Improved automated spot counting and modeling with bias correction.

A complete workflow was presented for estimating the concentration of microorganisms in biological samples by automatically counting spots that represent viral plaque forming units (PFU) bacterial colony forming units (CFU), or spot forming units (SFU) in images, and modeling the counts. The workflow was designed for processing images from dilution series but can also be applied to stand-alone images. The accuracy of the methods was greatly improved by adding a newly developed bias correction method. When the spots in images are densely populated, the probability of spot overlapping increases, leading to systematic undercounting. In this paper, this undercount issue was addressed in an empirical way. The proposed empirical bias correction method utilized synthetic images with known spot sizes and counts as a training set, enabling the development of an effective bias correction function using a thin-plate spline model. Its application focused on the bias correction for the automated spot counting algorithm LoST proposed by Lin et al. Simulation results demonstrated that the empirical bias correction significantly improved spot counts, reducing bias for both fixed and random spot sizes and counts.

An enriched approach to combining high-dimensional genomic and low-dimensional phenotypic data.

We describe an approach for combining and analyzing high-dimensional genomic and low-dimensional phenotypic data. The approach leverages a scheme of weights applied to the variables instead of observations and, hence, permits incorporation of the information provided by the low dimensional data source. It can also be incorporated into commonly used downstream techniques, such as random forest or penalized regression. Finally, the simulated lupus studies involving genetic and clinical data are used to illustrate the overall idea and show that the proposed enriched penalized method can select significant genetic variables while keeping several important clinical variables in the final model.

Factors influencing the indication of coronary angiography in patients presenting with chest pain unspecified: an analysis of two decades (1994-2014).

Guidelines for cardiac catheterization in patients with non-specific chest pain (NSCP) provide significant room for provider discretion, which has resulted in variability in the utilization of invasive coronary angiograms (CAs) and a high rate of normal angiograms. The overutilization of CAs in patients with NSCP and discharged without a diagnosis of coronary artery disease is an important issue in medical care quality. As a result, we sought to identify patient demographic, socioeconomic, and geographic factors that influenced the performance of a CA in patients with NSCP who were discharged without a diagnosis of coronary artery disease. We intended to establish reference data points for gauging the success of new initiatives for the evaluation of this patient population. In this 20-year retrospective cohort study (1994-2014), we examined 107 796 patients with NSCP from the Myocardial Infarction Data Acquisition System, a large statewide validated database that contains discharge data for all patients with cardiovascular disease admitted to every non-federal hospital in NJ. Patients were partitioned into two groups: those offered a CA (CA group; n = 12 541) and those that were not (No-CA group; n = 95 255). Geographic, demographic, and socioeconomic variables were compared between the two groups using multivariable logistic regression, which determined the predictive value of each categorical variable on the odds of receiving a CA. Whites were more likely than Blacks and other racial counterparts (19.7% vs. 5.6% and 16.5%, respectively; P < .001) to receive a CA. Geographically, patients who received a CA were more likely admitted to a large hospital compared to small- or medium-sized ones (12.5% vs. 8.9% and 9.7%, respectively; P < .05), a primary teaching institution rather than a teaching affiliate or community center (16.1 % vs. 14.3% and 9.1%, respectively; P < .001), and at a non-rural facility compared to a rural one (12.1% vs. 6.5%; P < .001). Lastly from a socioeconomic standpoint, patients with commercial insurance more often received a CA compared to those having Medicare or Medicaid/self-pay (13.7% vs. 9.5% and 6.0%, respectively; P < .001). The utilization of CA in patients with NSCP discharged without a diagnosis of coronary artery disease in NJ during the study period may be explained by differences in geographic, demographic, and socioeconomic factors. Patients with NSCP should be well scrutinized for CA eligibility, and reliable strategies are needed to reduce discretionary medical decisions and improve quality of care.

Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings.

BACKGROUND: Obstetrical complications impact the health of mothers and offspring along the life course, resulting in an increased burden of chronic diseases. One specific complication is abruption, a life-threatening condition with consequences for cardiovascular health that remains poorly studied. OBJECTIVES: To describe the design and data linkage algorithms for the Placental Abruption and Cardiovascular Event Risk (PACER) cohort. POPULATION: All subjects who delivered in New Jersey, USA, between 1993 and 2020. DESIGN: Retrospective, population-based, birth cohort study. METHODS: We linked the vital records data of foetal deaths and live births to delivery and all subsequent hospitalisations along the life course for birthing persons and newborns. The linkage was based on a probabilistic record-matching algorithm. PRELIMINARY RESULTS: Over the 28 years of follow-up, we identified 1,877,824 birthing persons with 3,093,241 deliveries (1.1%, n = 33,058 abruption prevalence). The linkage rates for live births-hospitalisations and foetal deaths-hospitalisations were 92.4% (n = 2,842,012) and 70.7% (n = 13,796), respectively, for the maternal cohort. The corresponding linkage rate for the live births-hospitalisations for the offspring cohort was 70.3% (n = 2,160,736). The median (interquartile range) follow-up for the maternal and offspring cohorts was 15.4 (8.1, 22.4) and 14.4 (7.4, 21.0) years, respectively. We will undertake multiple imputations for missing data and develop inverse probability weights to account for selection bias owing to unlinked records. CONCLUSIONS: Pregnancy offers a unique window to study chronic diseases along the life course and efforts to identify the aetiology of abruption may provide important insights into the causes of future CVD. This project presents an unprecedented opportunity to understand how abruption may predispose women and their offspring to develop CVD complications and chronic conditions later in life.

