Telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER): A pilot study for patients treated with surgery for oral cavity carcinoma.

BACKGROUND: To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/- adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard-of-care" SOC rehabilitation. METHOD: Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation. RESULTS: Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range-of-liquids" improved by +0.36 [95% CI, 0.02-0.70, p = 0.05] and "range-of-solids" improved by +0.73 [95% CI, 0.12-1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by -1.2 [95% CI, -2.45 to 0.053, p = 0.06], and "nutritional-mode" increased by +0.55 [95% CI, -0.15 to 1.24, p = 0.08]. CONCLUSION: This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.

Extinction in host-vector infection models and the role of heterogeneity.

For infections that become endemic in a population, the process may appear stable over a long time scale, but stochastic fluctuations can lead to eventual disease extinction. We consider the effects of model parameters and of population heterogeneities upon the expected time to extinction for host-vector disease systems. We find that non-homogeneous host selection by vectors increases persistence times relative to the homogeneous case, and that the effect becomes even more marked when there are strong associations between particular groups of vectors and hosts. Heterogeneity in vector lifespans, in contrast, is found to decrease persistence times relative to the homogeneous case. Neither the basic reproduction number R0, nor the endemic prevalence level in the corresponding deterministic model, is found to be sufficient to predict (for a given population size) time to extinction. The endemic level, in particular, proves a very unreliable guide to the duration of long-term persistence.

Brain computed tomography reading of stroke patients by resident doctors from different medical specialities: An eye-tracking study.

BACKGROUND: Using the eye-tracking technique, our work aimed to examine whether difference in clinical background may affect the training outcome of resident doctors' interpretation skills and reading behaviour related to brain computed tomography (CT). METHODS: Twelve resident doctors in the neurology, radiology, and emergency departments were recruited. Each participant had to read CT images of the brain for two cases. We evaluated each participant's accuracy of lesion identification. We also used the eye-tracking technique to assess reading behaviour. We recorded dwell times, fixation counts, run counts, and first-run dwell times of target lesions to evaluate visual attention. Transition entropy was applied to assess the temporal relations and spatial dynamics of systematic image reading. RESULTS: The eye-tracking results showed that the image reading sequence examined by transition entropy was comparable among resident doctors from different medical specialties (p = 0.82). However, the dwell time of the target lesions was shorter for the resident doctors from the neurology department (4828.63 ms, p = 0.01) than for those from the resident doctors from the radiology (6275.88 ms) and emergency (5305.00 ms) departments. The eye-tracking results in individual areas of interest only showed differences in the eye-tracking performance of the first-run dwell time (p = 0.05) in the anterior cerebral falx. DISCUSSION: Our findings demonstrate that resident doctors from different medical specialties may achieve similar imaging reading patterns for brain CT. This may mitigate queries regarding the influence of different backgrounds on training outcomes.

Interlayer donor-acceptor pair excitons in MoSe2/WSe2 moiré heterobilayer.

Localized interlayer excitons (LIXs) in two-dimensional moiré superlattices exhibit sharp and dense emission peaks, making them promising as highly tunable single-photon sources. However, the fundamental nature of these LIXs is still elusive. Here, we show the donor-acceptor pair (DAP) mechanism as one of the origins of these excitonic peaks. Numerical simulation results of the DAP model agree with the experimental photoluminescence spectra of LIX in the moiré MoSe2/WSe2 heterobilayer. In particular, we find that the emission energy-lifetime correlation and the nonmonotonic power dependence of the lifetime agree well with the DAP IX model. Our results provide insight into the physical mechanism of LIX formation in moiré heterostructures and pave new directions for engineering interlayer exciton properties in moiré superlattices.

Investigating the performance of level-specific fit indices in multilevel confirmatory factor analysis with dichotomous indicators: A Monte Carlo study.

