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52 Bayesian Logistic Regression Bias Adjustment for Data Observed without a Gold Standard: A Simulation Study of Clinical Alzheimer’s Disease
- William F Goette, Hudaisa Fatima, Jeff Schaffert, Anne R Carlew, Heidi Rossetti, Laura H Lacritz, C. Munro Cullum
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 259-260
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Objective:
Definitive diagnosis of Alzheimer’s disease (AD) is often unavailable, so clinical diagnoses with some degree of inaccuracy are often used in research instead. When researchers test methods that may improve clinical accuracy, the error in initial diagnosis can penalize predictions that are more accurate to true diagnoses but differ from clinical diagnoses. To address this challenge, the current study investigated the use of a simple bias adjustment for use in logistic regression that accounts for known inaccuracy in initial diagnoses.
Participants and Methods:A Bayesian logistic regression model was developed to predict unobserved/true diagnostic status given the sensitivity and specificity of an imperfect reference. This model considers cases as a mixture of true (with rate = sensitivity) and false positives (rate = 1 - specificity) while controls are mixtures of true (rate = specificity) and false negatives (rate = 1 - sensitivity). This bias adjustment was tested using Monte Carlo simulations over four conditions that varied the accuracy of clinical diagnoses. Conditions utilized 1000 iterations each generating a random dataset of n = 1000 based on a true logistic model with an intercept and three arbitrary predictors. Coefficients for parameters were randomly selected in each iteration and used to produce a set of two diagnoses: true diagnoses and observed diagnoses with imperfect accuracy. Sensitivity and specificity of the simulated clinical diagnosis varied with each of the four conditions (C): C1 = (0.77, 0.60), C2 = (0.87, 0.44), C3 = (0.71, 0.71), and C4 = (0.83, 0.55), which are derived from published values for clinical AD diagnoses against autopsy-confirmed pathology. Unadjusted and bias-adjusted logistic regressions were then fit to the simulated data to determine the models’ accuracy in estimating regression parameters and prediction of true diagnosis.
Results:Under all conditions, the bias-adjusted logistic regression model outperformed its unadjusted counterpart. Root mean square error (the variability of estimated coefficients around their true parameter values) ranged from 0.23 to 0.79 for the unadjusted model versus 0.24 to 0.29 for the bias-adjusted model. The empirical coverage rate (the proportion of 95% credible intervals that include their true parameter) ranged from 0.00 to 0.47 for the unadjusted model versus 0.95 to 0.96 for the bias-adjusted model. Finally, the bias-adjusted model produced the best overall diagnostic accuracy with correct classification of true diagnostic values about 78% of the time versus 62-72% without adjustment.
Conclusions:Results of this simulation study, which used published AD sensitivity and specificity statistics, provide evidence that bias-adjustments to logistic regression models are needed when research involves diagnoses from an imperfect standard. Results showed that unadjusted methods rarely identified true effects with credible intervals for coefficients including the true value anywhere from never to less than half of the time. Additional simulations are needed to examine the bias-adjusted model’s performance under additional conditions. Future research is needed to extend the bias adjustment to multinomial logistic regressions and to scenarios where the rate of misdiagnosis is unknown. Such methods may be valuable for improving detection of other neurological disorders with greater diagnostic error as well.
87 Not Normal but not MCI: Course of Memory over time
- Michael Conley, Jeff Schaffert, Anthony Longoria, Jessica Helphrey, C Munro Cullum, Laura Lacritz
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 389-390
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Objective:
A diagnosis of mild cognitive impairment (MCI) requires memory complaint and objective memory impairment. However, some individuals report subjective memory complaints (SMC) despite having intact memory performance, while others demonstrate subtle impairment on memory testing but have no memory complaints; neither case would meet criteria for MCI. This study aimed to compare memory performances over time in individuals who do not meet traditional MCI criteria to those with normal cognition and those who converted to MCI.
Participants and Methods:Diagnoses for a longitudinal sample from the Texas Alzheimer’s Research and Care Consortium were reviewed by a consensus panel of neuropsychologists and neurologists and reclassified at time of last visit. Diagnostic categories included SMC (i.e., memory complaint but no impairment on testing), objective cognitive impairment but no complaint (Impaired but not MCI), normal control (NC), MCI, and dementia. In this study, 827 participants were divided into 4 groups: 1) NC over 5 visits (n=511, 71% female; 42% Latinx/Hispanic), 2) baseline NC to amnestic MCI (n=62; 63% female; 57% Latinx/Hispanic), 3) SMC at last visit (n=133; 58% female; 70% Latinx/Hispanic), and 4) impaired but not MCI at last visit (n=121; 71% female; 60% Latinx/Hispanic). A memory composite (z-score) was created from the CERAD list-learning task (immediate, delayed, and recognition-discrimination) and Wechsler Memory Scale (Immediate and Delayed Logical Memory and Visual Reproduction) to evaluate memory performance over time. A linear mixed-model adjusting for age, education, sex, ethnicity, and number of APOE e4 alleles evaluated memory performance across 5 visits for the groups. To assess if depression followed a similar course, a linear mixed-model evaluated Geriatric Depression Scale (GDS) scores over time.
