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Free-listing is a quick, semi-quantitative methodology commonly used by anthropologists to uncover information within a cultural domain. In this method note, we review how anthropologists have used free-listing in a variety of research settings. We then apply the social-ecological framework to describe how free-listing can be used for formative, process, outcome, and impact stages of program evaluation. Each type of evaluation includes a set of example free-list prompts to help researchers begin using this tool. We propose that free-listing is a beneficial data collection method in program evaluation. The free-listing method has identified barriers to treatment within our own work with clients recovering from either substance use disorder or opioid use disorder and has aided in providing flexible, individualized services. We conclude by providing recommendations for collecting free-list data and demonstrating the ease of computing free-list results by providing instructions and an example on how to analyze free-list responses.

Transient stress lymphocytosis (TSL) is an under-recognized phenomenon associated with an acute stressful event such as physical trauma or various emergency medical conditions. Lymphocytosis generally resolves within several hours to days of the stressor. While most reports of TSL predominantly involve adult patients, it has only rarely been reported in pediatric patients. Here, we describe the clinical course of a 9-year-old male who developed TSL following a traumatic fall from a second-story balcony and provide a systematic literature review of TSL.

Abstract Physical activity offers numerous physical and mental health benefits for individuals with disabilities, while nutrition plays a crucial role in maintaining bodily homeostasis. This study aimed to assess the relationship between body composition and dietary habits among physically active people with disabilities. Fifty-five participants aged 16 to 61, including 28 with disabilities and 27 without, were included in the study. The FFQ-6 questionnaire, Tanita body composition analyzer, and Stadiometer were utilized. No significant differences in BMI were observed between the two groups. However, individuals with disabilities showed higher body fat, metabolic age, or pulse values, whereas the control group exhibited higher muscle mass, muscle quality, body type, or bone mass. Participants with disabilities were more likely to consume vegetables (p = 0.004) and animal fats (p = 0.027), while those without disabilities were more inclined to consume fast food, instant products (p = 0.006), sweetened beverages (p

When interacting with infants, humans often alter their speech and song in ways thought to support communication. Theories of human child-rearing, informed by data on vocal signalling across species, predict that such alterations should appear globally. Here, we show acoustic differences between infant-directed and adult-directed vocalizations across cultures. We collected 1,615 recordings of infant- and adult-directed speech and song produced by 410 people in 21 urban, rural and small-scale societies. Infant-directedness was reliably classified from acoustic features only, with acoustic profiles of infant-directedness differing across language and music but in consistent fashions. We then studied listener sensitivity to these acoustic features. We played the recordings to 51,065 people from 187 countries, recruited via an English-language website, who guessed whether each vocalization was infant-directed. Their intuitions were more accurate than chance, predictable in part by common sets of acoustic features and robust to the effects of linguistic relatedness between vocalizer and listener. These findings inform hypotheses of the psychological functions and evolution of human communication.

Acne vulgaris is the most common dermatosis among adolescents, but it can also affect adults. Acne lesions located on the face cause discomfort and lead to impaired quality of life for many patients. Acne is a dermatological condition with multiple causes and clinical manifestations, as well as varying degrees of severity. Dermatological treatment alone does not always bring good therapeutic effects, and occasionally it may result in symptoms of skin irritation. Therefore, using appropriate dermocosmetics is crucial in managing the condition. Dermocosmetics play a potentially important role in minimizing the adverse effects of acne medications, providing a synergistic effect by addressing other acne-causing factors and/or enhancing the efficacy of other treatment modalities, and protecting the skin against the adverse impacts of the exposome. In cases of mild acne, dermocosmetics can be used in monotherapy as an alternative to acne medications or for maintenance therapy. It is also advisable to combine dermocosmetics with topical or systemic therapies to achieve a synergistic effect or to prevent and reduce drug-induced adverse reactions. Dermocosmetics have keratolytic and anti-inflammatory properties, regulate sebum production, and help maintain the balance of the skin’s natural microbiome.