First Report of Colletotrichum chrysophilum Causing Anthracnose on Nance (Byrsonima crassifolia) in Mexico.

Nance fruit [Byrsonima crassifolia (L.) HBK] is a native crop widely distributed in Mexico and South America (Medina-Torres et al. 2018). It has been reported that nance is a good source of active compounds with anti-inflammatory, neuropharmacological and antioxidant effects. In 2022, the annual production of nance fruit in Mexico was of 7,713.13 tons and average yield of 5.64 t/ha with economic value of 51,952.66 million pesos (SIAP, 2022). This production generated significant economic income for the communities at a local, regional, and national level. In January 2023, irregular necrotic spots were observed on leaves and fruit of nance in an orchard of 50 nance trees located in San Sebastián Nopalera (16°54'52.73"N; 97°47'50.35"W), Oaxaca, Mexico. The incidence of the disease ranged from 50 to 60% of the trees. Infected fruit first showed dark-brown lesions with defined borders that coalesced to form large necrotic area. Isolates were purified by single spore isolation method (Choi et al. 1999).Colletotrichum strains were grown in PDA medium and five monoconidial isolates were obtained. A representative sample was selected (CNC-NP3) and deposited in the Culture Collection of Phytopathogenic Fungi of Plant Pathology Laboratory of the CIIDIR-Oaxaca of the Instituto Politécnico Nacional. Colony on PDA was white with sparse aerial mycelium, and the center was dark grey with abundant acervuli. Conidia (n = 100) were hyaline, aseptate, cylindrical with rounded apex, 13.5 to 15.2 × 4.3 to 5.1 µm. Appressoria (n = 20) were terminal or lateral, obovoid to clavate and some with slightly lobed, 9.9 to 11.6 × 5.3 to 6.6 µm. Based on the morphology, the isolate was identified as belonging to the Colletotrichum gloeosporioides species complex (Jayawardena et al. 2016). The representative isolate CNC-NP3 was identified by multilocus phylogenetic analysis using nucleotide sequences of internal transcribed spacer (ITS), actin (ACT), ß-tubulin (TUB2), and glyceraldehyde-3-phosphate-dehydrogenase (GAPDH) (Jayawardena et al. 2016). The sequences were deposited in GenBank (accessions nos. OQ861102 (ITS), OQ870548 (ACT), OQ870549 (TUB2), OQ870550 (GAPDH). The phylogenetic analysis was carried out by Maximum likelihood method using concatenated sequences of ITS, ACT, TUB2 and GAPDH genes (Kozlov et al. 2019). The multilocus phylogenetic analysis revelated clearly the isolate CNC-NP3 as Colletotrichum chrysophilum. To confirm pathogenicity of CNC-NP3, 30 healthy fruits were inoculated. Fifteen disinfected nance with wounds and fifteen nance without wounds were inoculate with 10 µL of conidial suspension (1×105 spores/mL) from 7-day old culture. And controls were inoculated using sterile distilled water. Fruits were placed in a moist chamber covered with plastic bag at 25 °C for 48 h to maintain high humidity. After 4 days the inoculation sites development symptoms that were identical to those initially observed in the field, whereas the control group remained symptomless. The pathogenicity test was performed twice, with the same results. The pathogen was re-isolated from the lesion to fulfill Koch's postulates. Currently, Colletotrichum chrysophilum has been reported causing anthracnose disease in several crops: apple in New York (Khodadadi et al. 2020), papaya in Mexico (Pacheco- Esteva et al.2022), Blueberry (Soares et al. 2022) and banana in Brazil (Astolfi et al. 2022). To our knowledge, this is the first report of anthracnose in Byrsonima crassifolia caused by Colletotrichum chrysophilum in Oaxaca, Mexico.

The cold-induced factor CBF3 mediates root stem cell activity, regeneration, and developmental responses to cold.

