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U.S. Regional Differences in Physical Distancing: Evaluating Racial and Socioeconomic Divides During the COVID-19 Pandemic
No full textAbstractHealth varies by U.S. region of residence. Despite regional heterogeneity in the outbreak of COVID-19, regional differences in physical distancing behaviors over time are relatively unknown. This study examines regional variation in physical distancing trends during the COVID-19 pandemic and investigates variation by race and socioeconomic status (SES) within regions.Data from the 2015-2019 five-year American Community Survey were matched with anonymized location pings data from over 20 million mobile devices (SafeGraph, Inc.) at the Census block group level. We visually present trends in the stay-at-home proportion by Census region, race, and SES throughout 2020 and conduct regression analyses to statistically examine these patterns.From March to December, the stay-at-home proportion was highest in the Northeast (0.25 in March to 0.35 in December) and lowest in the South (0.24 to 0.30). Across all regions, the stay-at-home proportion was higher in block groups with a higher percentage of Blacks, as Blacks disproportionately live in urban areas where stay-at-home rates were higher (0.009 [CI: 0.008, 0.009]). In the South, West, and Midwest, higher-SES block groups stayed home at the lowest rates pre-pandemic; however, this trend reversed throughout March before converging in the months following. In the Northeast, lower-SES block groups stayed home at comparable rates to higher-SES block groups during the height of the pandemic but diverged in the months following.Differences in physical distancing behaviors exist across U.S. regions, with a pronounced Southern and rural disadvantage. Results can be used to guide reopening and COVID-19 mitigation plans.</jats:p
Effective Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery Requires a Combination of Surgical Implant Prophylaxis and Avoidance of Sagittal Alignment Overcorrection.
No full textStudy designPropensity score matched analysis of a multi-center prospective adult spinal deformity (ASD) database.ObjectiveEvaluate if surgical implant prophylaxis combined with avoidance of sagittal overcorrection more effectively prevents proximal junctional failure (PJF) than use of surgical implants alone.Summary of background dataPJF is a severe form of proximal junctional kyphosis (PJK). Efforts to prevent PJF have focused on use of surgical implants. Less information exists on avoidance of overcorrection of age-adjusted sagittal alignment to prevent PJF.MethodsSurgically treated ASD patients (age ≥18 yrs; ≥5 levels fused, ≥1 year follow-up) enrolled into a prospective multi-center ASD database were propensity score matched (PSM) to control for risk factors for PJF. Patients evaluated for use of surgical implants to prevent PJF (IMPLANT) versus no implant prophylaxis (NONE), and categorized by the type of implant used (CEMENT, HOOK, TETHER). Postoperative sagittal alignment was evaluated for overcorrection of age-adjusted sagittal alignment (OVER) versus within sagittal parameters (ALIGN). Incidence of PJF was evaluated at minimum 1 year postop.ResultsSix hundred twenty five of 834 eligible for study inclusion were evaluated. Following PSM to control for confounding variables, analysis demonstrated the incidence of PJF was lower for IMPLANT (n = 235; 10.6%) versus NONE (n = 390: 20.3%; P ConclusionPropensity score matched analysis of 625 ASD patients demonstrated use of surgical implants alone to prevent PJF was less effective than combining implants with avoidance of sagittal overcorrection. Patients that received no PJF implant prophylaxis and had sagittal overcorrection had the highest incidence of PJF.Level of evidence3
The Early Life Environment and Adult Cognitive and Mental Health
No full textMany diverse adult diseases, from diabetes to dementia, are increasingly viewed as arising, in part, from early life environmental influences. The so-called Developmental Origins of Health and Disease (DOHaD) research paradigm offers the potential to improve our understanding of the etiology of many hard-to-treat adult diseases by focusing researcher’s attention on the pre and post-natal and early childhood years, where small interventions could pay large dividends later on. Along with great potential, the DOHaD framework offers great challenges, as it is logistically and conceptually difficult to investigate the environmental origins of chronic diseases that may manifest only decades after harmful exposures. This dissertation presents a series of five original studies that sought to answer open empirical questions about the developmental origins of health and disease focusing on early-life factors that influence the health and aging of the brain. Three increasingly broad "levels" of the early life environment are considered across three sequential dissertation chapters: (1) the individual micro-physical level, (2) the family level, and (3) the neighborhood level. At each level this dissertation considers at least one exposure that has relevance to researchers and policy makers, either because, like exposure to neighborhood vegetation / greenery, it may offer a good route for intervention (e.g., the exposure is potentially modifiable) or because, like exposure to the heavy metal lead, it is understood to be more widespread than previously assumed. Studies were conducted using data from two population-representative longitudinal birth cohorts, the New Zealand-based Dunedin Multidisciplinary Health and Development Study (born in 1972-1973) and the United Kingdom-based Environmental Risk Longitudinal Twin Study (born in 1994-1995).