Frontotemporal Dementia (FTD) encompasses a diverse group of progressive neurodegenerative diseases that impact speech production and comprehension, higher-order cognition, behavior, and motor control. Traditional acoustic speech markers have been extensively studied in FTD, as have assessments capturing apathy and impairments in recognizing and expressing emotion. This work leverages machine learning to track changes in emotional content within the speech of individuals with FTD and healthy controls. The aim of the project is to develop tools for assessing and monitoring emotional changes in individuals with FTD, quantifying these subtle aspects of the disease and thus potentially providing insights for assessing future therapeutic interventions. A retrospective analysis was conducted on a dataset comprising standard elicited speech tasks performed by 78 individuals diagnosed with FTD and 55 healthy elderly controls. We employed an ensemble-based convolutional neural network (CNN) classifier trained on the Interactive Emotional Dyadic Motion Capture (IEMOCAP) dataset to extract emotion scores from processed speech samples. The classifier was applied with a sliding window to the FTD and healthy control narratives to facilitate a granular examination of emotional changes throughout longer speech samples. Analysis of variance (ANOVA) was used to test for group differences in average emotion scores as well as emotional variability over the duration of the speech samples. Compared to healthy controls, people with FTD demonstrated reduced emotional change in a monologue task describing a happy experience, as measured by the interquartile range (IQR) (p ¡ 0.005) and slope of “happy” emotion scores vs. time (p ¡ 0.005). During a picture description task, people with FTD displayed a slightly elevated average level of frustration (p ¡ 0.005). Increased frustration levels in individuals with FTD could potentially indicate their difficulties in accomplishing the task. This study introduced the application of a pre-trained Speech Emotion Recognition (SER) model on overlapping short segments of extended speech samples, allowing for a detailed examination of emotional changes over time. Capturing the temporal evolution of emotional content offers a nuanced understanding of communication in individuals with FTD. Our findings lay the groundwork for further development of digital biomarkers to refine the assessment, monitoring, and understanding of the emotional and social communication impacts of FTD.

Abstract Background The primary aim was to explore the concept of isolated and combined threshold-insults for brain tissue oxygenation (pbtO2) in relation to outcome in traumatic brain injury (TBI). Methods A total of 239 TBI patients with data on clinical outcome (GOS) and intracranial pressure (ICP) and pbtO2 monitoring for at least 12 h, who had been treated at the neurocritical care unit, Addenbrooke’s Hospital, Cambridge, UK, between 2002 and 2022 were included. Outcome was dichotomised into favourable/unfavourable (GOS 4–5/1–3) and survival/mortality (GOS 2–5/1). PbtO2 was studied over the entire monitoring period. Thresholds were analysed in relation to outcome based on median and mean values, percentage of time and dose per hour below critical values and visualised as the combined insult intensity and duration. Results Median pbtO2 was slightly, but not significantly, associated with outcome. A pbtO2 threshold at 25 and 20 mmHg, respectively, yielded the highest x 2 when dichotomised for favourable/unfavourable outcome and mortality/survival in chi-square analyses. A higher dose and higher percentage of time spent with pbtO2 below 25 mmHg as well as lower thresholds were associated with unfavourable outcome, but not mortality. In a combined insult intensity and duration analysis, there was a transition from favourable towards unfavourable outcome when pbtO2 went below 25–30 mmHg for 30 min and similar transitions occurred for shorter durations when the intensity was higher. Although these insults were rare, pbtO2 under 15 mmHg was more strongly associated with unfavourable outcome if, concurrently, ICP was above 20 mmHg, cerebral perfusion pressure below 60 mmHg, or pressure reactivity index above 0.30 than if these variables were not deranged. In a multiple logistic regression, a higher percentage of monitoring time with pbtO2

