Tag: nevin manimala

eNeuro. 2021 Aug 19:ENEURO.0032-21.2021. doi: 10.1523/ENEURO.0032-21.2021. Online ahead of print.

ABSTRACT

Humans can use their previous experience in form of statistical priors to improve decisions. It is however unclear how such priors are learned and represented. Importantly, it has remained elusive whether prior learning is independent of the sensorimotor system involved in the learning process or not, as both modality-specific and modality-general learning have been reported in the past. Here, we used a saccadic eye movement task to probe the learning and representation of a spatial prior across a few trials. In this task, learning occurs in an unsupervised manner and through encountering trial-by-trial visual hints drawn from a distribution centered on the target location. Using a model-comparison approach, we found that participants’ prior knowledge is largely represented in the form of their previous motor actions, with minimal influence from the previously seen visual hints. By using two different motor contexts for response (looking either at the estimated target location, or exactly opposite to it), we could further compare whether prior experience obtained in one motor context can be transferred to the other. Although learning curves were highly similar, and participants seemed to use the same strategy for both response types, they could not fully transfer their knowledge between contexts, as performance and confidence ratings dropped after a switch of the required response. Together, our results suggest that humans preferably use the internal representations of their previous motor actions, rather than past incoming sensory information, to form statistical sensorimotor priors on the timescale of a few trials.Significance StatementHumans can learn statistical regularities and later use them as priors to inform decisions. It remains unclear what type of representation is used to store and integrate past experience. We designed an experiment where humans had to combine visual information over multiple trials to locate a hidden target location. Using computational modelling, we found that participants represented past experience in the form of their previous decisions, and not directly by memorizing the visual cues. As a consequence of overweighing past decisions relative to the veridical visual information, gained experience did not generalize across two different contexts, albeit they differed minimally with respect to the prior. Hence, the process through which past experience is learned determines its influence on our decisions.

PMID:34413084 | DOI:10.1523/ENEURO.0032-21.2021

BMJ Open. 2021 Aug 19;11(8):e045574. doi: 10.1136/bmjopen-2020-045574.

ABSTRACT

INTRODUCTION: In 2013, the WHO published the first global and regional estimates on physical and sexual intimate partner violence (IPV) and non-partner sexual violence (NPSV) based on a systematic review of population-based prevalence studies. In this protocol, we describe a new systematic review for the production of updated estimates for IPV and NPSV for global monitoring of violence against women, including providing the baseline for measuring Sustainable Development Goal to eliminate all forms of violence against women and girls.

METHODS AND ANALYSIS: The systematic review will update and extend the previous search for population-based surveys (either nationally or subnationally representative) conducted among women aged 15+ years that measured the prevalence of physical, sexual, psychological and physical and/or sexual IPV, NPSV or sexual violence by any perpetrator up to December 2019. Data will be extracted separately for all age groups, setting (urban/rural), partnership status (currently partnered/ever partnered/all women) and recall period (lifetime prevalence/past 12 months). Studies will be identified from electronic searches of online databases of EMBASE, MEDLINE, Global Health and PsycInfo. A search of national statistics office homepages will be conducted for each country to identify reports on population-based, national or subnational studies that include data on IPV or NPSV published outside academic journals. Two reviewers will be involved in quality assessment and data extraction of the review. The review is planned to be updated on a continuous basis. All findings will undergo a country consultation process.

ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected. This systematic review will provide a basis and a follow-up tool for global monitoring of the Sustainable Development Goal Target 5.2 on the elimination of all forms of violence against women and girls.

PROSPERO REGISTRATION NUMBER: CRD42017054100.

PMID:34413098 | DOI:10.1136/bmjopen-2020-045574

BMJ Open Qual. 2021 Aug;10(3):e001192. doi: 10.1136/bmjoq-2020-001192.

ABSTRACT

BACKGROUND: In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.

OBJECTIVES: This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.

METHODS: A single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.

RESULTS: 117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.

CONCLUSIONS: Remote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.

PMID:34413067 | DOI:10.1136/bmjoq-2020-001192

Br J Ophthalmol. 2021 Aug 19:bjophthalmol-2021-319232. doi: 10.1136/bjophthalmol-2021-319232. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Glucagon-like peptide-1 receptor (GLP-1R) agonists regulate blood glucose and are commonly used to treat type 2 diabetes mellitus. Recent work showed that treatment with the GLP-1R agonist NLY01 decreased retinal neuroinflammation and glial activation to rescue retinal ganglion cells in a mouse model of glaucoma. In this study, we used an insurance claims database (Clinformatics Data Mart) to examine whether GLP-1R agonist exposure impacts glaucoma risk.

