PLoS One. 2022 May 20;17(5):e0268768. doi: 10.1371/journal.pone.0268768. eCollection 2022.

ABSTRACT

BACKGROUND: Both elevated and low resting heart rates are associated with atrial fibrillation (AF), suggesting a U-shaped relationship. However, evidence for a U-shaped causal association between genetically-determined resting heart rate and incident AF is limited. We investigated potential directional changes of the causal association between genetically-determined resting heart rate and incident AF.

METHOD AND RESULTS: Seven cohorts of the AFGen consortium contributed data to this meta-analysis. All participants were of European ancestry with known AF status, genotype information, and a heart rate measurement from a baseline electrocardiogram (ECG). Three strata of instrumental variable-free resting heart rate were used to assess possible non-linear associations between genetically-determined resting heart rate and the logarithm of the incident AF hazard rate: <65; 65-75; and >75 beats per minute (bpm). Mendelian randomization analyses using a weighted resting heart rate polygenic risk score were performed for each stratum. We studied 38,981 individuals (mean age 59±10 years, 54% women) with a mean resting heart rate of 67±11 bpm. During a mean follow-up of 13±5 years, 4,779 (12%) individuals developed AF. A U-shaped association between the resting heart rate and the incident AF-hazard ratio was observed. Genetically-determined resting heart rate was inversely associated with incident AF for instrumental variable-free resting heart rates below 65 bpm (hazard ratio for genetically-determined resting heart rate, 0.96; 95% confidence interval, 0.94-0.99; p = 0.01). Genetically-determined resting heart rate was not associated with incident AF in the other two strata.

CONCLUSIONS: For resting heart rates below 65 bpm, our results support an inverse causal association between genetically-determined resting heart rate and incident AF.

PMID:35594314 | PMC:PMC9122202 | DOI:10.1371/journal.pone.0268768

PLoS One. 2022 Apr 29;17(4):e0267543. doi: 10.1371/journal.pone.0267543. eCollection 2022.

ABSTRACT

BACKGROUND AND PURPOSE: PARP inhibitors have been shown to increase the efficacy of radiotherapy in preclinical models. Radioimmunotherapy results in selective radiation cytotoxicity of targeted tumour cells. Here we investigate the combined effect of anti-CD37 β-emitting 177Lu-NNV003 radioimmunotherapy and the PARP inhibitor olaparib, and gene expression profiles in CD37 positive non-Hodgkin's lymphoma cell lines.

MATERIALS AND METHODS: The combined effect of 177Lu-NNV003 and olaparib was studied in seven cell lines using a fixed-ratio ray design, and combination index was calculated for each combination concentration. mRNA was extracted before and after treatment with the drug combination. After RNA-sequencing, hierarchical clustering was performed on basal gene expression profiles and on differentially expressed genes after combination treatment from baseline. Functional gene annotation analysis of significant differentially expressed genes after combination treatment was performed to identify enriched biological processes.

RESULTS: The combination of olaparib and 177Lu-NNV003 was synergistic in four of seven cell lines, antagonistic in one and both synergistic and antagonistic (conditionally synergistic) in two, depending on the concentration ratio between olaparib and 177Lu-NNV003. Cells treated with the combination significantly overexpressed genes in the TP53 signalling pathway. However, cluster analysis did not identify gene clusters that correlate with the sensitivity of cells to single agent or combination treatment.

CONCLUSION: The cytotoxic effect of the combination of the PARP inhibitor olaparib and the β-emitting radioimmunoconjugate 177Lu-NNV003 was synergistic in the majority of tested lymphoma cell lines.

PMID:35486574 | PMC:PMC9053826 | DOI:10.1371/journal.pone.0267543

PLoS One. 2022 Apr 22;17(4):e0260905. doi: 10.1371/journal.pone.0260905. eCollection 2022.

ABSTRACT

Fitness is at the core of evolutionary theory, but it is difficult to measure accurately. One way to measure long-term fitness is by calculating the individual's reproductive value, which represents the expected number of allele copies an individual passes on to distant future generations. However, this metric of fitness is scarcely used because the estimation of individual's reproductive value requires long-term pedigree data, which is rarely available in wild populations where following individuals from birth to death is often impossible. Wild study systems therefore use short-term fitness metrics as proxies, such as the number of offspring produced. This study compared two frequently used short-term metrics for fitness obtained at different offspring life stages (eggs, hatchlings, fledglings and recruits), and compared their ability to predict reproductive values derived from the genetic pedigree of a wild passerine bird population. We used twenty years of precise field observations and a near-complete genetic pedigree to calculate reproductive success, individual growth rate and de-lifed fitness as lifetime fitness measures, and as annual de-lifed fitness. We compared the power of these metrics to predict reproductive values and lineage survival to the end of the study period. The three short-term fitness proxies predict the reproductive values and lineage survival only when measured at the recruit stage. There were no significant differences between the different fitness proxies at the same offspring stages in predicting the reproductive values and lineage survival. Annual fitness at one year old predicted reproductive values equally well as lifetime de-lifed fitness. However, none of the short-term fitness proxies were strongly associated with the reproductive values. The commonly used short-term fitness proxies best predict long-term fitness when measured at recruitment stage. Thus, because lifetime fitness measured at recruit stage and annual fitness in the first year of life were the best proxies of long-term fitness in short-lived birds, we encourage their future use.

PMID:35452482 | PMC:PMC9032343 | DOI:10.1371/journal.pone.0260905

PLoS One. 2022 Apr 21;17(4):e0267313. doi: 10.1371/journal.pone.0267313. eCollection 2022.

ABSTRACT

BACKGROUND: Preeclampsia causes substantial maternal and perinatal morbidity and mortality and significant societal economic impact. Effective screening would facilitate timely and appropriate prevention and management of preeclampsia.

OBJECTIVES: To develop an early cost-effectiveness analysis to assess both costs and health outcomes of a new screening test for preeclampsia from a healthcare payer perspective, in the United Kingdom (UK), Ireland, the Netherlands and Sweden.

METHODS: A decision tree over a 9-month time horizon was developed to explore the cost-effectiveness of the new screening test for preeclampsia compared to the current screening strategy. The new test strategy is being developed so that it can stratify healthy low risk nulliparous women early in pregnancy to either a high-risk group with a risk of 1 in 6 or more of developing preeclampsia, or a low-risk group with a risk of 1 in 100 or less. The model simulated 25 plausible scenarios in a hypothetical cohort of 100,000 pregnant women, in which the sensitivity and specificity of the new test were varied to set a benchmark for the minimum test performance that is needed for the test to become cost-effective. The input parameters and costs were mainly derived from published literature. The main outcome was incremental costs per preeclampsia case averted, expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty.

RESULTS: Base case results showed that the new test strategy would be more effective and less costly compared to the current situation in the UK. In the Netherlands, the majority of scenarios would be cost-effective from a threshold of €50,000 per preeclampsia case averted, while in Ireland and Sweden, the vast majority of scenarios would be considered cost-effective only when a threshold of €100,000 was used. In the best case analyses, ICERs were more favourable in all four participating countries. Aspirin effectiveness, prevalence of preeclampsia, accuracy of the new screening test and cost of regular antenatal care were identified as driving factors for the cost-effectiveness of screening for preeclampsia.

CONCLUSION: The results indicate that the new screening test for preeclampsia has potential to be cost-effective. Further studies based on proven accuracy of the test will confirm whether the new screening test is a cost-effective additional option to the current situation.

PMID:35446907 | PMC:PMC9022877 | DOI:10.1371/journal.pone.0267313

PLoS One. 2022 Apr 18;17(4):e0266972. doi: 10.1371/journal.pone.0266972. eCollection 2022.

ABSTRACT

To raise biodiversity awareness effectively, communicators should be aware of knowledge levels in their audiences. Species identification skills have been used in the past as a measure of what people know about species, yet it is not known whether they serve as good indicators. To study the link between species identification and in-depth species knowledge, we presented an animal knowledge test to an online audience of over 7,000 Dutch adults, and used correlation and regression analyses to determine the extent to which species identification predicts in-depth knowledge about species' origin, habitat, diet, and behavior. We found that in-depth knowledge was higher in those who correctly identified species as compared with those who did not correctly identify species, for all four types of in-depth knowledge. Moreover, as compared to alternative variables (work, age, gender, and educational level), species identification was by far the best predictor for in-depth knowledge about species. However, species identification levels were generally higher than levels of in-depth knowledge, and knowledge gaps and misconceptions were uncovered. The results confirm the value of species identification tests, but also highlight limitations and challenges that should be taken into account when establishing knowledge levels and communicating biodiversity.

