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Objectives/Goals: Aspiration causes or aggravates lung diseases. While bedside swallow evaluations are not sensitive/specific, gold standard tests for aspiration are invasive, uncomfortable, expose patients to radiation, and are resource intensive. We propose the development and validation of an AI model that analyzes voice to noninvasively predict aspiration. Methods/Study Population: Retrospectively recorded [i] phonations from 163 unique ENT patients were analyzed for acoustic features including jitter, shimmer, harmonic to noise ratio (HNR), etc. Patients were classified into three groups: aspirators (Penetration-Aspiration Scale, PAS 6–8), probable (PAS 3–5), and non-aspirators (PAS 1–2) based on video fluoroscopic swallow (VFSS) findings. Multivariate analysis evaluated patient demographics, history of head and neck surgery, radiation, neurological illness, obstructive sleep apnea, esophageal disease, body mass index, and vocal cord dysfunction. Supervised machine learning using five folds cross-validated neural additive network modelling (NAM) was performed on the phonations of aspirator versus non-aspirators. The model was then validated using an independent, external database. Results/Anticipated Results: Aspirators were found to have quantifiably worse quality of sound with higher jitter and shimmer but lower harmonics noise ratio. NAM modeling classified aspirators and non-aspirators as distinct groups (aspirator NAM risk score 0.528+0.2478 (mean + std) vs. non-aspirator (control) risk score of 0.252+0.241 (mean + std); p Discussion/Significance of Impact: We report the use of voice as a novel, noninvasive biomarker to detect aspiration risk using machine learning techniques. This tool has the potential to be used for the safe and early detection of aspiration in a variety of clinical settings including intensive care units, wards, outpatient clinics, and remote monitoring.
Altered reinforcement learning (RL) and decision-making have been implicated in the pathophysiology of anorexia nervosa. To determine whether deficits observed in symptomatic anorexia nervosa are also present in remission, we investigated RL in women remitted from anorexia nervosa (rAN).
Methods:
Participants performed a probabilistic associative learning task that involved learning from rewarding or punishing outcomes across consecutive sets of stimuli to examine generalization of learning to new stimuli over extended task exposure. We fit a hybrid RL and drift diffusion model of associative learning to model learning and decision-making processes in 24 rAN and 20 female community controls (cCN).
Results:
rAN showed better learning from negative outcomes than cCN and this was greater over extended task exposure (p < .001, ηp2 = .30). rAN demonstrated a reduction in accuracy of optimal choices (p = .007, ηp2 = .16) and rate of information extraction on reward trials from set 1 to set 2 (p = .012, ηp2 = .14), and a larger reduction of response threshold separation from set 1 to set 2 than cCN (p = .036, ηp2 = .10).
Conclusions:
rAN extracted less information from rewarding stimuli and their learning became increasingly sensitive to negative outcomes over learning trials. This suggests rAN shifted attention to learning from negative feedback while slowing down extraction of information from rewarding stimuli. Better learning from negative over positive feedback in rAN might reflect a marker of recovery.
Representation scholarship has drawn from intersectionality theory 0to examine how systemic structures of oppression and privilege have created social groups with distinct political needs. Derived from Black feminist theory that recognizes that identities are mutually constitutive and interconnected, intersectionality research is rooted in the lived experiences of marginalized groups who call attention to social (in)justice. Empirical scholarship building on the insights of Black feminist theorists such as Collins and Bilge (2016), Hill Collins (1990), Crenshaw (1989; 1991), and King (1988) has constituted nothing less than a paradigm shift in the study of gender and politics. Nevertheless, there remain an array of opportunities to expand upon the potential for intersectional frameworks and methods, as well as pressing new questions concerning the operationalization of intersectionality itself. This Critical Perspectives section offers a moment to take stock of these developments and debates, as well as to highlight new pathways for scholarship committed to centering the margins and considering the nexus of multiple power structures that frame our political lives.
In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.
We demonstrate the importance of radio selection in probing heavily obscured galaxy populations. We combine Evolutionary Map of the Universe (EMU) Early Science data in the Galaxy and Mass Assembly (GAMA) G23 field with the GAMA data, providing optical photometry and spectral line measurements, together with Wide-field Infrared Survey Explorer (WISE) infrared (IR) photometry, providing IR luminosities and colours. We investigate the degree of obscuration in star-forming galaxies, based on the Balmer decrement (BD), and explore how this trend varies, over a redshift range of $0<z<0.345$. We demonstrate that the radio-detected population has on average higher levels of obscuration than the parent optical sample, arising through missing the lowest BD and lowest mass galaxies, which are also the lower star formation rate (SFR) and metallicity systems. We discuss possible explanations for this result, including speculation around whether it might arise from steeper stellar initial mass functions in low mass, low SFR galaxies.
