As coronavirus disease 2019 (COVID-19) spread, efforts were made to preserve resources for the anticipated surge of COVID-19 patients in British Columbia, Canada. However, the relationship between COVID-19 hospitalizations and access to cancer surgery is unclear. In this project, we analyze the impact of COVID-19 patient volumes on wait time for cancer surgery.

We conducted a retrospective study using population-based datasets of regional surgical wait times and COVID-19 patient volumes. Weekly median wait times for urgent, nonurgent, cancer, and noncancer surgeries, and maximum volumes of hospitalized patients with COVID-19 were studied. The results were qualitatively analyzed.

A sustained association between weekly median wait time for priority and other cancer surgeries and increase hospital COVID-19 patient volumes was not qualitatively discernable. In response to the first phase of COVID-19 patient volumes, relative to pre-COVID-19 pandemic levels, wait time were shortened for urgent cancer surgery but increased for nonurgent surgeries. During the second phase, for all diagnostic groups, wait times returned to pre-COVID-19 pandemic levels. During the third phase, wait times for all surgeries increased.

Cancer surgery access may have been influenced by other factors, such as policy directives and local resource issues, independent of hospitalized COVID-19 patient volumes. The initial access limitations gradually improved with provincial and institutional resilience, and vaccine rollout.

To evaluate the rates and patterns of distant metastasis in head and neck SCC at the time of presentation and to study the association between distant metastasis with pre-treatment, clinical, and pathological predictors of outcomes.

This is a retrospective study conducted in a tertiary care hospital. All patients with primary head and neck squamous cell carcinoma that had been evaluated at our institute between October 2018 and December 2020 were included in the study. Various clinical data were analysed and pattern of metastasis was studied.

Ten per cent (50 cases) of 501 studied patients had distant metastasis. The most common site of distant metastasis was lung. The rate of distant metastasis was high in patients with poorly differentiated cancers. By Kaplan–Meier analysis, the median survival duration after diagnosis of metastasis was four months.

The rate of distant metastasis was 10 per cent in the study. Patients with poorly differentiated tumours, locally advanced primary lesions, higher nodal stage, particularly with extra nodal extension, and hypopharyngeal primary, tend to exhibit increased risk for distant metastasis at the time of presentation.

Profiling patients on a proposed ‘immunometabolic depression’ (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment.

To test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants.

Data on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses.

Although AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001–0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01–0.22, I2 = 23.91%), with a higher – but still small – effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission.

Depressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.

To examine neurocognitive correlates of oculomotor performance among U.S. military personnel with history of mild traumatic brain injury (mTBI).

A series of studies (total n=356) were conducted to examine saccadic eye movements and manual button presses collected in response to attention stimuli, and to compare these findings to the results of standardized neuropsychological tests. Study 1 included n=27 with remote mTBI and n=54 controls who completed the Bethesda Eye and Attention Measure (BEAM), an eye tracking task that was designed to measure visual attention and executive function. In Study 2, n=51 with chronic mTBI and n=33 controls completed the Fusion n-Back task, an eye tracking task that was designed to assess the impact of working memory load on visual attention performance. Study 3 examined psychometric characteristics of BEAM among n=191 military personnel with remote mTBI. In all studies, participants completed eye tracking tasks, a structured TBI diagnostic interview, and a brief battery of standardized neuropsychological tests.

In Study 1, BEAM saccadic and manual metrics demonstrated strong reliability and high sensitivity to multiple cognitive cues designed to elicit spatial orienting, temporal alerting, executive interference, perceptual release (gap) and inhibition (n2p=.76, p<.001). However, corresponding saccadic and manual measurements were weakly related to each other, and only manual (not saccadic) measurements were related to estimated verbal intelligence or years of education. Standardized neuropsychological measures did not differ between groups, but mTBI participants were more likely to be impaired on saccadic metrics than controls.

In Study 2, Standardized cognitive measures and estimated premorbid intelligence were positively associated with all manual metrics from the Fusion n-Back test, but were not associated with mTBI history or with saccadic metrics. Fusion n-Back saccadic and manual metrics had strong reliability and complementary sensitivity to chronic mTBI, with combined predictive power of PPV=.78, NPV=.72, r2=.44 for classification of remote mild TBI vs. controls on the more cognitively-challenging 1-back task condition.

In Study 3, BEAM metrics including manual RT latency and consistency, saccadic RT consistency, and saccadic inhibition errors showed consistent correlations with standardized measures of visual attention, processing speed, task switching, working memory, and executive functions. Hierarchical regressions showed that BEAM saccadic and manual metrics were independently predictive of cognitive test performance, above and beyond effects of demographic factors and clinical characteristics.

Results demonstrated some surprising findings related to neurocognitive influences on oculomotor performance. While both saccadic and manual performance were strongly and similarly influenced by attention cues, these two modalities were only weakly correlated to one another. Additionally, manual metrics were more strongly and consistently related to standardized cognitive test performance and premorbid intelligence than saccadic metrics. However, saccadic metrics demonstrated superior sensitivity to remote/chronic mTBI relative to manual metrics and standardized neuropsychological measures. Overall, these results suggest that saccadic eye tracking measures may provide unique value in assessment of mTBI and neurocognitive functions that is complementary with more common forms of assessment relying upon somatomotor response modalities.