Results:At baseline, groups differed by age (F=22.82; p<.001), education (F=8.60; p<.001), MMSE scores (F=9.38; p<.001), GDS-30 scores (F=3.56; p=.015), and memory composites (F=24.29; p<.001). A significant group X time interaction was observed (F=4.83, p<.001). Memory performance improved in both the SMC and the NC groups, remained stable in the impaired but not MCI group, and declined (as expected) in those who converted to amnestic MCI. Depression scores also showed a significant group X time interaction (F=2.43; p=.004), in which the NC to MCI group endorsed slightly more depression symptoms over time, while other groups declined or remained stable.
Conclusions:Memory trajectories in this diverse sample differed across groups. Individuals with SMC but without objective memory impairment and normal controls showed some improvement in memory over time, presumably due to practice effects. Those with subtle memory impairments but no complaint (i.e., did not meet MCI criteria) remained stable and those who converted to amnestic MCI had worse memory across time. The stability of memory performances in the impaired not MCI group suggests these subtle memory inefficiencies may be longstanding or unperceived. However, because our sample achieved retrospective diagnoses of SMC and impaired not MCI, it will be important for future studies to prospectively follow these groups to determine which risk factors may predict progression to MCI and what impact ethnicity may have on these trajectories.
97 Looking in the Webcam Reflection: A Scoping Review of Videoconferencing-Based Teleneuropsychological Assessment Since the Start of the COVID-19 Pandemic
- Joshua T Fox-Fuller, Preeti Sunderaraman, C. Munro Cullum, Yakeel T. Quiroz
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 770-771
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Objective:
Following the start of the SARS-COV-2 (COVID-19) pandemic there was a rapid uptake in teleneuropsychology (TeleNP). Many clinicians and researchers used videoconferencing technologies (e.g., Zoom®) to conduct remote neuropsychological assessments. Prior reviews (e.g., Marra et al., 2020) have indicated promise for the use of videoconference-based approaches to cognitive assessment under certain circumstances, though arguably nobody foresaw the widespread use of teleNP during the pandemic. Given the rapid expansion in the teleNP literature in the past couple of years, in this scoping review we specifically discuss research updates made during the COVID-19 pandemic pertaining to teleNP assessment of adults conducted via videoconferencing and their potential clinical applications.
Participants and Methods:GoogleScholar and PubMed were used to search for peer-reviewed original research articles published between January 1, 2020 (i.e., the approximate beginning of the COVID-19 pandemic) and August 1, 2022. Broad search terms were used pertaining to teleNP, remote cognitive assessment, videoconferencing, and neuropsychological assessment, resulting in 16 articles.
Results:Though most of the included studies were based in the United States (n=5), there was international representation across studies (Chile=1; United Kingdom=1; Australia=2; New Zealand=1; France=2; Greece=1; Japan=2, Singapore=1). All of the identified articles examined TeleNP-related research questions using cognitive tests administered via videoconferencing that have been previously studied in-person to varying degrees. Several of the studies focused on psychometric characterization (i.e., reliability and validity) of the examined tests when delivered via videoconferencing, whereas others focused on demonstrating the relative equivalence of neuropsychological scores obtained via videoconferencing versus in-person evaluations.
Conclusions:Formal psychometric studies of traditional in-person neuropsychological tests delivered via videoconferencing since the start of the COVID-19 pandemic suggest that this remote modality of assessment is generally reliable and valid. Moreover, multiple recent studies have demonstrated relative equivalence of neuropsychological scores obtained via videoconferencing versus neuropsychological test scores obtained in-person. When considered alongside teleNP research conducted prior to the COVID-19 pandemic (e.g. Cullum et al., 2014), recent studies on videoconference-based neuropsychological assessment indicate that videoconferencing may not necessarily be a complete substitute for an in-person comprehensive evaluation given the inherent limitations of the procedure. However, teleNP via videoconferencing may be a promising tool in the neuropsychologist’s toolbox because it can help reduce common barriers to in-person neuropsychological assessment (e.g., travel time to clinics). Additional research on videoconferencing-based cognitive assessment is needed, especially in low-and-middle income countries (LMIC) and diverse populations where there may be more economic barriers to remote neuropsychological assessment relative to more economically-developed countries. Notably it is possible that research from LMIC may have been missed through the screening processes used in this review (e.g., inclusion of articles written in English).
3 Separating Memory Impairment from Other Neuropsychological Deficits on the CVLT-II
- William F Goette, Jeff Schaffert, Anne R Carlew, David Denney, Heidi Rossetti, C. Munro Cullum, Laura H Lacritz
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 678
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Objective:
Learning curve patterns on list-learning tasks can help clinicians determine the nature of memory difficulties, as an “impaired” score may actually reflect attention and/or executive difficulties rather than a true memory impairment. Though such pattern analysis is often qualitative, there are quantitative methods to assess these concepts that have been generally underutilized. This study aimed to develop a model that decomposes learning over repeated trials into separate cognitive processes and then include other testing data to predict performance at each trial as a function of general cognitive functioning.