Across the five studies, results supported the DOHaD framework and provided new evidence about the long-term consequences of childhood exposure to lead, adversity (e.g., physical and emotional abuse, household dysfunction, etc.), and neighborhood disadvantage. These negative early life events / exposures at the micro-physical, family, and neighborhood-levels associated, across multiple decades, with subtle and diverse poor brain-related outcomes later in life, including diminished cognitive capacity, increased symptoms of psychopathology, altered epigenetic controls, disadvantageous personality styles, and worse physical health. Results collectively reinforce the view that the early life represents a profound window of vulnerability and opportunity, with a lifespan perspective offering great potential for more efficacious public health research, clinical practice, and policy, as the diseases of the adult likely have roots in the life of the child.</p
Dental topography of the Oligocene anthropoids Aegyptopithecus zeuxis and Apidium phiomense: Paleodietary insights from analysis of wear series.
No full textFossil primate dietary inference is enhanced when ascertained through multiple, distinct proxies. Dental topography can be used to assess changes in occlusal morphology with macrowear, providing insight on tooth use and function across the lifespans of individuals. We measured convex Dirichlet normal energy-a dental topography metric reflecting occlusal sharpness of features such as cusps and crests-in macrowear series of the second mandibular molars of two African anthropoid taxa from ∼30 Ma (Aegyptopithecus zeuxis and Apidium phiomense). Wear was quantified via three proxies: occlusal dentine exposure, inverse relief index, and inverse occlusal relief. The same measurements were calculated on macrowear series of four extant platyrrhine taxa (Alouatta, Ateles, Plecturocebus, and Sapajus apella) to provide an analogical framework for dietary inference in the fossil taxa. We predicted that Ae. zeuxis and Ap. phiomense would show similar patterns in topographic change with wear to one another and to extant platyrrhine frugivores like Ateles and Plecturocebus. The fossil taxa have similar distributions of convex Dirichlet normal energy to one another, and high amounts of concave Dirichlet normal energy 'noise' in unworn molars-a pattern shared with extant hominids that may distort dietary interpretations. Inverse relief index was the most useful wear proxy for comparison among the taxa in this study which possess disparate enamel thicknesses. Contrary to expectations, Ae. zeuxis and Ap. phiomense both resemble S. apella in exhibiting an initial decline in convex Dirichlet normal energy followed by an increase at the latest stages of wear as measured by inverse relief index, lending support to previous suggestions that hard-object feeding played a role in their dietary ecology. Based on these results and previous analyses of molar shearing quotients, microwear, and enamel microstructure, we suggest that Ae. zeuxis had a pitheciine-like strategy of seed predation, whereas Ap. phiomense potentially consumed berry-like compound fruits with hard seeds
Radiographical and Implant-Related Complications in Adult Spinal Deformity Surgery: Incidence, Patient Risk Factors, and Impact on Health-Related Quality of Life.