We conducted a Monte Carlo study to examine the performance of level-specific χ2 test statistics and fit regarding their capacity to determine model fit at specific levels in multilevel confirmatory factor analysis with dichotomous indicators. Five design factors-numbers of groups (NG), group size (GS), intra-class correlation (ICC), thresholds of dichotomous indicators (THR), and factor loadings (FL)-were considered in this study. According to our simulation results, we recommend that practitioners should be aware that the performance of between-level-specific (b-l-s) χ2 and fit indices was mainly influenced by ICC and FL, followed by NG. At the same time, THR could slightly weigh in the performance of b-l-s fit indices in some conditions. Both b-l-s χ2 and fit indices were more promising indicators to correctly indicate model fit when ICC or FL increased. A small to medium NG (50-100) might be sufficient for b-l-s χ2 and fit indices only if both ICC and factor loadings were high, while in remaining conditions, an NG of 200 was needed. Moreover, practitioners could use within-level-specific (w-l-s) χ2 and fit indices (except for RMSEAW) along with traditional cut-off values to evaluate within-level models comprising dichotomous indicators. W-l-s χ2 and fit indices were more promising to determine model fit when FL increased. THR had a slight impact and could weigh in the performance of [Formula: see text], RMSEAW, CFIW, and TLIW. Unfortunately, RMSEAW was heavily affected by FL and THR and could determine model fit only when FL was high and THR was symmetric.

Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study.

BACKGROUND: To study whether oral presentation (OP) assessment could reflect the novice learners' interpretation skills and reading behaviour on brain computed tomography (CT) reading. METHODS: Eighty fifth-year medical students were recruited, received a 2-hour interactive workshop on how to read brain CT, and were assigned to read two brain CT images before and after instruction. We evaluated their image reading behaviour in terms of overall OP post-test rating, the lesion identification, and competency in systematic image reading after instruction. Students' reading behaviour in searching for the target lesions were recorded by the eye-tracking technique and were used to validate the accuracy of lesion reports. Statistical analyses, including lag sequential analysis (LSA), linear mixed models, and transition entropy (TE) were conducted to reveal temporal relations and spatial complexity of systematic image reading from the eye movement perspective. RESULTS: The overall OP ratings [pre-test vs. post-test: 0 vs. 1 in case 1, 0 vs. 1 in case 2, p < 0.001] improved after instruction. Both the scores of systematic OP ratings [0 vs.1 in both cases, p < 0.001] and eye-tracking studies (Case 1: 3.42 ± 0.62 and 3.67 ± 0.37 in TE, p = 0.001; Case 2: 3.42 ± 0.76 and 3.75 ± 0.37 in TE, p = 0.002) showed that the image reading behaviour changed before and after instruction. The results of linear mixed models suggested a significant interaction between instruction and area of interests for case 1 (p < 0.001) and case 2 (p = 0.004). Visual attention to the target lesions in the case 1 assessed by dwell time were 506.50 ± 509.06 and 374.38 ± 464.68 milliseconds before and after instruction (p = 0.02). However, the dwell times in the case 2, the fixation counts and the frequencies of accurate lesion diagnoses in both cases did not change after instruction. CONCLUSION: Our results showed OP performance may change concurrently with the medical students' reading behaviour on brain CT after a structured instruction.

Comparisons of Science Motivational Beliefs of Adolescents in Taiwan, Australia, and the United States: Assessing the Measurement Invariance Across Countries and Genders.

