Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States.

ObjectivesTo identify and examine heterogeneous trajectories of general health status (GHS) and depressive symptoms (DS) among persons with cognitive impairment (PCIs). Methods: We use group-based trajectory models to study 2361 PCIs for GHS and 1927 PCIs for DS from the National Health and Aging Trends Survey 2011-2018, and apply multinomial logistic regressions to predict identified latent trajectory group memberships using individual characteristics. Results: For both GHS and DS, there were six groups of PCIs with distinct trajectories over a 7-year period. More than 40% PCIs experienced sharp declines in GHS, and 35.5% experienced persistently poor GHS. There was greater heterogeneity in DS trajectories with 55% PCIs experiencing improvement, 16.4% experiencing persistently high DS, and 30.5% experiencing deterioration. Discussion: The GHS trajectories illustrate the heavy burden of poor and declining health among PCIs. Further research is needed to understand the factors underlying stable or improving DS despite declining GHS.

Effect of reversal of residual neuromuscular blockade on the amplitude of motor evoked potentials: a randomized controlled crossover study comparing sugammadex and placebo.

PURPOSE: To compare the amplitude changes in motor evoked potentials (MEP) with reversal of residual neuromuscular blockade using sugammadex or placebo in patients with cervical myelopathy. METHODS: In this prospective randomized double-blind, placebo-controlled crossover trial, 38 patients with cervical myelopathy undergoing posterior cervical decompression and fusion were randomized to either sugammadex (2mg/kg) or placebo. The primary outcome measure was the increase in amplitude of the MEP in the first dorsal interossei (FDI) muscle at 3 min. Mann-Whitney U test was used to analyze the primary outcome measure. RESULTS: There was a significant increase in the amplitude of MEP at 3 min with sugammadex when compared to placebo group. The median (IQR) increase in MEP amplitude (µV) at 3 min from the left FDI in sugammadex and placebo group was 652.9 (142:1650) and 20.6 (-183.5:297.5) (p <0.001), respectively. Corresponding values from right FDI were 2153.4 (1400:4536.8) and 55(-65.2:480.8) (p=<0.001). CONCLUSION: Our study showed that there was a 200% increase in the MEP amplitude in the first dorsal interosseous muscle at 3 min following reversal of residual neuromuscular blockade with sugammadex. By ensuring that maximal MEP amplitude is recorded at baseline, early commencement of neuromonitoring can be achieved. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: The study was registered at http://clinicaltrials.gov , ID NCT03087513, Feb 5th 2018.

Racial/Ethnic and Educational Disparities in the Impact of Diabetes on Population Health Among the U.S.-Born Population.

OBJECTIVES: This study examines total life expectancies (TLEs) for both healthy and diabetic U.S.-born populations and 2 measures capturing quality of life: (a) the proportion of remaining life to be spent without either other chronic conditions or activities of daily living disabilities (ADLs) and (b) the proportion of remaining life to be spent with ADLs for U.S.-born diabetic populations by race/ethnicity and educational attainment. METHODS: Using the 1998-2014 waves of the Health and Retirement Study (n = 16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables. RESULTS: TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex-race combinations and from 5.6 to 9.2 years across sex-education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower. DISCUSSION: The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals.

Recovering genotypes and phenotypes using allele-specific genes.

With the recent increase in RNA sequencing efforts using large cohorts of individuals, surveying allele-specific gene expression is becoming increasingly frequent. Here, we report that, despite not containing explicit variant information, a list of genes known to be allele-specific in an individual is enough to recover key variants and link the individuals back to their genotypes and phenotypes. This creates a privacy conundrum.

Trends in cancer imaging by indication, care setting, and hospital type during the COVID-19 pandemic and recovery at four hospitals in Massachusetts.