PMID:35436302 | PMC:PMC9015127 | DOI:10.1371/journal.pone.0266972

PLoS One. 2022 Apr 14;17(4):e0266499. doi: 10.1371/journal.pone.0266499. eCollection 2022.

ABSTRACT

Social relationships are important predictors of a range of individual outcomes, such as wellbeing and health. These social relationships are conceptualised in different ways, such as (inter-personal) forms of social support, identification with groups, or social capital. What is the overlap among these concepts and in what ways do they differ? The present work aims to clarify this with empirical evidence from two panel studies (N = 3934; N = 2912). The studies include central measures of social relationships (group identification, group membership, social support and social capital). Empirical differences and overlap were studied by evaluating the factor structure of the data with both confirmatory factor analyses and bi-factor analyses. Results showed that the different concepts had a large amount of empirical overlap (together accounting for over 60% of common variance). Surprisingly, results also revealed that subcomponents were identifiable based on who they target and not based on their conceptualisation. For example, items about identification with neighbourhood factored together with support items from the neighbourhood, and not with other identification items. Accordingly, we conclude that in addition to a general factor, it is possible to meaningfully distinguish components of social relations based on which group is targeted by the items (e.g. neighbourhood or family and friends). For future research on the relationship between social relations and health, the present measures are unlikely to be sufficiently precise to disentangle whether health effects are caused by identification, support or capital. Differences between targets appear to be more important than differences between these concepts for understanding the relationship between social relations and health and wellbeing.

PMID:35421128 | PMC:PMC9009600 | DOI:10.1371/journal.pone.0266499

PLoS One. 2022 Apr 14;17(4):e0263769. doi: 10.1371/journal.pone.0263769. eCollection 2022.

ABSTRACT

BACKGROUND: Social functioning is often impaired in schizophrenia (SZ) and Alzheimer's disease (AD). However, commonalities and differences in social dysfunction among these patient groups remain elusive.

MATERIALS AND METHODS: Using data from the PRISM study, behavioral (all subscales and total score of the Social Functioning Scale) and affective (perceived social disability and loneliness) indicators of social functioning were measured in patients with SZ (N = 56), probable AD (N = 50) and age-matched healthy controls groups (HC, N = 29 and N = 28). We examined to what extent social functioning differed between disease and age-matched HC groups, as well as between patient groups. Furthermore, we examined how severity of disease and mood were correlated with social functioning, irrespective of diagnosis.

RESULTS: As compared to HC, both behavioral and affective social functioning seemed impaired in SZ patients (Cohen's d's 0.81-1.69), whereas AD patients mainly showed impaired behavioral social function (Cohen's d's 0.65-1.14). While behavioral indices of social functioning were similar across patient groups, SZ patients reported more perceived social disability than AD patients (Cohen's d's 0.65). Across patient groups, positive mood, lower depression and anxiety levels were strong determinants of better social functioning (p's <0.001), even more so than severity of disease.

CONCLUSIONS: AD and SZ patients both exhibit poor social functioning in comparison to age- and sex matched HC participants. Social dysfunction in SZ patients may be more severe than in AD patients, though this may be due to underreporting by AD patients. Across patients, social functioning appeared as more influenced by mood states than by severity of disease.

PMID:35421108 | PMC:PMC9009658 | DOI:10.1371/journal.pone.0263769

PLoS One. 2022 Apr 7;17(4):e0265283. doi: 10.1371/journal.pone.0265283. eCollection 2022.

ABSTRACT

BACKGROUND: Increased opioid prescribing has raised concern, as the benefits of pain relief not always outweigh the risks. Acute and chronic pain is often treated in a primary care out-of-hours (OOH) setting. This setting may be a driver of opioid use but the extent to which opioids are prescribed OOH is unknown. We aimed to investigate weak and strong opioid prescribing at OOH primary care services (PCS) in Flanders (Northern, Dutch-speaking part of Belgium) and the Netherlands between 2015 and 2019.

METHODS: We performed a retrospective cross sectional study using data from routine electronic health records of OOH-PCSs in Flanders and the Netherlands (2015-2019). Our primary outcome was the opioid prescribing rate per 1000 OOH-contacts per year, in total and for strong (morphine, hydromorphone, oxycodone, oxycodone and naloxone, fentanyl, tapentadol, and buprenorphine and weak opioids (codeine combinations and tramadol and combinations) and type of opioids separately.

RESULTS: Opioids were prescriped in approximately 2.5% of OOH-contacts in both Flanders and the Netherlands. In Flanders, OOH opioid prescribing went from 2.4% in 2015 to 2.1% in 2017 and then increased to 2.3% in 2019. In the Netherlands, opioid prescribing increased from 1.9% of OOH-contacts in 2015 to 2.4% in 2017 and slightly decreased thereafter to 2.1% of OOH-contacts. In 2019, in Flanders, strong opioids were prescribed in 8% of the OOH-contacts with an opioid prescription. In the Netherlands a strong opioid was prescribed in 57% of these OOH-contacts. Two thirds of strong opioids prescriptions in Flanders OOH were issued for patients over 75, in the Netherlands one third was prescribed to this age group.

CONCLUSION: We observed large differences in strong opioid prescribing at OOH-PCSs between Flanders and the Netherlands that are likely to be caused by differences in accessibility of secondary care, and possibly existing opioid prescribing habits. Measures to ensure judicious and evidence-based opioid prescribing need to be tailored to the organisation of the healthcare system.

PMID:35390027 | PMC:PMC8989290 | DOI:10.1371/journal.pone.0265283

PLoS One. 2022 Apr 7;17(4):e0263990. doi: 10.1371/journal.pone.0263990. eCollection 2022.

ABSTRACT

BACKGROUND AND OBJECTIVES: Facial expression recognition has been studied extensively, including in relation to social anxiety. Nonetheless, a limited number of studies examined recognition of disgust expressions. Results suggest that disgust is perceived as more threatening than anger, and thus may invite more extreme responses. However, few studies have examined responses to facial expressions. These studies have focused on approach-avoidance responses. Our primary aim was to examine to what extent anger and disgust expressions might invite interpersonal responses in terms of quarrelsomeness-agreeableness and dominance-submissiveness. As social anxiety has been previously associated with a heightened sensitivity to anger and disgust expressions, as well as with alterations in quarrelsomeness-agreeableness and dominance-submissiveness, our secondary aim was to examine whether social anxiety would moderate these responses.

METHODS: Participants were 55 women and 43 men who completed social anxiety measures, including the Brief Fear of Negative Evaluation scale, and two tasks that involved "targets" expressing anger, disgust, or happiness at 0%, 50%, or 100%. Participants first indicated how quarrelsome or agreeable and how dominant or submissive they would be towards each target, and then how much they would avoid or approach each target.

RESULTS: While 100% disgust and anger expressions invited similar levels of quarrelsomeness and avoidance, 50% disgust invited more quarrelsomeness and stronger avoidance than 50% anger. While these patterns were not meaningfully moderated by social anxiety, individuals with higher BFNE scores showed a relatively strong approach of happy faces.

LIMITATIONS: Actual interpersonal behaviour in response to facial expressions was not assessed.

CONCLUSIONS: Findings support the relevance of disgust as an interpersonal signal and suggest that, especially at mild intensity, disgust may have a stronger impact than anger on people's quarrelsomeness and avoidance responses. Findings provided no support for the view that people with social anxiety would be particularly responsive to disgust (or anger) expressions.

PMID:35390004 | PMC:PMC8989355 | DOI:10.1371/journal.pone.0263990

PLoS One. 2022 Apr 1;17(4):e0262886. doi: 10.1371/journal.pone.0262886. eCollection 2022.

ABSTRACT

Visual deficits are common after stroke and are powerful predictors for the chronic functional outcome. However, while basic visual field and recognition deficits are relatively easy to assess with standardized methods, selective deficits in visual primitives, such as shape or motion, are harder to identify, as they often require a symmetrical bilateral posterior lesion in order to provoke full field deficits. Therefore, we do not know how often they occur. Nevertheless, they can have severe repercussions for daily-life functioning. We aimed to investigate the prevalence and co-occurrence of hemifield "mid-range" visual deficits (i.e. color, shape, location, orientation, correlated motion, contrast, texture and glossiness), using a novel experimental set-up with a gaze-contingent presentation of the stimuli. To this end, a prospective cohort of 220 ischemic (sub)cortical stroke patients and a healthy control group was assessed with this set-up. When comparing performance of patients with controls, the results showed that deficits in motion-perception were most prevalent (26%), followed by color (22%), texture (22%), location (21%), orientation (18%), contrast (14%), shape (14%) and glossiness (13%). 63% of the stroke patients showed one or more mid-range visual deficits. Overlap of deficits was small; they mostly occurred in isolation or co-occurred with only one or two other deficits. To conclude, it was found that deficits in "mid-range" visual functions were very prevalent. These deficits are likely to affect the chronic post-stroke condition. Since we found no strong patterns of co-occurrences, we suggest that an assessment of deficits at this level of visual processing requires screening the full range of visual functions.

