Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction

Cognitive dysfunction commonly occurs among older patients during admission and is associated with adverse prognosis. This study evaluated clinical characteristics and outcome determinants in hospitalized older patients with cognitive disorders. The main outcomes were length of stay, readmission within 30 days, Barthel index (BI) score at discharge, BI score change (discharge BI score minus BI score), and proportion of positive BI score change to indicate change of activities of daily living (ADL) change during hospitalization. A total of 642 inpatients with a mean age of 79.47 years (76–103 years) were categorized into three groups according to the medical history of dementia, and Mini-Mental State Examination (MMSE) scores at admission. Among them, 74 had dementia diagnosis (DD), 310 had cognitive impairment (CI), and 258 had normal MMSE scores. Patients with DD and CI generally had a higher risk of many geriatric syndromes, such as multimorbidities, polypharmacy, delirium, incontinence, visual and auditory impairment, fall history, physical frailty. They had less BI score, BI score change, and proportion of positive BI score change ADL at discharge. (DD 70.0%, CI 79.0%), suggesting less ADL change during hospitalization compared with those with normal MMSE scores (92.9%; p < 0.001). Using multiple regression analysis, we found that among patients with DD and CI, age (p = 0.008) and walking speed (p = 0.023) were predictors of discharge BI score. In addition, age (p = 0.047) and education level were associated with dichotomized BI score change (positive vs. non-positive) during hospitalization. Furthermore, the number and severity of comorbidities predicted LOS (p < 0.001) and readmission (p = 0.001) in patients with cognitive disorders. It is suggested that appropriate strategies are required to improve clinical outcomes in these patients.

Screening for Giftedness Using a Reading Curriculum Based Measure

The psychometric integrity of a curriculum-based measure to screen for academic giftedness (Monitoring Instructional Responsiveness: Reading [MIR:R]) was evaluated by examining its ceiling, item gradient, and predictive capacity using 460 fourth grade students. Eighty fourth graders (17.39%) scored one standard deviation above the MIR:R mean. Ten fourth graders (2.17%) scored two or more standard deviations above the mean, indicating an adequate ceiling. Item gradients were sufficient, that is, one raw score change produced less than one-third of a standard deviation change in standard deviation units. The MIR:R accurately screened students who performed in the “advanced” range on an end-of-the-year measure (i.e., Tennessee Comprehensive Assessment Program [TCAP]). Results of a chi-square indicated that 78.3% were identified as non-gifted by both the TCAP and MIR:R and 5.9% were identified as gifted.

Hip Accelerometry Activity Patterns Improve Machine Learning Prediction of 1-Year MoCA Score Change

We tested whether free-living hip accelerometry measures improved prediction of 1-year change in Montreal Cognitive Assessment (MoCA) scores beyond clinically available information. We analyzed data (n=126) from predominantly African American (78.2%) older adults without moderate-severe dementia residing near our geriatrics clinic. Age (73.6 ±6.1 years), gender, education, comorbidities, income, and MoCA performance were collected at baseline; participants then wore a right hip, triaxial Actigraph accelerometer (30Hz) continuously for 7 days. A MoCA was repeated at 1 year. Six measures were calculated from the daytime (7am-5pm) data: mean/variance of hourly counts per minute, mean/variance of daily percent of time spent in the lowest activity quartile, and mean/variance of daily percent of time spent in the highest activity quartile. In a random forest model containing baseline MoCA, demographics and comorbidities, the accelerometry measures improved prediction of 1-year MoCA performance by ~17.8%. Accelerometry data may be clinically useful for predicting early cognitive decline.

Effectiveness and Safety of Rituximab for Refractory Myasthenia Gravis: A Systematic Review and Single-Arm Meta-Analysis

Background and Objective: Myasthenia gravis (MG) is an autoimmune neuromuscular disease. Nearly 10–30% of patients with MG are refractory to conventional therapy. Rituximab (RTX), a monoclonal antibody targeting CD20, is increasingly used in autoimmune disorders. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of RTX for refractory MG.Methods: Studies published between January 1, 2000 and January 17, 2021 were searched in PubMed, EMBASE, Cochrane Library, and ClincalTrails.gov. Primary outcomes included proportion of patients achieving minimal manifestation status (MMS) or better and quantitative MG (QMG) score change from baseline. Secondary outcomes were glucocorticoids (GC) doses change from baseline and proportion of patients discontinuing oral immunosuppressants.Results: A total of 24 studies involving 417 patients were included in the meta-analysis. An overall 64% (95% confidence interval, 49–77%) of patients achieved MMS or better. The estimated reduction of QMG score was 1.55 (95% confidence interval, 0.88–2.22). The mean reduction of GC doses was 1.46 (95% confidence interval, 1.10–1.82). The proportion of patients discontinuing oral immunosuppressants was 81% (95% confidence interval, 66–93%). Subgroup analyses showed that the proportion of patients achieving MMS or better and discontinuing oral immunosuppressants was higher in MuSK-MG group than those in AChR-MG group. Improvement was more pronounced in patients with mild to moderate MG compared to those with severe MG. Moreover, the efficacy appeared to be independent of the dose of RTX. 19.6% of patients experienced adverse events, most of which were mild to moderate. Only one patient developed progressive multifocal leukoencephalopathy.Conclusions: RTX can alleviate the symptom of weakness, decrease QMG score and reduce the doses of steroids and non-steroid immunosuppressive agents in refractory MG. It is well-tolerated with few severe adverse events. Randomized controlled trials are urgently needed to study the efficacy of RTX in treating refractory MG and to identify the characteristics of patients who might respond well to RTX.