BACKGROUND: We aimed to investigate the effects of COVID-19 on computed tomography (CT) imaging of cancer. METHODS: Cancer-related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre-COVID-19 (1/5/20-3/14/20), COVID-19 peak (3/15/20-5/2/20), and post-COVID-19 peak (5/3/20-11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non-urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university-affiliated community hospital (UACH), and sole community hospitals (SCHs). RESULTS: During the COVID-19 peak, a significant drop in CT volumes was observed (-42.2%, p < 0.0001), with cancer screening, initial workup, active cancer, and cancer surveillance declining by 81.7%, 54.8%, 30.7%, and 44.7%, respectively (p < 0.0001). In the post-COVID-19 peak period, cancer screening and initial workup CTs did not recover (-11.7%, p = 0.037; -20.0%, p = 0.031), especially in the outpatient setting. CT volumes for active cancer recovered, but inconsistently across hospital types: the QAC experienced a 9.4% decline (p = 0.022) and the UACH a 41.5% increase (p < 0.001). Outpatient CTs recovered after the COVID-19 peak, but with a shift in utilization away from the QAC (-8.7%, p = 0.020) toward the UACH (+13.3%, p = 0.013). Inpatient and ED-based oncologic CTs increased post-peak (+20.0%, p = 0.004 and +33.2%, p = 0.009, respectively). CONCLUSIONS: Cancer imaging was severely impacted during the COVID-19 pandemic. CTs for cancer screening and initial workup did not recover to pre-COVID-19 levels well into 2020, a finding that suggests more patients with advanced cancers may present in the future. A redistribution of imaging utilization away from the QAC and outpatient settings, toward the community hospitals and inpatient setting/ED was observed.

The environmental performance of protecting seedlings with plastic tree shelters for afforestation in temperate oceanic regions: A UK case study.

Restoration of forested land represents an effective strategy to achieve net-zero target emissions by enhancing the removal of greenhouse gases from the atmosphere. The most common afforestation strategy envisages planting seedlings, which are germinated and grown to the desired age at tree nurseries, with plastic shelters to increase growth and survival of trees. This article presents a comprehensive Life Cycle Assessment (LCA) study that compares the environmental performance of current and prospective scenarios for shelter-aided seedling planting compared with a base case where shelters are not employed. The study focuses on the UK, but results and conclusions are valid for other temperate oceanic regions. The scenarios investigated are a combination of different shelters materials and end-of-life (EoL) strategies. Our analysis demonstrates that (i) planting seedling without shelters is the most preferable option across most environmental impact categories (including Climate Change), and in terms of weighted results, (ii) polypropylene shelters are preferable to bio-based alternatives, including polylactic acid-starch blends and bio-polypropylene, (iii) recycling is the most environmentally advantageous EoL treatment. Our study also showed that that the carbon emissions of the scenarios investigated are negligible when compared to the amount of carbon sequestered by a tree in 25 years.

Under pressure: Hydrogel swelling in a granular medium.

Hydrogels hold promise in agriculture as reservoirs of water in dry soil, potentially alleviating the burden of irrigation. However, confinement in soil can markedly reduce the ability of hydrogels to absorb water and swell, limiting their widespread adoption. Unfortunately, the underlying reason remains unknown. By directly visualizing the swelling of hydrogels confined in three-dimensional granular media, we demonstrate that the extent of hydrogel swelling is determined by the competition between the force exerted by the hydrogel due to osmotic swelling and the confining force transmitted by the surrounding grains. Furthermore, the medium can itself be restructured by hydrogel swelling, as set by the balance between the osmotic swelling force, the confining force, and intergrain friction. Together, our results provide quantitative principles to predict how hydrogels behave in confinement, potentially improving their use in agriculture as well as informing other applications such as oil recovery, construction, mechanobiology, and filtration.

Clinical correlates of laterality among school-age children in the United States.

Researchers have long been interested in whether lateral preference is associated with giftedness, season of birth, and/or ADHD constructs (short attention span, high level of activity, and impulsivity). The objective of this study was to examine these associations in a large, longitudinal sample of U.S. children (National Collaborative Perinatal Project (CPP), 1959-1973). Children born to women in this pregnancy cohort underwent a neonatal exam and an exam at age 7 years to assess lateral preference of the hand and eye, IQ on the Wechsler Intelligence Scale for Children (WISC), and ADHD symptoms. Children with perinatal/neonatal risk factors for neurologic impairment or early signs of neurological abnormality were excluded from our analyses. The final sample included 25,385 children. Associations between laterality and IQ were examined using linear and logistic regression models adjusted for sex, race, and socioeconomic status. Associations between laterality and ADHD symptoms and between season of birth and laterality were estimated using multivariable logistic regression. In this large, longitudinal study of neurologically healthy children, modest associations were observed between hand/eye preference and IQ and hyperactivity only.