Participants and Methods:Data for CVLT-II learning trials were obtained from an outpatient neuropsychology service within an academic medical center referred for clinical reasons. Participants with a cognitive diagnosis of non-demented (ND) or probable Alzheimer’s disease (AD) were included. The final sample consisted of 323 ND [Mage = 58.6 (14.8); Medu = 15.4 (2.7); 55.7% female] and 915 AD [Mage = 72.6 (9.0); Medu = 14.2 (3.1); 60.1% female cases. A Bayesian non-linear beta-binomial multilevel model was used, which uses three parameters to predict CVLT-II recall-by-trial: verbal attention span (VAS), maximal learning potential (MLP), and learning rate (LR). Briefly, VAS predicts expected first trial performance while MLP, conversely, predicts the expected best performance as trials are repeated, and LR weights the influence of VAS versus MLR over repeated trials. Predictors of these parameters included age, education, sex, race, and clinical diagnosis, in addition to raw scores on Trail Making Test Parts A and B, phonemic (FAS) fluency, animal fluency, Boston Naming Test, Wisconsin Card Sorting Test (WCST) Categories Completed, and then age-adjusted scaled scores from WAIS-IV Digit Span, Block Design, Vocabulary, and Coding. Random intercepts were included for each parameter and extracted for comparison of residual differences by diagnosis.
Results:The model explained 84% of the variance in CVLT-II raw scores. VAS reduced with age and time-to-complete Trails B but improved with both verbal fluencies and confrontation naming. MLP increased as a function of WAIS Digit Span, animal fluency, confrontation naming, and WCST categories completed. Finally, LR was greater for females and WAIS-IV Coding and Vocabulary performances but reduced with age. Participants with AD had lower estimates of all three parameters: Cohen’s d = 2.49 (VAS) - 3.48 (LR), though including demographic and neuropsychological tests attenuated differences, Cohen’s d = 0.34 (LR) - 0.95 (MLP).
Conclusions:The resulting model highlights how non-memory neuropsychological deficits affect list-learning test performance. At the same time, the model demonstrated that memory patterns on the CVLT-II can still be identified beyond other confounding deficits since having AD affected all parameters independent of other cognitive impairments. The modeling approach can generate conditional learning curves for individual patient data, and when multiple diagnoses are included in the model, a person-fit statistic can be computed to return the mostly likely diagnosis for an individual. The model can also be used in research to quantify or adjust for the effect of other patient data (e.g., neuroimaging, biomarkers, medications).
50 Sex differences in psychological features in adolescents after concussion
- Hannah M. Doggett, Linda S. Hynan, Cheryl H. Silver, Danyah Ahmed, Logan Shurtz, Ingrid Tamez, C. Munro Cullum, Mathew A. Stokes
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 155-156
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Objective:
Few concussion studies have investigated the psychological domain of concussions. Of the 22 postconcussion symptoms assessed on the Graded Symptom Checklist of the SCAT-5, five do not overlap with core symptoms of anxiety and depression. 43% of patients report at least one psychiatric symptom, the median is four after injury. Previous studies focus on total scores and not individual items; furthermore, few consider resilience as part of psychological factors that impact recovery. This research aims to describe general and specific characteristics of psychological functioning in males/females ages 12-18 after concussion to help guide treatment. We compared total scores for each measure between males/females and looked at the differences between the genders for individual items in each measure.
Participants and Methods:Participants were evaluated at an outpatient concussion clinic participating in the North Texas Concussion Registry (ConTex; N=1238, 53% female, mean age=15.4 years, SD=1.16 years). The Generalized Anxiety Disorder 7-item Scale (GAD-7, the Patient Health Questionnaire-8 (PHQ-8), the Brief Resilience Scale (BRS), and the Pittsburgh Sleep Quality Index (PSQI) were used to determine levels of anxiety, depression, resilience, and sleep quality.
Results:Utilizing Mann-Whitney U tests (median, interquartile range) to examine group distributions for the GAD-7, PHQ-8, and BRS, females had significantly higher scores than males for the GAD (p<0.001; Female: 4, 1-9 v. Male: 2, 0-5) and PHQ (p<0.001; Female: 5, 210 v. Male: 3, 1-7). For the BRS, total scores for females were significantly lower than males (p<0.001; Female: 3.67, 3-4 v. Male: 3.83, 3.214.33). The PSQI media score was significantly different between males and females: item 2, p=.016 and item 4 p=.007 using an exact sampling distribution for U. Pearson Chi square tests were used to examine sex differences for each item of the psychological measures. Items 1-7 within the GAD-7 were significant between sexes (i.e. male or female). The seven items assess (1) Feelings of nervousness, (2) Inability to stop/control worry, (3) Worrying too much about different things, (4) Trouble relaxing, (5) Inability to sit still due to restlessness, (6) Irritability, and (7) Feeling afraid. Items 2-8 within the PHQ were significant between sexes. The items assess (2) Feeling down/depressed/hopeless, (3) Trouble falling/staying asleep, (4) Feeling tired/no energy, (5) Appetite changes, (6) Lowered/poor self-esteem, (7) Concentration issues, and (8) Feeling slowed down or unable to be still. There was a statistically significant difference between genders and Items 2 and 4 within the BRS were significant between sexes. The items assess (2) Difficulty surviving hard times and (4) Difficulty snapping back from something bad.