METHODS: A retrospective cohort of patients who initiated a new GLP-1R agonist was 1:3 age, gender, race, classes of active diabetes medications and year of index date matched to patients who initiated a different class of oral diabetic medication. Inverse probability of treatment weighting (IPTW) was used within a multivariable Cox proportional hazard regression model to test the association between GLP-1R agonist exposure and a new diagnosis of primary open-angle glaucoma, glaucoma suspect or low-tension glaucoma.

RESULTS: Cohorts were comprised of 1961 new users of GLP-1R agonists matched to 4371 unexposed controls. After IPTW, all variables were balanced (standard mean deviation <|0.1|) between cohorts. Ten (0.51%) new diagnoses of glaucoma were present in the GLP-1R agonist cohort compared with 58 (1.33%) in the unexposed controls. After adjustment, GLP-1R exposure conferred a reduced hazard of 0.56 (95% CI: 0.36 to 0.89, p=0.01), suggesting that GLP-1R agonists decrease the risk for glaucoma.

CONCLUSIONS: GLP-1R agonist use was associated with a statistically significant hazard reduction for a new diagnosis of glaucoma. Our findings support further investigations into the use of GLP-1R agonists in glaucoma prevention.

PMID:34413054 | DOI:10.1136/bjophthalmol-2021-319232

AJNR Am J Neuroradiol. 2021 Aug 19. doi: 10.3174/ajnr.A7230. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Conventional MR imaging scoring is a valuable tool for risk stratification and prognostication of outcomes, but manual scoring is time-consuming, operator-dependent, and requires high-level expertise. This study aimed to automate the regional measurements of an established brain MR imaging scoring system for preterm neonates scanned between 29 and 47 weeks’ postmenstrual age.

MATERIALS AND METHODS: This study used T2WI from the longitudinal Prediction of PREterm Motor Outcomes cohort study and the developing Human Connectome Project. Measures of biparietal width, interhemispheric distance, callosal thickness, transcerebellar diameter, lateral ventricular diameter, and deep gray matter area were extracted manually (Prediction of PREterm Motor Outcomes study only) and automatically. Scans with poor quality, failure of automated analysis, or severe pathology were excluded. Agreement, reliability, and associations between manual and automated measures were assessed and compared against statistics for manual measures. Associations between measures with postmenstrual age, gestational age at birth, and birth weight were examined (Pearson correlation) in both cohorts.

RESULTS: A total of 652 MRIs (86%) were suitable for analysis. Automated measures showed good-to-excellent agreement and good reliability with manual measures, except for interhemispheric distance at early MR imaging (scanned between 29 and 35 weeks, postmenstrual age; in line with poor manual reliability) and callosal thickness measures. All measures were positively associated with postmenstrual age (r = 0.11-0.94; R² = 0.01-0.89). Negative and positive associations were found with gestational age at birth (r = -0.26-0.71; R² = 0.05-0.52) and birth weight (r = -0.25-0.75; R² = 0.06-0.56). Automated measures were successfully extracted for 80%-99% of suitable scans.

CONCLUSIONS: Measures of brain injury and impaired brain growth can be automatically extracted from neonatal MR imaging, which could assist with clinical reporting.

PMID:34413061 | DOI:10.3174/ajnr.A7230

Am J Geriatr Psychiatry. 2021 Jul 28:S1064-7481(21)00399-7. doi: 10.1016/j.jagp.2021.07.013. Online ahead of print.

ABSTRACT

OBJECTIVE: The aims of this study are to describe the chronology of functional disabilities in primary progressive aphasia (PPA), and to examine associations between psychiatric comorbidities and functional disabilities.

METHODS: We conducted a retrospective data analysis using subjects enrolled at Alzheimer’s Disease Research Centers between 2005 and 2019. Data were obtained from the National Alzheimer’s Coordinating Center database. We included subjects whose primary diagnosis was PPA. Functional status was coded as a binary variable for the following functions: ambulation, transaction skills, verbal communication, meal preparation, and self-care. Behavioral data derived from the Neuropsychiatric Inventory Questionnaire. Descriptive statistics and cox proportional hazard analyses were used to characterize the emergence of disabilities and their association with psychiatric comorbidities.