Digital sextortion: Internet predators and pediatric interventions.

PURPOSE OF REVIEW: Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents. RECENT FINDINGS: Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators. SUMMARY: Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.

Relationships Between a History of Abuse, Changes in Body Mass Index, Physical Health, and Self-Reported Depression in Female Bariatric Surgery Patients.

Background/Objectives: A history of physical and sexual abuse has been implicated in weight gain. Although bariatric surgery is effective for weight loss in severely obese individuals, we investigated whether bariatric surgery patients who self-report a history of physical and/or sexual abuse have differential outcomes regarding weight loss, body mass index (BMI), quality of life (SF-36), and depressive symptoms (Center for Epidemiologic Studies Depression [CESD]) compared with nonabused patients. Materials and Methods: Standardized assessments at baseline and follow-up visits were performed on 103 obese (BMI >35) female bariatric surgery patients (mean age: 44.11 years, standard deviation: 11.67 years). Results: In total 49.5% of participants reported abuse. Abused group had significantly higher BMI (p < 0.01) and depression scores (p < 0.01). After surgery, the BMI between the two groups was no longer significantly different, although the abused group remained significantly more depressed. Mixed models showed that abuse was associated with CESD scores (p < 0.01) and SF-36 mental composite scores (p = 0.03) after adjusting for smoking history. Conclusion: Bariatric surgery leads to a better weight loss in abused patients. Abuse history might be an additional factor for clinicians to consider when advising bariatric surgery, as our study suggests that women with history of abuse may have a higher weight loss benefit but less mental health improvement from the intervention.

Crack formation and self-closing in shrinkable, granular packings.

Many clays, soils, biological tissues, foods, and coatings are shrinkable, granular materials: they are composed of packed, hydrated grains that shrink when dried. In many cases, these packings crack during drying, critically hindering applications. However, while cracking has been widely studied for bulk gels and packings of non-shrinkable grains, little is known about how packings of shrinkable grains crack. Here, we elucidate how grain shrinkage alters cracking during drying. Using experiments with model shrinkable hydrogel beads, we show that differential shrinkage can dramatically alter crack evolution during drying-in some cases, even causing cracks to spontaneously "self-close". In other cases, packings shrink without cracking or crack irreversibly. We developed both granular and continuum models to quantify the interplay between grain shrinkage, poromechanics, packing size, drying rate, capillarity, and substrate friction on cracking. Guided by the theory, we also found that cracking can be completely altered by varying the spatial profile of drying. Our work elucidates the rich physics underlying cracking in shrinkable, granular packings, and yields new strategies for controlling crack evolution.

Cooperative size sorting of deformable particles in porous media.

Diverse applications-ranging from enhanced oil recovery, filtration, and lab on a chip sorting-rely on the flow-induced transport of deformable particles in porous media. However, how fluid flow can force such particles to squeeze through pore constrictions of complex geometries is poorly understood. Here, we study the transport of model deformable particles in millifluidic porous media with constrictions of tunable aspect ratio. We find that multiple particles can unexpectedly squeeze through large-aspect ratio constrictions, even when isolated particles cannot. This phenomenon arises from pairwise flow-mediated interactions between the particles: when one particle is trapped at a constriction, the increased fluid flow around it enables a second to squeeze past due to locally increased hydrodynamic stresses. This cooperative mechanism causes the particles to ultimately sort themselves by size through the pore space. By revealing a new mode of deformable particle transport in porous media, our work helps to inform real-world applications and provides a straightforward way to sort particles based on size.

Suppressing viscous fingering in structured porous media.

Finger-like protrusions that form along fluid-fluid displacement fronts in porous media are often excited by hydrodynamic instability when low-viscosity fluids displace high-viscosity resident fluids. Such interfacial instabilities are undesirable in many natural and engineered displacement processes. We report a phenomenon whereby gradual and monotonic variation of pore sizes along the front path suppresses viscous fingering during immiscible displacement, that seemingly contradicts conventional expectation of enhanced instability with pore size variability. Experiments and pore-scale numerical simulations were combined with an analytical model for the characteristics of displacement front morphology as a function of the pore size gradient. Our results suggest that the gradual reduction of pore sizes act to restrain viscous fingering for a predictable range of flow conditions (as anticipated by gradient percolation theory). The study provides insights into ways for suppressing unwanted interfacial instabilities in porous media, and provides design principles for new engineered porous media such as exchange columns, fabric, paper, and membranes with respect to their desired immiscible displacement behavior.