Abstract Background The primary aim was to explore the association of global cerebral physiological variables including intracranial pressure (ICP), cerebrovascular reactivity (PRx), cerebral perfusion pressure (CPP), and deviation from the PRx-based optimal CPP value (∆CPPopt; actual CPP-CPPopt) in relation to brain tissue oxygenation (pbtO2) in traumatic brain injury (TBI). Methods A total of 425 TBI patients with ICP- and pbtO2 monitoring for at least 12 h, who had been treated at the neurocritical care unit, Addenbrooke’s Hospital, Cambridge, UK, between 2002 and 2022 were included. Generalized additive models (GAMs) and linear mixed effect models were used to explore the association of ICP, PRx, CPP, and CPPopt in relation to pbtO2. PbtO2 20 mmHg, PRx > 0.30, CPP 20 mmHg, PRx > 0.30, CPP

Dermocosmetics (active cosmetics, functional cosmetics, cosmeceuticals) are preparations for external use, supporting pharmacotherapy of skin diseases during the active phase of the disease and in remission. They are also used for healthy skin (preventive) care. Historically, topical skin care products have been divided into cosmetics and drugs, as defined by the Federal Food, Drug and Cosmetic Act of 1938. A cosmetic was defined as ”articles intended to cleanse, care, beautify and improve the appearance of the skin”. Drugs were defined as ”products intended to affect the structure or any function of the body, or products intended for use in the diagnosis, treatment, mitigation, treatment or prevention of human diseases”. Dermocosmetics (cosmeceuticals) remain cosmetics from a legal point of view, but they fill the gap between cosmetics and drugs. These products achieve a cosmetic effect with active substances however are not subject to drug regulations.

Introduction: Adoption of the ICM+® brain monitoring software by clinical research centres worldwide has been continuously growing over the past 20 years. This has necessitated ongoing updates to accommodate evolving neuromonitoring research needs, including recent explosion of artificial intelligence (AI). Research question: We sought to provide an update on the current features of the software. In particular, we aimed to highlight the new options of integrating AI models. Material and methods: We reviewed all currently available ICM+ analytical areas and discussed potential AI based extensions in each. We tested a proof-of-concept integration of an AI model and evaluated its performance for real-time data processing. Results: ICM+ current analytical tools serve both real-time (bed-side) and offline (file based) analysis, including the calculation engine, Signal Calculator, Custom Statistics, Batch tools, ScriptLab and charting. The ICM+ Python plugin engine allows to execute custom Python scripts and take advantage of complex AI frameworks. For the proof-of-concept, we used a neural network convolutional model with 207,000 trainable parameters that classifies morphology of intracranial pressure (ICP) pulse waveform into 5 pulse categories (normal to pathological plus artefactual). When evaluated within ICM+ plugin script on a Windows 10 laptop the classification of a 5 min ICP waveform segment took only 0.19s with a 2.3s of initial, one-off, model loading time required. Conclusions: Modernised ICM+ analytical tools, reviewed in this manuscript, include integration of custom AI models allowing them to be shared and run in real-time, facilitating rapid prototyping and validating of new AI ideas at the bed-side.

Introduction: Pressure reactivity index (PRx) is used for continuous monitoring of cerebrovascular reactivity in traumatic brain injury (TBI). However, PRx has a noisy character. Oscillations in arterial blood pressure (ABP) introduced by cyclic positive end-expiratory pressure adjustment, can make PRx more reliable. However, if oscillations are introduced by the cycling process of an anti-decubitus-mattress the effect on PRx is confounding, as they affect directly also intracranial pressure (ICP). In our routine monitoring in TBI patients we noticed periods of highly regular, slow, spontaneous oscillations in ABP and ICP signals. Research question: We set out to explore the nature of these oscillations and establish if PRx remains reliable during the oscillations. Materials and methods: 10 TBI patients’ recordings with oscillations in ICP and ABP were analysed. We computed PRx, PRx variability (hourly-average of standard-deviation, SD), phase-shift and coherence between ABP and ICP in the slow frequency range. Metrics were compared between oscillation and peri-oscillation periods. Results: During oscillations (frequency 0.006± 0.002Hz), a significantly lower variability of PRx (SD 0.185vs0.242) and higher coherence ABP-ICP (0.618±0.09 vs 0.534 ±0.09) were observed. No external oscillations sources could be identified. 34 out of 48 events showed signs of 'active' transmission associated with negative PRx, indicating a potential positive impact on PRx reliability. Discussion and conclusions: Spontaneous oscillations observed in ABP and ICP signals were found to enhance rather than confound PRx reliability. Further research is warranted to elucidate the nature of these oscillations and develop strategies to leverage them for enhancing PRx reliability in TBI monitoring.