Plant growth and development involve the specification and regeneration of stem cell niches (SCNs). Although plants are exposed to disparate environmental conditions, how environmental cues affect developmental programs and stem cells is not well understood. Root stem cells are accommodated in meristems in SCNs around the quiescent center (QC), which maintains their activity. Using a combination of genetics and confocal microscopy to trace morphological defects and correlate them with changes in gene expression and protein levels, we show that the cold-induced transcription factor (TF) C-REPEAT BINDING FACTOR 3 (CBF3), which has previously been associated with cold acclimation, regulates root development, stem cell activity, and regeneration. CBF3 is integrated into the SHORT-ROOT (SHR) regulatory network, forming a feedback loop that maintains SHR expression. CBF3 is primarily expressed in the root endodermis, whereas the CBF3 protein is localized to other meristematic tissues, including root SCNs. Complementation of cbf3-1 using a wild-type CBF3 gene and a CBF3 fusion with reduced mobility show that CBF3 movement capacity is required for SCN patterning and regulates root growth. Notably, cold induces CBF3, affecting QC activity. Furthermore, exposure to moderate cold around 10°C-12°C promotes root regeneration and QC respecification in a CBF3-dependent manner during the recuperation period. By contrast, CBF3 does not appear to regulate stem cell survival, which has been associated with recuperation from more acute cold (∼4°C). We propose a role for CBF3 in mediating the molecular interrelationships among the cold response, stem cell activity, and development.

Chemical analysis of pottery reveals the transition from a maritime to a plant-based economy in pre-colonial coastal Brazil.

Understanding long-term dynamics of past socio-ecological systems is essential for their future management. The southern Atlantic Forest coast of Brazil with its biodiverse littoral zone and artisanal fishing communities, is a priority for conservation. Traditional maritime knowledge is thought to have a deep-history and indeed, marine exploitation can be traced back to the middle Holocene. As part of one of South America's largest diasporas, Guarani groups reached the southern Brazilian coast at around 1000 years ago. Their impact on the long-standing coastal economy is unknown, due to poor preservation of organic remains. Through the first organic residue study on Guarani pottery, we show that maize rather than aquatic foods was the most dominant product in pottery at this time. By developing a mixing model based on carbon isotope values of saturated and mono-unsaturated fatty acids we propose new criteria for the identification of maize, opening up avenues for future research. Our data confirms the importance of maize to the pre-colonial Guarani, even in a highly productive coastal environment. The Guarani occupation of this region marks a significant departure from previous socio-economic systems, potentially leading to loss of traditional knowledge and alleviating anthropogenic pressure, albeit temporarily, on the marine environment.

Automated Spot Counting in Microbiology.

Biological samples are routinely analyzed for microbe concentration. The samples are diluted, loaded onto established host cell cultures, and incubated. If infectious agents are present in the samples, they form circular spots that do not contain the host cells. Each spot is assumed to be originated from a single microbial unit such as a bacterial colony forming unit or viral plaque forming unit. The undiluted sample concentration is estimated by counting the spots and back-calculating. Counting the number of spots by trained technicians is currently the gold standard but it is laborious, subjective, and hard to scale. This paper presents a new automated algorithm for spot counting, Localized and Sequential Thresholding (LoST). Validation studies showed that LoST performance was comparable with manual counting and outperformed several existing tools on images with overlapping spots. The LoST algorithm employs sequential thresholding through a two-stage segmentation and borrows information across all images from the same dilution series to fine-tune the count and identify right censoring. The algorithm increases the efficiency of the spot counting and the quality of the downstream analysis, especially when coupled with an appropriate statistical serial dilution model to enhance the undiluted sample concentration estimation procedure.

Compression-based Facies Modelling.

Simple object- or pixel-based facies models use facies proportions as the constraining input parameter to be honored in the output model. The resultant interconnectivity of the facies bodies is an unconstrained output property of the modelling, and if the objects being modelled are geometrically representative in three dimensions, commonly-available methods will produce well-connected facies when the model net:gross ratio exceeds about 30%. Geological processes have more degrees of freedom, and facies in high net:gross natural systems often have much lower connectivity than can be achieved by object-based or common implementations of pixel-based forward modelling. The compression method decouples facies proportion from facies connectivity in the modelling process and allows systems to be generated in which both are defined independently at input. The two-step method first generates a model with the correct connectivity but incorrect facies proportions using a conventional method, and then applies a geometrical transform to scale the model to the correct facies proportions while retaining the connectivity of the original model. The method, and underlying parameters, are described and illustrated using examples representative of low and high connectivity geological systems.

US Initiative to Eliminate Racial and Ethnic Disparities in Health: The Impact on the Outcomes of ST-Segment-Elevation Myocardial Infarction in New Jersey.

