A regionally tailored epidemiological forecast and monitoring program to guide a healthcare system in the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, analytics and predictive models built on regional data provided timely, accurate monitoring of epidemiological behavior, informing critical planning and decision-making for health system leaders. At Atrium Health, a large, integrated healthcare system in the southeastern United States, a team of statisticians and physicians created a comprehensive forecast and monitoring program that leveraged an array of statistical methods. METHODS: The program utilized the following methodological approaches: (i) exploratory graphics, including time plots of epidemiological metrics with smoothers; (ii) infection prevalence forecasting using a Bayesian epidemiological model with time-varying infection rate; (iii) doubling and halving times computed using changepoints in local linear trend; (iv) death monitoring using combination forecasting with an ensemble of models; (v) effective reproduction number estimation with a Bayesian approach; (vi) COVID-19 patients hospital census monitored via time series models; and (vii) quantified forecast performance. RESULTS: A consolidated forecast and monitoring report was produced weekly and proved to be an effective, vital source of information and guidance as the healthcare system navigated the inherent uncertainty of the pandemic. Forecasts provided accurate and precise information that informed critical decisions on resource planning, bed capacity and staffing management, and infection prevention strategies. CONCLUSIONS: In this paper, we have presented the framework used in our epidemiological forecast and monitoring program at Atrium Health, as well as provided recommendations for implementation by other healthcare systems and institutions to facilitate use in future pandemics.

Evolution of Cross-Sectional Survey Protocol Quality Over Time: A Case Series of Index U.S. REMS Knowledge Survey Protocols (2007-2020).

INTRODUCTION: Surveys are commonly used to assess effectiveness of FDA-required risk evaluation and mitigation strategies (REMS) for drugs and biologics in the United States. OBJECTIVE: The aim of this study was to assess the scientific rigor of REMS knowledge survey protocols submitted to FDA and compare protocols before and after FDA's 2012 public workshop and 2019 draft guidance. METHOD: A content analysis of index survey protocols submitted to FDA (2007-2020) for single-product REMS with elements to assure safe use (39 programs, 78 protocols) was conducted. Each protocol was scored against 52 core essential elements (CEE), abstracted from FDA's guidance and grouped into six domains: study objective (n = 5), study design (n = 18), survey instrument (n = 9), participant recruitment (n = 7), survey administration (n = 9), and statistical analysis plan (n = 4). Scores were collected by time periods: (A) Oct 2007 to Jul 2012; (B) Aug 2012 to Feb 2019; (C) Mar 2019 to Dec 2020; and compared using logistic generalized linear mixed models adjusting for domain, survey population, vendor, program, and protocol. RESULTS: There were 30 (38.5%), 40 (51.3%), and 8 (10.3%) protocols submitted in time period A, B, and C, respectively. Adjusted marginal means of elements present (on the probability scale) by time period were 0.5816 (SE = 0.0242), 0.6429 (SE = 0.0229), and 0.7543 (SE = 0.0394). The likelihood of missing a CEE declined over time (adjusted p-value = 0.0094, time period A vs C). The statistical analysis plan domain had the most improvement; study design remained the weakest domain with the scientific justification CEE particularly underrepresented. CONCLUSION: The rigor of REMS knowledge survey protocols improved over time consistent with FDA's efforts to advance regulatory science, but gaps remain.

Skin Tone and Gender of High-Fidelity Simulation Manikins in Emergency Medicine Residency Training and their Use in Cultural Humility Training.

INTRODUCTION: It is important for physicians to learn how to provide culturally sensitive care. Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another's culture as well as performing self-exploration about one's own beliefs, identities, and biases. One way to teach cultural humility in medicine is simulation. However, there are no peer-reviewed published studies that examine whether the skin tone or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine (EM) residency programs reflects the US population nor whether high-fidelity simulation is used to teach cultural humility. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EM residency programs use HFS to teach cultural humility. Our secondary objective was to evaluate whether the skin tone and gender breakdown of the EM residency program HFSM is representative of the US population. METHODS: We conducted a simple random sample of 80 EM residency programs to characterize HFSM and cultural humility training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin tone and gender and whether cultural humility was taught via HFSM. We calculated point and interval estimates for the proportion of dark-, medium-, and light-toned skin and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin tone was 20/20/60 and that the female/male ratio was 50/50. Both ratios were extrapolated from the US Census data. RESULTS: Our response rate was 74% (59/80). Fifty-five of 59 EM residency programs that had manikins (0.93, 95% confidence interval [CI] 0.88-0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 programs with manikins reported using HFS to teach cultural humility (0.71, 95% CI 0.60-0.82). Proportions of light-, medium-, and dark-toned manikins were 0.52 (0.43-0.62), 0.38 (0.29-0.47), and 0.10 (0.07-0.14), respectively. Proportions of male and female HFSM were 0.69 (0.64-0.76) and 0.31 (0.24-0.36), respectively. The null hypotheses that skin tone follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values. CONCLUSION: While most EM residency programs surveyed use high-fidelity simulation to teach cultural humility, the manikins do not reflect either the skin tone or gender of the US population.