PMID:35363793 | PMC:PMC8975013 | DOI:10.1371/journal.pone.0262886

PLoS One. 2022 Mar 17;17(3):e0260829. doi: 10.1371/journal.pone.0260829. eCollection 2022.

ABSTRACT

OBJECTIVE: To develop and internally validate prediction models for future hospital care utilization in patients with multiple chronic conditions.

DESIGN: Retrospective cohort study.

SETTING: A teaching hospital in the Netherlands (542 beds).

PARTICIPANTS: All adult patients (n = 18.180) who received care at the outpatient clinic in 2017 for two chronic diagnoses or more (including oncological diagnoses) and who returned for hospital care or outpatient clinical care in 2018. Development and validation using a stratified random split-sample (n = 12.120 for development, n = 6.060 for internal validation).

OUTCOMES: ≥2 emergency department visits in 2018, ≥1 hospitalization in 2018 and ≥12 outpatient visits in 2018.

STATISTICAL ANALYSIS: Multivariable logistic regression with forward selection.

RESULTS: Evaluation of the models' performance showed c-statistics of 0.70 (95% CI 0.69-0.72) for the hospitalization model, 0.72 (95% CI 0.70-0.74) for the ED visits model and 0.76 (95% 0.74-0.77) for the outpatient visits model. With regard to calibration, there was agreement between lower predicted and observed probability for all models, but the models overestimated the probability for patients with higher predicted probabilities.

CONCLUSIONS: These models showed promising results for further development of prediction models for future healthcare utilization using data from local electronic health records. This could be the first step in developing automated alert systems in electronic health records for identifying patients with multimorbidity with higher risk for high healthcare utilization, who might benefit from a more integrated care approach.

PMID:35298467 | PMC:PMC8929569 | DOI:10.1371/journal.pone.0260829

PLoS One. 2022 Mar 4;17(3):e0264616. doi: 10.1371/journal.pone.0264616. eCollection 2022.

ABSTRACT

The prognosis of aneurysmal subarachnoid hemorrhage (aSAH) is highly variable. This study aims to investigate whether skeletal muscle atrophy and myosteatosis are associated with poor outcome after aSAH. In this study, a cohort of 293 consecutive aSAH-patients admitted during a 4-year period was retrospectively analyzed. Cross-sectional muscle measurements were obtained at the level of the third cervical vertebra. Muscle atrophy was defined by a sex-specific cutoff value. Myosteatosis was defined by a BMI-specific cutoff value. Poor neurological outcome was defined as modified Rankin Scale 4-6 at 2 and 6-month follow-up. Patient survival state was checked until January 2021. Generalized estimating equation was performed to assess the effect of muscle atrophy / myosteatosis on poor neurological outcome after aSAH. Cox regression was performed to analyze the impact of muscle atrophy and myosteatosis on overall survival. The study found that myosteatosis was associated with poor neurological condition (WFNS 4-5) at admission after adjusting for covariates (odds ratio [OR] 2.01; 95%CI 1.05,3.83; P = .03). It was not associated with overall survival (P = .89) or with poor neurological outcomes (P = .18) when adjusted for other prognostic markers. Muscle atrophy was not associated with overall survival (P = .58) or neurological outcome (P = .32) after aSAH. In conclusion, myosteatosis was found to be associated with poor physical condition directly after onset of aSAH. Skeletal muscle atrophy and myosteatosis were however irrelevant to outcome in the Western-European aSAH patient. Future studies are needed to validate these finding.

PMID:35245308 | PMC:PMC8896675 | DOI:10.1371/journal.pone.0264616

PLoS One. 2022 Mar 3;17(3):e0264699. doi: 10.1371/journal.pone.0264699. eCollection 2022.

ABSTRACT

BACKGROUND: Reviewing the epidemiological profile of medication errors (MEs) reported by African countries and the systems put in place to report such errors is crucial because reporting plays an important role in improving patient safety. The objectives of this study were to characterize the profile of spontaneously reported MEs submitted by African countries to VigiBase; the World Health Organization (WHO) global database of individual case safety reports, describe systems in place for reporting these errors, and explore the challenges and facilitators for spontaneous reporting and understand the potential role of patients.

METHODS: In the present study, we used, a mixed-methods sequential explanatory design involving a quantitative review of ME reports over a 21-year period (1997-2018) and qualitative interviews with employees from African countries that are members of the WHO Program for International Drug Monitoring (WHO PIDM). Descriptive statistics were used to summarize key variables of interest.

RESULTS: A total of 4,205 ME reports were submitted by African countries to VigiBase representing 0.4% of all reports in the database. Only 15 countries out of the 37 WHO PIDM members from Africa contributed ME to reports, with 99% (3,874) of them reports originating from Egypt, Morocco, and South Africa. The reasons given for low reporting of MEs were weak healthcare and pharmacovigilance systems, lack of staff capacity at the national centers, illiteracy, language difficulties, and socio-cultural and religious beliefs. Some facilitators suggested by the participants to promote reporting included proactive engagement of patients regarding issues relating to MEs, leveraging on increased technology, benchmarking and mentoring by more experienced national centers. Sixteen of the twenty countries interviewed had systems for reporting MEs integrated into adverse drug reaction reporting with minimal patient involvement in seven of these countries. Patients were not involved in directly reporting MEs in the remaining 13 countries.

CONCLUSIONS: MEs are rarely reported through pharmacovigilance systems in African countries with limited patient involvement. The systems are influenced by multifactorial issues some of which are not directly related to healthcare.

PMID:35239736 | PMC:PMC8893697 | DOI:10.1371/journal.pone.0264699

PLoS One. 2022 Feb 28;17(2):e0264555. doi: 10.1371/journal.pone.0264555. eCollection 2022.

ABSTRACT

AIMS: Little is known about usual care by physicians and pharmacy teams to support adherence to statins and whether the extent of this care is associated with adherence to statins. Objective of the study was to examine the relationship between the extent of adherence supporting activities of healthcare practitioners (HCPs) and patients' adherence to statins.

METHODS: Cross-sectional study in 48 pharmacies and affiliated physicians' practices, between September 3, 2014 and March 20, 2015. Patients visiting the pharmacy with a statin prescription from participating prescribers were invited to participate. Usual care to support adherence was assessed among HCPs with the Quality of Standard Care questionnaire about usual care activities to support adherence. Adherence to statins was assessed among patients with the MARS-5 questionnaire. The association between the extent of HCPs' adherence supporting activities and patients' adherence was examined by means of multilevel regression analysis.

RESULTS: 1,504 patients and 692 HCPs (209 physicians, 118 pharmacists and 365 pharmacy technicians) participated. No association was found between the extent of physicians' adherence supporting activities and patients' adherence to statins. The extent of adherence supporting activities by pharmacy teams in usual care was negatively associated with patients' adherence to statins (B coefficient -0.057 (95%CI: -0.112- -0.002).

CONCLUSIONS: This study suggests that there is no positive relationship between the extent of HCPs' adherence supporting activities in usual care and patients' adherence to statins. Other methods than questionnaires (e.g. electronic monitors (to assess adherence) and observations (to assess usual care) should be applied to confirm the results of this study.

PMID:35226701 | PMC:PMC8884488 | DOI:10.1371/journal.pone.0264555

PLoS One. 2022 Feb 28;17(2):e0264497. doi: 10.1371/journal.pone.0264497. eCollection 2022.

ABSTRACT

Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, Mage = 32.6, SDage = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, indicating that grief may be considered in interventions for victims of traffic accidents. Trauma rumination strongly predicted class membership and appears a critical treatment target to alleviate distress.

PMID:35226697 | PMC:PMC8884715 | DOI:10.1371/journal.pone.0264497

PLoS One. 2022 Feb 25;17(2):e0264387. doi: 10.1371/journal.pone.0264387. eCollection 2022.

ABSTRACT

PURPOSE: 11C-Methionine (11C-MET) PET prognostication of isocitrate dehydrogenase (IDH) wild type glioblastomas is inadequate as conventional parameters such as standardized uptake value (SUV) do not adequately reflect tumor heterogeneity. We retrospectively evaluated whether volume-based parameters such as metabolic tumor volume (MTV) and total lesion methionine metabolism (TLMM) outperformed SUV for survival correlation in patients with IDH wild type glioblastomas.

METHODS: Thirteen IDH wild type glioblastoma patients underwent preoperative 11C-MET PET. Both SUV-based parameters and volume-based parameters were calculated for each lesion. Kaplan-Meier curves with log-rank testing and Cox regression analysis were used for correlation between PET parameters and overall survival.

