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Background: The advent of remote and unsupervised digital cognitive assessment facilitates the use of frequent assessments only days apart to examine learning rates. Learning rates have been shown to differentiate patients with Mild Cognitive Impairment (MCI) and preclinical Alzheimer's disease (AD) from healthy individuals across a variety of cognitive measures. Here, we investigated whether impairments in learning rates in a mnemonic discrimination task were domain specific, as object and scene memory have been found to rely on anatomically distinct neural pathways that are differentially affected by AD. Methods: We examined learning rates over two weeks in the Mnemonic Discrimination Task for Objects and Scenes (MDT‐OS) in N = 54 older adults (age = 67.1 ± 5.68) recruited through a memory clinic who were clinically cognitively unimpaired (CU, n = 44, nAβ– = 28, nAβ+ = 6) or had MCI (n = 10, nAβ– = 3, nAβ+ = 7). Five identical stimuli sets were completed at three‐day intervals on participants' own smartphone or tablet. Results: Using linear mixed modeling, we found significant cognitive status‐by‐time interactions indicating that the MCI group showed reduced learning compared to the CU group in the Scene condition, though not the Object condition. However, a cognitive status‐by‐time‐by‐condition model indicated no significant effect of condition. We found no significant Aβ status‐by‐time interaction in either condition. However, an Aβ status‐by‐time‐by‐condition model revealed diminished learning in the Scene condition compared to the Object condition for the Aβ+ group but not the Aβ– group. In a sub‐group analysis including only CU individuals, this three‐way interaction effect remained significant. Conclusion: The current results suggest that individuals with MCI show diminished learning rates in mnemonic discrimination of scenes, compared to CU individuals. We identified ceiling effects in the Object condition, which may have contributed to a null finding. Additionally, we found that Aβ positivity was associated with reduced learning of scenes but not objects, both in the overall sample and in individuals with no clinical indication of cognitive impairment. In conclusion, learning rates in the MDT‐OS may be a sensitive marker of AD in individuals who do not yet meet the clinical threshold for cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Traditional pen‐and‐paper neuropsychological assessments fail to capture subtle cognitive changes in the early stages of Alzheimer's disease (AD). Remote and unsupervised digital assessments available on smartphones, tablets, and personal computers may offer a solution to this by increasing the amount and types of data available to researchers and clinicians, while simultaneously improving ecological validity and alleviating patient burden. As these remote and unsupervised digital cognitive assessment tools become more widely available, it is important that they are validated in a systematic way. In this review, we evaluate the validity of available remote tools, focusing on active assessment tools with which the patient interacts with (i.e., cognitive tests, active speech) that have been used to investigate subtle cognitive differences in preclinical AD, defined as clinically unimpaired individuals with biomarkers indicating increased risk of dementia due to AD. Methods: We performed a systematic literature review on PubMed, Web of Science, and PsycInfo using terms such as "digital," "remote," "unsupervised," "cognition," "aging," and "Alzheimer's," which resulted in a total of 1,453 unique peer‐reviewed articles and pre‐prints. After filtering for tools that were remotely self‐administered in humans, and excluding papers detailing findings in populations with other diseases than AD (e.g., multiple sclerosis, Parkinson's disease) or papers reporting findings of intervention studies, 14 papers reporting the use or planned use of 14 tools to detect AD pathology in preclinical AD were selected (as of Jan. 2024). Results: We evaluate each tool with regards to its use‐case and usability, as well as various types of validity, and suggest a framework with which future tools may also be evaluated. Additionally, we discuss current directions in the field of remote and unsupervised digital cognitive assessment in early AD. Conclusion: With this review, we hope to show that the systematic and validated use of such tools will increase our understanding of subtle changes in cognition due to AD pathology, as well as make screening for clinical trials and treatment more accessible. [ABSTRACT FROM AUTHOR]