Assessing Platelet Mitochondrial Dysfunction in a Murine Model of Acute Acetaminophen Toxicity.

INTRODUCTION: Acetaminophen (APAP) toxicity remains a significant cause of adult and pediatric liver failure in North America and Europe. Previous research has evaluated the impaired mitochondrial function associated with APAP toxicity. The primary aim of this study was to evaluate the effects of APAP toxicity on platelet mitochondrial function using platelet oxygen consumption in a murine model in vivo. Our secondary objectives were to determine the effect of 4-MP on platelet mitochondrial function and hepatic toxicity in the setting of APAP overdose, and to correlate platelet mitochondrial function with other markers of APAP toxicity. METHODS: Male C57Bl/6 mice were randomized to receive APAP (300 or 500 mg/kg) or vehicle followed 90 minutes later by either 4-MP (50 mg/kg) or vehicle via intraperitoneal injection. Mice were euthanized 0, 12, or 24 hours later and platelets isolated from cardiac blood and counted. Platelet oxygen consumption (POC) was determined using a closed-system respirometer. Liver injury was assessed by measuring alanine transferase (ALT) and histological evaluation. RESULTS: Injection of 500 mg/kg APAP led to increased POC versus pair-matched control (vehicle) (p < 0.001). Administration of 4-MP did not affect POC in control or 300 mg/kg APAP mice. In mice receiving 500 mg/kg APAP and 4-MP, POC decreased significantly compared to mice receiving 500 mg/kg APAP alone (p < 0.01). Serum and histological analysis confirmed APAP-induced hepatic damage in mice receiving 500 mg/kg APAP and these effects blunted by treatment with 4-MP. CONCLUSIONS: Platelet oxygen consumption as a measure of mitochondrial function may be useful as a biomarker of hepatic APAP toxicity in the setting of moderate to severe overdose. Treatment with 4-MP decreases hepatic necrosis and may mitigate the harmful effects of APAP on platelet mitochondrial function detected via POC.

Estimating contact network properties by integrating multiple data sources associated with infectious diseases.

To effectively mitigate the spread of communicable diseases, it is necessary to understand the interactions that enable disease transmission among individuals in a population; we refer to the set of these interactions as a contact network. The structure of the contact network can have profound effects on both the spread of infectious diseases and the effectiveness of control programs. Therefore, understanding the contact network permits more efficient use of resources. Measuring the structure of the network, however, is a challenging problem. We present a Bayesian approach to integrate multiple data sources associated with the transmission of infectious diseases to more precisely and accurately estimate important properties of the contact network. An important aspect of the approach is the use of the congruence class models for networks. We conduct simulation studies modeling pathogens resembling SARS-CoV-2 and HIV to assess the method; subsequently, we apply our approach to HIV data from the University of California San Diego Primary Infection Resource Consortium. Based on simulation studies, we demonstrate that the integration of epidemiological and viral genetic data with risk behavior survey data can lead to large decreases in mean squared error (MSE) in contact network estimates compared to estimates based strictly on risk behavior information. This decrease in MSE is present even in settings where the risk behavior surveys contain measurement error. Through these simulations, we also highlight certain settings where the approach does not improve MSE.

Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study.

Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.

Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis.