This study utilized international, large-scale assessment data to compare science motivational beliefs of adolescents within and between countries and genders. The study focused on the beliefs about science of eighth graders, including their self-concept in science, the intrinsic value they ascribed to science, and their beliefs about the utility of the subject. The study data were derived from the Trends in International Mathematics and Science Study in 2019 (TIMSS) that was conducted in Taiwan, Australia, and the United States. To ensure the validity of mean cross-group comparisons, the measurement invariance (MI) of the constructs was first assessed. The multiple-group confirmatory factor analysis and latent factor mean comparisons were applied to the data. The results indicated that the MI of science motivational beliefs across the three countries attained only metric invariance, rendering a latent mean comparison implausible. However, the cross-gender MI within each country attained scalar invariance, supporting the comparison of means across genders. The science motivational beliefs of females were significantly lower than those of males, with the exception of beliefs of US students about their utility value. The findings of this study raise concerns about the validity of current international comparisons of science motivational beliefs of the students while supporting the use of TIMSS data to identify gender differences in science motivation within each country. The implications of MI across countries and genders are discussed, and the importance of establishing MI is highlighted. The findings affirm that gender disparities in science motivational beliefs can be compared using constructs with sound psychometric properties.

Impact of cancelled General Anaesthetic dental extraction appointments on children due to the COVID-19 pandemic.

BACKGROUND: COVID-19 has resulted in the cancellation of general anaesthetic procedures including dental extractions (GAX) for children in the UK, exacerbating existing inequalities. There is robust evidence that children from deprived and some ethnic backgrounds are at greater risk of caries and are, therefore, more likely to be affected by cancellations. AIM: To identify the impact of, and possible mitigations for, cancelled general anaesthetic procedures on children in the South East of England. DESIGN: Data were collected from service providers on the number of children who had their appointments cancelled during the first lockdown. Paediatric dentists and clinical leads contributed views on the likely impact of these cancellations on the affected children. RESULTS: 1,456 children had their appointments cancelled in the six weeks between 20th March and 30th June 2020. The key themes identified from providers included lengthening waiting lists, challenges of swab testing and self-isolation and the need to re-orientate dental services to increase prevention. CONCLUSION: COVID-19 has exacerbated existing health inequalities within our communities. Different parts of the NHS must work together to ensure that all children have access to services to treat and improve oral health.

Spatial proteomics defines the content of trafficking vesicles captured by golgin tethers.

Intracellular traffic between compartments of the secretory and endocytic pathways is mediated by vesicle-based carriers. The proteomes of carriers destined for many organelles are ill-defined because the vesicular intermediates are transient, low-abundance and difficult to purify. Here, we combine vesicle relocalisation with organelle proteomics and Bayesian analysis to define the content of different endosome-derived vesicles destined for the trans-Golgi network (TGN). The golgin coiled-coil proteins golgin-97 and GCC88, shown previously to capture endosome-derived vesicles at the TGN, were individually relocalised to mitochondria and the content of the subsequently re-routed vesicles was determined by organelle proteomics. Our findings reveal 45 integral and 51 peripheral membrane proteins re-routed by golgin-97, evidence for a distinct class of vesicles shared by golgin-97 and GCC88, and various cargoes specific to individual golgins. These results illustrate a general strategy for analysing intracellular sub-proteomes by combining acute cellular re-wiring with high-resolution spatial proteomics.

Effectiveness of Common Fabrics to Block Aqueous Aerosols of Virus-like Nanoparticles.

Layered systems of commonly available fabric materials can be used by the public and healthcare providers in face masks to reduce the risk of inhaling viruses with protection that is about equivalent to or better than the filtration and adsorption offered by 5-layer N95 respirators. Over 70 different common fabric combinations and masks were evaluated under steady-state, forced convection air flux with pulsed aerosols that simulate forceful respiration. The aerosols contain fluorescent virus-like nanoparticles to track transmission through materials that greatly assist the accuracy of detection, thus avoiding artifacts including pore flooding and the loss of aerosol due to evaporation and droplet breakup. Effective materials comprise both absorbent, hydrophilic layers and barrier, hydrophobic layers. Although the hydrophobic layers can adhere virus-like nanoparticles, they may also repel droplets from adjacent absorbent layers and prevent wicking transport across the fabric system. Effective designs are noted with absorbent layers comprising terry cloth towel, quilting cotton, and flannel. Effective designs are noted with barrier layers comprising nonwoven polypropylene, polyester, and polyaramid.

pH Biosensing by PI4P Regulates Cargo Sorting at the TGN.