Objective: To describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). Methods: Prescriptions by OMFS were identified from IQVIA Longitudinal Prescription Dataset, 2016–2019. OMFS‐based, patient‐based and population‐based prescribing rates and changes in high‐risk opioid prescribing were calculated annually. We used linear regression to describe trends. Results: There were 13.9 million opioid prescriptions among 12.5 million patients (627 prescriptions/OMFS/year). Hydrocodone and oxycodone decreased by 20.9% and 39.2% (p < 0.05), while tramadol and codeine increased by 24.3% and 6.1% (p < 0.05), respectively. Opioid prescribing rates significantly decreased by 27 prescriptions/OMFS/year, 18.6 patients/OMFS/year and by 0.9 prescriptions/100,000 population/year (p < 0.05 for all). From 2016 to 2019, the proportion of opioids >3 days decreased by 54.2% (p < 0.05) and prescriptions ≥50 MME/day decreased by 66.3% (p < 0.05). Although the number of opioid prescriptions by OMFS decreased in most states, 12% of states experienced increases. Conclusion: Opioid prescribing, especially high‐risk prescribing, by OMFS has decreased. However, targeted interventions are warranted in some areas. [ABSTRACT FROM AUTHOR]

We investigate the reliability of individual differences of four quantities measured by magnetic resonance imaging‐based multiparameter mapping (MPM): magnetization transfer saturation (MT), proton density (PD), longitudinal relaxation rate (R1), and effective transverse relaxation rate (R2*). Four MPM datasets, two on each of two consecutive days, were acquired in healthy young adults. On Day 1, no repositioning occurred and on Day 2, participants were repositioned between MPM datasets. Using intraclass correlation effect decomposition (ICED), we assessed the contributions of session‐specific, day‐specific, and residual sources of measurement error. For whole‐brain gray and white matter, all four MPM parameters showed high reproducibility and high reliability, as indexed by the coefficient of variation (CoV) and the intraclass correlation (ICC). However, MT, PD, R1, and R2* differed markedly in the extent to which reliability varied across brain regions. MT and PD showed high reliability in almost all regions. In contrast, R1 and R2* showed low reliability in some regions outside the basal ganglia, such that the sum of the measurement error estimates in our structural equation model was higher than estimates of between‐person differences. In addition, in this sample of healthy young adults, the four MPM parameters showed very little variability over four measurements but differed in how well they could assess between‐person differences. We conclude that R1 and R2* might carry only limited person‐specific information in some regions of the brain in healthy young adults, and, by implication, might be of restricted utility for studying associations to between‐person differences in behavior in those regions. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study is to determine whether alumni who completed training in the Center for Patients with Special Needs (CPSN) feel more prepared and treat more patients with special healthcare needs (SHCN) than alumni who completed training prior to the establishment of the Center (pre-CPSN).Methods: Alumni graduating in 2000-2017 from the University of Pittsburgh School of Dental Medicine (Pitt Dental Medicine) completed a survey addressing how well their dental school training prepared them to treat patients with SHCN and their current practice patterns as dental professionals. Alumni completed self-reported questionnaires online or on paper by mail.Results: The authors obtained a 16% response rate (N = 209; nPre-CPSN = 75; nCPSN = 134). Compared with the pre-CPSN alumni, CPSN alumni reported feeling more prepared in all 12 skills surveyed (t = 4.86, P < 0.05). There was a 0.85-point difference between groups, on average, across the 12 skills. However, CPSN alumni were no more likely to treat individuals with SHCN than the pre-CPSN alumni.Conclusions: Information obtained from this survey supports the hypothesis that experience is associated with perceptions of preparedness and raises new questions about factors associated with deciding whether to treat or refer. This information may inform schools of the amount of training necessary to reach preparedness goals. [ABSTRACT FROM AUTHOR]