RESULTS: Median overall survival for the entire cohort was 393 days. MTV (HR 1.136, p = 0.007) and TLMM (HR 1.022, p = 0.030) were inversely correlated with overall survival. SUV-based 11C-MET PET parameters did not show a correlation with survival. In a paired analysis with other clinical parameters including age and radiotherapy dose, MTV and TLMM were found to be independent factors.

CONCLUSIONS: MTV and TLMM, and not SUV, significantly correlate with overall survival in patients with IDH wild type glioblastomas. The incorporation of volume-based 11C-MET PET parameters may lead to a better outcome prediction for this heterogeneous patient population.

PMID:35213602 | PMC:PMC8880430 | DOI:10.1371/journal.pone.0264387

PLoS One. 2022 Feb 10;17(2):e0263433. doi: 10.1371/journal.pone.0263433. eCollection 2022.

ABSTRACT

OBJECTIVES: Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers' responses to these utterances.

METHODS: Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients' expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study.

RESULTS: 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion disclosed in the cue/concern. Future research should elaborate on these exploratory observations, especially regarding why HCPs often only leave limited space for further disclosure of emotions in palliative care.

PMID:35143534 | PMC:PMC8830703 | DOI:10.1371/journal.pone.0263433

PLoS One. 2022 Feb 9;17(2):e0262845. doi: 10.1371/journal.pone.0262845. eCollection 2022.

ABSTRACT

Seagrasses form the foundation of many coastal ecosystems but are rapidly declining on a global scale. The Dutch Wadden Sea once supported extensive subtidal seagrass meadows that have all disappeared. Here, we report on the setbacks and successes of intertidal seed-based restoration experiments in the Dutch Wadden Sea between 2014-2017. Our main goals were to 1) optimize plant densities, and 2) reduce seed losses. To achieve our goals, we conducted research-based, adaptive seagrass (Zostera marina) restoration, adjusting methods yearly based on previous results. We applied various seeding methods in three subsequent years-from Buoy Deployed Seeding (BuDS), and 'BuDS-in-frame' in fall, to a newly developed 'Dispenser Injection Seeding' (DIS) method. Our adaptive experimental approach revealed high seed losses between seeding and seedling establishment of the BuDS methods (>99.9%), which we mitigated by controlled harvest and storage of seeds throughout fall and winter, followed by DIS-seeding in spring. These iterative innovations resulted in 83 times higher plant densities in the field (0.012 to 1.00 plants m-2) and a small reduction in seed loss (99.94 to 99.75%) between 2015-2017. Although these developments have not yet resulted in self-sustaining seagrass populations, we are one step closer towards upscaling seagrass restoration in the Dutch Wadden Sea. Our outcomes suggest that an iterative, research-based restoration approach that focuses on technological advancement of precision-seeding may result in advancing knowledge and improved seed-based seagrass restoration successes.

PMID:35139086 | PMC:PMC8827467 | DOI:10.1371/journal.pone.0262845

PLoS One. 2022 Feb 2;17(2):e0262557. doi: 10.1371/journal.pone.0262557. eCollection 2022.

ABSTRACT

Suids (Sus sp.) played a crucial role in the transition to farming in northern Europe and, like in many regions, in the Netherlands pig husbandry became an important subsistence activity at Neolithic sites. Yet little is known about wild boar palaeoecology and hunting in the Late Mesolithic Netherlands with which to contextualize this transition. This paper presents the first multi-proxy analysis of archaeological suid remains in the Netherlands. It explores human-suid interactions at the Swifterbant culture sites of Hardinxveld-Giessendam Polderweg and De Bruin (5450-4250 BC) through biometric analysis, estimation of age-at-death, and stable carbon and nitrogen isotope analysis. The results reveal targeted hunting of adult wild boar in the Late Mesolithic (5450-4850 BC), with a possible shift over time towards more juveniles. The wild boar in this period are demonstrated to be of comparably large size to contemporary northern European populations and exhibiting a wide range of dietary regimes. In the final occupational period (4450-4250 BC), small suids are present, possibly domestic pigs, but there is no evidence of pig management. This study demonstrates that the nature of human-suid interactions varied over time, which may have been connected to changing environmental conditions, human mobility, and wild boar behaviour. This study also contributes the first biometric and dietary baseline for mid-Holocene wild boar in the Netherlands.

PMID:35108285 | PMC:PMC8809594 | DOI:10.1371/journal.pone.0262557

PLoS One. 2022 Feb 2;17(2):e0243877. doi: 10.1371/journal.pone.0243877. eCollection 2022.

ABSTRACT

In many groups of animals the dominance hierarchy is linear. What mechanisms underlie this linearity of the dominance hierarchy is under debate. Linearity is often attributed to cognitively sophisticated processes, such as transitive inference and eavesdropping. An alternative explanation is that it develops via the winner-loser effect. This effect implies that after a fight has been decided the winner is more likely to win again, and the loser is more likely to lose again. Although it has been shown that dominance hierarchies may develop via the winner-loser effect, the degree of linearity of such hierarchies is unknown. The aim of the present study is to investigate whether a similar degree of linearity, like in real animals, may emerge as a consequence of the winner-loser effect and the socio-spatial structure of group members. For this purpose, we use the model DomWorld, in which agents group and compete and the outcome of conflicts is self-reinforcing. Here dominance hierarchies are shown to emerge. We analyse the dominance hierarchy, behavioural dynamics and network triad motifs in the model using analytical methods from a previous study on dominance in real hens. We show that when one parameter, representing the intensity of aggression, was set high in the model DomWorld, it reproduced many patterns of hierarchical development typical of groups of hens, such as its high linearity. When omitting from the model the winner-loser effect or spatial location of individuals, this resemblance decreased markedly. We conclude that the combination of the spatial structure and the winner-loser effect provide a plausible alternative for hierarchical linearity to processes that are cognitively more sophisticated. Further research should determine whether the winner-loser effect and spatial structure of group members also explains the characteristics of hierarchical development in other species with a different dominance style than hens.

PMID:35108262 | PMC:PMC8809560 | DOI:10.1371/journal.pone.0243877

PLoS One. 2022 Jan 27;17(1):e0262718. doi: 10.1371/journal.pone.0262718. eCollection 2022.

ABSTRACT

The attentional blink (AB) phenomenon reveals a bottleneck of human information processing: the second of two targets is often missed when they are presented in rapid succession among distractors. In our previous work, we showed that the size of the AB can be changed by applying transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) (London & Slagter, Journal of Cognitive Neuroscience, 33, 756-68, 2021). Although AB size at the group level remained unchanged, the effects of anodal and cathodal tDCS were negatively correlated: if a given individual's AB size decreased from baseline during anodal tDCS, their AB size would increase during cathodal tDCS, and vice versa. Here, we attempted to replicate this finding. We found no group effects of tDCS, as in the original study, but we no longer found a significant negative correlation. We present a series of statistical measures of replication success, all of which confirm that both studies are not in agreement. First, the correlation here is significantly smaller than a conservative estimate of the original correlation. Second, the difference between the correlations is greater than expected due to sampling error, and our data are more consistent with a zero-effect than with the original estimate. Finally, the overall effect when combining both studies is small and not significant. Our findings thus indicate that the effects of lDPLFC-tDCS on the AB are less substantial than observed in our initial study. Although this should be quite a common scenario, null findings can be difficult to interpret and are still under-represented in the brain stimulation and cognitive neuroscience literatures. An important auxiliary goal of this paper is therefore to provide a tutorial for other researchers, to maximize the evidential value from null findings.

PMID:35085301 | PMC:PMC8794161 | DOI:10.1371/journal.pone.0262718

PLoS One. 2022 Jan 21;17(1):e0262350. doi: 10.1371/journal.pone.0262350. eCollection 2022.

ABSTRACT

Humans can learn simple new tasks very quickly. This ability suggests that people can reuse previously learned procedural knowledge when it applies to a new context. We have proposed a modeling approach based on this idea and used it to create a model of the attentional blink (AB). The main idea of the skill-based approach is that models are not created from scratch but, instead, built up from reusable pieces of procedural knowledge (skills). This approach not only provides an explanation for the fast learning of simple tasks but also shows much promise to improve certain aspects of cognitive modeling (e.g., robustness and generalizability). We performed two experiments, in order to collect empirical support for the model's prediction that the AB will disappear when the two targets are consolidated as a single chunk. Firstly, we performed an unsuccessful replication of a study reporting that the AB disappears when participants are instructed to remember the targets as a syllable. However, a subsequent experiment using easily combinable stimuli supported the model's prediction and showed a strongly reduced AB in a large group of participants. This result suggests that it is possible to avoid the AB with the right consolidation strategy. The skill-based approach allowed relating this finding to a general cognitive process, thereby demonstrating that incorporating this approach can be very helpful to generalize the findings of cognitive models, which otherwise tends to be rather difficult.