Conclusions:Like other studies, this study found females have higher levels of negative affect (i.e., depressive and anxious symptoms). Females displayed lower resilience and reported poorer sleep. By analyzing psychiatric measures, treatment protocols can be tailored to address specific problems, and mental health difficulties can be mitigated by teaching specific coping techniques. These results suggest clinicians should consistently be providing education on depression, anxiety, sleep, and resilience, particularly to female patients, who appear at greater risk for psychological distress.
23 The Utility of Global versus Domain-specific Neuropsychological Test Score Dispersion as Markers of Cognitive Decline
- Hudaisa Fatima, Jeff Schaffert, Anne Carlew, Will Goette, Jessica Helphrey, Laura Lacritz, Heidi Rossetti, C. Munro Cullum
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 233-234
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Objective:
Higher baseline dispersion (intra-individual variability) across neuropsychological test scores at a single time-point has been associated with more rapid cognitive decline, onset of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), faster rates of hippocampal and entorhinal atrophy, and increased AD neuropathology. Comparison between predictions made from test score dispersion within a cognitive domain versus global, cross-domain dispersion is understudied. Global dispersion may be influenced by ability-and test-specific characteristics. This study examined the performance of global versus domain-specific dispersion metrics to identify which is most predictive of cognitive decline over time.
Participants and Methods:Data for baseline and five follow-up visits of 308 participants with normal cognition (Mage=73.90, SD=8.12) were selected from the National Alzheimer’s Coordinating Center (NACC) Dataset. Participants were required to have no focal neurological deficits, or history of depression, stroke, or heart attack. Diagnoses and progression to MCI and/or dementia were determined at each visit through consensus conferences. Raw neuropsychological scores were standardized using NACC norms. Global baseline dispersion was defined as the intraindividual standard deviation (ISD) across the 10 scores in the NACC battery. Domain-specific dispersions were calculated by constructing composites and ISD was computed across tests sampling their respective domains (executive functioning/attention/processing speed [EFAS], language, and memory; see Table 1 for details on these tests). Higher values on each of these metrics reflect greater dispersion. Multinomial logistic regression model fit statistics and parameter estimates were compared across four different models (global, EFAS, Language, and Memory dispersion) covarying for age, years of education, sex, race, ethnicity, and ApoE4 status. Models were compared using the Likelihood Ratio Test (LRT) and the Akaike Information Criteria (AIC) of Models statistics.
Results:Of the 308 participants, 70 (22.7%) progressed to MCI, and 82 (26.6%) progressed to dementia. Tables 1 and 2 show the results of the logistic regressions for the four models. All models fit the data well, with statistically significant predictions of conversion. Model 1 (global dispersion) showed a better fit than domain-specific models of dispersion per LRT and AIC values. Consistent with the results from mean differences between groups, parameter estimates showed that only global dispersion and EFAS dispersion significantly predicted conversion to dementia (when included with other covariates in models), with higher dispersion reflecting a greater risk of conversion.
Conclusions:In this sample, baseline global and EFAS dispersion measures significantly predicted conversion to dementia. Although global dispersion was a stronger predictor of dementia progression, findings suggest that executive functioning performance may be driving this relationship. A single index of global variability, from the calculation of standard deviation across test scores, may be supplementary for clinicians when distinguishing individuals at risk for dementia progression. None of the models were predictive of conversion to MCI. Further research is required to examine cognitive variability differences among patients who progress to MCI and patient-specific factors that may relate to test score dispersion and its utility in predicting the progression of symptoms.
Validation of a Bayesian Diagnostic and Inferential Model for Evidence-Based Neuropsychological Practice
- William F. Goette, Anne R. Carlew, Jeff Schaffert, Ben K. Mokhtari, C. Munro Cullum
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 07 April 2022, pp. 182-192
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Objective:
Evidence-based diagnostic methods have clinical and research applications in neuropsychology. A flexible Bayesian model was developed to yield diagnostic posttest probabilities from a single person’s neuropsychological score profile by utilizing sample descriptive statistics of the test battery across diagnostic populations of interest.
Methods:Three studies examined the model’s performance. One simulation examined estimation accuracy of true z-scores. A diagnostic accuracy simulation utilized descriptive statistics from two popular neuropsychological tests, the Wechsler Adult Intelligence Scale–IV (WAIS-IV) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The final simulation examined posterior predictive accuracy of scores to those reported in the WAIS manual.
Results:The model produced minimally biased z-score estimates (root mean square errors: .02–.18) with appropriate credible intervals (95% credible interval empirical coverage rates: .94–1.00). The model correctly classified 80.87% of simulated normal, mild cognitive impairment, and Alzheimer’s disease cases using a four subtest WAIS-IV and the RBANS compared to accuracies of 60.67–65.60% from alternative methods. The posterior predictions of raw scores closely aligned to percentile estimates published in the WAIS-IV manual.
Conclusion:This model permits estimation of posttest probabilities for various combinations of neuropsychological tests across any number of clinical populations with the principal limitation being the accessibility of applicable reference samples. The model produced minimally biased estimates of true z-scores, high diagnostic classification rates, and accurate predictions of multiple reported percentiles while using only simple descriptive statistics from reference samples. Future nonsimulation research on clinical data is needed to fully explore the utility of such diagnostic prediction models.