Background In 1998, President Clinton launched a federal initiative to eliminate racial and ethnic health disparities. The impact on the outcomes of ST-segment-elevation myocardial infarction has not been well studied. Methods and Results ST-segment-elevation myocardial infarction outcomes from 1994 to 2015 were studied in 7942 Black, 27 665 Hispanic, and 88 727 White patients with first admission of ST-segment-elevation myocardial infarction using the Myocardial Infarction Data Acquisition System. Logistic regressions were used to assess mortality adjusting for demographics, comorbidities, and interventional procedures. There was an overall rise from 1994 to 2015 in the use of percutaneous coronary interventions in all 3 groups. Before 1998, White patients received more percutaneous coronary interventions compared with Black and Hispanic patients (P<0.05). After 1998, the disparity in use of percutaneous coronary interventions in Black and Hispanic patients was greatly reduced compared with White patients, and the difference reversed in favor of Hispanic patients after 2005 (P<0.05). There was an overall downward trend of in-hospital mortality without evidence of disparity among Black, Hispanic, and White patients. A linear regression model was used with a change point in 1998. Before 1998, the slope of 1-year all-cause and cardiovascular mortality was not statistically significant. After 1998, the mortality showed negative slopes for all 3 groups, however, with lower overall crude mortality for Hispanic patients compared with Black and White patients (P<0.0001). Conclusions The initiative launched in 1998 may have contributed to a reduction in percutaneous coronary intervention usage disparity in patients with ST-segment-elevation myocardial infarction. Short- and long-term mortality decreased in all 3 groups, but more in the Hispanic population.

Divergent regulation of auxin responsive genes in root-knot and cyst nematodes feeding sites formed in Arabidopsis.

Cysts (CNs) and root-knot nematodes (RKNs) induce specialized feeding cells, syncytia, and giant cells (GCs), respectively, within plant roots. The plant tissues around the GCs usually by respond forming a root swelling called a gall that contains the GCs. The ontogenesis of feeding cells is different. GC formation is a process of new organogenesis from vascular cells, which are still not well characterized, that differentiate into GCs. In contrast, syncytia formation involves the fusion of adjacent cells that have already differentiated. Nonetheless, both feeding sites show an auxin maximum pertinent to feeding site formation. However, data on the molecular divergences and similarities between the formation of both feeding sites regarding auxin-responsive genes are still scarce. We studied genes from the auxin transduction pathways that are crucial during gall and lateral root (LR) development in the CN interaction by using promoter-reporter (GUS/LUC)transgenic lines, as well as loss of function lines of Arabidopsis. The promoters pGATA23 and several deletions of pmiR390a were active in syncytia, as were in galls, but pAHP6 or putative up-stream regulators as ARF5/7/19 were not active in syncytia. Additionally, none of these genes seemed to play a key role during cyst nematode establishment in Arabidopsis, as the infection rates in loss of function lines did not show significant differences compared to control Col-0 plants. Furthermore, the presence of only canonical AuxRe elements in their proximal promoter regions is highly correlated with their activation in galls/GCs (AHP6, LBD16), but those promoters active in syncytia (miR390, GATA23) carry AuxRe overlapping core cis-elements for other transcription factor families (i.e., bHLH, bZIP). Strikingly, in silico transcriptomic analysis showed very few genes upregulated by auxins common to those induced in GCs and syncytia, despite the high number of upregulated IAA responsive genes in syncytia and galls. The complex regulation of auxin transduction pathways, where different members of the auxin response factor (ARF) family may interact with other factors, and the differences in auxin sensitivity, as indicated by the lower induction of the DR5 sensor in syncytia than galls, among other factors, may explain the divergent regulation of auxin responsive genes in the two types of nematode feeding sites.

The Effectiveness of Day Hospitals in the Personal Recovery of Mental Disorder Patients during the COVID-19 Pandemic.

BACKGROUND: In recent years, a new recovery model has gained ground in which recovery is understood as a process of change where individuals are able to improve their health and wellbeing, lead self-sufficient lives and strive to achieve their maximum potential (personal recovery). Despite the existence of data regarding the effectiveness of mental health day hospitals (MHDHs) in reducing relapses in terms of hospital admissions and emergencies, no studies have to date assessed how this change affected the new personal recovery model. OBJECTIVES: To verify the effectiveness of MHDHs in improving personal recovery processes among people with mental disorders (MDs). METHODS: A prospective cohort study. A group of patients receiving follow-up at MHDHs was compared with another group of patients receiving follow-up in other therapeutic units over a period of three months. RESULTS: Patient recovery at the MHDHs, assessed using the Individual Recovery Outcomes Counter (I.ROC), was found to be significantly better than that of patients attended in other units. CONCLUSIONS: MHDHs can contribute to the recovery of people with MDs. This is particularly important at a time when some patients may have experienced impediments to their recovery processes due to the pandemic.