PMID:35061799 | PMC:PMC8782399 | DOI:10.1371/journal.pone.0262350

PLoS One. 2022 Jan 20;17(1):e0260664. doi: 10.1371/journal.pone.0260664. eCollection 2022.

ABSTRACT

BACKGROUND: Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis.

METHODS AND FINDINGS: This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up.

CONCLUSION: Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

PMID:35051181 | PMC:PMC8775208 | DOI:10.1371/journal.pone.0260664

PLoS One. 2022 Jan 19;17(1):e0261606. doi: 10.1371/journal.pone.0261606. eCollection 2022.

ABSTRACT

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence and young adulthood. The social causation theory implies that the social environment (e.g. at school) influences adolescents' drinking behaviour. Conversely, the health-related selection hypothesis posits that alcohol use (along other health-related characteristics) predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, educational gradients in alcohol use may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use from adolescence to young adulthood in a selective educational system. We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years (waves 2 to 6). First, we evaluated the directionality in longitudinal associations between education and drinking with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11 (wave 1), i.e. IQ, effortful control, and parental SES, both as confounders in these associations, and as predictors of educational level and drinking around age 14 (wave 2). In fixed effects models, lower education around age 14 predicted increases in drinking around 16. From age 19 onward, we found a tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. Childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking. We mainly found evidence for the social causation theory in early adolescence, when lower education predicted increases in subsequent alcohol use. We found no evidence in support of the health-related selection hypothesis with respect to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use.

PMID:35045096 | PMC:PMC8769339 | DOI:10.1371/journal.pone.0261606

PLoS One. 2022 Jan 13;17(1):e0253406. doi: 10.1371/journal.pone.0253406. eCollection 2022.

ABSTRACT

Early-life adversity (ELA) causes long-lasting structural and functional changes to the brain, rendering affected individuals vulnerable to the development of psychopathologies later in life. Immediate-early genes (IEGs) provide a potential marker for the observed alterations, bridging the gap between activity-regulated transcription and long-lasting effects on brain structure and function. Several heterogeneous studies have used IEGs to identify differences in cellular activity after ELA; systematically investigating the literature is therefore crucial for comprehensive conclusions. Here, we performed a systematic review on 39 pre-clinical studies in rodents to study the effects of ELA (alteration of maternal care) on IEG expression. Females and IEGs other than cFos were investigated in only a handful of publications. We meta-analyzed publications investigating specifically cFos expression. ELA increased cFos expression after an acute stressor only if the animals (control and ELA) had experienced additional hits. At rest, ELA increased cFos expression irrespective of other life events, suggesting that ELA creates a phenotype similar to naïve, acutely stressed animals. We present a conceptual theoretical framework to interpret the unexpected results. Overall, ELA likely alters IEG expression across the brain, especially in interaction with other negative life events. The present review highlights current knowledge gaps and provides guidance to aid the design of future studies.

PMID:35025862 | PMC:PMC8757918 | DOI:10.1371/journal.pone.0253406

PLoS One. 2022 Jan 6;17(1):e0261509. doi: 10.1371/journal.pone.0261509. eCollection 2022.

ABSTRACT

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.

PMID:34990459 | PMC:PMC8735619 | DOI:10.1371/journal.pone.0261509

PLoS One. 2022 Jan 4;17(1):e0262072. doi: 10.1371/journal.pone.0262072. eCollection 2022.

ABSTRACT

BACKGROUND: Prior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD.

MATERIALS/METHODS: This study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012-2013 to 2015-2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization.

RESULTS: Over a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24-0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21-0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13-0.26). A significant part of the effect could be attributed to "healthy vaccinee" bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65-0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60-0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31-0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80-1.18).

CONCLUSIONS: Among elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality.

PMID:34982781 | PMC:PMC8726500 | DOI:10.1371/journal.pone.0262072

PLoS One. 2021 Dec 29;16(12):e0260952. doi: 10.1371/journal.pone.0260952. eCollection 2021.

ABSTRACT

The endeavor to understand the human brain has seen more progress in the last few decades than in the previous two millennia. Still, our understanding of how the human brain relates to behavior in the real world and how this link is modulated by biological, social, and environmental factors is limited. To address this, we designed the Healthy Brain Study (HBS), an interdisciplinary, longitudinal, cohort study based on multidimensional, dynamic assessments in both the laboratory and the real world. Here, we describe the rationale and design of the currently ongoing HBS. The HBS is examining a population-based sample of 1,000 healthy participants (age 30-39) who are thoroughly studied across an entire year. Data are collected through cognitive, affective, behavioral, and physiological testing, neuroimaging, bio-sampling, questionnaires, ecological momentary assessment, and real-world assessments using wearable devices. These data will become an accessible resource for the scientific community enabling the next step in understanding the human brain and how it dynamically and individually operates in its bio-social context. An access procedure to the collected data and bio-samples is in place and published on https://www.healthybrainstudy.nl/en/data-and-methods/access. Trail registration: https://www.trialregister.nl/trial/7955.

PMID:34965252 | PMC:PMC8716054 | DOI:10.1371/journal.pone.0260952

PLoS One. 2021 Dec 28;16(12):e0261784. doi: 10.1371/journal.pone.0261784. eCollection 2021.

ABSTRACT

INTRODUCTION: After rehabilitation following total hip or knee arthroplasty (THA/TKA), patients are advised to participate in physical activity (PA) and sports. However, profound insight into whether people adopt a physically active lifestyle is lacking. Aim is to gain insight into the performed amount and type of PA (including sports) and time spent sedentarily by persons after THA/TKA.

METHODS: A systematic review (PROSPERO: CRD42020178556). Pubmed, Cinahl, EMBASE and PsycInfo were systematically searched for articles reporting on amount of PA, and on the kind of activities performed between January 1995-January 2021. Quality of the articles was assessed with the adapted tool from Borghouts et al.

RESULTS: The search retrieved 5029 articles, leading to inclusion of 125 articles reporting data of 123 groups; 53 articles reported on subjects post-THA, 16 on post-hip-resurfacing arthroplasty, 40 on post-TKA, 15 on post-unicompartimental knee arthroplasty and 12 on a mix of arthroplasty types. With respect to quality assessment, 14 articles (11%) met three or fewer criteria, 29 (24%) met four, 32 (26%) met five, 42 (34%) met six, and 6 (5%) met seven out of the eight criteria. PA levels were comparable for THA and TKA, showing a low to moderately active population. Time spent was mostly of low intensity. Roughly 50% of -subjects met health-enhancing PA guidelines. They spent the largest part of their day sedentarily. Sports participation was relatively high (rates above 70%). Most participation was in low-impact sports at a recreational level. Roughly speaking, participants were engaged in sports 3 hours/week, consisting of about three 1-hour sessions.

CONCLUSION: Activity levels seem to be low; less than half of them seemed to perform the advised amount of PA following health-enhancing guidelines Sports participation levels were high. However, many articles were unclear about the definition of sports participation, which could have led to overestimation.

PMID:34962967 | PMC:PMC8714096 | DOI:10.1371/journal.pone.0261784

PLoS One. 2021 Dec 17;16(12):e0261406. doi: 10.1371/journal.pone.0261406. eCollection 2021.

ABSTRACT

BACKGROUND: One of the most influential integrated approaches towards reducing childhood obesity is EPODE, a program that has been translated to over 20 different countries worldwide.

AIM: The goal of this study was to explore how JOGG-the Dutch EPODE adaptation-might reduce overweight prevalence among children.

METHODS: To compare whether overweight prevalence was different in JOGG areas vs. non-JOGG areas, in long-term JOGG areas vs. short-term JOGG areas, and in low SES JOGG areas vs. middle/high SES JOGG areas, secondary anthropometric and personal data of 209,565 Dutch children were mapped onto publicly available JOGG data.

RESULTS: Findings showed that overweight prevalence decreased from 25.17% to 16.08% in JOGG-areas, and from 32.31% to 18.43% in long-term JOGG areas. However, when taking into account SES, the decrease in prevalence was mainly visible in low SES long-term JOGG areas.

CONCLUSION: JOGG appeared to be successful in targeting areas where overweight was most prevalent. Low SES areas that had implemented JOGG for a longer period of time, i.e., six years, appeared to be successful in decreasing overweight prevalence.

PMID:34919583 | PMC:PMC8682899 | DOI:10.1371/journal.pone.0261406

PLoS One. 2021 Dec 17;16(12):e0260870. doi: 10.1371/journal.pone.0260870. eCollection 2021.