BACKGROUND: Patients undergoing emergency general surgery (EGS) and interhospital transfer (IHT) have increased mortality. Prior analyses of IHT have been limited by the inability to track post-discharge outcomes or have not included nonoperative EGS. We evaluated outcomes for IHT to our tertiary care facility compared with direct admission through the emergency department. STUDY DESIGN: Patients admitted directly (2015 to 2017) with a common EGS diagnosis (appendicitis, cholecystitis, choledocholithiasis, small bowel obstruction, and diverticulitis) were propensity score matched to patients transferred from another acute care hospital. Propensity score matching (PSM) was performed using patient characteristics, EGS diagnosis, comorbidities, and surgical critical care consultation. The primary outcome was inpatient mortality, and secondary outcomes were length of stay (LOS) 30-day hospital readmission. RESULTS: We identified 3,153 directly admitted patients and 1,272 IHT patients. IHT patients were older (mean 59.4 vs 51.5 years), had a higher Charlson comorbidity index (median 3 vs 1), White race (72% vs 49%), and BMI greater than 40 kg/m2 (11.6% vs 9.8%). After PSM, each group included 1,033 patients. IHT patients had a higher median LOS (5.5 days vs 3.8, p < 0.001), higher inpatient mortality (odds ratio [OR] 1.69, p = 0.03), and more complications (OR 1.57, p < 0.001). The rate of post-discharge 30-day hospital encounters was similar (OR 1.08, p = 0.460). However, IHT patients had more emergency department encounters (OR 1.35, p = 0.04) and fewer observation-status readmissions (OR 0.53, p = 0.01). CONCLUSIONS: After PSM to reduce confounding variables, patients with common EGS diagnoses transferred to a tertiary care facility have increased inpatient morbidity and mortality. The increased morbidity and resource utilization for these patients extends beyond the index hospital stay.

Forecasting COVID-19 Hospital Census: A Multivariate Time-Series Model Based on Local Infection Incidence.

BACKGROUND: COVID-19 has been one of the most serious global health crises in world history. During the pandemic, health care systems require accurate forecasts for key resources to guide preparation for patient surges. Forecasting the COVID-19 hospital census is among the most important planning decisions to ensure adequate staffing, number of beds, intensive care units, and vital equipment. OBJECTIVE: The goal of this study was to explore the potential utility of local COVID-19 infection incidence data in developing a forecasting model for the COVID-19 hospital census. METHODS: The study data comprised aggregated daily COVID-19 hospital census data across 11 Atrium Health hospitals plus a virtual hospital in the greater Charlotte metropolitan area of North Carolina, as well as the total daily infection incidence across the same region during the May 15 to December 5, 2020, period. Cross-correlations between hospital census and local infection incidence lagging up to 21 days were computed. A multivariate time-series framework, called the vector error correction model (VECM), was used to simultaneously incorporate both time series and account for their possible long-run relationship. Hypothesis tests and model diagnostics were performed to test for the long-run relationship and examine model goodness of fit. The 7-days-ahead forecast performance was measured by mean absolute percentage error (MAPE), with time-series cross-validation. The forecast performance was also compared with an autoregressive integrated moving average (ARIMA) model in the same cross-validation time frame. Based on different scenarios of the pandemic, the fitted model was leveraged to produce 60-days-ahead forecasts. RESULTS: The cross-correlations were uniformly high, falling between 0.7 and 0.8. There was sufficient evidence that the two time series have a stable long-run relationship at the .01 significance level. The model had very good fit to the data. The out-of-sample MAPE had a median of 5.9% and a 95th percentile of 13.4%. In comparison, the MAPE of the ARIMA had a median of 6.6% and a 95th percentile of 14.3%. Scenario-based 60-days-ahead forecasts exhibited concave trajectories with peaks lagging 2 to 3 weeks later than the peak infection incidence. In the worst-case scenario, the COVID-19 hospital census can reach a peak over 3 times greater than the peak observed during the second wave. CONCLUSIONS: When used in the VECM framework, the local COVID-19 infection incidence can be an effective leading indicator to predict the COVID-19 hospital census. The VECM model had a very good 7-days-ahead forecast performance and outperformed the traditional ARIMA model. Leveraging the relationship between the two time series, the model can produce realistic 60-days-ahead scenario-based projections, which can inform health care systems about the peak timing and volume of the hospital census for long-term planning purposes.

Longitudinal tendon healing assessed with multi-modality advanced imaging and tissue analysis.

