Remote Ischemic Conditioning May Improve Disability and Cognition After Acute Ischemic Stroke: A Pilot Randomized Clinical Trial

Background and Aim: Remote ischemic conditioning is a procedure purported to reduce the ischemic injury of an organ. This study aimed to explore the efficiency and safety of remote ischemic conditioning in patients with acute ischemic stroke. We hypothesized that remote ischemic conditioning administered from the first day of hospital admission would improve the infarct volume and clinical outcome at 180 days.Material and Methods: We performed a unicentric double-blind randomized controlled trial. We included all patients consecutively admitted to an Emergency Neurology Department with acute ischemic stroke, ineligible for reperfusion treatment, up to 24 hours from onset. All subjects were assigned to receive secondary stroke prevention treatment along with remote ischemic conditioning on the non-paretic upper limb during the first 5 days of hospitalization, twice daily - a blood pressure cuff placed around the arm was inflated to 20 mmHg above the systolic blood pressure (up to 180 mmHg) in the experimental group and 30 mmHg in the sham group. The primary outcome was the difference in infarct volume (measured on brain CT scan) at 180 days compared to baseline, whereas the secondary outcomes included differences in clinical scores (NIHSS, mRS, IADL, ADL) and cognitive/mood changes (MoCA, PHQ-9) at 180 days compared to baseline.Results: We enrolled 40 patients; the mean age was 65 years and 60% were men. Subjects in the interventional group had slightly better recovery in terms of disability, as demonstrated by the differences in disability scores between admission and 6 months (e.g., the median difference score for Barthel was −10 in the sham group and −17.5 in the interventional group, for ADL −2 in the sham group and −2.5 in the interventional group), as well as cognitive performance (the median difference score for MoCA was −2 in the sham group and −3 in the interventional group), but none of these differences reached statistical significance. The severity of symptoms (median difference score for NIHSS = 5 for both groups) and depression rate (median difference score for PHQ-9 = 0 for both groups) were similar in the two groups. The median difference between baseline infarct volume and final infarct volume at 6 months was slightly larger in the sham group compared to the interventional group (p = 0.4), probably due to an initial larger infarct volume in the former.Conclusion: Our results suggest that remote ischemic conditioning might improve disability and cognition. The difference between baseline infarct volume and final infarct volume at 180 days was slightly larger in the sham group.

Estimating Difference-Score Reliability in Pretest–Posttest Settings

Clinical, medical, and health psychologists use difference scores obtained from pretest–posttest designs employing the same test to assess intraindividual change possibly caused by an intervention addressing, for example, anxiety, depression, eating disorder, or addiction. Reliability of difference scores is important for interpreting observed change. This article compares the well-documented traditional method and the unfamiliar, rarely used item-level method for estimating difference-score reliability. We simulated data under various conditions that are typical of change assessment in pretest–posttest designs. The item-level method had smaller bias and greater precision than the traditional method and may be recommended for practical use.

Correlation between myocardial perfusion imaging findings and future cardiac events in patients with type 2 diabetes mellitus

Introduction/Objective. Myocardial perfusion imaging (MPI) is clinically useful for the evaluation of coronary artery disease (CAD) in patients with diabetes mellitus (DM). However, the prevalence of ischemia and its ability to predict future cardiac events is less clear. The aim was to determine the incidence of cardiac events in diabetic patients and relationship between them and MPI findings. Methods. Two cohorts of patients, 98 diabetics and 100 non-diabetics, with medium- to high-risk of CAD without previous coronary revascularization were studied prospectively. All of them were outpatients underwent 99mTc-sestamibi MPI with dipyridamole. The data about cardiac events were collected during follow-up period of two years. Results. Cardiac events occurred in 17.3% diabetics and in 8% non-diabetics (p = 0.048). Diabetics had shorter estimated event-free time 24.7 months (95% CI 23.2-26.2) versus non-diabetics 28.5 months (95% CI 27.4-29.5) (p = 0.046). The independent predictors of cardiac events were male sex (p = 0.010), previous myocardial infarction (p < 0.001), presence of the symptoms of angina (p = 0.014) and all variables derived from MPI findings. After adjustment for variables derived from MPI findings, the significant predictors in diabetics were size of stress perfusion defect (p = 0.022), summed stress score (p = 0.011) and summed difference score (p = 0.044). Conclusion. In diabetic patients, the cumulative rate of cardiac events was higher and the event-free survival was worse. MPI could help in prediction of cardiac events in diabetics and the most important predictors were size of stress perfusion defect, summed stress score and summed difference score.