ABSTRACT

BACKGROUND: Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors.

METHODS: Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores.

RESULTS: Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001).

CONCLUSION: This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.

PMID:34919552 | PMC:PMC8682881 | DOI:10.1371/journal.pone.0260870

PLoS One. 2021 Dec 16;16(12):e0261089. doi: 10.1371/journal.pone.0261089. eCollection 2021.

ABSTRACT

Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables distal tip steering through proximal instrument bending while retaining high axial and flexural rigidity. Finite element analysis evaluated the design and the prototype was validated in experiments involving tissue simulants and ex-vivo bovine tissue. Ultrasound (US) images were used to provide visualization and shape-reconstruction of the instrument during the insertions. In the experiments lateral tip steering up to 20 mm was found. Manually controlled active needle tip steering in inhomogeneous tissue simulants and ex-vivo tissue resulted in mean targeting errors of 1.4 mm and 2 mm in 3D position, respectively. The experiments show that steering response of the instrument is history-independent. The results indicate that the endpoint accuracy of the steerable instrument is similar to that of the conventional rigid HDR BT needle while adding the ability to steer along curved paths. Due to the design of the steerable needle sufficient axial and flexural rigidity is preserved to enable puncturing and path control within various heterogeneous tissues. The developed instrument has the potential to overcome problems currently unavoidable with conventional instruments, such as pubic arch interference in HDR BT, without major changes to the clinical workflow.

PMID:34914777 | PMC:PMC8675730 | DOI:10.1371/journal.pone.0261089

PLoS One. 2021 Dec 16;16(12):e0261417. doi: 10.1371/journal.pone.0261417. eCollection 2021.

ABSTRACT

The use of clearing agents has provided new insights in various fields of medical research (developmental biology, neurology) by enabling examination of tissue architecture in 3D. One of the challenges is that clearing agents induce tissue shrinkage and the shrinkage rates reported in the literature are incoherent. Here, we report that for a classical clearing agent, benzyl-alcohol benzyl-benzoate (BABB), the shrinkage decreases significantly with increasing sample size, and present an analytical formula describing this.

PMID:34914768 | PMC:PMC8675714 | DOI:10.1371/journal.pone.0261417

PLoS One. 2021 Dec 16;16(12):e0261353. doi: 10.1371/journal.pone.0261353. eCollection 2021.

ABSTRACT

BACKGROUND: Along with mechanical and genetic factors, emerging evidence suggests that the presence of low-grade inflammation has a role in the pathogenesis of osteoarthritis (OA) and seems to be related to the microbiome composition of the gut.

PURPOSE: To provide evidence whether there is clinical or preclinical evidence of gut-joint axis in the pathogenesis and symptoms of OA.

METHODS: An extensive review of the current literature was performed using three different databases. Human, as well as animal studies, were included. The risk of bias was identified using ROBINS and SYRCLE tools, while the quality of evidence was assessed using GRADE and CAMADARES criteria.

RESULTS: A total of nineteen articles were included. Multiple animal studies demonstrated that both obesity, and high-fat and high-sugar diets resulted in a gut dysbiosis status characterized by increased Firmicutes/Bacteroidetes (F/B) phyla ratio and increased permeability. These changes were associated with increased lipopolysaccharide serum levels, which consequently resulted in synovitis and OA severity. The administration of pre-and probiotics partially reversed this bacterial composition. In addition, in human studies, a decreased amount of gut Bacteroidetes, subsequent increased F/B ratio, have also been observed in OA patients.

CONCLUSIONS: Our review confirms preliminary yet sound evidence supporting a gut-joint axis in OA in primarily preclinical models, by showing an association between diet, gut dysbiosis and OA radiological severity and self-reported symptoms. Clinical studies are needed to confirm these findings, and to investigate whether interventions targeting the composition of the microbiome will have a beneficial clinical effect.

PMID:34914764 | PMC:PMC8675674 | DOI:10.1371/journal.pone.0261353

PLoS One. 2021 Dec 16;16(12):e0260256. doi: 10.1371/journal.pone.0260256. eCollection 2021.

ABSTRACT

BACKGROUND AND PURPOSE: Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular).

MATERIALS AND METHODS: We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed.

RESULTS: A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles.

CONCLUSION: For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients' recovery and how we forecast pain chronification.

PMID:34914714 | PMC:PMC8675689 | DOI:10.1371/journal.pone.0260256

PLoS One. 2021 Dec 8;16(12):e0261078. doi: 10.1371/journal.pone.0261078. eCollection 2021.

ABSTRACT

OBJECTIVES: To examine the relation between physical and psychological health indicators at adolescence (age 18) and household, personal, and nursing home care use later in life at ages 57-69 years.

METHODS: Using medical examinations on men born in 1944-1947 who were evaluated for military service at age 18 in the Netherlands, we link physical and psychological health assessments to national administrative microdata on the use of home care services at ages 57-69 years. We postulate a panel probit model for home care use over these years. In the analyses, we account for selective survival through correlated panel probit models.

RESULTS: Poor mental health and being overweight at age 18 are important predictors of later life home care use. Home care use at ages 57-69 years is also highly related to and interacts with father's socioeconomic status and recruits' education at age 18.

DISCUSSION: Specific health characteristics identified at age 18 are highly related to the later utilization of home-care at age 57-69 years. Some characteristics may be amenable to early life health interventions to decrease the future costs of long-term home care.

PMID:34879115 | PMC:PMC8654204 | DOI:10.1371/journal.pone.0261078

PLoS One. 2021 Dec 8;16(12):e0259660. doi: 10.1371/journal.pone.0259660. eCollection 2021.

ABSTRACT

We investigate the market's reactions to serial acquirers that switch strategy. We collect data on 204 serial acquirers in four high tech industries, and use March's explore-exploit framework, to classify these firms' 1,415 acquisitions. We then distinguish, for example, exploration-based acquisitions, conducted after a series of exploitation-based acquisitions. Our results suggest that the market takes a portfolio perspective when reacting to an acquisition. In support of the ambidexterity literature, we show that the market responds positively to a switch from one type of strategy to another. Zooming in on the direction of the shift, we find that the market responds more positively to a switch towards exploration after exploitation, compared with the alternative. In so doing, we contribute to the literature on acquisition motives, by showing that prior announcements matter in explaining market reactions, and we contribute to the literature on ambidexterity, by showing that the market favours firms that oscillate between exploration and exploitation.

PMID:34879073 | PMC:PMC8654236 | DOI:10.1371/journal.pone.0259660

PLoS One. 2021 Dec 2;16(12):e0260705. doi: 10.1371/journal.pone.0260705. eCollection 2021.

ABSTRACT

The process of brain death (BD) detrimentally affects donor lung quality. Ex vivo lung perfusion (EVLP) is a technique originally designed to evaluate marginal donor lungs. Nowadays, its potential as a treatment platform to repair damaged donor lungs is increasingly studied in experimental models. Rat models for EVLP have been described in literature before, yet the pathophysiology of BD was not included in these protocols and prolonged perfusion over 3 hours without anti-inflammatory additives was not achieved. We aimed to establish a model for prolonged EVLP of rat lungs from brain-dead donors, to provide a reliable platform for future experimental studies. Rat lungs were randomly assigned to one of four experimental groups (n = 7/group): 1) healthy, directly procured lungs, 2) lungs procured from rats subjected to 3 hours of BD and 1 hour cold storage (CS), 3) healthy, directly procured lungs subjected to 6 hours EVLP and 4), lungs procured from rats subjected to 3 hours of BD, 1 hour CS and 6 hours EVLP. Lungs from brain-dead rats showed deteriorated ventilation parameters and augmented lung damage when compared to healthy controls, in accordance with the pathophysiology of BD. Subsequent ex vivo perfusion for 6 hours was achieved, both for lungs of healthy donor rats as for pre-injured donor lungs from brain-dead rats. The worsened quality of lungs from brain-dead donors was evident during EVLP as well, as corroborated by deteriorated ventilation performance, increased lactate production and augmented inflammatory status during EVLP. In conclusion, we established a stable model for prolonged EVLP of pre-injured lungs from brain-dead donor rats. In this report we describe tips and pitfalls in the establishment of the rat EVLP model, to enhance reproducibility by other researchers.

PMID:34855870 | PMC:PMC8638921 | DOI:10.1371/journal.pone.0260705

PLoS One. 2021 Nov 18;16(11):e0258946. doi: 10.1371/journal.pone.0258946. eCollection 2021.