Validation of a diet-induced Macaca fascicularis model of non-alcoholic steatohepatitis with dietary and pioglitazone interventions.

AIM: To develop an obese, insulin-resistant cynomolgus monkey model of non-alcoholic steatohepatitis (NASH) with fibrosis with a high fat/high cholesterol (HFHC) diet (with or without high fructose) and test its responsiveness to caloric restriction or pioglitazone. METHODS: First, two groups of monkeys (n = 24/group) with histologically proven NASH and fibrosis were fed the HFHC diet for 17 weeks. The treatment group was subjected to a 40% caloric restriction (CR) and had their diet switched from the HFHC diet to a chow diet (DSCR). Paired liver biopsies were taken before and 17 weeks after DSCR. Subsets of monkeys (nine/group) had whole liver fat content assessed by MRI. Next, two groups of monkeys with histologically proven NASH and fibrosis were treated with vehicle (n = 9) or pioglitazone (n = 20) over 24 weeks. RESULTS: The HFHC and DSCR groups lost 0.9% and 11.4% of body weight, respectively. After 17 weeks, non-alcoholic fatty liver disease activity score (NAS) improvement was observed in 66.7% of the DSCR group versus 12.5% of the HFHC group (P < .001). Hepatic fat was reduced to 5.2% in the DSCR group versus 23.0% in the HFHC group (P = .0001). After 24 weeks, NAS improvement was seen in 30% of the pioglitazone group versus 0% of the vehicle group (P = .08). CONCLUSIONS: Both weight loss induced by DSCR and treatment with pioglitazone improve the histological features of NASH in a diet-induced cynomolgus monkey model. This model provides a translational preclinical model for testing novel NASH therapies.

Problematic Internet Use and Psychological Problems among University Students with Disabilities. / Uso problemático de Internet y problemas psicológicos entre estudiantes universitarios con discapacidad.

Problematic internet use (PIU) among people with disabilities has received very little attention in scientific literature. The objective of this work is to study PIU among Spanish university students with disabilities, and determine whether it is related to the presence of psychological problems and discomfort. A total of 432 Spanish university students with disabilities from six universities participated in the study (35% motor disability, 22.7% sensory disability and 42.1% other disabilities, excluding psychical or intellectual disability). PIU in the sample was assessed using the Internet Addiction Test (IAT), while psychological problems were assessed using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). PIU prevalence was 6.3%, and significant differences were found by age (< 22 had a PIU prevalence five times higher), onset of disability (prevalence was 3.7 times higher in those with congenital disability) and main type of internet use (recreational). There were no differences by sex, level of education or type of disability. In all the dimensions measured by CORE-OM (psychological problems, subjective well-being, life functioning and risk of self-harm and harm to others), the prevalence of psychological problems was significantly higher among problematic internet users. In conclusion, university students who are disabled from birth (regardless of their type of disability and sex), under the age of 22, and use the internet mainly for social networking and recreational purposes are at greater risk of psychological distress and are more vulnerable to problems like anxiety and difficulties with social relationships.

El uso problemático de internet (UPI) entre las personas con discapacidad ha recibido muy poca atención en la literatura científica. El objetivo de este trabajo es estudiar el UPI entre los estudiantes universitarios españoles con discapacidad, y si se relaciona con malestar y problemas psicológicos. En el estudio participaron 432 universitarios españoles con discapacidad de seis universidades (35 %: discapacidad motora, 22,7 %: discapacidad sensorial y 42,1 %: otras discapacidades, excluyendo la discapacidad psíquica o intelectual). El UPI se evaluó mediante el Test de Adicción a Internet (IAT), mientras que los problemas psicológicos se evaluaron mediante el cuestionario Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). La prevalencia del UPI fue del 6,3 %, y no hubo diferencias estadísticamente significativas por sexo, tipo de discapacidad o estudios. Sí hubo diferencias en función de la edad (< 22 mostraron una prevalencia 5 veces mayor), origen de la discapacidad (discapacidad congénita mostraron una prevalencia 3,7 veces mayor) y tipo principal de uso (recreativo). La prevalencia de problemas psicológicos es significativamente mayor entre los usuarios problemáticos de Internet, en todas las dimensiones medidas por el CORE-OM (problemas psicológicos, bienestar subjetivo, funcionamiento general y riesgo de autolesión y de daño a otros). En conclusión, los estudiantes universitarios con discapacidad desde el nacimiento (independientemente del tipo de discapacidad y del sexo), menores de 22 años y que utilizan Internet principalmente con fines recreativos y las redes sociales tienen mayor riesgo de sufrir trastornos psicológicos y mayor vulnerabilidad a problemas como ansiedad y dificultades en las relaciones sociales.