Transportable, Chemical Genetic Methodology for the Small Molecule-Mediated Inhibition of Heat Shock Factor 1.

Proteostasis in the cytosol is governed by the heat shock response. The master regulator of the heat shock response, heat shock factor 1 (HSF1), and key chaperones whose levels are HSF1-regulated have emerged as high-profile targets for therapeutic applications ranging from protein misfolding-related disorders to cancer. Nonetheless, a generally applicable methodology to selectively and potently inhibit endogenous HSF1 in a small molecule-dependent manner in disease model systems remains elusive. Also problematic, the administration of even highly selective chaperone inhibitors often has the side effect of activating HSF1 and thereby inducing a compensatory heat shock response. Herein, we report a ligand-regulatable, dominant negative version of HSF1 that addresses these issues. Our approach, which required engineering a new dominant negative HSF1 variant, permits dosable inhibition of endogenous HSF1 with a selective small molecule in cell-based model systems of interest. The methodology allows us to uncouple the pleiotropic effects of chaperone inhibitors and environmental toxins from the concomitantly induced compensatory heat shock response. Integration of our method with techniques to activate HSF1 enables the creation of cell lines in which the cytosolic proteostasis network can be up- or down-regulated by orthogonal small molecules. Selective, small molecule-mediated inhibition of HSF1 has distinctive implications for the proteostasis of both chaperone-dependent globular proteins and aggregation-prone intrinsically disordered proteins. Altogether, this work provides critical methods for continued exploration of the biological roles of HSF1 and the therapeutic potential of heat shock response modulation.

Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring.

BACKGROUND: During spinal surgery, intraoperative monitoring of motor-evoked potentials (MEPs) is a useful means of assessing the intraoperative integrity of corticospinal pathways. However, MEPs are known to be particularly sensitive to the suppressive effects of inhalational halogenated anesthetic agents. OBJECTIVE: To investigate the effects of increasing end-tidal concentrations of desflurane and sevoflurane anesthesia in a background of propofol and remifentanil with multipulse cortical stimulation on intraoperative monitoring of MEPs. METHODS: In this randomized crossover trial, 14 consecutive patients (7 in each arm) undergoing major spine surgery, under a background anesthetic of propofol (75 to 125 mcg/kg/min) and remifentanil (0.1 to 0.2 mcg/kg/min), were randomly assigned to receive the sequence of inhalational agents studied: either DES-SEVO (desflurane followed by sevoflurane); or SEVO-DES (sevoflurane followed by desflurane). Multiples (0.3, 0.5, and 0.7) of minimum alveolar concentration (MAC) of desflurane and sevoflurane were administered. After a washout period of 15 minutes using high fresh oxygen/air flows, each of the patients then received the other gas as the second agent. Cortical stimulation was achieved with a train of 5 equivalent square pulses, each 0.05 ms in duration, delivered at 2 ms intervals. MEP recordings were made in the upper limb (UL) from first dorsal interosseus and lower limb (LL) from tibialis anterior with subdermal needle electrodes. RESULTS: At 0.3 MAC desflurane, there was no statistical significant difference in transcranial-evoked MEP amplitudes from the baseline in both UL and LL stimulation. However, this was not the case for sevoflurane for which even a low concentration at 0.3 MAC significantly depressed MEP amplitudes of LL (but not UL) from baseline value. Desflurane at 0.5 and 0.7 MAC depresses LL MEP to 58.4% and 59.9% of baseline, respectively (P<0.05), whereas sevoflurane at 0.3, 0.5, and 0.7 MAC depresses LL MEP to 66.2%, 41.3%, and 25.3% of baseline, respectively (P<0.05). There was no difference in latency of the responses at any MAC. CONCLUSIONS: Inhalational anesthetic agents (sevoflurane >desflurane) suppress MEP amplitudes in a dose-dependent manner. The use of 0.3 MAC of desflurane (but not sevoflurane) provided good MEP recordings acceptable for clinical interpretation for both upper and LLs. The LL appears to be more sensitive to anesthetic-induced depression compared with the UL. All patients studied had normal neurological examination hence, these results may not be applicable to those with preexisting deficits.