Introduction: Cerebrospinal fluid (CSF) infusion test analysis allows recognizing and appropriately evaluating CSF dynamics in the context of normal pressure hydrocephalus (NPH), which is crucial for effective diagnosis and treatment. However, existing methodology possesses drawbacks that may compromise the precision and interpretation of CSF dynamics parameters. Research question: This study aims to circumvent these constraints by introducing an innovative analysis method grounded in Bayesian inference. Material and methods: A single-centre retrospective cohort study was conducted on 858 patients who underwent a computerized CSF infusion test between 2004 and 2020. We developed a Bayesian framework-based method for parameter estimation and compared the results to the current, gradient descent-based approach. We evaluated the accuracy and reliability of both methods by analysing erroneous prediction rates and curve fitting errors. Results: The Bayesian method surpasses the gradient descent approach, reflected in reduced inaccurate prediction rates and an improved goodness of model fit. On whole cohort level both techniques produced comparable results. However, the Bayesian method holds an added advantage by providing uncertainty intervals for each parameter. Sensitivity analysis revealed significance of the CSF production rate parameter and its interplay with other variables. The resistance to CSF outflow demonstrated excellent robustness. Discussion and conclusion: The proposed Bayesian approach offers a promising solution for improving robustness of CSF dynamics assessment in NPH, based on CSF infusion tests. Additional provision of the uncertainty measure for each diagnostic metric may perhaps help to explain occasional poor diagnostic performance of the test, offering a robust framework for improved understanding and management of NPH.

Introduction: Cerebral autoregulation (CA) dysfunction is a key complication following brain injury. CA assessment using near-infrared spectroscopy (NIRS) offers a promising alternative to the current non-invasive standard, cerebral blood flow velocity (CBFV) measured with transcranial Doppler. Research question: Can autoregulatory slow waves (frequency range 0.005–0.05 Hz) associated with spontaneous and induced changes in ABP in healthy volunteers be detected by parameters measured with the Masimo O3 NIRS device? Methods: ABP, CBFV and Masimo O3 parameters were measured in 10 healthy volunteers at baseline and during ABP oscillations induced by squat/stand manoeuvres. Transmission of slow waves was assessed with power spectral density and coherence analysis in NIRS signals and compared to that of CBFV. Results: At baseline, slow waves were detected with sufficient power that substantially exceeded the signals’ measurement resolution in all parameters except cerebral oxygen saturation. During ABP oscillations in the 0.033 Hz range (induced by squat/stand), the power of slow waves increased in all parameters in a similar pattern, with total (cHb) and oxygenated (O2Hb) haemoglobin concentrations most closely mirroring CBFV (median standardised power [first-third quartile], baseline vs squat/stand: CBFV 0.35 [0.28–0.42] vs 0.50 [0.45–0.62], O2Hb 0.47 [0.33–0.68] vs 0.61 [0.59–0.69]). Coherence with ABP increased for both CBFV and NIRS measures from low at baseline (0.8). Conclusion: Spontaneous fluctuations in ABP can be observed in analysed Masimo O3 metrics to a varying degree. The clinical utility of Masimo O3 signals in CA assessment requires further investigation in brain injury patients.