No full textStudy designA multicenter, prospective review of surgical patients with adult spine deformity.ObjectiveAssessment of the incidence, risk factor, and impact of radiographical and implant-related complications (RIC) on health-related quality of life measures.Summary of background dataThis study provides assessment of the incidence of RIC in adult spinal deformity surgery and impact of these complications on need for reoperation. Risk factors for development of RIC are also assessed, as well as the impact of these complications on health-related quality of life (HRQOL) outcomes measures.MethodsA multicenter, prospective database of surgical patients with adult spinal deformity was reviewed. All patients with complete 2-year follow-up were included. HRQOL was measured using the Oswestry Disability Index, General Health Survey (36-Item Short Form Health Survey [SF-36]), and Scoliosis Research Society-22 (SRS-22r) at baseline, 6 weeks, 1 year, and 2 years postoperatively. Univariate testing was performed as appropriate. Multivariate logistic regression modeling was used to determine independent predictors of RIC. Multivariate repeated-measures mixed models were used to examine HRQOL, accounting for confounders.ResultsA total of 245 patients met inclusion criteria. The incidence of RIC was 31.7% and 52.6% of those patients required reoperation. Rod breakage accounted for 47% of the implant-related complications, and proximal junctional kyphosis accounted for 54.5% of radiographical complications. Univariate analysis identified the following potential risk factors for RIC: weight, American Society of Anesthesiologists score, revision, stopping the fusion in the lower thoracic spine, worse SRS-Schwab classification modifiers (pelvic tilt++, pelvic incidence minus lumbar lordosis++, sagittal vertical axis++), higher T1 spinopelvic inclination, and higher T1 slope. Independent predictors of RIC as identified on multivariate logistic regression included American Society of Anesthesiologists (odds ratio: 1.75, P = 0.029) and sagittal vertical axis modifier ++ (odds ratio 3.43, P = 0.0001). The RIC and no RIC groups each experienced significant improvement over time, as measured on the Oswestry Disability Index (P = 0.0001), SF-36 (P = 0.0001), and SRS-22r (P = 0.0001). However, the rate of improvement over time was less for patients with RIC (SRS-22r P = 0.043, SF-36 P = 0.0001).ConclusionThis study identified that nearly one-third of patients undergoing adult spinal deformity surgery experienced a radiographical or implant-related complication, and that just more than one-half of these patients experiencing complication required a reoperation within 2 years of surgery. These complications significantly affected HRQOL measures. Baseline patient characteristics and parameters of the SRS-Schwab classification can be used to help identify those patients at greater risk.Level of evidence3
Self-administration by female rats of low doses of nicotine alone vs. nicotine in tobacco smoke extract.
No full textBackgroundNicotine has reinforcing effects, but there are thousands of other compounds in tobacco, some of which might interact with nicotine reinforcement.AimsThis rat study was conducted to determine if nicotine self-administration is altered by co-administration of the complex mixture of compounds in tobacco smoke extract (TSE).MethodsFemale Sprague-Dawley rats were tested for self-administration of low doses of nicotine (3 or 10 µg/kg/infusion) at three different rates of reinforcement (FR1, FR3 and FR5) over three weeks either alone or together with the complex mixture of tobacco smoke extract (TSE).ResultsRats self-administering 3 µg/kg/infusion of nicotine alone showed a rapid initiation on an FR1 schedule, but declined with FR5. Rats self-administering nicotine in TSE acquired self-administration more slowly, but increased responding over the course of the study. With 10 µg/kg/infusion rats self-administered significantly more nicotine alone than rats self-administering the same nicotine dose in TSE. Rats self-administering nicotine alone took significantly more infusions with the 10 than the 3 µg/kg/infusion dose, whereas rats self-administering nicotine in TSE did not. Nicotine in TSE led to a significantly greater locomotor hyperactivity at a dose of 0.1 mg/kg compared to rats that received nicotine alone. Rats self-administering nicotine alone had significantly more responding on the active vs. inactive lever, but rats self-administering the same nicotine doses in TSE did not.ConclusionsSelf-administration of nicotine in a purer form appears to be more clearly discriminated and dose-related than nicotine self-administered in the complex mixture of TSE
Injection laryngoplasty through a transoral approach using the Guedel oral airway.