RESULTS: Data included 91 subjects with a clinical dementia rating scale of zero at baseline. At the initial visit, no individuals had impairments in self-care, while 7% had impairments in transactions, 3% in ambulation, and 2% in meal preparation. Ninety-three percent had language impairments at the onset of the study, and all by visit 4. By visit 5, 41% of patients had impairments in ambulation and in self-care, 49% were impaired in meal preparation and 70% had impairment in transactions. The presence of anxiety, depression, sleep disturbance and psychosis were all significantly associated with an increased risk for multiple functional disabilities.

CONCLUSION: These findings provide clinicians with guidance for forecasting disabilities and targeting interventions in PPA.

PMID:34412935 | DOI:10.1016/j.jagp.2021.07.013

Z Evid Fortbild Qual Gesundhwes. 2021 Aug 16:S1865-9217(21)00121-5. doi: 10.1016/j.zefq.2021.07.004. Online ahead of print.

ABSTRACT

INTRODUCTION: The growing number of people with multimorbidity and polypharmacy in Germany has led to increasing complexity in health care and risks to patient safety. A high priority should therefore be placed on identifying and preventing avoidable adverse events. The patient perspective plays an important role in improving patient safety. In this study, we conducted a representative, population-based survey of knowledge, perceptions and experiences of patient safety, especially of subjectively experienced errors in health care. Our aim was in particular to assess patient safety from the patients’ point of view, and to analyze differences in assessments of risk and preventability between persons that felt well or poorly informed about patient safety topics.

METHODS: In 2019, computer-assisted telephone interviews were conducted nationwide as part of the “TK-Monitor Patient Safety” project. Recruitment was carried out by using multistage selection and forming a stratified random sample. Adults (18 years and older) with sufficient knowledge of German were included. The survey was conducted using a structured guideline containing 21 questions concerning perceptions and experiences of patient safety, and 12 questions on sociodemographic factors. The results were analyzed both descriptively and using inferential statistical methods.

RESULTS: Of a total of 1,000 respondents (51% female), approx. half (52%) were gainfully employed, and 57% rated their state of health as “very good” or “good”. The patients regarded data protection, medication errors, hospital infections and diagnostic (un)certainty as of major relevance to patient safety. Overall, 55% of the respondents rated their knowledge of patient safety as “very good” or “good”. The results showed that subjective knowledge was negatively associated with important outcome parameters such as having experience of medication errors or suspecting errors had been made in a medical examination or treatment. Patients that considered themselves well-informed also reckoned they could contribute towards increasing safety in health care.

DISCUSSION: The respondents considered diagnostic uncertainty to be one of the greatest risks to their person. This shows that they recognized a need for further information and felt this need was inadequately satisfied in the German research landscape. With regard to the correlation between subjective knowledge and outcome parameters, it is also necessary to analyze whether the respondents’ subjective knowledge reflects their actual knowledge, as this would be necessary for preventive measures to be effective. This question will be the subject of further studies.

CONCLUSION: The patient perspective is an important addition to the study of the safety of medical care in Germany. Factors influencing subjective knowledge should be investigated. Furthermore, regular surveys would be desirable in order to gain greater insight into the topic.

PMID:34412979 | DOI:10.1016/j.zefq.2021.07.004

J Infect Chemother. 2021 Aug 16:S1341-321X(21)00234-8. doi: 10.1016/j.jiac.2021.08.016. Online ahead of print.

ABSTRACT

BACKGROUND: Reduced sensitivity of tuberculosis (TB) interferon-γ release assays (IGRAs) among the elderly has been reported, which is presumably due to diminished immune function. We evaluated the clinical performance of QuantiFERON®-TB Gold plus (QFT-Plus) compared with QuantiFERON®-TB Gold In-Tube (QFT-GIT) and T-Spot®.TB (T-SPOT) in the elderly.

METHODS: Blood samples for all three IGRAs were drawn at the same time from all the participants. Both CD4 and CD8 T-cell counts in patients’ peripheral blood were also measured.