Patterns of care for octogenarian patients with head and neck cancer
- M S Iqbal, C Navarro-Rodriguez, S Munro, B Ozalp, C Kelly
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- Journal:
- The Journal of Laryngology & Otology / Volume 136 / Issue 5 / May 2022
- Published online by Cambridge University Press:
- 26 November 2021, pp. 461-463
- Print publication:
- May 2022
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Objective
To examine the patterns of care for octogenarian head and neck cancer patients.
MethodsAll newly diagnosed patients aged 80 years or older, who presented at our centre between June 2018 and October 2020, were included.
ResultsThe total number of patients was 42. The median Charlson Comorbidity Index was 5 (range, 4–9). The larynx was the most common subsite (n = 12). Twenty-nine patients (66 per cent) were diagnosed at disease stage IV. Squamous cell carcinoma was the most common histology (86 per cent). Twenty-six patients (62 per cent) had radical treatment and 16 (38 per cent) had palliative treatment. The estimated six-month and one-year overall survival rates for the radical and palliative treatment cohorts were 92.3 per cent and 42.9 per cent (p = 0.001) and 65.4 per cent and 15.4 per cent (p = 0.003), respectively.
ConclusionThis study provides useful information on octogenarian patients with head and neck cancer. This information may help in conducting prospective studies, especially those focusing on older patients with head and neck cancer, in order to define the ideal care of this patient population.
Does anthropogenic fragmentation selectively filter avian phylogenetic diversity in a critically endangered forest system?
- DAVID A. EHLERS SMITH, SANDI WILLOWS-MUNRO, YVETTE C. EHLERS SMITH, COLLEEN T. DOWNS
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- Journal:
- Bird Conservation International / Volume 32 / Issue 4 / December 2022
- Published online by Cambridge University Press:
- 16 November 2021, pp. 674-686
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Documenting phylogenetic diversity for conservation practice allows elucidation of ecosystem functioning and processes by highlighting the commonality and divergence of species’ functional traits within their evolutionary context. Conserving distinct evolutionary histories has intrinsic value, and the conservation of phylogenetically diverse communities is more likely to preserve distinct or relic evolutionary lineages. We explored the potential for anthropogenic forest fragmentation to act as a selective filter of avian phylogenetic diversity within the community of forest-dependent birds of the critically endangered Indian Ocean Coastal Belt Forest (IOCBF), South Africa. We conducted avian point count surveys during the austral breeding season, and calculated fragmentation metrics of forest structural complexity, patch size and isolation. We constructed a maximum likelihood phylogeny using the combined analysis of two mitochondrial genes and three nuclear markers and measured the influence of the fragmentation metrics on six measures of phylogenetic diversity. Our results indicated that the avian community was variously affected by anthropogenic forest fragmentation, with the different metrics of phylogenetic diversity responding with no definitive overall pattern. However, forest structural complexity emerged as an important metric explaining phylogenetic structuring. While the avian community’s phylogenetic diversity displayed resilience to anthropogenic fragmentation, previous research showed a reduction in functional diversity along the fragmentation gradient. Therefore, we recommend studies that especially aim to guide conservation management, incorporate both phylogenetic and functional diversity measures to sufficiently interrogate communities’ resilience to the threats under investigation.
Telephone consultation for two-week-wait ENT and head and neck cancer referrals: initial evaluation including patient satisfaction
- A Rovira, S Brar, T Munroe-Gray, E Ofo, C Rodriguez, D Kim
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- Journal:
- The Journal of Laryngology & Otology / Volume 136 / Issue 7 / July 2022
- Published online by Cambridge University Press:
- 26 October 2021, pp. 615-621
- Print publication:
- July 2022
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Objective
To analyse the outcomes of telephone consultation, including patient satisfaction, for two-week-wait head and neck cancer referrals.
MethodsAnalysis of the data of this prospective study was centred on outcomes of the consultation, patient satisfaction and preference for telephone consultation.
ResultsPatient satisfaction and preference for telephone consultation were influenced by patient awareness of cancer referral. When comparing the three most common presenting symptoms, patients with sore throat were more satisfied than those with neck mass. Regarding telephone consultation outcomes, patients with neck mass were less likely to be discharged and more likely to require investigations than those with sore throat or hoarseness. Patients with hoarseness more often required a face-to-face appointment.
ConclusionTelephone consultation might be a valid initial encounter for the majority of two-week-wait head and neck cancer referrals, especially when the referral symptoms are considered. This work shows the validity and safety of telephone consultation for two-week-wait head and neck cancer referrals.
UK regional paediatric home parenteral nutrition (HPN) data suggest a national underestimate in service requirements
- A. R. Barclay, C. E. Paxton, J. Livingstone, D. Hoole, F. Munro, P. Gillett, D. C. Wilson
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- Journal:
- Proceedings of the Nutrition Society / Volume 67 / Issue OCE3 / May 2008
- Published online by Cambridge University Press:
- 30 June 2021, E140
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Nonventilator hospital-acquired pneumonia: A call to action: Recommendations from the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) among nonventilated patients
- Shannon C. Munro, Dian Baker, Karen K. Giuliano, Sheila C. Sullivan, Judith Haber, Barbara E. Jones, Matthew B. Crist, Richard E. Nelson, Evan Carey, Olivia Lounsbury, Michelle Lucatorto, Ryan Miller, Brian Pauley, Michael Klompas
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 8 / August 2021
- Published online by Cambridge University Press:
- 09 June 2021, pp. 991-996
- Print publication:
- August 2021
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In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non–ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans’ Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia.