Phosphoinositides, diacylglycerolpyrophosphate, ceramide-1-phosphate, and phosphatidic acid belong to a unique class of membrane signaling lipids that contain phosphomonoesters in their headgroups having pKa values in the physiological range. The phosphomonoester headgroup of phosphatidic acid enables this lipid to act as a pH biosensor as changes in its protonation state with intracellular pH regulate binding to effector proteins. Here, we demonstrate that binding of pleckstrin homology (PH) domains to phosphatidylinositol 4-phosphate (PI4P) in the yeast trans-Golgi network (TGN) is dependent on intracellular pH, indicating PI4P is a pH biosensor. pH biosensing by TGN PI4P in response to nutrient availability governs protein sorting at the TGN, likely by regulating sterol transfer to the TGN by Osh1, a member of the conserved oxysterol-binding protein (OSBP) family of lipid transfer proteins. Thus, pH biosensing by TGN PI4P allows for direct metabolic regulation of protein trafficking and cell growth.

Evaluating fit indices in a multilevel latent growth curve model: A Monte Carlo study.

The multilevel latent growth curve model (MLGCM), which is subsumed by the multilevel structural equation modeling framework, has been advocated as a means of investigating individual and cluster trajectories. Still, how to evaluate the goodness of fit of MLGCMs has not been well addressed. The purpose of this study was to conduct a systematic Monte Carlo simulation to carefully investigate the effectiveness of (a) level-specific fit indices and (b) target-specific fit indices in an MLGCM, in terms of their independence from the sample size's influence and their sensitivity to misspecification in the MLGCM that occurs in either the between-covariance, between-mean, or within-covariance structure. The design factors included the number of clusters, the cluster size, and the model specification. We used Mplus 7.4 to generate simulated replications and estimate each of the models. We appropriately controlled the severity of misspecification when we generated the simulated replications. The simulation results suggested that applying RMSEAT_S_COV, TLIT _ S _ COV, and SRMRB maximizes the capacity to detect misspecifications in the between-covariance structure. Moreover, the use of RMSEAPS _ B, CFIPS _ B, and TLIPS _ B is recommended for evaluating the fit of the between-mean structure. Finally, we found that evaluation of the within-covariance structure turned out to be unexpectedly challenging, because none of the within-level-specific fit indices (RMSEAPS _ W, CFIPS _ W, TLIPS _ W, and SRMRW) had a practically significant sensitivity.

MRI Is a DNA Damage Response Adaptor during Classical Non-homologous End Joining.

The modulator of retrovirus infection (MRI or CYREN) is a 30-kDa protein with a conserved N-terminal Ku-binding motif (KBM) and a C-terminal XLF-like motif (XLM). We show that MRI is intrinsically disordered and interacts with many DNA damage response (DDR) proteins, including the kinases ataxia telangiectasia mutated (ATM) and DNA-PKcs and the classical non-homologous end joining (cNHEJ) factors Ku70, Ku80, XRCC4, XLF, PAXX, and XRCC4. MRI forms large multimeric complexes that depend on its N and C termini and localizes to DNA double-strand breaks (DSBs), where it promotes the retention of DDR factors. Mice deficient in MRI and XLF exhibit embryonic lethality at a stage similar to those deficient in the core cNHEJ factors XRCC4 or DNA ligase IV. Moreover, MRI is required for cNHEJ-mediated DSB repair in XLF-deficient lymphocytes. We propose that MRI is an adaptor that, through multivalent interactions, increases the avidity of DDR factors to DSB-associated chromatin to promote cNHEJ.

Using iMCFA to Perform the CFA, Multilevel CFA, and Maximum Model for Analyzing Complex Survey Data.