We describe a co-flow structure that models internal, goal-directed changes to an attribute (e.g., employee loyalty) of fundamental material (e.g., employees). This co-flow accommodates problems not adequately modeled with an existing, generic structure. Our structure builds on the co-flow proposed by Hines, which uses an information delay to model external change to an attribute. We use a first-order information delay to model both external changes to the attribute from the material stock and internal changes from an internal goal for the attribute. We provide an exact, dynamic solution for this co-flow enabling us to precisely describe its equilibrium and non-equilibrium behavior. Several examples are provided and discussed, including a situation where a management program is designed to increase average employee loyalty. In addition, we review applications of traditional and Hines co-flow structures to provide background and to describe our evolutionary path towards design of the new co-flow. Copyright © 2017 System Dynamics Society [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there is an Appalachian disparity in caries prevalence or extent in children living in Pennsylvania. Methods We conducted a cross-sectional clinical assessment of caries in a sample representing 1st, 3rd, 9th, and 11th grade students across Pennsylvania. We used logistic regression and zero-inflated negative binomial regression controlling for age to examine the association of residence in an Appalachian county with caries prevalence and extent in the primary and permanent dentitions. Results Compared with children living outside Appalachia, more children living in Appalachia had a dft >0 ( OR = 1.37, 95% CI = 1.07-1.76) and more had a DMFT >0 ( OR = 1.32, 95% CI = 1.06-1.64). In addition, compared with children living outside Appalachia, children living in Appalachia had a greater primary but not permanent caries extent ( IRR = 1.10, 95% CI = 1.01-1.19). Conclusions We found Appalachian disparities in caries prevalence in both the primary and permanent dentitions and an Appalachian disparity in caries extent in the primary dentition. None of the disparities was moderated by age. This suggests that the search for the mechanism or mechanisms for the Appalachian disparities should focus on differential exposures to risk factors occurring prior to and at the start of elementary school. [ABSTRACT FROM AUTHOR]

Objectives Dental caries of the permanent dentition is a multifactorial disease resulting from the complex interplay of endogenous and environmental risk factors. The disease is not easily quantitated due to the innumerable possible combinations of carious lesions across individual tooth surfaces of the permanent dentition. Global measures of decay, such as the DMFS index (which was developed for surveillance applications), may not be optimal for studying the epidemiology of dental caries because they ignore the distinct patterns of decay across the dentition. We hypothesize that specific risk factors may manifest their effects on specific tooth surfaces leading to patterns of decay that can be identified and studied. In this study, we utilized two statistical methods of extracting patterns of decay from surface-level caries data to create novel phenotypes with which to study the risk factors affecting dental caries. Methods Intra-oral dental examinations were performed on 1068 participants aged 18-75 years to assess dental caries. The 128 tooth surfaces of the permanent dentition were scored as carious or not and used as input for principal components analysis ( PCA) and factor analysis ( FA), two methods of identifying underlying patterns without a priori knowledge of the patterns. Demographic (age, sex, birth year, race/ethnicity, and educational attainment), anthropometric (height, body mass index, waist circumference), endogenous (saliva flow), and environmental (tooth brushing frequency, home water source, and home water fluoride) risk factors were tested for association with the caries patterns identified by PCA and FA, as well as DMFS, for comparison. The ten strongest patterns (i.e. those that explain the most variation in the data set) extracted by PCA and FA were considered. Results The three strongest patterns identified by PCA reflected (i) global extent of decay (i.e. comparable to DMFS index), (ii) pit and fissure surface caries and (iii) smooth surface caries, respectively. The two strongest patterns identified by FA corresponded to (i) pit and fissure surface caries and (ii) maxillary incisor caries. Age and birth year were significantly associated with several patterns of decay, including global decay/ DMFS index. Sex, race, educational attainment, and tooth brushing were each associated with specific patterns of decay, but not with global decay/ DMFS index. Conclusions Taken together, these results support the notion that caries experience is separable into patterns attributable to distinct risk factors. This study demonstrates the utility of such novel caries patterns as new outcomes for exploring the complex, multifactorial nature of dental caries. [ABSTRACT FROM AUTHOR]