EPA-1399 – A Journey Through Shared Decision Making in Schizophrenia
- J. Munro, C. Young
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Digital health technologies may improve the management of individuals with mental health disorders by targeting important barriers to effective care. For patients with schizophrenia, for example, addressing:
• The challenge of dealing with individual variation in treatment response. No specific tools are available to facilitate the delivery of truly patient-centric care. Predictors of an individual's side effects or treatment efficacy are not available, patients’ views on care are often not recorded, clinical state between appointments cannot be easily assessed, precise symptoms and side effects experiences are not captured in a reliable way and physical health is often neglected.
• The challenge of effectively accessing and utilizing the vast amounts of evidence-based information to direct patient management at the point-of-care. Valuable evidence-based information, including guidelines and systematic reviews, is not used to guide care because there is too much information to assimilate, it is inaccessible at the point-of-care and it is difficult to personalize to any individual patient.
Optimal Medicine will present findings related to use of a web-based clinical decision support software system which enables clinicians to deliver individualised, evidence-based treatment at the point of care including:
• Delivery of context-specific personalized decision support through a workflow driven interface
• Interactive visualisation and monitoring of longitudinal status
• Side effect risk profiling based on an individual's unique and evolving characteristics
• Symptom and side effect rapid evaluation and monitoring using a hierarchical data selection
• Integrated remote-monitoring technologies (iTunes app) for use between clinical contacts at times of particular vulnerability, such as discharge from hospital.
10 - Planning for Growth: The Professionalisation of the Taskforce for Gaelic Revitalisation
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- By Michelle MacLeod, University of Aberdeen, Timothy C. Armstrong, UHI/University of Aberdeen., Gillian Munro, University of Aberdeen., Iain Taylor, Sabhal Mòr Ostaig, where he teaches courses on language planning and sociolinguistics as well as Gaelic language.
- Edited by Marsaili MacLeod, Cassie Smith-Christmas
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- Book:
- Gaelic in Contemporary Scotland
- Published by:
- Edinburgh University Press
- Published online:
- 18 December 2019
- Print publication:
- 30 September 2018, pp 141-155
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Summary
Introduction
It is only relatively recently that scholars and the public have become aware of the accelerating loss of linguistic diversity around the world; consequently, the develop-ment of organised planning for survival in response to the crisis is also relatively new. Given that language planning for linguistic diversity is such a new endeavour, it is not surprising that a culture of professionalism and expertise among its practitioners is also still in the early stages of development. We have much to learn about what does and does not work when it comes to language planning in this respect, and there is also much work to be done in terms of disseminating this knowledge to those language planners, educators and activists working on the ground in indigenous communi-ties who might use it. This chapter explores the levels of training experienced and required by individuals involved in the implementation of planning interventions in the Scottish Gaelic context.
Background
In Scotland, the development of an organised, national response to the demographic decline of Gaelic-speaking communities is very recent indeed (see, for example, Dunbar 2010 and Macleod 2008). In the last quarter of the twentieth century, as language activists became increasingly concerned about the growing crisis in Gaelic-speaking communities, various initiatives in education, in the media, and in local-government service provision, were effected aiming to re-strengthen the transmission and use of Gaelic. These early efforts, while motivated by good intentions, were nonetheless characterised by a general lack of professional expertise. In the absence of a clear understanding of the nature of the problem, and without access to state-of-the-art theory of best practice in indigenous-language education and revitalisation, these early efforts tended to be of limited efficacy (McLeod 2002). Commenting in 2001, McLeod identified a lack of professionalisation in Scottish language planning bodies as a pervasive problem:
Despite the growing institutionalization of the Gaelic movement in Scotland – an institutionalization underpinned by millions of pounds of government investment every year – very little specialist professional expertise is brought to bear on Gaelic develop-ment, a phenomenon one activist has unkindly described as ‘amateur hour’. Almost none of those steering the various Gaelic organisations have any specialist training or experience in applied linguistics or language planning, and there is relatively little awareness of theoreti-cal and analytical advances in the field of language revitalization and language planning in general […]. (McLeod 2001: 23)
Associations of rumen parameters with feed efficiency and sampling routine in beef cattle
- S. Lam, J. C. Munro, M. Zhou, L. L. Guan, F. S. Schenkel, M. A. Steele, S. P. Miller, Y. R. Montanholi