To construct CFA, MCFA, and maximum MCFA with LISREL v.8 and below, we provide iMCFA (integrated Multilevel Confirmatory Analysis) to examine the potential multilevel factorial structure in the complex survey data. Modeling multilevel structure for complex survey data is complicated because building a multilevel model is not an infallible statistical strategy unless the hypothesized model is close to the real data structure. Methodologists have suggested using different modeling techniques to investigate potential multilevel structure of survey data. Using iMCFA, researchers can visually set the between- and within-level factorial structure to fit MCFA, CFA and/or MAX MCFA models for complex survey data. iMCFA can then yield between- and within-level variance-covariance matrices, calculate intraclass correlations, perform the analyses and generate the outputs for respective models. The summary of the analytical outputs from LISREL is gathered and tabulated for further model comparison and interpretation. iMCFA also provides LISREL syntax of different models for researchers' future use. An empirical and a simulated multilevel dataset with complex and simple structures in the within or between level was used to illustrate the usability and the effectiveness of the iMCFA procedure on analyzing complex survey data. The analytic results of iMCFA using Muthen's limited information estimator were compared with those of Mplus using Full Information Maximum Likelihood regarding the effectiveness of different estimation methods.

Author Correction: TBC1D23 is a bridging factor for endosomal vesicle capture by golgins at the trans-Golgi.

In the version of Supplementary Table 1 originally published with this Article, in the sheet relating to Fig. 3c, all values in the 'golgin-97-mito' column were 1.3 times larger than the actual values, which was due to author error when generating the Supplementary Table. These errors did not affect the graph in Fig. 3c, which was plotted with the correct values. Supplementary Table 1 has now been replaced so that it contains the correct values.

Analyzing individual growth with clustered longitudinal data: A comparison between model-based and design-based multilevel approaches.

To prevent biased estimates of intraindividual growth and interindividual variability when working with clustered longitudinal data (e.g., repeated measures nested within students; students nested within schools), individual dependency should be considered. A Monte Carlo study was conducted to examine to what extent two model-based approaches (multilevel latent growth curve model - MLGCM, and maximum model - MM) and one design-based approach (design-based latent growth curve model - D-LGCM) could produce unbiased and efficient parameter estimates of intraindividual growth and interindividual variability given clustered longitudinal data. The solutions of a single-level latent growth curve model (SLGCM) were also provided to demonstrate the consequences of ignoring individual dependency. Design factors considered in the present simulation study were as follows: number of clusters (NC = 10, 30, 50, 100, 150, 200, and 500) and cluster size (CS = 5, 10, and 20). According to our results, when intraindividual growth is of interest, researchers are free to implement MLGCM, MM, or D-LGCM. With regard to interindividual variability, MLGCM and MM were capable of producing accurate parameter estimates and SEs. However, when D-LGCM and SLGCM were applied, parameter estimates of interindividual variability were not comprised exclusively of the variability in individual (e.g., students) growth but instead were the combined variability of individual and cluster (e.g., school) growth, which cannot be interpreted. The take-home message is that D-LGCM does not qualify as an alternative approach to analyzing clustered longitudinal data if interindividual variability is of interest.

A Solution to Modeling Multilevel Confirmatory Factor Analysis with Data Obtained from Complex Survey Sampling to Avoid Conflated Parameter Estimates.

The issue of equality in the between-and within-level structures in Multilevel Confirmatory Factor Analysis (MCFA) models has been influential for obtaining unbiased parameter estimates and statistical inferences. A commonly seen condition is the inequality of factor loadings under equal level-varying structures. With mathematical investigation and Monte Carlo simulation, this study compared the robustness of five statistical models including two model-based (a true and a mis-specified models), one design-based, and two maximum models (two models where the full rank of variance-covariance matrix is estimated in between level and within level, respectively) in analyzing complex survey measurement data with level-varying factor loadings. The empirical data of 120 3rd graders' (from 40 classrooms) perceived Harter competence scale were modeled using MCFA and the parameter estimates were used as true parameters to perform the Monte Carlo simulation study. Results showed maximum models was robust to unequal factor loadings while the design-based and the miss-specified model-based approaches produced conflated results and spurious statistical inferences. We recommend the use of maximum models if researchers have limited information about the pattern of factor loadings and measurement structures. Measurement models are key components of Structural Equation Modeling (SEM); therefore, the findings can be generalized to multilevel SEM and CFA models. Mplus codes are provided for maximum models and other analytical models.