Study Objectives To determine the proportion of hospitalized adults with hospital-onset Clostridium difficile infection ( CDI) who continued to receive concomitant non-CDI antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of CDI, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after CDI diagnosis. Design Retrospective cohort study. Data Source Drug use and administrative discharge data from 42 United States academic medical centers. Patients A total of 5968 adult inpatients with hospital-onset CDI between January 1, 2002, and June 30, 2006. Measurements and Main Results We characterized patient-level antibacterial agent use before and after CDI diagnosis. Overall, 3479 patients (58.3%) continued antibacterial therapy for 2 or more days after CDI diagnosis (interhospital range 6.7-72.2%). Although the number of different antibacterial agents received in the week preceding CDI diagnosis was positively associated with continued antibacterial therapy, the relationship between continuation and severity of illness was statistically significant but nonlinear. Patients who were receiving oral vancomycin alone were less likely to have antibacterial therapy continued (28/61 patients [45.9%]) than patients receiving metronidazole alone (1154/2333 patients [49.5%]) or receiving both metronidazole and oral vancomycin (2297/3576 [64.2%]). After adjusting for confounders, patients who continued to receive antibacterial therapy had a 62.7% (95% confidence interval [ CI] 48.6-78.0%, p<0.001) longer length of hospital stay after CDI diagnosis than those who did not continue therapy; the adjusted odds of mortality and odds of readmission were 1.7 (95% CI 1.4-2.1, p<0.001) and 1.2 (95% CI 1.1-1.5, p=0.025) times higher, respectively, with continued antibacterial therapy. Conclusion A majority of patients with CDI continued to receive antibacterial agents after their CDI diagnosis, although the interhospital range was large. Compared with patients who did not continue therapy, hospital length of study, mortality, and subsequent admissions among patients who continued their antibacterial therapy remained significantly higher after adjusting for confounders. The adverse outcomes associated with continued therapy likely reflect the severity of the underlying primary infection and/or a poorer response to CDI therapy, suggesting an opportunity for antimicrobial stewardship programs to make important contributions to patient care. [ABSTRACT FROM AUTHOR]

Hospitals are implementing antimicrobial stewardship programs ( ASPs) in response to national guidelines to improve the use and to extend the utility of antiinfective drugs. An often implied purpose of ASPs is to curb or reverse the emergence of resistant bacteria. Because antibiotic use causes antibiotic resistance, there is a natural tendency to link local measures of antibiotic use to local measures of bacterial resistance, and the hospital antibiogram is a readily available measure of resistance. We performed a literature review to identify published reports that used hospitalwide and unit-specific antibiograms to assess the relationship of ASP interventions to changes in resistance. Eight studies were identified and reviewed. The relationship between hospital antibiotic use and resistance is complex, and the existing literature has several limitations. Furthermore, the antibiogram itself is neither designed nor well suited to reflect changes in hospital antimicrobial drug use. The literature on the effectiveness of ASPs in reducing resistance continues to emerge, but at this time the antibiogram bears an inconsistent relationship with changes in hospital antibiotic use and cannot be recommended to reliably evaluate an ASP intervention. Interrupted time series analysis is a superior strategy to assess the effect of an ASP intervention on bacterial resistance, but it is not widely used because of its complexity and greater data requirements. Nevertheless, before ASP efforts can be convincingly demonstrated to have a favorable impact on resistance, a more sophisticated approach that links drug use to resistance should become a priority, at least for hospitals that have sufficient resources. [ABSTRACT FROM AUTHOR]

Study Objective. To assess the economic impact of Clostridium difficile infection (CDI) in a large multihospital cohort. Design. Retrospective case-control study. Data Source. Administrative claims data from 45 academic medical centers. Patients. A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-associated CDI (19,214 controls). Measurements and Main Results. Patients with health care-associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined-Diagnosis Related Group (APR-DRG) severity of illness level, race, and sex with use of multivariable linear regression. The adjusted mean cost for cases was significantly higher than that for controls ($55,769 vs $28,609), and adjusted mean length of stay was twice as long (21.1 vs 10.0 days). The interaction between CDI and APR-DRG severity of illness level was significant; the effect of CDI on costs and length of stay decreased as severity of illness increased. Conclusion. This large CDI economic evaluation confirms that health care-associated cases of CDI are associated with significantly higher mean cost and longer length of stay than those of matched controls, with the greatest effect on costs at the lowest level of severity of illness. [ABSTRACT FROM AUTHOR]