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Characterizing ruminal parameters in the context of sampling routine and feed efficiency is fundamental to understand the efficiency of feed utilization in the bovine. Therefore, we evaluated microbial and volatile fatty acid (VFA) profiles, rumen papillae epithelial and stratum corneum thickness and rumen pH (RpH) and temperature (RT) in feedlot cattle. In all, 48 cattle (32 steers plus 16 bulls), fed a high moisture corn and haylage-based ration, underwent a productive performance test to determine residual feed intake (RFI) using feed intake, growth, BW and composition traits. Rumen fluid was collected, then RpH and RT logger were inserted 5.5±1 days before slaughter. At slaughter, the logger was recovered and rumen fluid and rumen tissue were sampled. The relative daily time spent in specific RpH and RT ranges were determined. Polynomial regression analysis was used to characterize RpH and RT circadian patterns. Animals were divided into efficient and inefficient groups based on RFI to compare productive performance and ruminal parameters. Efficient animals consumed 1.8 kg/day less dry matter than inefficient cattle (P⩽0.05) while achieving the same productive performance (P⩾0.10). Ruminal bacteria population was higher (P⩽0.05) (7.6×1011v. 4.3×1011 copy number of 16S rRNA gene/ml rumen fluid) and methanogen population was lower (P⩽0.05) (2.3×109v. 4.9×109 copy number of 16S rRNA gene/ml rumen fluid) in efficient compared with inefficient cattle at slaughter with no differences (P⩾0.10) between samples collected on-farm. No differences (P⩾0.10) in rumen fluid VFA were also observed between feed efficiency groups either on-farm or at slaughter. However, increased (P⩽0.05) acetate, and decreased (P⩽0.05) propionate, butyrate, valerate and caproate concentrations were observed at slaughter compared with on-farm. Efficient had increased (P⩽0.05) rumen epithelium thickness (136 v. 126 µm) compared with inefficient cattle. Efficient animals also spent 318% and 93.2% more time (P⩽0.05) in acidotic (4.14% v. 1.30%) (pH⩽5.6) and optimal (5.6<pH<6.0) (8.53% v. 4.42%) RpH range compared with inefficient cattle. The circadian patterns revealed lower (P⩽0.05) RpH and no differences (P⩾0.10) in RT pre-, during, and post-prandial periods in efficient compared with inefficient cattle. In essence, superior feed efficiency in cattle seems linked to rumen features consistent with improved efficiency of feed utilization. Microbial abundance, rumen epithelial histomorphology, and RpH, may serve as indicators for feed efficiency in cattle. The divergences of assessments made on-farm and at slaughter should be considered in the development of proxies for feed efficiency.
26 - Hayonim Cave
- from Part III: - Archaeology of Human Evolution
- Edited by Yehouda Enzel, Hebrew University of Jerusalem, Ofer Bar-Yosef, Harvard University, Massachusetts
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- Book:
- Quaternary of the Levant
- Published online:
- 04 May 2017
- Print publication:
- 27 April 2017, pp 231-240
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Summary
Layer A in the Hayonim Cave in the western Galilee is an accumulation of ashes and dung caused by penned flocks since the 3rd century AD. A 2nd century AD glass furnace was found, dug into the Natufian deposits below (Layer B). Five Natufian occupation phases were characterized by a series of small rounds built from brought-in rocks. Burials including decorated individuals, a collection of incised limestone slabs and bone objects, rich assemblages of marine shells, bone pendants bone tools together with abundant lithics characterize the Natufian remains. At the entrance to the cave the Natufian dug into the Kebaran deposit (Layer C) and inside the cave into Aurignacian occupation (Layer D). Fortunately the later preserved a typical European-style lithic industry and an assemblage of bone and antler objects. The Late Mousterian, poorly represented, overlies rich occupations with lithic assemblages resembling Qafzeh cave. The latter cover with minimal interruptions a rich Early Mousterian deposit characterized by (many) retouched elongated blade blanks and points, (Layers E and F). Layer G, an Acheulo-Yabrudian, was tested in the deep sounding but bedrock was not attained.
Chronology of latest Pleistocene mountain glaciation in the western Wasatch Mountains, Utah, U.S.A.
- Benjamin J. C. Laabs, David W. Marchetti, Jeffrey S. Munroe, Kurt A. Refsnider, John C. Gosse, Elliott W. Lips, Richard A. Becker, David M. Mickelson, Brad S. Singer
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- Journal:
- Quaternary Research / Volume 76 / Issue 2 / September 2011
- Published online by Cambridge University Press:
- 20 January 2017, pp. 272-284
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Understanding the timing of mountain glacier and paleolake expansion and retraction in the Great Basin region of the western United States has important implications for regional-scale climate change during the last Pleistocene glaciation. The relative timing of mountain glacier maxima and the well-studied Lake Bonneville highstand has been unclear, however, owing to poor chronological limits on glacial deposits. Here, this problem is addressed by applying terrestrial cosmogenic 10Be exposure dating to a classic set of terminal moraines in Little Cottonwood and American Fork Canyons in the western Wasatch Mountains. The exposure ages indicate that the main phase of deglaciation began at 15.7 ± 1.3 ka in both canyons. This update to the glacial chronology of the western Wasatch Mountains can be reconciled with previous stratigraphic observations of glacial and paleolake deposits in this area, and indicates that the start of deglaciation occurred during or at the end of the Lake Bonneville hydrologic maximum. The glacial chronology reported here is consistent with the growing body of data suggesting that mountain glaciers in the western U.S. began retreating as many as 4 ka after the start of northern hemisphere deglaciation (at ca. 19 ka).