Introduction: PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi consensus of clinicians concluded that consensus could not be reached on the accuracy, reliability, and validation of any current CA assessment method. Research question: We aimed to quantify the short-term uncertainty of PRx time-trends and to relate this to other physiological measurements. Material and methods: Intracranial pressure (ICP), arterial blood pressure (ABP), end-tidal CO2 (EtCO2) high-resolution recordings of 911 TBI patients were processed with ICM + software. Hourly values of metrics that describe the variability within modalities derived from ABP, ICP and EtCO2, were calculated for the first 24h of neuromonitoring. Generalized additive models were used to describe the time trend of the variability in PRx. Linear correlations were studied for describing the relationship between PRx variability and the other physiological modalities. Results: The time profile of variability of PRx decreases over the first 12h and was higher for average PRx ∼0. Increased variability of PRx was not linearly linked with average ABP, ICP, or CPP. For coherence between slow waves of ABP and ICP >0.7, the variability in PRx decreased (R = −0.47, p

Introduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for better real-time interpretability of the autoregulation status. When PRx>0.3 is sustained for long periods, typically of at least half an hour, the bar shows a pattern called “red solid line” (RSL). RSL was previously described to precede refractory intracranial hypertension and brain death. Research question: We aimed to describe pathophysiological changes in measured signals/parameters during RSL. Material and methods: Observation of time-trends of PRx, intracranial pressure, cerebral perfusion pressure, brain oxygenation and compensatory reserve of TBI patients with RSL. Results: Three pathophysiological patterns were identified: RSL precedes intracranial hypertension, RSL is preceded by intracranial hypertension, or RSL is preceded by brain hypoperfusion. In all cases, RSL was followed by death and the RSL onset was between 1 h and 1 day before the terminal event. Discussion and conclusion: RSL precedes death in intensive care and could represent a marker for terminal clinical deterioration in TBI patients. These findings warrant further investigations in larger cohorts to characterise pathophysiological mechanisms underlying the RSL pattern and whether RSL has a significant relationship with outcome after TBI.

The treatment goal in alopecia areata is induction of hair regrowth and halting the progression of the disease. Treatment decisions depend on the severity of the alopecia areata as assessed by the Severity of Alopecia Tool (SALT) or the Alopecia Areata Scale (AAS). In mild alopecia areata, very ultra-high potency topical glucocorticoids and intralesional triamcinolone acetonide are the mainstay of treatment. In moderate to severe alopecia areata, systemic treatment is usually required. Currently, the only drug dedicated for alopecia areata, approved in Europe and the United States is baricitinib. Ritlecitinib, a JAK3/TEC inhibitor is approved in the United States for individuals 12 years of age and older with severe alopecia areata and is expected to be approved in Europe soon. Other systemic medications used in alopecia areata include glucocorticoids, cyclosporine, and methotrexate. Contact immunotherapy may be considered. In alopecia areata, long-maintenance treatment is of substantial significance.

The existence of two types of alopecia areata is suggested (probably genetically different): early-onset, with more severe symptoms, longer disease duration, higher tendency to relapse, often with a positive family history, and late-onset, in which the first symptoms occur after the age of 50, the course is milder and the family history is negative. Alopecia areata may exist in the form of: focal alopecia areata, multifocal alopecia areata, ophiasis, diffuse alopecia areata, alopecia totalis and alopecia universalis. Alopecia areata incognita remains a form with a discussed relationship to alopecia areata. Occasionally hair loss associated with alopecia areata may occur only in locations outside the scalp (e.g. beard, eyebrows, eyelashes, body hair). The diagnosis of alopecia areata can be made on the basis of clinical examination and trichoscopy. There are two main scoring systems for assessing the severity of alopecia areata. This is the Severity of Alopecia Tool (SALT) and the Alopecia Areata Score (AAS), which is also partly based on the SALT assessment. Both scoring systems allow differentiation between mild, moderate, and severe alopecia areata. These assessment results have a direct impact on therapeutic decisions.