Polk DE, Weyant RJ, Manz MC. Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions? Community Dent Oral Epidemiol 2010; 38: 1–9. © 2009 John Wiley & Sons A/S Objectives: To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. Methods: A cross-sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). Results: Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. Conclusions: There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES-associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES-associated disparities occur. [ABSTRACT FROM AUTHOR]

Study Objective. To measure diversity (or heterogeneity) of antibiotic use in a sample of hospitals in the United States and to assess an association with bacterial resistance. Design. Observational cross-sectional study. Setting. Forty-two general medical-surgical hospitals, mostly in the Eastern United States. Data Source. Administrative claims data and hospital antibiograms during 2003. Measurements and Main Results. Antibiotic use was measured by defined daily dose (DDD), and diversity was assessed by using Simpson's Index and the Shannon-Weiner Index. Aggregated antibiograms (from 17 hospitals) were used to assess resistance. There were a total of 3,655,579 patient-days during 2003, with a mean ± SD of 87, 037 ± 62,679 patient-days/hospital. Mean ± SD antibiotic use was 704 ± 244 DDD/1000 patient-days/hospital, and fluoroquinolones represented the largest single class. Mean ± SD diversity by Simpson's Index was 0.861 ± 0.022/hospital, and a strong correlation was noted between the two diversity measures. Multivariate analysis found no significant relationship between diversity and the proportion of resistant pathogens. Conclusion. Diversity of aggregate antibiotic use can be measured, but additional investigations are needed to determine if it is a useful strategy to contain resistance. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the metabolic profile, routes of elimination, and total recovery of amprenavir and its metabolites after a single oral dose of [14C]-amprenavir. Six healthy male subjects each received a single oral 630 mg dose of amprenavir containing 95.76 µCi of [14C]-amprenavir in this Phase I mass balance study. The metabolic disposition of amprenavir was determined through analyses of radiocarbon in whole blood, plasma, urine, and stool samples, collected for a period of 10 to 17 days postdosing. Cerebral spinal fluid (CSF) sampling was conducted on day 1. The ratio of unchanged amprenavir AUC0→ to plasma radiocarbon was 27%, suggesting that most of the radiocarbon was metabolites. The median total recovery of the administered dose of radiocarbon was 89% (range: 66%-93%), with 75% (range: 56%-80%) recovered in the feces and 14% (range: 10%-17%) in the urine. Most of the recovered radiocarbon in the feces and urine was excreted within 240 and 48 hours postdose, respectively. Of the 75% of the radiocarbon dose recovered in the feces, 62% was identified as a metabolite resulting from dioxidation of the tetrahydrofuran ring (GW549445X) and 32% as a metabolite resulting from subsequent oxidation of the p-aniline sulfonate group (GW549444X). Unchanged amprenavir was below the limit of quantitation in feces and urine. Therefore, approximately 94% of the dose excreted in the feces was accounted for by these two metabolites. Concentrations of radiocarbon in the CSF were below the limit of quantitation in 5 of 6 subjects sampled. In summary, oral amprenavir is extensively metabolized in humans, with concentrations of unchanged drug below the limits of quantitation in urine and feces. The majority (75%) of administered radiocarbon was excreted in feces. [ABSTRACT FROM PUBLISHER]

The article presents a study, conducted by the authors, which investigated what cautions psychologists should take while using the abbreviated forms of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). In assessing mental retardation, psychologists are frequently called on to administer and interpret some type of intellectual measure. The WAIS-R is often used for such assessment purposes, particularly for individuals who are in the mild range of retardation. The WAIS-R can require approximately 30-45 minutes to administer when assessing a mildly mentally retarded individual. Due to increasing service demands and a desire to deliver valid, efficient services, psychologists sometimes use abbreviated forms of the Wechsler scales to assess the mentally retarded.