Associations of acute stress and overnight heart rate with feed efficiency in beef heifers
- J. C. Munro, F. S. Schenkel, P. W. Physick-Sheard, A. B. P. Fontoura, S. P. Miller, T. Tennessen, Y. R. Montanholi
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Proxies have the potential to accelerate feed efficiency (residual feed intake (RFI); kg dry matter/day) improvement, assisting with the reduction of beef cattle feed costs and environmental impact. Heart rate (HR) (beats per minute (BPM)) is associated with feed efficiency and influenced by autonomic activity and peripheral metabolism, suggesting HR could be used as a proxy for feed efficiency. Objectives were to assess associations between overnight HR, lying patterns and RFI, and between acute stress HR and RFI. Heifer calves (n=107; 408±28 days of age, 341±42.2 kg) and yearling heifers (n=36; 604±92 days of age, 539±52.2 kg) were exposed to a performance test to determine productive performance. Overnight HR (electrode based) and lying patterns (accelerometer based) were monitored on a subgroup of heifer calves (n=40; 20 lowest RFI; 20 highest RFI). In the 10-min acute stress assessment, all heifers were individually exposed to the opening and closing of an umbrella and HR before (HRBEF), in response to (HRMAX), after (HRAFT) and change (HRCHG; HRAFT−HRBEF) as a result of exposure were determined. Using polynomial regression, rate of HR decrease pre-exposure (β1) and rates of HR increase (β2) and decrease (β3, β4) post-exposure were determined. Heifer calves in the overnight assessment were classified into equal RFI groups (low RFI; high RFI) and HR means were treated as repeated measures and compared using multiple regression. In the acute stress assessment, heifers were classified within cattle category into equal RFI groups (low RFI; high RFI) and means and polynomial regression parameters were compared using multiple regression. Low-RFI heifer calves had a lower overnight HR (69.2 v. 72.6 BPM), similar HR change from lying to standing intervals (8.9 v. 9.2 BPM) and similar time lying (61.1% v. 64.5%) compared with high-RFI heifer calves. Low-RFI heifer calves had a higher absolute HRMAX (162.9 v. 145.7 BPM) and β2 (−0.34 v. −0.20) than high-RFI heifer calves. Low-RFI yearling heifers had similar acute stress HR means and a lower β1 (0.003 v. 0.006) than high-RFI yearling heifers. Overnight HR and acute stress HR are potential indicators of RFI in heifer calves. However, acute stress HR results varied in yearling heifers, suggesting previous handling experience and/or age influence stress response. Pending further development (predictive ability, repeatability), the acute stress assessment could have potential for on-farm application as a feed efficiency proxy in young heifers with minimal handling experience.
Contributors
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- By Douglas W. Arner, Emilios Avgouleas, Lorand Bartels, Tomer Broude, Ross P. Buckley, Elisabetta Cervone, Julien Chaisse, Andrew Filis, An Hertogen, Holger Hestermeyer, Anita K. Krug, Rafael Leal-Arcas, C. L. Lim, Antoine Martin, Bryan Mercurio, Andrew Mitchell, James Munro, Junji Nakagawa, Martins Paparinskis, Shin-Yi Peng, Juan Ignacio Stampalija, Tania Voon, Rolf H. Weber
- Edited by C. L. Lim, The University of Hong Kong, Bryan Mercurio, The Chinese University of Hong Kong
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- Book:
- International Economic Law after the Global Crisis
- Published online:
- 05 May 2015
- Print publication:
- 30 April 2015, pp ix-xii
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Evaluation of the Effects of Severe Depression on Global Cognitive Function and Memory
- Shawn M. McClintock, C. Munro Cullum, Mustafa M. Husain, A. John Rush, Rebedca G. Knapp, Martina Mueller, Georgios Petrides, Shirlene Sampson, Charles H. Kellner
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- Journal:
- CNS Spectrums / Volume 15 / Issue 5 / May 2010
- Published online by Cambridge University Press:
- 07 November 2014, pp. 304-313
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Introduction: Major depressive disorder (MDD) is thought to negatively impact cognitive function; however, the relationship has not been well explored.
Objective: This study examined the association between depression severity and global cognitive function and memory in subjects with severe, treatment-resistant MDD.
Methods: We enrolled 66 subjects with Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosed unipolar MDD in a multicenter trial to assess the efficacy and neurocognitive effects of electroconvulsive therapy (ECT). We measured depression severity with the 24 item Hamilton Rating Scale for Depression (HRSD24). Neuropsychologic measures included the Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and the Complex Figure Test (CFT). Correlational and regression analyses were conducted to explore associations between depression severity and cognitive function.
Results: The mean age of the subjects was 53.6 years (SD=15.8), 65% were female, and mean HRSD24 was 33.9 (SD=6.7). Mean demographic-corrected T-scores for each neurocognitive measure were in the average to borderline range, and HRSD24 values were unrelated to performance on the MMSE, RAVLT immediate and delayed recall, and CFT immediate and delayed recall.
Conclusion: In this sample of severely depressed subjects referred for ECT, depression severity was unrelated to global cognitive function or memory. Future research should examine the interactions between other depressive characteristics and neurocognitive function.