Ultra-processed plant-based foods, such as plant-based burgers, have gained in popularity. Particularly in the out-of-home (OOH) environment, evidence regarding their nutritional profile and environmental sustainability is still evolving. Plant-based burgers available at selected OOH sites were randomly sampled in Amsterdam, Copenhagen, Lisbon and London. Plant-based burgers (patty, bread and condiment) (n 41) were lab analysed for their energy, macronutrients, amino acids and minerals content per 100 g and serving and were compared with reference values. For the plant-based burgers, the median values per 100 g were 234 kcal, 20·8 g carbohydrates, 3·5 g dietary fibre and 12·0 g fat, including 0·08 g TFS and 2·2 g SFA. Protein content was 8·9 g/100 g, with low protein quality according to amino acid composition. Median Na content was 389 mg/100 g, equivalent to 1 g salt. Compared with references, the median serving provided 31% of energy intake based on a 2000 kcal per day and contributed to carbohydrates (17–28%), dietary fibre (42%), protein (40%), total fat (48%), SFA (26%) and Na (54%). One serving provided 15–23% of the reference values for Ca, K and Mg, while higher contributions were found for Zn, Mn, P and Fe (30–67%). The ultra-processed plant-based burgers provide protein, dietary fibre and essential minerals and contain relatively high levels of energy, Na and total fats. The amino acid composition indicated low protein quality. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits, including reducing energy, Na and total fats.
Female fertility is a complex trait with age-specific changes in spontaneous dizygotic (DZ) twinning and fertility. To elucidate factors regulating female fertility and infertility, we conducted a genome-wide association study (GWAS) on mothers of spontaneous DZ twins (MoDZT) versus controls (3273 cases, 24,009 controls). This is a follow-up study to the Australia/New Zealand (ANZ) component of that previously reported (Mbarek et al., 2016), with a sample size almost twice that of the entire discovery sample meta-analysed in the previous article (and five times the ANZ contribution to that), resulting from newly available additional genotyping and representing a significant increase in power. We compare analyses with and without male controls and show unequivocally that it is better to include male controls who have been screened for recent family history, than to use only female controls. Results from the SNP based GWAS identified four genomewide significant signals, including one novel region, ZFPM1 (Zinc Finger Protein, FOG Family Member 1), on chromosome 16. Previous signals near FSHB (Follicle Stimulating Hormone beta subunit) and SMAD3 (SMAD Family Member 3) were also replicated (Mbarek et al., 2016). We also ran the GWAS with a dominance model that identified a further locus ADRB2 on chr 5. These results have been contributed to the International Twinning Genetics Consortium for inclusion in the next GWAS meta-analysis (Mbarek et al., in press).
University students face vast mental health challenges, and both attitudinal and structural barriers to seeking care. Embedding interventions in college courses is one solution. Acceptance and commitment therapy (ACT) is an ideal candidate intervention given its emphasis on values, context, and skill building from a transdiagnostic perspective. This study embedded a brief ACT intervention in a required freshman seminar that was delivered by trained but unlicensed graduate students. In two class sessions of the freshman seminar taught by the same instructor, one session was randomly assigned to receive the course as usual, and one session received the ACT intervention. ACT content was delivered to all students in the intervention course on five consecutive weekly class periods. Students in both classes who chose to participate in the study completed assessments before and after the intervention and at follow-up. There were no significant changes with tests that were run, including non-parametric tests given the small sample sizes. Descriptively, the intervention group had slight improvements in wellbeing and mindfulness and decreases in distress, and the control group had worsened wellbeing, mindfulness and distress. A moderate portion of intervention group students enjoyed the intervention and indicated use of ACT skills, particularly mindfulness. Results suggest that this classroom-based intervention was feasible and acceptable, but further study should occur given small sample sizes. Future work should continue course-based ACT interventions, and should also explore potential applications of student training to deliver interventions given the shortage of mental health providers on college campuses.
Key learning aims
(1) Can acceptance and commitment therapy content and skills be integrated into an existing freshman seminar curriculum?