Uso problemático de Internet y problemas psicológicos entre estudiantes universitarios con discapacidad / Problematic Internet Use and Psychological Problems among University Students with Disabilities

El uso problemático de internet (UPI) entre las personas con discapacidadha recibido muy poca atención en la literatura científica. El objetivo de estetrabajo es estudiar el UPI entre los estudiantes universitarios españoles condiscapacidad, y si se relaciona con malestar y problemas psicológicos. En elestudio participaron 432 universitarios españoles con discapacidad de seisuniversidades (35 %: discapacidad motora, 22,7 %: discapacidad sensorialy 42,1 %: otras discapacidades, excluyendo la discapacidad psíquicao intelectual). El UPI se evaluó mediante el Test de Adicción a Internet(IAT), mientras que los problemas psicológicos se evaluaron mediante elcuestionario Clinical Outcomes in Routine Evaluation-Outcome Measure(CORE-OM). La prevalencia del UPI fue del 6,3 %, y no hubo diferenciasestadísticamente significativas por sexo, tipo de discapacidad o estudios. Síhubo diferencias en función de la edad (< 22 mostraron una prevalencia 5veces mayor), origen de la discapacidad (discapacidad congénita mostraronuna prevalencia 3,7 veces mayor) y tipo principal de uso (recreativo). Laprevalencia de problemas psicológicos es significativamente mayor entre losusuarios problemáticos de Internet, en todas las dimensiones medidas porel CORE-OM (problemas psicológicos, bienestar subjetivo, funcionamientogeneral y riesgo de autolesión y de daño a otros). En conclusión, los estudiantesuniversitarios con discapacidad desde el nacimiento (independientementedel tipo de discapacidad y del sexo), menores de 22 años y que utilizanInternet principalmente con fines recreativos y las redes sociales tienenmayor riesgo de sufrir trastornos psicológicos y mayor vulnerabilidad aproblemas como ansiedad y dificultades en las relaciones sociales. (AU)

Problematic internet use (PIU) among people with disabilities has receivedvery little attention in scientific literature. The objective of this work isto study PIU among Spanish university students with disabilities, anddetermine whether it is related to the presence of psychological problemsand discomfort. A total of 432 Spanish university students with disabilitiesfrom six universities participated in the study (35% motor disability, 22.7%sensory disability and 42.1% other disabilities, excluding psychical orintellectual disability). PIU in the sample was assessed using the InternetAddiction Test (IAT), while psychological problems were assessed usingthe Clinical Outcomes in Routine Evaluation-Outcome Measure (COREOM). PIU prevalence was 6.3%, and significant differences were foundby age (< 22 had a PIU prevalence five times higher), onset of disability(prevalence was 3.7 times higher in those with congenital disability) andmain type of internet use (recreational). There were no differences by sex,level of education or type of disability. In all the dimensions measured byCORE-OM (psychological problems, subjective well-being, life functioningand risk of self-harm and harm to others), the prevalence of psychologicalproblems was significantly higher among problematic internet users. Inconclusion, university students who are disabled from birth (regardless oftheir type of disability and sex), under the age of 22, and use the internetmainly for social networking and recreational purposes are at greater risk ofpsychological distress and are more vulnerable to problems like anxiety anddifficulties with social relationships. (AU)

Estilos de cuidados y la implicación como protector psicológico del cuidador de personas con Parkinson en España / Care styles and involvement as a psychological protective of the caregiver of people with Parkinson's disease in Spain

Resumen Los familiares de personas con enfermedad de Parkinson (EP) se enfrentan a una variedad de situaciones estresantes como consecuencia del desempeño de su rol de cuidadores. Esto puede tener un impacto negativo en su calidad de vida. Un mayor conocimiento de la relación entre las variables evaluadas en los cuidadores puede ser importante de cara a implementar programas de intervención eficaces. El objetivo fue explorar la personalidad y las estrategias de afrontamiento en familiares cuidadores de personas con EP, estudiando su relación con el malestar psicológico y el grado de implicación en los cuidados. Se trabajó con una muestra de 106 cuidadores que completaron los cuestionarios de personalidad NEO-FFI, estrategias de afrontamiento COPE-28, malestar psicológico CORE-OM y un instrumento para evaluar la implicación del cuidador realizado a partir del índice Katz. El análisis de regresión logística mostró que las personas con puntuaciones por encima de la media en neuroticismo y por debajo en el resto de factores de personalidad y estrategias de afrontamiento tenían más riesgo de padecer malestar psicológico (OR = 9.250; p < .001) y una menor implicación en los cuidados (OR = 4.125; p < .001). Estos resultados sugieren que la personalidad y las estrategias de afrontamiento pueden contribuir a identificar estilos para los cuidados más eficientes, que impliquen una mayor participación en los cuidados con un menor impacto negativo.