BACKGROUND: The range of diagnostic modalities available to evaluate superficial digital flexor tendon (SDFT) injury includes magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). Direct, comprehensive comparison of multi-modality imaging characteristics to end-point data has not previously been performed using a model of tendinopathy but is required to obtain a better understanding of each modality's diagnostic capabilities. OBJECTIVE: To compare CT, MRI and US evaluation to outcome measures for histologic, biochemical and biomechanical parameters using an equine surgical model of tendinopathy. STUDY DESIGN: Controlled experiment. METHODS: Lesions were surgically created in both forelimb SDFTs of eight horses and imaged using MRI, CT and US at seven time points over 12 months. Imaging characteristics were then correlated to end point histologic, biochemical and biomechanical data using lasso regression. Longitudinal lesion size was compared between imaging modalities. RESULTS: Lesion to tendon isoattenuation on CT evaluation correlated with the greatest levels of aggrecan deposition. A significant correlation between cellular density and percentage of tendon involvement on the T2-weighted sequence and signal intensity on the proton density fat saturated (PD FS) sequence was appreciated at the 12-month time point (P = .006, P = .02 respectively). There was no significant correlation between end-point data and US or contrast imaging characteristics. Cross sectional area lesion to tendon measurements were significantly largest on CT evaluation, followed by MRI and then US (P < .001). MAIN LIMITATIONS: Experimentally induced tendon injury with singular end-point data correlation. CONCLUSIONS: Lesion isoattenuation on CT evaluation suggested scar tissue deposition, while T2-weighted hyperintensity indicated hypercellular tendinopathy even in chronic stages of healing. Non contrast-enhanced MRI and CT evaluation correlated most closely to cellular characteristics of surgically damaged tendons assessed over a twelve month study period. Ultrasonographic evaluation underestimates true lesional size and should be interpreted with caution.

A predictive internet-based model for COVID-19 hospitalization census.

The COVID-19 pandemic has strained hospital resources and necessitated the need for predictive models to forecast patient care demands in order to allow for adequate staffing and resource allocation. Recently, other studies have looked at associations between Google Trends data and the number of COVID-19 cases. Expanding on this approach, we propose a vector error correction model (VECM) for the number of COVID-19 patients in a healthcare system (Census) that incorporates Google search term activity and healthcare chatbot scores. The VECM provided a good fit to Census and very good forecasting performance as assessed by hypothesis tests and mean absolute percentage prediction error. Although our study and model have limitations, we have conducted a broad and insightful search for candidate Internet variables and employed rigorous statistical methods. We have demonstrated the VECM can potentially be a valuable component to a COVID-19 surveillance program in a healthcare system.

The pelvic flexure separates distinct microbial communities in the equine hindgut.

As hindgut fermenters, horses are especially dependent on the microbiota residing in their cecum and large intestines. Interactions between these microbial populations and the horse are critical for maintaining gut homeostasis, which supports proper digestion. The current project was motivated to determine if any features of the fecal microbiota are informative of the microbial communities from the cecum, ventral colon, or dorsal colon. Digesta from the cecum, ventral colon, dorsal colon and feces were collected from 6 yearling miniature horses. Microbial DNA was isolated and the microbiota from each sample was characterized by profiling the V4 region of the 16S rRNA. Principal coordinate analysis of the beta diversity results revealed significant (p = 0.0001; F = 5.2393) similarities between the microbial populations from cecal and ventral colon and the dorsal colon and fecal samples, however, there was little overlap between the proximal and distal ends of the hindgut. These distinct population structures observed in our results coincide with the pelvic flexure, which itself separates intestinal compartments with distinct roles in digestive physiology. An indicator species analysis confirmed the population differences, supported by the identification of several microbial families characteristic of the compartments upstream of the pelvic flexure that were not represented following it. Our data suggest that the fecal microbiota is not informative of the proximal hindgut but can provide insight into communities of the distal compartments. Further, our results suggest that the pelvic flexure might be an important anatomical landmark relative to the microbial communities in the equine large intestine.

Lingual electrotactile discrimination ability is associated with the presence of specific connective tissue structures (papillae) on the tongue surface.

Electrical stimulation of nerve endings in the tongue can be used to communicate information to users and has been shown to be highly effective in sensory substitution applications. The anterior tip of the tongue has very small somatosensory receptive fields, comparable to those of the finger tips, allowing for precise two-point discrimination and high tactile sensitivity. However, perception of electrotactile stimuli varies significantly between users, and across the tongue surface. Despite this, previous studies all used uniform electrode grids to stimulate a region of the dorsal-medial tongue surface. In an effort to customize electrode layouts for individual users, and thus improve efficacy for sensory substitution applications, we investigated whether specific neuroanatomical and physiological features of the tongue are associated with enhanced ability to perceive active electrodes. Specifically, the study described here was designed to test whether fungiform papillae density and/or propylthiouracil sensitivity are positively or negatively associated with perceived intensity and/or discrimination ability for lingual electrotactile stimuli. Fungiform papillae number and distribution were determined for 15 participants and they were exposed to patterns of electrotactile stimulation (ETS) and asked to report perceived intensity and perceived number of stimuli. Fungiform papillae number and distribution were then compared to ETS characteristics using comprehensive and rigorous statistical analyses. Our results indicate that fungiform papillae density is correlated with enhanced discrimination ability for electrical stimuli. In contrast, papillae density, on average, is not correlated with perceived intensity of active electrodes. However, results for at least one participant suggest that further research is warranted. Our data indicate that propylthiouracil taster status is not related to ETS perceived intensity or discrimination ability. These data indicate that individuals with higher fungiform papillae number and density in the anterior medial tongue region may be better able to use lingual ETS for sensory substitution.