RESULTS: A total of 142 active pulmonary TB patients (median age: 84, interquartile range; 76-89 years) were recruited. The sensitivities of the tested IGRAs (excluding invalid/indeterminate cases) were as follows: QFT-Plus, 93.6%; QFT-GIT, 91.4%; and T-SPOT 68.1%. QFT-Plus displayed significantly higher sensitivity than T-SPOT (p < 0.00001). All three IGRAs exhibited the same specificity (100%), as assessed using blood samples from healthy, low TB-risk individuals (n = 118; median age: 39, IQR; 32-47 years). Positivity in 43 active TB patients with CD4 T-cell counts <200/μL, 39 of whom were ≥80 years of age, was as follows: QFT-Plus, 83.7%; QFT-GIT, 74.4%; and T-SPOT, 58.1%. The difference between TB2-TB1 of the QFT-Plus assay was statistically correlated with CD8 but not CD4 T-cell counts in blood (r = 0.193, p = 0.0298).

CONCLUSIONS: QFT-Plus showed high performance in the detection of TB infection in patients irrespective of their advanced age (≥80 years) or lower CD4 counts. QFT-Plus can be useful for the diagnosis of TB infection in all patients, including those who are elderly and/or immunocompromised.

PMID:34412981 | DOI:10.1016/j.jiac.2021.08.016

Arch Med Res. 2021 Aug 9:S0188-4409(21)00167-3. doi: 10.1016/j.arcmed.2021.08.002. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: During the current Coronavirus Disease 2019 (COVID-19) pandemic, patients with diabetes face disproportionately more. This study was performed to clarify anti-inflammatory effects of anti-diabetic agents on COVID-19 in patients with diabetes.

METHODS AND RESULTS: Relevant literature was searched on 15 databases up to November 14, 2020 and was updated on April 13, 2021. The pooled ORs along with 95% CIs were calculated to evaluate combined effects. 31 studies with 66,914 patients were included in qualitative and quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality (pooled OR = 0.62, 95% CI, 0.50-0.76, p = 0.000) and poor composite outcomes (pooled OR = 0.83, 95% CI, 0.71-0.97, p = 0.022) in diabetic patients with COVID-19. Significance of slight lower mortality remained in sulfonylurea/glinides (pooled OR = 0.93, 95% CI, 0.89-0.98, p = 0.004), but of poor composite outcomes was not (pooled OR = 1.48, 95% CI, 0.61-3.60, p = 0.384). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR = 0.95, 95% CI, 0.72-1.26, p = 0.739) or poor composite outcomes (pooled OR = 1.27, 95% CI, 0.91-1.77, p = 0.162) of COVID-19 in diabetic patients.

CONCLUSION: Metformin might be beneficial in decreasing mortality and poor composite outcomes in diabetic patients infected with SARS-CoV-2. DPP-4 inhibitors, sulfonylurea/glinides, SGLT-2 inhibitors, and GLP-1RA would not seem to be adverse. There was insufficient evidence to conclude effects of other anti-diabetic agents. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed. Registration number: PROSPERO-CRD42020221951.

PMID:34412904 | DOI:10.1016/j.arcmed.2021.08.002

Am J Geriatr Psychiatry. 2021 Jul 29:S1064-7481(21)00398-5. doi: 10.1016/j.jagp.2021.07.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the circulating cell-free mitochondrial DNA (ccf-mtDNA) levels, a marker of cellular stress and damage, in older adults with late-life depression (LLD) and frailty. We hypothesize that individuals with both frailty and LLD will have higher ccf-mtDNA levels than individuals with either condition in isolation.

METHODS: Fifty-three older adults (Never Depressed+Robust (reference group, n = 16), LLD+Robust (n = 9), Never Depressed+Prefrail/Frail (n = 5), and LLD+Prefrail/Frail (n = 23)) were included in the study. DNA was extracted from EDTA plasma samples, and ccf-mtDNA was quantified by RT-PCR.

RESULTS: We found a statistically significant difference in the levels of ccf-mtDNA across groups (F_(3,49) = 3.07, p = 0.036), with individuals in the LLD+Prefrail/Frail group showing the highest levels of ccf-mtDNA.

CONCLUSION: The coexistence of LLD and frailty is associated with increased markers of cellular damage and stress (i.e., ccf-mtDNA). Our results suggest that these conditions may share cellular stress and mitochondrial dysfunction phenomena as a common biological mechanism, offering potential future opportunities for geroscience-guided interventions for these conditions.

PMID:34412934 | DOI:10.1016/j.jagp.2021.07.012