During the COVID-19 pandemic, many neuropsychological services shifted from an in-person assessment to a tele-neuropsychological assessment format. Prior research studies support the use of telemedicine assessments but have also noted some limitations (i.e., tasks involving direct manipulation of physical stimuli and visuospatial tasks). We sought to examine the relationship between the same neuropsychological tasks administered via a telemedicine versus inperson format in a treatment seeking clinical sample of Veterans with history of TBI.

Veterans with history of mild to severe TBI (predominantly mild TBI) referred to the TBI Cognitive Rehabilitation Clinic within the San Diego Veterans Affairs Medical Center completed a comprehensive neuropsychological assessment to help inform diagnosis and treatment recommendations. 515 Veterans completed traditional in-person assessment (pre-pandemic) and 45 Veterans completed neuropsychological assessment via a telemedicine platform during the pandemic (Veteran was in their home and examiner was in their home or facility office). The total sample consisted of 93% male and 7% female, average age of 33, 13 years of education, 63% White, 13% Other/Non-reported, 12% Black, 6% Asian, 6% Pacific Islander, 2% Alaskan Native, and 1% Multi-Racial, 73% Non-Hispanic, and 27% Hispanic. For the purposes of this study, we used age-corrected subtest scores from the Delis-Kaplan Executive Function System (D-KEFS): Color Word Interference (CWI) and Verbal Fluency (VF), WASI-II Matrix Reasoning, California Verbal Learning Test (CVLT-II), Wechsler Memory Scale (WMS-IV): Logical Memory, and WRAT-IV Reading. We also examined symptoms of anxiety (BAI), sleep quality (PSQI), neurological symptoms (NSI), and symptoms of PTSD (PCL-5). ANOVAs were used to analyze the relationship between tele-neuropsychological versus in-person administration. Additionally, we controlled for performance validity failure.

Tele-neuropsychological task results were comparable to in-person assessment across all tasks, except for D-KEFS CWI color naming subtest where individuals completing the task via telemedicine performed approximately 2 scaled scores below the in-person assessment group, F (1, 278)=6.44, p=.012. Individuals who completed the tele-neuropsychological assessment during the COVID-pandemic did not differ on scores of self-reported symptoms of PTSD or neuropsychological symptoms when compared to in-person assessment of pre-pandemic individuals within our clinic. However, the telemedicine group reported better sleep quality (F (1, 377)=11.94, p=.001) but a trend towards more symptoms of anxiety (F (1, 552)=2.90, p=.089.

These results suggest that many of the verbal memory, language, premorbid functioning, and verbal/visual tasks of executive function can be adequately administered via telemedicine. Substantial variability may exist on measures of processing speed administered via telemedicine, however. Additionally, changes in lifestyle and daily demands during the COVID-19 pandemic may have created unique circumstances that benefited sleep quality for some individuals but also increased symptoms of anxiety/uncertainty.

To determine the association between blood markers of white matter injury (e.g., serum neurofilament light and phosphorylated neurofilament heavy) and a novel neuroimaging technique measuring microstructural white matter changes (e.g., diffusion kurtosis imaging) in regions (e.g., anterior thalamic radiation and uncinate fasciculus) known to be impacted in traumatic brain injury (TBI) and associated with symptoms common in those with chronic TBI (e.g., sleep disruption, cognitive and emotional disinhibition) in a heterogeneous sample of Veterans and non-Veterans with a history of remote TBI (i.e., >6 months).

Participants with complete imaging and blood data (N=24) were sampled from a larger multisite study of chronic mild-moderate TBI. Participants ranged in age from young to middle-aged (mean age = 34.17, SD age = 10.96, range = 19-58) and primarily male (66.7%). The number of distinct TBIs ranged from 1-5 and the time since most recent TBI ranged from 0-30 years. Scores on a cognitive screener (MoCA) ranged from 22-30 (mean = 26.75). We performed bivariate correlations with mean kurtosis (MK) in the anterior thalamic radiation (ATR; left, right) uncinate fasciculus (UF; left, right), and serum neurofilament light (NFL), and phosphorylated neurofilament heavy (pNFH). Both were log transformed for non-normality. Significance threshold was set at p<0.05.

pNFH was significantly and negatively correlated to MK in the right (r=-0.446) and left (r=-0.599) UF and right (r=-0.531) and left (r=-0.469) ATR. NFL showed moderate associations with MK in the right (r=-0.345) and left (r=-0.361) UF and little to small association in the right (r=-0.063) and left (r=-0.215) ATR. In post-hoc analyses, MK in both the left (r=0.434) and right (r=0.514) UF was positively associated with performance on a frontally-mediated list-learning task (California Verbal Learning Test, 2nd Edition; Trials 1-5 total).

Results suggest that serum pNFH may be a more sensitive blood marker of microstructural complexity in white matter regions frequently impacted by TBI in a chronic mild-moderate TBI sample. Further, it suggests that even years after a mild-moderate TBI, levels of pNFH may be informative regarding white matter integrity in regions related to executive functioning and emotional disinhibition, both of which are common presenting problems when these patients are seen in a clinical setting.