Information-Seeking Preferences of the Colorado Equine Industry for Distribution of Disease Outbreak Information.

The purpose of this study was to learn how perceptions of accuracy and availability of sources affect how members of the Colorado equine industry seek both everyday information and information during an equine disease outbreak. A survey was distributed by email and social media to members of Colorado-based equine organizations. A total of 256 survey responses were obtained from individuals representing a spectrum of ages and roles in the Colorado equine industry. Survey participants predominantly identified as female (95.3%) and their industry role as a horse owner (41%) or a competitive (25.8%) or pleasure (13.3%) rider. Younger survey participants reported greater (P < .0001) use of social media, and both participant age (P < .015) and information source (P < .0001) affected the perception of resource accuracy. In the event of an equine disease outbreak, industry role was an important factor (P = .003) in the selection of news sources, whereas age was not (P = .19). Many participants (56%) identified disease symptoms/signs to be the most important information to be sought during a disease outbreak and most (69.9%) preferred state or veterinary resources for this information. The identification of why Colorado equine industry members access information from specific sources may guide animal health and extension professionals to tailor their online presence to best meet the communication needs of the Colorado equine industry.

Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study.

BACKGROUND: Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. OBJECTIVE: The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. METHODS: Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. RESULTS: Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 - the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. CONCLUSIONS: Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak.

A quantitative assessment of the effectiveness of USDA's AgrAbility project.

BACKGROUND: There is evidence that the combination of assistive technology and education increases ability to live and work independently, which in turn increases the quality of life (QOL) levels of adults with disabilities. No previously published treatment-comparison group intervention studies were found with adult farmers and ranchers with disabilities. Knowing how effective USDA's AgrAbility Project is at increasing this population's QOL and independent living and working (ILW) levels will reinforce and inform change in AgrAbility and will provide outcomes for stakeholders and public decision makers to better address agricultural communities' needs. OBJECTIVES: To assess whether or not AgrAbility is effective for enhancing QOL and ILW levels of agricultural producers with functional limitations and to assess intervention-comparison group differences. METHODS: Intervention group participants (N = 225) included ranchers and farmers from 12 states with various disabilities who participated in AgrAbility. Comparison group participants (N = 100) from 17 states also included farmers and ranchers with various disabilities; they received no on-site visits or other AgrAbility services. RESULTS: In this 10-year, 27-state study, AgrAbility participants reported statistically significant presurvey-postsurvey improvements in QOL levels (mean presurvey = 5.56; mean postsurvey = 7.13) while comparison group participants reported no change in QOL (mean presurvey = 5.10; mean postsurvey = 4.91). AgrAbility group mean ILW scores rose from 2.86 to 3.71 while comparison group mean ILW scores rose slightly from 3.24 to 3.50. CONCLUSIONS: These results suggest that AgrAbility was effective as compared with a no-treatment comparison group on improving QOL and ILW levels.

Perceived Intensity and Discrimination Ability for Lingual Electrotactile Stimulation Depends on Location and Orientation of Electrodes.