Assessment and Learning in Knowledge Spaces (ALEKS) Adaptive System Impact on Students’ Perception and Self-Regulated Learning Skills

Adaptive learning is an educational method that uses computer algorithms and artificial intelligence (AI) to customize learning materials and activities based on each user’s model. Adaptive learning has been used for more than 20 years. However, it is still unique, and no other system could bring more or even similar capabilities than the ones adaptive technology offers, including the application of AI, psychology, psychometrics, machine learning, and providing a personalized learning environment. However, there are not many studies on its practicality, usefulness, improving students’ learning skills, students’ perception, etc., due to the limited number of institutes investing in this new technology. This paper presents the results of administering the newly developed Adaptive Self-regulated Learning Questionnaire (ASRQ) in an adaptive learning course equipped with the ALEKS (Assessment and Learning in Knowledge Spaces) system to study the amount of Self-regulated Learning Skills (SRL) score change, if any, of the students. The ASRQ was administered at the beginning and end of the semester as a pretest and posttest. Then, the quantitative Sample Paired t Test was run to measure the students’ SRL score change between the beginning and end of the semester. The results showed a significant decline in students’ SRL skills score while working with ALEKS. This paper also discusses the reasons for the considerable drop in SRL skills based on students’ perception and feedback collected through administering an open-ended survey at the end of the semester. The survey’s qualitative analysis showed various possible factors contributing to the decline of the SRL skills score, including lack of motivation, system complexity, hard penalty, lack of social presence, and lack of system practicality.

Raw scores on subjective sleepiness, fatigue, and vigor metrics consistently define resilience and vulnerability to sleep loss

Study Objectives Although trait-like individual differences in subjective responses to sleep restriction (SR) and total sleep deprivation (TSD) exist, reliable characterizations remain elusive. We comprehensively compared multiple methods for defining resilience and vulnerability by subjective metrics. Methods 41 adults participated in a 13-day experiment:2 baseline, 5 SR, 4 recovery, and one 36h TSD night. The Karolinska Sleepiness Scale (KSS) and the Profile of Mood States Fatigue (POMS-F) and Vigor (POMS-V) were administered every 2h. Three approaches (Raw Score [average SR score], Change from Baseline [average SR minus average baseline score], and Variance [intraindividual SR score variance]), and six thresholds (±1 standard deviation, and the highest/lowest scoring 12.5%, 20%, 25%, 33%, 50%) categorized Resilient/Vulnerable groups. Kendall’s tau-b correlations compared the group categorization’s concordance within and between KSS, POMS-F, and POMS-V scores. Bias-corrected and accelerated bootstrapped t-tests compared group scores. Results There were significant correlations between all approaches at all thresholds for POMS-F, between Raw Score and Change from Baseline approaches for KSS, and between Raw Score and Variance approaches for POMS-V. All Resilient groups defined by the Raw Score approach had significantly better scores throughout the study, notably including during baseline and recovery, whereas the two other approaches differed by measure, threshold, or day. Between-measure correlations varied in strength by measure, approach, or threshold. Conclusion Only the Raw Score approach consistently distinguished Resilient/Vulnerable groups at baseline, during sleep loss, and during recovery‒‒we recommend this approach as an effective method for subjective resilience/vulnerability categorization. All approaches created comparable categorizations for fatigue, some were comparable for sleepiness, and none were comparable for vigor. Fatigue and vigor captured resilience/vulnerability similarly to sleepiness but not each other.

Retrospective longitudinal analysis of the effects of postnatal weight gain on the timing and tempo of puberty and menarche in a cohort of Italian girls

Objectiveover the last few decades there has been a progressive decline in the average age of onset of pubertal development stages in both sexes. The increase in the prevalence of childhood obesity seems to play an important role in this phenomenon.Designwe undertook a retrospective, longitudinal evaluation of the average age of thelarche and menarche to evaluate the relationship between BMI and weight change during the first years of life and the timing and tempo of puberty.Methodswe evaluated data for 577 Italian girls born between 1995 and 2003. We collected the main auxological and clinical parameters, including age at B2 and at menarche, BMI SDS at B2 and menarche, gestational age and birth weight and Z-score change from birth weight (BW) to BMI at B2 and menarche.Resultsthe mean age of B2 was 10.06 ± 1.03 years and the mean age of menarche was 12.08 ± 1.02 years. Age at B2 and menarche were inversely correlated with BMI SDS (p < 0.0001). Both age at menarche and at thelarche have an inverse relationship with the Z-score change from birth weight and BMI at menarche and thelarche respectively (p < 0.0001).Conclusionsour data confirm a significant relationship between BMI and age of B2 and menarche. We observed a clear relationship among weight change during the first years of life, age at thelarche and menarche and the duration of puberty, demonstrating the importance of weight and weight gain in determining the timing and tempo of pubertal changes and growth.

Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

Background Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in comparison to usual care. Methods A cluster-randomized trial was performed. The intervention involved providing practitioners with the new patient-education booklet and a 30-min training session on its use. The booklet was provided during the clinical consult to all consenting LBP patients in the intervention group. Primary outcomes were the proportion of patients presenting with LBP who underwent imaging examinations during the first three months of follow-up and PROMIS PF-20 (Patient-Reported Outcomes Measurement Information System, 20-item physical functioning short form) change between baseline and three-month follow-up. Secondary outcomes, including sick leave and imaging examinations at 12 months, were investigated. Logistic regression using GEE-estimation was used for dichotomous outcomes, Poisson regression using GEE-estimation for count outcomes, and linear mixed models for continuous outcomes. Results Using the patient education booklet appeared to substantially reduce the proportion of LBP patients who underwent an imaging examination at three months, but the result was not statistically significant (OR 0.57, 95% confidence interval (Cl) 0.27 to 1.22). At 12 months, the effect was slightly larger and statistically significant (OR 0.50, 95%Cl 0.30 to 0.83, p = 0.008). No difference was observed in the PROMIS PF-20 T-score change between baseline and 3 months or 12 months (p = 0.365 and p = 0.923, respectively). The number of sick leave days in the intervention group was less than that in the control group at 3 months (RR 0.47, 95%Cl 0.26 to 0.83, p = 0.010) and at 12 months (RR 0.36, 95%Cl 0.18 to 0.72, p = 0.004). Conclusions The booklet appeared to be effective in reducing the proportion of LBP patients who underwent imaging examinations over 12 months. The intervention had no discernible effect on the PROMIS PF20 T-score change. The number of sick leave days was substantially lower in the intervention group. Trial registration ISRCTN, ISRCTN14389368, Registered 4 April 2019—Retrospectively registered.

The impact of a multimodal/hybrid design on student learning in a diabetes pharmacotherapy series for third professional year pharmacy student population

Introduction: Over the last several years, pharmacy education has been moving towards a blended/hybrid model of learning. The purpose of this study was to evaluate the impact of a hybrid, multi-modal design in a diabetes sequence. Method: A diabetes series was converted from a lecture-based to a hybrid design. Percentage scores from Exam 1 and Final exam questions compared a control cohort to different cohorts over two years. Primary outcome measure was student scores. Results: The score difference on Exam 1 between the 2015 and 2017 cohorts was -6.69 (p = 0.19). Comparison of 2016 and 2017 showed a -5.13% (p = 0.33) score change. An 8.6-point improvement in Final exam scores was observed. Both hybrid model cohorts scored higher on questions related to insulin titration and treatment selection. Conclusion: No change in knowledge acquisition using the hybrid multi-modal design was seen; however there an improvement in knowledge retention was observed.

Reduction of impulsivity in patients receiving deep transcranial magnetic stimulation treatment for obesity

Purpose Aims of the present study were to investigate a wide array of psychological symptoms through validated psychometric tests, before and after 5 weeks of deep Transcranial Magnetic Stimulation (dTMS) in individuals with obesity, and to identify possible relationships with neuroendocrine parameters. Methods Forty-five patients with obesity (33 F, 12 M; age 48.8 ± 9.9 years; body wt 97.6 ± 14.2 Kg; BMI 36.2 ± 4.2) were randomized into two groups: 26 received high frequency (HF) dTMS and 19 Sham stimulation for 5 weeks. At baseline and after the 5-week treatment, all patients underwent the following psychometric evaluations: Food Cravings Questionnaire-Trait (FCQ-T) and its subscales, Barratt Impulsiveness Scale-11 (BIS-11), State and Trait Anxiety Inventory (STAI-y1 and STAI-y2), and Beck Depression Inventory (BDI). Hormonal and neuroendocrine markers were assessed at the first and last dTMS session. Results By adjusting for baseline variables and treatment arms, a significant decrease in body wt and BMI was found in HF group, both with univariate (p = 0.019) and multivariate analyses (p = 0.012). Impulsivity significantly decreased in HF group, both with univariate (p = 0.031) and multivariate analyses (p = 0.011). A positive association between the impulsivity score change and the leptin level variation (p = 0.031) was found. Conclusion The decrease of impulsivity together with the BMI reduction in individuals with obesity, treated with real stimulation, suggests that impulsivity may be a risk factor for obesity. Treatment with dTMS revealed to be effective in reducing both BMI and impulsivity by enhancing inhibitory capacity of Pre-Frontal Cortex (PFC), and modulating neuroendocrine system, especially leptin.