ABSTRACT

The lack of standardized language assessment tools in Russian impedes clinical work, evidence-based practice, and research in Russian-speaking clinical populations. To address this gap in assessment of neurogenic language disorders, we developed and standardized a new comprehensive assessment instrument-the Russian Aphasia Test (RAT). The principal novelty of the RAT is that each subtest corresponds to a specific level of linguistic processing (phonological, lexical-semantic, syntactic, and discourse) in different domains: auditory comprehension, repetition, and oral production. In designing the test, we took into consideration various (psycho)linguistic factors known to influence language performance, as well as specific properties of Russian. The current paper describes the development of the RAT and reports its psychometric properties. A tablet-based version of the RAT was administered to 85 patients with different types and severity of aphasia and to 106 age-matched neurologically healthy controls. We established cutoff values for each subtest indicating deficit in a given task and cutoff values for aphasia based on the Receiver Operating Characteristic curve analysis of the composite score. The RAT showed very high sensitivity (> .93) and specificity (> .96), substantiating its validity for determining presence of aphasia. The test's high construct validity was evidenced by strong correlations between subtests measuring similar linguistic processes. The concurrent validity of the test was also strong as demonstrated by a high correlation with an existing aphasia battery. Overall high internal, inter-rater, and test-retest reliability were obtained. The RAT is the first comprehensive aphasia language battery in Russian with properly established psychometric properties. It is sensitive to a wide range of language deficits in aphasia and can reliably characterize individual profiles of language impairments. Notably, the RAT is the first comprehensive aphasia test in any language to be fully automatized for administration on a tablet, maximizing further standardization of presentation and scoring procedures.

PMID:34793469 | PMC:PMC8601577 | DOI:10.1371/journal.pone.0258946

PLoS One. 2021 Nov 12;16(11):e0258416. doi: 10.1371/journal.pone.0258416. eCollection 2021.

ABSTRACT

BACKGROUND: Adolescents' aspirations have potential to influence their present and future well-being. Limited knowledge exists on adolescent girls' aspirations and their determinants, particularly in low-income contexts.

METHODS AND FINDINGS: Using cross-sectional data, collected in 2018 in Nepal, within the Suaahara II Adolescent Panel Survey, (n = 840), adolescent girls' aspirations in several domains-education, occupation, marriage, fertility, health, and nutrition-were described. Regression models were estimated to explore associations between individual, household and community characteristics and these aspirations for all adolescents and separately for younger (10-14 years) and older (15-19 years) girls. Age, school attendance, and self-efficacy, as well as household wealth, caste/ethnicity, size, and agro-ecological zone of residence were significantly associated with aspirations, although effect sizes and significance varied by aspiration domain and age group.

CONCLUSIONS: Findings underscore the curtailing effect of poverty on aspirations and the dynamic nature of aspirations. Initiatives to foster girls' aspirations must address both individual and contextual factors.

PMID:34767580 | PMC:PMC8589221 | DOI:10.1371/journal.pone.0258416

PLoS One. 2021 Nov 8;16(11):e0258588. doi: 10.1371/journal.pone.0258588. eCollection 2021.

ABSTRACT

BACKGROUND: The FI-35 is a valid multidimensional Chinese frailty assessment instrument. Like other scales, functional measures rely on the information the total score provides. Our research aimed to analyze the contribution of each item.

METHODS: Descriptive statistics were used to summarize the sample characteristics. The expected item score (EIS) was used to determine how the items contribute to the generic measure of frailty.

RESULTS: This study showed that most of the EIS curves increased across the entire range of frailty levels, and most of the items discriminate relatively well over the entire frailty range. Items differentially contributed to the total frailty score and differentially discriminated between frailty levels.

CONCLUSIONS: Although nearly all items monotonically increased with frailty levels, there were large differences between items in their ability to differentiate between persons being either weakly, moderately or highly frail.

PMID:34748553 | PMC:PMC8575277 | DOI:10.1371/journal.pone.0258588

PLoS One. 2021 Nov 2;16(11):e0259394. doi: 10.1371/journal.pone.0259394. eCollection 2021.

ABSTRACT

BACKGROUND: Transcutaneous vagal nerve stimulation has analgesic potential and might be elicited by abdominally administered low-frequency vibrations. The objective was to study the safety and effect of a combination of music and abdominally administered low-frequency vibrations on pain intensity in elderly patients with chronic musculoskeletal pain.

METHODS: This trial was an international multicenter, randomized controlled pilot study. Patients at age ≥ 65 years with musculoskeletal pain for ≥ 3 months and a daily pain score ≥ 4 out of 10 were recruited at three centers. They were randomized to receive either a combination of music and low-frequency (20-100 Hz) vibrations administered to the abdomen, or a combination with the same music but with higher frequency (200-300 Hz) vibrations administered to the abdomen. Low-frequency vibrations were expected to result in pain reduction measured with a numeric pain rating scale (NRS). Patients in both groups received eight treatments of the music combined with the vibrations in three weeks. Primary outcomes were safety (Serious Adverse Events) and pain intensity measured at baseline, after the last treatment and at six weeks follow-up. Multilevel linear model analyses were performed to study group and time effects.

RESULTS: A total of 45 patients were analyzed according to intention-to-treat principle. After 344 treatments, 1 Adverse Event was found related to the intervention, while 13 Adverse Events were possibly related. A multilevel linear model showed that the interaction effect of group by time did not predict pain intensity (F[1, 45.93] = 0.002, p = 0.97) when comparing pain intensity at baseline, after the last treatment and at follow-up.

CONCLUSIONS: The combination of music and abdominally administered vibrations was found to be safe and well tolerated by the elderly patients. However, over time, neither the low-frequency treatment group nor the high-frequency treatment group provided clinically meaningful pain relief. There is no evidence that the low-frequency treatment elicited vagal nerve stimulation.

TRIAL REGISTRATION: The trial was prospectively registered in the Netherlands Trial Register (NTR: NL7606) on 21-03-2019.

PMID:34727128 | PMC:PMC8562790 | DOI:10.1371/journal.pone.0259394

PLoS One. 2021 Oct 20;16(10):e0256740. doi: 10.1371/journal.pone.0256740. eCollection 2021.

ABSTRACT

During the initial phase of the COVID-19 pandemic, U.S. conservative politicians and the media downplayed the risk of both contracting COVID-19 and the effectiveness of recommended health behaviors. Health behavior theories suggest perceived vulnerability to a health threat and perceived effectiveness of recommended health-protective behaviors determine motivation to follow recommendations. Accordingly, we predicted that-as a result of politicization of the pandemic-politically conservative Americans would be less likely to enact recommended health-protective behaviors. In two longitudinal studies of U.S. residents, political conservatism was inversely associated with perceived health risk and adoption of health-protective behaviors over time. The effects of political orientation on health-protective behaviors were mediated by perceived risk of infection, perceived severity of infection, and perceived effectiveness of the health-protective behaviors. In a global cross-national analysis, effects were stronger in the U.S. (N = 10,923) than in an international sample (total N = 51,986), highlighting the increased and overt politicization of health behaviors in the U.S.

PMID:34669724 | PMC:PMC8528320 | DOI:10.1371/journal.pone.0256740

PLoS One. 2021 Oct 15;16(10):e0258330. doi: 10.1371/journal.pone.0258330. eCollection 2021.

ABSTRACT

BACKGROUND: Null Hypothesis Significance Testing (NHST) is the most familiar statistical procedure for making inferences about population effects. Important problems associated with this method have been addressed and various alternatives that overcome these problems have been developed. Despite its many well-documented drawbacks, NHST remains the prevailing method for drawing conclusions from data. Reasons for this have been insufficiently investigated. Therefore, the aim of our study was to explore the perceived barriers and facilitators related to the use of NHST and alternative statistical procedures among relevant stakeholders in the scientific system.

METHODS: Individual semi-structured interviews and focus groups were conducted with junior and senior researchers, lecturers in statistics, editors of scientific journals and program leaders of funding agencies. During the focus groups, important themes that emerged from the interviews were discussed. Data analysis was performed using the constant comparison method, allowing emerging (sub)themes to be fully explored. A theory substantiating the prevailing use of NHST was developed based on the main themes and subthemes we identified.

RESULTS: Twenty-nine interviews and six focus groups were conducted. Several interrelated facilitators and barriers associated with the use of NHST and alternative statistical procedures were identified. These factors were subsumed under three main themes: the scientific climate, scientific duty, and reactivity. As a result of the factors, most participants feel dependent in their actions upon others, have become reactive, and await action and initiatives from others. This may explain why NHST is still the standard and ubiquitously used by almost everyone involved.

CONCLUSION: Our findings demonstrate how perceived barriers to shift away from NHST set a high threshold for actual behavioral change and create a circle of interdependency between stakeholders. By taking small steps it should be possible to decrease the scientific community's strong dependence on NHST and p-values.

