when eye pain was the primary RFV. Additional follow-up was scheduled in 89.4% (95% CI, 86.2%-92.6%) of visits.

CONCLUSIONS AND RELEVANCE: More than 5 million eye pain visits occur annually; the largest percentage are outpatient with ophthalmologists. Most diagnoses were non-vision threatening in both the outpatient and ED setting and resulted in additional care. Expanding therapeutic approaches to treat the causes of eye pain may reduce the burden on the health care system and optimize outcomes.

PMID:38842822 | DOI:10.1001/jamaophthalmol.2024.1808

JAMA Netw Open. 2024 Jun 3;7(6):e2415340. doi: 10.1001/jamanetworkopen.2024.15340.

NO ABSTRACT

PMID:38842812 | DOI:10.1001/jamanetworkopen.2024.15340

JAMA Netw Open. 2024 Jun 3;7(6):e2415094. doi: 10.1001/jamanetworkopen.2024.15094.

ABSTRACT

IMPORTANCE: Data are limited on the association of physical activity (PA) with incident cardiovascular disease (CVD) and mortality in prediabetes, especially in racial and ethnic minority groups, including Hispanic and Latino populations.

OBJECTIVE: To determine the association of PA with incident CVD and mortality by prediabetes status among Hispanic or Latino and non-Hispanic adults.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included data from 2 cohorts of adults with prediabetes or normoglycemia who were free of CVD at baseline visit: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from baseline examination through 2017, with median (IQR) follow-up of 7.8 (7.2-8.5) years, and the Framingham Heart Study (FHS) with non-Hispanic participants from index examination through 2019, with median (IQR) follow-up of 9.6 (8.1-10.7) years. Analyses were conducted between September 1, 2022, and January 10, 2024.

EXPOSURE: The primary exposure was baseline accelerometry-measured moderate to vigorous PA, insufficient vs sufficient to meet 2018 Physical Activity Guidelines for Americans (PAG) in both cohorts; additional accelerometer-measured exposures in HCHS/SOL were steps per day, sedentary behavior, and counts per min.

MAIN OUTCOMES AND MEASURES: The outcome was a composite of incident CVD or all-cause mortality, whichever came first.

RESULTS: This cohort study included 13 223 participants: from HCHS/SOL, there were 9456 adults (all self-identified Hispanic or Latino ethnicity; survey-adjusted mean [SD] age, 38.3 [13.9] years, unweighted counts 5673 (60.0%) female; 4882 [51.6%] with normoglycemia; 4574 [48.4%] with prediabetes), and from FHS there were 3767 adults (3623 [96.2%] non-Hispanic and 140 [3.7%] Hispanic or Latino ethnicity, with 4 [0.1%] participants missing ethnicity; mean [SD] age, 54.2 [13.6] years; 2128 (56.5%) female; 2739 [72.7%] with normoglycemia; 1028 [27.3%] with prediabetes). Not meeting PAG was associated with higher risk of the composite outcome among participants with normoglycemia (vs PAG met; hazard ratio [HR], 1.85 [95% CI, 1.12-3.06]), but not among participants with prediabetes (HR, 1.07 [95% CI, 0.72-1.58]). For HCHS/SOL, no statistically significant association was found between the composite outcome and other PA metrics, although estimated HRs tended to be higher for lower activity in the normoglycemia group but not for the prediabetes group (eg, for steps less than vs at least 7000 per day, the HR was 1.58 [95% CI, 0.85-2.93] for normoglycemia vs 1.08 [95% CI 0.67-1.74] for prediabetes). While there was also no association in HCHS/SOL between the composite outcome and sedentary behavior, results were similar in the prediabetes group (HR per 30 minutes per day of sedentary behavior, 1.05 [95% CI 0.99-1.12]) and in the normoglycemia group (HR, 1.07 [95% CI 0.98-1.16]).

CONCLUSIONS AND RELEVANCE: In this cohort study of US Hispanic or Latino and non-Hispanic adults, lower moderate to vigorous PA levels were associated with CVD or mortality among participants with normoglycemia but not participants with prediabetes. Adults with prediabetes may benefit from reducing sedentary behavior and improving multiple lifestyle factors beyond improving moderate to vigorous PA alone.

PMID:38842811 | DOI:10.1001/jamanetworkopen.2024.15094

JAMA Netw Open. 2024 Jun 3;7(6):e2415102. doi: 10.1001/jamanetworkopen.2024.15102.

ABSTRACT

IMPORTANCE: Moyamoya disease (MMD) is a rare chronic cerebrovascular disease, and the outcomes of bypass management in adult patients remain controversial.

OBJECTIVE: To categorize adult MMD based on asymptomatic, ischemic, and hemorrhagic onset and compare the outcomes (death, hemorrhagic stroke [HS], and ischemic stroke [IS]) of bypass surgery (direct or indirect) with those of conservative management.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, nationwide, population-based longitudinal cohort study used Korean National Health Insurance Research data to identify adults (aged ≥15 years) with MMD who were diagnosed between January 1, 2008, and December 31, 2020, and followed up until December 31, 2021 (median follow-up, 5.74 [IQR, 2.95-9.42] years). A total of 19 700 participants (3194 with hemorrhagic, 517 with ischemic, and 15 989 with asymptomatic MMD) were included. Data were analyzed from January 2 to April 1, 2023.

EXPOSURES: Bypass surgery and conservative management.

MAIN OUTCOMES AND MEASURES: Death constituted the primary outcome; secondary outcomes consisted of HS or IS. Kaplan-Meier survival curve and Cox proportional hazards regression analysis were applied. The propensity score-matching and stratified analyses were performed to control covariate effects.

RESULTS: A total of 19 700 patients (mean [SD] age, 45.43 [14.98] years; 12 766 [64.8%] female) were included. Compared with conservative management, bypass was associated with a reduced risk of death (adjusted hazard ratio [AHR], 0.50 [95% CI, 0.41-0.61]; P < .001) and HS (AHR, 0.36 [0.30-0.40]; P < .001) in hemorrhagic MMD; reduced risk of IS (AHR, 0.55 [95% CI, 0.37-0.81]; P = .002) in ischemic MMD; and reduced risk of death (AHR, 0.74 [95% CI, 0.66-0.84]; P < .001) in asymptomatic MMD. However, bypass was associated with an increased risk of HS (AHR, 1.76 [95% CI, 1.56-2.00]; P < .001) in asymptomatic MMD. Both direct and indirect bypass demonstrated similar effects in hemorrhagic and asymptomatic MMD, except only direct bypass was associated with a reduced risk of IS (AHR, 0.52 [95% CI, 0.33- 0.83]; P = .01) in ischemic MMD. After stratification, bypass was associated with a reduced risk of death in patients younger than 55 years with ischemic (AHR, 0.34 [95% CI, 0.13- 0.88]; P = .03) and asymptomatic (AHR, 0.69 [95% CI, 0.60-0.79]; P < .001) MMD, but an increased risk of HS in patients 55 years or older with ischemic MMD (AHR, 2.13 [95% CI, 1.1-4.16]; P = .03).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study of bypass outcomes for patients with MMD emphasize the importance of tailoring management strategies in adult patients based on onset types.

PMID:38842810 | DOI:10.1001/jamanetworkopen.2024.15102