No full textInjection laryngoplasty has gained popularity as a treatment modality for glottal insufficiency. Several approaches have been described, specifically transcutaneous, transoral and transnasal. The authors describe a novel technique performed successfully on three subjects, namely endoscopic injection laryngoplasty using the modified Guedel oral airway. There was marked improvement in dysphonia, maximum phonation time and closed quotient in all three subjects with a decrease in the Voice Handicap Index-10 score. This new approach is a viable approach for the treatment of glottal insufficiency
Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.
No full textDeprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between anticholinergic burden and sleep. We conducted a cross-sectional analysis of baseline data from a pilot randomized-controlled trial in older adult veterans with medical complexity (Care Assessment Need score > 90), and suspected CI (Telephone Interview for Cognitive Status score 20−31). CNS medication classes included antipsychotics, benzodiazepines, H2-receptor antagonists, hypnotics, opioids, and skeletal muscle relaxants. We also coded anticholinergic-active medications according to their Anticholinergic Cognitive Burden (ACB) score. Other measures included self-reported medication side effects and the Pittsburgh Sleep Quality Index (PSQI). ACB association with sleep (PSQI) was examined using adjusted linear regression. In this sample (N = 40), the mean number of prescribed CNS medications was 2.2 (SD 1.5), 65% experienced ≥ 1 side effect, and 50% had an ACB score ≥ 3 (high anticholinergic exposure). The ACB score ≥ 3 compared to ACB < 3 was not significantly associated with PSQI scores (avg diff in score = −0.1, 95% CI −2.1, 1.8). Although results did not demonstrate a clear relationship with worsened sleep, significant side effects and anticholinergic burden support the deprescribing need in this population
Development and Testing of a Clinical Tool to Predict and Optimize Liver Contrast-Enhanced CT Imaging
No full textAchieving consistent and sufficient hepatic parenchyma contrast enhancement (HPCE) level can improve diagnostic performance and reduce enhancement variability; this raises the baseline image quality and optimize injection practices, both carries economic and safety implications. Patient factors, Iodine injection and scanning parameters (e.g. tube potential, scanning delay) affect HPCE in CT imaging. In this study, we developed and prospectively tested a clinical graphical user interface (GUI) tool which predicts enhancement level and suggests alternative injection/scanning parameters based on patient attributes (height, weight, sex, age). Methods: This work was based on our retrospectively-validated neural-network prediction model. We built a GUI to combine our model with an optimization algorithm, which suggests alternative injection/scanning parameters for patients with predicted-insufficient enhancement. The system was clinically-deployed and prospectively-tested in 24 patients considering a 110HU+/-10HU target portal-venous HPCE. For each patient, HPCE was calculated as the average HU-value of three ROIs and compared against the target value. Additionally, we compared the outcome with the patient’s previous similarly-protocoled scan to assess improvement and consistency. Results: The system suggested adjustment for 15 patients with median 8.8% and 9.1% reductions to volume and injection rate, respectively. All scan delays were reduced by an average of 42.6%. Comparison with previous scans shows increased consistency (CV=0.21 v. 0.11,p=0.012) while median enhancement remained relatively unchanged (111.3HU v. 108.7HU). The number of under-enhanced patients was halved, and all previously over-enhanced patients received enhancement reductions. Conclusion: We developed and tested a patient-informed clinical framework which predicts optimal patient’s HPCE; and suggests empiric injection/scanning parameters when predicted enhancement is deemed insufficient. The system improved HPCE consistency and decreased the number of under-enhanced patients as compared to their previous scans. This study demonstrated that the patient-informed clinical framework can predict an optimal patient's HPCE and suggest empiric injection/scanning parameters to achieve consistent and sufficient HPCE levels