PMID:34653185 | PMC:PMC8519469 | DOI:10.1371/journal.pone.0258330

PLoS One. 2021 Oct 13;16(10):e0258337. doi: 10.1371/journal.pone.0258337. eCollection 2021.

ABSTRACT

BACKGROUND: Healthcare purchasers such as health insurers and governmental bodies are expected to strategically manage chronic care chains. In doing so, purchasers can contribute to the goal of improving task division and collaboration between chronic care providers as has been recommended by numerous studies. However, healthcare purchasing research indicates that, in most countries, purchasers still struggle to fulfil a proactive, strategic approach. Consequently, a typical pattern occurs in which care improvement initiatives are instigated, but not transformed into regular care. By acknowledging that healthcare purchasers are embedded in a care chain of stakeholders who have different, sometimes conflicting, interests and, by taking an institutional logics lens, we seek to explain why achieving strategic purchasing and sustainable improvement is so elusive.

METHOD AND FINDINGS: We present a longitudinal case study in which we follow a health insurer and care providers aiming to improve the care of patients with Chronic Obstructive Pulmonary Disease (COPD) in a region of the Netherlands. Taking a theoretical lens of institutional logics, our aim was to answer 'how stakeholder pressures influence a purchaser's use of institutional logics when pursuing the right care at the right place'. The insurer by default predominantly expressed a bookkeeper's logic, reflecting a focus on controlling short-term care costs by managing individual providers. Over time, a contrasting orchestrator's logic emerged in an attempt to achieve chain-wide improvement, striving for better health outcomes and lower long-term costs. We established five types of stakeholder pressure to explain the shift in logic adoption: relationship pressures, cost pressures, medical demands, public health demands and uncertainty. Linking the changes in logic over time with stakeholder pressures showed that, firstly, the different pressures interact in influencing the purchaser. Secondly, we saw that the lack of intra-organisational alignment affects how the purchaser deals with the different stakeholder pressures.

CONCLUSIONS: By highlighting the purchaser's difficult position in the care chain and the consequences of their own internal responses, we now better understand why the intended orchestrator's logic and thereby a strategic approach to purchasing chronic care proves unsustainable within the Dutch healthcare system of managed competition.

PMID:34644324 | PMC:PMC8513887 | DOI:10.1371/journal.pone.0258337

PLoS One. 2021 Oct 7;16(10):e0257922. doi: 10.1371/journal.pone.0257922. eCollection 2021.

ABSTRACT

Exporting is a central growth strategy for most firms and managers with international experience are instrumental for export decisions. We suggest that such managers can be hired from Multinational Corporations (MNCs). We integrate theory from strategic human capital research into models explaining export decisions. We theorize that hiring managers from MNCs increases the odds of domestic firms to start exporting and this effect depends on the similarities between hiring firms and MNCs. We hypothesize that young firms will benefit comparatively less from hiring MNC managers. In contrast, firms with internationally diverse workforces and with high degrees of hierarchical specialization will benefit the most from hiring MNC managers. We test and support these hypotheses for 474,926 domestic firms in Sweden, which we observe between 2007 and 2015.

PMID:34618860 | PMC:PMC8496813 | DOI:10.1371/journal.pone.0257922

PLoS One. 2021 Sep 17;16(9):e0256860. doi: 10.1371/journal.pone.0256860. eCollection 2021.

ABSTRACT

BACKGROUND: Anti-tumour necrosis factor alpha (TNFα) therapy is widely used in the management of Crohn's disease (CD) and ulcerative colitis (UC). However, up to a third of patients do not respond to induction therapy and another third of patients lose response over time. To aid patient stratification, polygenetic risk scores have been identified as predictors of response to anti-TNFα therapy. We aimed to replicate the association between polygenetic risk scores and response to anti-TNFα therapy in an independent cohort of patients, to establish its clinical validity.

MATERIALS AND METHODS: Primary non-response, primary response, durable response and loss of response to anti-TNFα therapy was retrospectively assessed for each patient using stringent definitions. Genome wide genotyping was performed and previously described polygenetic risk scores for primary non-response and durable response were calculated. We compared polygenetic risk scores between patients with primary response and primary non-response, and between patients with durable response and loss of response, using separate analyses for CD and UC.

RESULTS: Out of 334 patients with CD, 15 (4%) patients met criteria for primary non-response, 221 (66%) for primary response, 115 (34%) for durable response and 35 (10%) for loss of response. Out of 112 patients with UC, 12 (11%) met criteria for primary non-response, 68 (61%) for primary response, 19 (17%) for durable response and 20 (18%) for loss of response. No significant differences in polygenetic risk scores were found between primary non-responders and primary responders, and between durable responders and loss of responders.

CONCLUSIONS: We could not replicate the previously reported association between polygenetic risk scores and response to anti-TNFα therapy in an independent cohort of patients with CD or UC. Currently, there is insufficient evidence to use polygenetic risk scores to predict response to anti-TNFα therapy in patients with IBD.

PMID:34534227 | PMC:PMC8448323 | DOI:10.1371/journal.pone.0256860

PLoS One. 2021 Sep 15;16(9):e0256251. doi: 10.1371/journal.pone.0256251. eCollection 2021.

ABSTRACT

This paper describes a randomized controlled trial on the Online Life Story Book (OLSB), a digital reminiscence intervention for people with (very) mild dementia living at home. The aim of the study was to investigate the effectiveness of the OLSB on (i) neuropsychiatric symptoms (NPS) in persons with dementia and (ii) the distress and quality of life (QOL) of primary informal caregivers. A randomized controlled trial with individual randomization to one of two conditions was conducted: 1) intervention "Online Life Story Book"; 2) wait list control condition. In the intervention OLSB, a trained volunteer guided the participants through the process of creating an OLSB in approximately 5 meetings within a period of 8-10 weeks. Participants in the control condition received care as usual while they waited for 6 months before starting. Outcomes on NPS and distress and QOL of the informal caregiver were assessed at baseline (baseline, T0), 3 months (T1) and 6 months (T2) post baseline. Of the 42 persons with dementia, 23 were female and 19 were male. They had a mean age of 80 years, ranging from 49 to 95. The total drop-out rate was 14.3 percent. Small but insignificant effects on NPS, caregiver distress and QOL of caregivers were found with the exception of self-rated caregiver distress that reduced significantly during the intervention. One reason to explain the results might be that the included participants were in relatively good health. Practical challenges during the intervention could have affected the results as well. It might also be that the intervention caused effects on other outcomes than NPS and caregiver distress. In future research, it is important to study the effects in persons with more complaints and higher distress and to be careful in the selection of outcome variables in relation to the reminiscence functions served by the intervention.

PMID:34525105 | PMC:PMC8443059 | DOI:10.1371/journal.pone.0256251

PLoS One. 2021 Sep 10;16(9):e0256295. doi: 10.1371/journal.pone.0256295. eCollection 2021.

ABSTRACT

BACKGROUND: Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya.

METHODS: We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services.

RESULTS: The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15-24 years (aOR = 0.69, 95% CI = 0.56-0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33-0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44-0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65-0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42-2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03-1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively.

CONCLUSION: The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.

PMID:34506509 | PMC:PMC8432739 | DOI:10.1371/journal.pone.0256295

PLoS One. 2021 Sep 2;16(9):e0256919. doi: 10.1371/journal.pone.0256919. eCollection 2021.

ABSTRACT

Structured protocols offer a transparent and systematic way to elicit and combine/aggregate, probabilistic predictions from multiple experts. These judgements can be aggregated behaviourally or mathematically to derive a final group prediction. Mathematical rules (e.g., weighted linear combinations of judgments) provide an objective approach to aggregation. The quality of this aggregation can be defined in terms of accuracy, calibration and informativeness. These measures can be used to compare different aggregation approaches and help decide on which aggregation produces the "best" final prediction. When experts' performance can be scored on similar questions ahead of time, these scores can be translated into performance-based weights, and a performance-based weighted aggregation can then be used. When this is not possible though, several other aggregation methods, informed by measurable proxies for good performance, can be formulated and compared. Here, we develop a suite of aggregation methods, informed by previous experience and the available literature. We differentially weight our experts' estimates by measures of reasoning, engagement, openness to changing their mind, informativeness, prior knowledge, and extremity, asymmetry or granularity of estimates. Next, we investigate the relative performance of these aggregation methods using three datasets. The main goal of this research is to explore how measures of knowledge and behaviour of individuals can be leveraged to produce a better performing combined group judgment. Although the accuracy, calibration, and informativeness of the majority of methods are very similar, a couple of the aggregation methods consistently distinguish themselves as among the best or worst. Moreover, the majority of methods outperform the usual benchmarks provided by the simple average or the median of estimates.

PMID:34473784 | PMC:PMC8412308 | DOI:10.1371/journal.pone.0256919