Evaluating the Internal Consistency of Subtraction-Based and Residualized Difference Scores: Considerations for Studies of Event-Related Potentials

In studies of event-related brain potentials (ERPs), difference scores between conditions in a task are frequently used to isolate neural activity for use as a dependent or independent variable. Adequate score reliability is a prerequisite for studies examining relationships between ERPs and external correlates, but there is a widely held view that difference scores are inherently unreliable and unsuitable for studies of individual differences. This view fails to consider the nuances of difference score reliability that are relevant to ERP research. In the present study, we provide formulas from classical test theory and generalizability theory for estimating the internal consistency of subtraction-based and residualized difference scores. These formulas are then applied to error-related negativity (ERN) and reward positivity (RewP) difference scores from the same sample of 117 participants. Analyses demonstrate that ERN difference scores can be reliable, which supports their use in studies of individual differences. However, RewP difference scores yielded poor reliability due to the high correlation between the constituent reward and non-reward ERPs. Findings emphasize that difference score reliability largely depends on the internal consistency of constituent scores and the correlation between those scores. Furthermore, generalizability theory estimates yielded higher internal consistency estimates for subtraction-based difference scores than classical test theory estimates did. Despite some beliefs that difference scores are inherently unreliable, ERP difference scores can show adequate reliability and be useful for isolating neural activity in studies of individual differences.

DEVELOPMENT OF TOEIC TEST-TAKING SKILLS BY APPLYING KAHOOT! AS A REMEDIAL TEACHING TOOL

The purpose of this study is to investigate and compare TOEIC scores before and after applying Kahoot! as a remedial teaching tool on the sample of 180 (6 groups, 30 students each group) first-year students enrolled on the Airline Business Program in the International College, Suan Sunandha Rajabhat University. The research instruments in this study were TOEIC test and all questions on Kahoot! to improve students’ skills in TOEIC test reading section. The researcher applied Kahoot! at the end of 15 classes, 15-20 minutes each class. The researcher analyzed students’ TOEIC scores before and after applying Kahoot! as a remedial teaching tool by calculating TOEIC scores and percentage. The findings show that all average scores in the semester 1/2018 were higher than the score in semester 3/2017 which the score in listening section was more than the one in the reading section. Similarly, in each group, the average score in semester 1/2018 was higher than the score in semester 3/2017 while the score in listening section was more than the one in reading section. Generally, students’ TOEIC scores before applying Kahoot! were higher than after applying Kahoot!. The percentage of difference score before and after employing Kahoot! in the reading section was more than in the listening section. The group that obtained the highest percentage of difference score was group 6, followed by groups 5, 2, 4, 3 and 1, respectively. In part of the listening section, the group that obtained the highest percentage of difference score was group 4, followed by groups 6, 2, 5, 3 and 1, respectively. In part of the reading section, the group that obtained the highest percentage of difference score was group 5, followed by groups 6, 3, 2, 4 and 1, respectively. From Kahoot! score results, the researcher found that the average score, including the percentage of correct answers on Kahoot! tends to get higher. Therefore, lecturers should promote and develop students’ TOEIC test-taking skills in part of its listening and reading sections by means of integrating Kahoot! or other active learning strategies in the everyday classroom.

A-137 Increased Symptom Burden during Baseline Concussion Testing: What Does it Mean?

Objective Explore factors that are predictive of an increase in symptoms over the course of a baseline neuropsychological evaluation and examine the impact of symptom increase on objective test performance. Method 266 athletes (M = 198, F = 68) were assessed at baseline. A 21-item post-concussion symptom checklist (PCSS) was administered at the beginning (Pre-PCSS) and end (Post-PCSS) of a two-and-half hour baseline assessment. Symptoms were rated on a 7-point Likert scale (0 = none, 6 = severe). A difference score was calculated for each athlete by subtracting Post-PCSS from Pre-PCSS. Athletes were categorized into three groups based on the criterion of a half standard deviation cutoff from the mean difference score: decrease (N = 47), increase (N = 57), and no change (N = 162). The decrease and no change groups were combined into the “stable symptom” group (N = 219) which was compared to the “increased symptom” group (N = 47). Clinically significant depression was operationalized as a Beck Depression Inventory-Fast Screen score ≥ 4. Two neurocognitive composites were created (memory and attention/processing-speed). Results Independent samples t-tests were conducted to compare the stable symptom and increased symptom groups on the two neurocognitive composites. Compared with the stable symptom group, the increased symptom group demonstrated significantly worse memory composite performance, t(264) = 2.21, p = .03, d = .33, but no differences on attention/processing-speed composite performance, p &gt; .05. Also, a significantly greater proportion of athletes in the increased symptom group reported depression (17%) compared to the stable symptom group (3%), χ2(1,N = 266) = 13.81, p &lt; .001, φ = .23. Conclusions Depression and poor memory performance are associated with an increase in self-reported symptoms during the cognitive exertion associated with a typical baseline concussion assessment.