Abstract Carers of people with Parkinson's disease (PD) experience stressful situations as a result of performing their role as caregivers. This can have a negative outcome on their quality of life. A greater understanding of the relationship between the variables assessed in caregivers can be important in implementing effective intervention programs. The aim of this study was to explore the personality and coping strategies used by family caregivers of people with PD, analyzing their relationship with psychological distress and the carer involvement. A cross-sectional study based on a sample of 106 caregivers of people with Parkinson's disease tested the hypothesis that personality and coping strategies can contribute to identifying differences in carer involvement and psychological distress. Caregiver psychological distress was assessed using the CORE-OM questionnaire. The CORE-OM is able to distinguish the population within the clinical and non-clinical range. NEO Five-Factor Inventory (NEO-FFI) was used to assess personality. Coping strategies were evaluated with the COPE-28 inventory. An operational measure of the carer involvement was also used. For this purpose, an adaptation of the Katz index assessing basic functional capacity was made. Results: First, all cases were clustered according to personality variables and coping strategies. A K-means cluster analysis was performed and two groups were requested. After this, binary logistic regression analysis was used to test the research hypothesis. The resulting clusters in the above analysis were selected as predictors. Two analyses were performed. In the first, the dependent variable in logistic regression analysis was the psychological distress of the caregivers (dichotomized variable: clinical and non-clinical). Results showed that people clustered within cluster 1 had a 9.250 times higher risk of psychological distress than those included in cluster 2 (OR = 9.250; p < .001). In a second logistic regression analysis, the dependent variable was participation in care (dichotomized variable: low - high carer involvement). The group of people belonging to cluster 1 showed a carer involvement 4.125 times lower than the people grouped in cluster 2 (OR = 4.125; p < .001). The results of this research suggest the existence of a relationship between psychological variables and carer involvement, showing two different styles of care, which are described based on the personality and coping strategies of the family caregivers. In addition, we found that these styles of care show clear differences in efficiency, reflected in greater carer involvement and a lower psychological distress. The results reported that the cluster of people with below-average scores on neuroticism and above-average scores on the other personality factors (extraversion, openness to experience, agreeableness, and conscientiousness) and coping strategies (planning; active coping; emotional support; social support; positive re-evaluation and acceptance) were associated with increased carer involvement and reduced risk of psychological distress. It has already been suggested that high scores in neuroticism may affect the need to take on a large number of care-related tasks or manage stressful situations in people with PD (Tew et al., 2013). However, our results indicate that the definition of different types of caregivers, where other care-related variables are also included, can help define more efficient styles of care. This is associated with increased carer involvement and minor psychological distress. We propose that in the future these variables be investigated in order to know the outcome of carer involvement and psychological distress, contributing to the description of more efficient care styles in family caregivers.

Relation of Socioeconomic Status to 1-Year Readmission and Mortality in Patients With Acute Myocardial Infarction.

Cardiovascular (CV) disease accounts for 1/3 of deaths worldwide and 1/4 of deaths nationwide. Socioeconomic status (SES) affects CV health and outcomes. Previous studies that examined the association of SES and CV outcomes have yielded mixed results. Using a large-scale database, the aim of this study was to assess the magnitude of the association between categorized median household income, an indicator for SES, and nonfatal or fatal acute myocardial infarction (AMI). Using logistic regression models, zip code median household income data from the United States Census Bureau were matched to 1-year rates of hospital readmission for AMI and CV death. Patient outcomes were obtained from the Myocardial Infarction Data Acquisition System, a comprehensive database that includes all patient CV disease admissions to acute care New Jersey hospitals. Our main results indicate that compared with those in the highest household income level (>$68,000), patients in the lowest-income group (<$43,000) had significantly higher risk for AMI readmission (adjusted odds ratio 1.1388, 95% confidence interval 1.0905 to 1.1893, p = 0) and CV death (odds ratio 1.0479, 95% confidence interval 1.0058 to 1.0917, p = 0.0254) after 1 year. This study also found that the likelihood of AMI readmission increased as household income levels decreased. Our findings suggest that healthcare professionals and policy makers should allocate additional resources to low-income communities to reduce disparities in AMI hospital readmissions and AMI case fatalities.

Assessment of one-year risk of ischemic stroke versus major bleeding in patients with atrial fibrillation.