Malfunctioning sensory systems can severely impact quality of life and repair is not always possible. One solution, called sensory substitution, is to use another sensory system to bring lost information to the brain. This approach often involves the use of bioengineered devices that electrically stimulate somatosensory fibers. Interestingly, the tongue is an ideal location for electrotactile stimulation due to its dense innervation, moisture, and protected environment. Success with transmitting visual and vestibular information through the tongue indicates promise for future applications. However, sensitivity and discrimination ability varies between individuals and across the tongue surface complicating efforts to produce reliable and consistent sensations. The goals of the present study were to investigate these differences more precisely to better understand the mechanosensory innervation of the tongue so that future electrotactile devices can be designed more effectively. Specifically, we tested whether stimulation of certain regions of the tongue consistently result in better perception, whether the spacing of stimulating electrodes affects perceived intensity, and whether the orientation of electrodes affects perceived intensity and discrimination. To test these hypotheses, we built a custom tongue stimulation device, recruited 25 participants, and collected perceived intensity and discrimination data. We then subjected the data to thorough statistical analyses. Consistent with previous studies, we found that stimulation of the anterior medial tongue region was perceived as more intense than stimulation of lateral and posterior regions. This region also had the best discrimination ability for electrodes. Dividing the stimulated tongue area into 16 distinct regions allowed us to compare perception ability between anterior and posterior regions, medial and lateral regions, and the left and right sides of the tongue. Stimulation of the most anterior and medial tongue resulted in the highest perceived intensity and the best discrimination ability. Most individuals were able to perceive and discriminate electrotactile stimulation better on one side of the tongue, and orientation of stimulating electrodes affected perception. In conclusion, the present studies reveal new information about the somatosensory innervation of the tongue and will assist the design of future electrotactile tongue stimulation devices that will help provide sensory information to people with damaged sensory systems.

Perceived distance and obesity: It's what you weigh, not what you think.

Action abilities are constrained by physical body size and characteristics, which, according to the action-specific account of perception, should influence perceived space. We examined whether physical body size or beliefs about body size affect distance perception by taking advantage of naturally-occurring dissociations typical in people who are obese but believe themselves to weigh less. Normal weight, overweight, and obese individuals made verbal distance estimates. We also collected measures of beliefs about body size and measures of physical body size. Individuals who weighed more than others estimated distances to be farther. Furthermore, physical body weight influenced perceived distance but beliefs about body size did not. The results illustrate that whereas perception is influenced by physical characteristics, it is not influenced by beliefs. The results also have implications for perception as a contributing factor for lifestyle choices: people who weigh more than others may choose to perform less physically demanding actions not as a result of how they perceive their bodies, but as a result of how they perceive the environment.

Changes in cell shape are correlated with metastatic potential in murine and human osteosarcomas.

Metastatic cancer cells for many cancers are known to have altered cytoskeletal properties, in particular to be more deformable and contractile. Consequently, shape characteristics of more metastatic cancer cells may be expected to have diverged from those of their parental cells. To examine this hypothesis we study shape characteristics of paired osteosarcoma cell lines, each consisting of a less metastatic parental line and a more metastatic line, derived from the former by in vivo selection. Two-dimensional images of four pairs of lines were processed. Statistical analysis of morphometric characteristics shows that shape characteristics of the metastatic cell line are partly overlapping and partly diverged from the parental line. Significantly, the shape changes fall into two categories, with three paired cell lines displaying a more mesenchymal-like morphology, while the fourth displaying a change towards a more rounded morphology. A neural network algorithm could distinguish between samples of the less metastatic cells from the more metastatic cells with near perfect accuracy. Thus, subtle changes in shape carry information about the genetic changes that lead to invasiveness and metastasis of osteosarcoma cancer cells.

Use of multiple modes of flight subsidy by a soaring terrestrial bird, the golden eagle Aquila chrysaetos, when on migration.

Large birds regularly use updrafts to subsidize flight. Although most research on soaring bird flight has focused on use of thermal updrafts, there is evidence suggesting that many species are likely to use multiple modes of subsidy. We tested the degree to which a large soaring species uses multiple modes of subsidy to provide insights into the decision-making that underlies flight behaviour. We statistically classified more than 22 000 global positioning satellite-global system for mobile communications telemetry points collected at 30-s intervals to identify the type of subsidized flight used by 32 migrating golden eagles during spring in eastern North America. Eagles used subsidized flight on 87% of their journey. They spent 41.9% ± 1.5 ([Formula: see text], range: 18-56%) of their subsidized northbound migration using thermal soaring, 45.2% ± 2.1 (12-65%) of time gliding between thermals, and 12.9% ± 2.2 (1-55%) of time using orographic updrafts. Golden eagles responded to the variable local-scale meteorological events they encountered by switching flight behaviour to take advantage of multiple modes of subsidy. Orographic soaring occurred more frequently in morning and evening, earlier in the migration season, and when crosswinds and tail winds were greatest. Switching between flight modes allowed migration for relatively longer periods each day and frequent switching behaviour has implications for a better understanding of avian flight behaviour and of the evolution of use of subsidy in flight.