TBC1D23 is a bridging factor for endosomal vesicle capture by golgins at the trans-Golgi.

The specificity of membrane traffic involves tethers at destination organelles that selectively capture incoming transport vesicles to allow SNAREs on opposing membranes to then assemble and drive fusion. Tethers include both protein complexes and long coiled-coil proteins, although how they contribute to specificity remains unclear. The golgin coiled-coil proteins at the Golgi apparatus capture vesicles from different origins, but the vesicle-specific molecular cues that they recognize are unknown. Vesicle tethering is typically a transient process and therefore is challenging to interrogate in vivo. Thus, we have used a system in which an ectopic golgin causes vesicles to accumulate in a tethered state. By applying proximity biotinylation to the golgin-captured vesicles, we identify TBC1D23, an apparently catalytically inactive member of a family of Rab GTPase-activating proteins (GAPs), as a vesicle-golgin adaptor that is required for endosome-to-Golgi trafficking. The Rab GAP domain of TBC1D23 binds to a conserved motif at the tip of golgin-245 and golgin-97 at the trans-Golgi, while the C terminus binds to the WASH complex on endosome-derived vesicles. Thus, TBC1D23 is a specificity determinant that links the vesicle to the target membrane during endosome-to-Golgi trafficking.

Exploring the potential value of using data on dental extractions under general anaesthesia (DGA) to monitor the impact of dental decay in children.

Aim To explore the value of DGA data as an indicator of the impact and inequalities associated with child dental decay (caries) in Southampton.Design Data from the local DGA provider in Southampton was used to investigate trends in child (17 years and under) DGAs between 2006/7 and 2014/15. Retrospective analysis of anonymised child-level 2013/14 and 2014/15 data from the same service was carried out to identify any inequalities with respect to deprivation, impact on school attendance and cost to the health economy.Results Around 400-500 Southampton children needed a DGA annually within this period. There were year-on-year variations, but no upward or downward trend. The DGA rate was 2.5 to three times higher in the most deprived quintile compared to the least. This translates to an equivalent gap in school absences, which could impact on educational achievement. The cost of these procedures in 2014/15 was around £210,000.Conclusions DGA data have value in highlighting the impact and inequalities associated with dental decay on children and the wider economy. Nationally, they could be used for benchmarking. Locally, these data could be used to target and evaluate health improvement programmes as well as to highlight DGA service changes that would disproportionately affect children from more deprived backgrounds.

Outcomes and costs of pre-school and school-based fluoride varnish pilots.

Objective Fluoride varnish (FV) applications reduce the risk of dental decay in research trials. These pilots were conducted to test the feasibility and costs of providing FV applications in schools. Changes in dental decay levels were also monitored.Methods Data were collected on the proportion of children with dental decay, mean number of teeth affected and whether the child had attended for dental care. The cost of delivering the intervention was calculated.Results More children were reported to be attending for dental care by the end of the pilot than at the start. The proportion of children with dental decay and the mean number of teeth affected increased, but more children seemed to have received treatment. The intervention cost about £88 per child per year, with most of the costs due to the intensive efforts needed to recruit and maintain participation in the pilots.Conclusions Establishing community FV programmes requires significant investment and the long-term benefits in practice are unclear. If dental decay levels are to be reduced, there is a need to improve diets, alongside fluoride strategies. This may be best achieved by integrating oral health improvement programmes into other health programmes, particularly sugar-reduction strategies.