Background: Patients diagnosed with atrial fibrillation (AF) are at increased risk of stroke. Several guidelines to assess the risk of ischemic stroke and major bleeding in AF patients have been published. The CHA 2 DS 2 -VASc score has been adopted widely for predicting stroke within one year of the index AF diagnosis and is used to guide the prescription of anticoagulants. Anticoagulation therapy increases the risk of bleeding and scoring systems such as HAS-BLED assess the risk of major bleeding in anticoagulated patients. Despite these advances, no study has examined the risks of the two outcomes simultaneously. How patients' fear of particular outcomes affects these risks also remains unknown. Methods: We incorporated the risks of ischemic stroke and major bleeding within one year of the index AF admission as well as the fear of stroke and bleeding of each individual patient. The patients enrolled in this retrospective observational study were identified using hospital admission data from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database including all hospitalizations for cardiovascular disease in New Jersey. Probabilities of the outcomes (ischemic stroke, major bleeding, both, or neither within one year of the index AF admission) were estimated using multinomial regression with patient demographics and comorbidities (heart failure [HF], hypertension [HTN], diabetes mellitus [DM], anemia, chronic obstructive pulmonary disease [COPD], kidney disease [KD], prior stroke or transient ischemic attack [TIA]) as predictors. These estimates were used in a Deming regression to model the association of ischemic stroke and major bleeding in grouped patients. The assessment of the importance of each outcome was superimposed on the final model to arrive at a recommendation for anticoagulation therapy. Results: The results of the Deming regression indicated a positive relationship between ischemic stroke and major bleeding (slope = 1.67, 95% confidence interval [CI] 1.37 to 1.97). Estimates of the risks of the two outcomes and the lines of best fit from Deming regression were determined. This model for risk assessment of stroke and major bleeding within one year of the index AF hospital admission combined objective data and subjective assessment of the relative fear of stroke versus bleeding by each hypothetical patient on 0-100 scale. Examples with the fears of stroke versus major bleeding being equal (50-50) and a higher fear of stroke (80-20) are presented. Conclusions: The new model for risk assessment of ischemic stroke and major bleeding within one year of the index AF hospital admission proposed in this work used objective, empirically driven measures, and subjective assessment of the outcomes' importance for individual patients. Such models may assist physicians in their decision making regarding anticoagulation therapy.

Stroke Recovery Program with Modified Cardiac Rehabilitation Improves Mortality, Functional & Cardiovascular Performance.

BACKGROUND: Physical activity and exercise after stroke is strongly recommended, providing many positive influences on function and secondary stroke prevention. The purpose of this study was to investigate the effect of a stroke recovery program (SRP) integrating modified cardiac rehabilitation on mortality and functional outcomes for stroke survivors. METHODS: This study used a retrospective analysis of data from a prospectively collected stroke rehabilitation database which followed 449 acute stroke survivors discharged from an inpatient rehabilitation facility between 2015 and 2020. For 1-year post-stroke, 246 SRP-participants and 203 nonparticipants were compared. The association of the SRP including modified cardiac rehabilitation with all-cause mortality and functional performance was assessed using the following statistical techniques: log rank test, Cox proportional hazard model and linear mixed effect models. Cardiovascular performance over 36 sessions of modified cardiac rehabilitation was assessed using linear effect model with Tukey procedure. The primary outcome measure was 1-year all-cause mortality rate. Secondary outcomes were functional performance measured in Activity Measure of Post-Acute Care scores and cardiovascular performance measured in metabolic equivalent of tasks times minutes. RESULTS: The SRP-participants had: (1) a significantly reduced 1-year post-stroke mortality rate from hospital admission corresponding to a four-fold reduction in mortality (P = 0.005, CI for risk ratio = [0.08, 0.71]), (2) statistically and clinically significant improvement of function in all Activity Measure of Post-Acute Care domains (P < 0.001 for all, 95% CI for differences in Basic Mobility [5.9, 10.1], Daily Activity [6.2, 11.8], and Applied Cognitive [3.0, 6.8]) compared to the matched cohort and (3) an improvement in cardiovascular performance over 36 sessions with an increase of 78% metabolic equivalent of tasks times minutes (P < 0.001, 95% CI [70.6, 85.9%]) compared to baseline. CONCLUSIONS: Stroke survivors who participated in a comprehensive stroke recovery program incorporating modified cardiac rehabilitation had decreased all-cause mortality, improved overall function, and improved cardiovascular performance.

The Impact of Experimental and Calculated Error on the Performance of Affinity Predictions.

The accurate prediction of binding affinity between protein and small molecules with free energy methods, particularly the difference in binding affinities via relative binding free energy calculations, has undergone a dramatic increase in use and impact over recent years. The improvements in methodology, hardware, and implementation can deliver results with less than 1 kcal/mol mean unsigned error between calculation and experiment. This is a remarkable achievement and beckons some reflection on the significance of calculation approaching the accuracy of experiment. In this article, we describe a statistical analysis of the implications of variance (standard deviation) of both experimental and calculated binding affinities with respect to the unknown true binding affinity. We reveal that plausible ratios of standard deviation in experiment and calculation can lead to unexpected outcomes for assessing the performance of predictions. The work extends beyond the case of binding free energies to other affinity or property prediction methods.