(2) Can acceptance and commitment therapy improve wellbeing and decrease distress amongst college students?
(3) How will students engage with and practise acceptance and commitment therapy skills outside of the context of session delivery?
Includes 'The Will of Roger Benetheton, 1438/9', edited by the late Rev. R. M. Serjeantson (A Latin transcription with English translation of a will entered on the court rolls of Higham Ferrers, Northamptonshire.).
'Ancient Bedfordshire Deeds II: Deeds relating to Elstow,' by F. A, Page-Turner (Sixty-six deeds made between 1553 and 1665, transcribed, translated, abstracted or listed.).
'Ancient Indictments, 1341-2,' by G. Herbert Fowler (Latin transcriptions with English translations of Indictments in the court of King's Bench, with an introduction.).
'Selections from Jury Lists,' by the Rev. J. E. Brown (Jurors are listed by parish for 1780, 1785, 1791, 1798, 1800, 1810, 1820 and 1830. Most parishes are included but a notable exception is Bedford itself. The introduction summarises the qualifications for serving on a jury.)
Includes 'The Beauchamps, Barons of Bedford', by C. Gore Chambers and G. Herbert Fowler. 'Clerical Subsidies in the Archdeaconry of Bedford, 1390-2, 1400-1', by J. E. Brown. 'Domesday Notes', by G. Herbert Fowler. 'A Lease of Caddington Manor in 1299', by C. Gore Chambers. 'Sir William Harper, Knt.', by F. A. Page-Turner. 'Early Charters of the Priory of Chicksand', by G. Herbert Fowler. 'Notes on Two Trades: (i) Strawplaiting, (ii) Brickmaking', by William Austin. 'The Bedford Eyre, 1202', by G. Herbert Fowler. 'Records of Northill College, No. I', by C. Gore Chambers.
The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) lacks a rigorous enrollment audit process, unlike other collaborative networks. Most centers require individual families to consent to participate. It is unknown whether there is variation across centers or biases in enrollment.
Methods:
We used the Pediatric Cardiac Critical Care Consortium (PC4) registry to assess enrollment rates in NPC-QIC for those centers participating in both registries using indirect identifiers (date of birth, date of admission, gender, and center) to match patient records. All infants born 1/1/2018–12/31/2020 and admitted 30 days of life were eligible. In PC4, all infants with a fundamental diagnosis of hypoplastic left heart or variant or who underwent a surgical or hybrid Norwood or variant were eligible. Standard descriptive statistics were used to describe the cohort and center match rates were plotted on a funnel chart.
Results:
Of 898 eligible NPC-QIC patients, 841 were linked to 1,114 eligible PC4 patients (match rate 75.5%) in 32 centers. Match rates were lower in patients of Hispanic/Latino ethnicity (66.1%, p = 0.005), and those with any specified chromosomal abnormality (57.4%, p = 0.002), noncardiac abnormality (67.8%, p = 0.005), or any specified syndrome (66.5%, p = 0.001). Match rates were lower for patients who transferred to another hospital or died prior to discharge. Match rates varied from 0 to 100% across centers.
Conclusions:
It is feasible to match patients between the NPC-QIC and PC4 registries. Variation in match rates suggests opportunities for improvement in NPC-QIC patient enrollment.
To determine whether the gender of clinicians making antimicrobial stewardship recommendations has an impact on intervention acceptance rate.
Design:
A retrospective, multivariable analysis of antimicrobial stewardship prospective audit and feedback outcomes.
Setting:
A multisite healthcare system including Mayo Clinic Rochester (MN), Mayo Clinic Arizona, Mayo Clinic Florida and 17 health-system hospital sites, where prospective audit and feedback is performed and documented within an electronic tool embedded in the medical record.
Participants:
The study included 143 Mayo Clinic clinicians (84 cisfemales and 59 cismales).
Methods:
Outcomes were analyzed from July 1, 2017, to June 30, 2022, for intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status of patient.
Results:
Of 81,927 rules, 71,729 rules met study inclusion. There were 18,175 (25%) rules associated with an intervention. Most of the rules were reviewed by pharmacists (86.2%) and stewardship staff (85.5%). Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (P = .19). Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02–1.08; P = .001). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45–0.7; P < .001).
Conclusions:
Female and male clinicians were equally effective at prospective audit and feedback in a multisite antimicrobial stewardship program. Patients in the ICU were less likely to have stewardship interventions accepted.