Abstract Background A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort. Methods Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal–Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong’s test. Results Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP

Rosacea is a chronic inflammatory skin disease characterised by periods of remission and subsequent relapses typically provoked by environmental factors. Eruptions located on the face are easily visible and may be difficult to conceal, which leads to a decrease in patients’ self-esteem, quality of life, and general well-being. Since the aetiology of rosacea is multifactorial and not entirely understood, and the clinical characteristics and course of the disease are heterogeneous, therapy may be challenging. While a complete cure is not possible, in the majority of cases clinical improvement and long-term remission are satisfying both to the patient and physician. In recent years, the therapeutic approach has been significantly modified. Currently, the focus is placed on the need to personalise the treatment process and adapt it to the patients’ phenotypic characteristics. Combination therapies and new variants of existing topical and systemic drugs are increasingly being recommended. The mainstays of therapy are antiinflammatory agents. Proper skin care – along with the identification and avoidance of factors known to trigger consecutive episodes of rosacea – are also essential.

Joanna Rybak-d’Obyrn,1 Waldemar Placek,1 Agnieszka Owczarczyk-Saczonek,1 Maria Derkaczew,1 Ewelina Joniec,1 Robert Hofman,1 Małgorzata Stompór2 1Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland; 2Department of Family Medicine and Infectious Diseases, Collegium Medicum, University of Warmia and Mazury, Olsztyn, PolandCorrespondence: Maria Derkaczew, Tel +48 607654914, Email m.derkaczew@gmail.comPurpose: The aim of this study was to assess the incidence and characteristics of COVID-19 cutaneous manifestations among geriatric patients infected with the SARS-CoV-2 virus.Patients and Methods: Sixty-four nursing home residents in Dobre Miasto, Poland (mean age: 79 years) infected with SARS-CoV-2 were monitored for skin lesions during the epidemic outbreak in 2020. Only five of them presented COVID-19 dermatological manifestation: vesicular (4 cases) and erythematous (1 case) skin lesions, which appeared after the remaining symptoms of the disease had resolved.Results: The average time between COVID-19 onset and cutaneous manifestation was 22 days. Skin lesions persisted in five cases 112, 17, 21,19 and 27 days, respectively, and were often accompanied by pruritus and neuropathic pain.Conclusion: Skin manifestations of SARS-CoV-2 infection might be misdiagnosed or overlooked, particularly among elderly patients with chronic diseases. The recognition of skin lesions due to COVID-19 might improve patients’ quality of life by reducing the intensity of symptoms such as pruritus or neuropathic pain.Keywords: geriatrics, dermatology, skin manifestation, vesicular

Abstract Trigeminal trophic syndrome (TTS) is a rare condition resulting from self‐manipulation of the skin after an injury to the trigeminal nerve. We describe the case of a 70‐year‐old woman who was hospitalized because of erythema, ulceration, and crusts on the right side of her face, accompanied by itching, burning, and irritation forcing self‐manipulation of the skin. She had been previously repeatedly treated with antibiotics, acyclovir, and topical medications without any improvement. Her medical history revealed an episode of ischemic stroke in 2016, after which a deformation and partial atrophy of the right ala nasi appeared. Trigeminal neuropathy was confirmed by a neurological consultation. Diagnosis and treatment of TTS requires a multidisciplinary approach. Awareness of this disease should be raised to enable proper diagnosis and management of difficult‐to‐treat facial ulcers that cannot be explained by common causes.

Abstract This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department.

Rosacea is a chronic, relapsing, inflammatory, but not infectious, skin disease. The prevalence of rosacea is relatively high in the adult population of Northern Europe. Its characteristic symptoms include recurrent flushing, erythema, telangiectasia, papules and pustules, localized on cheeks, nose, chin and forehead. At present, four, not mutually exclusive subtypes of acne are classified: erythematotelangiectatic, maculopapular, hypertrophic and ocular. The clinical presentation of this dermatosis is heterogeneous. Clinical symptoms and their severity may vary individually. For this reason, treatment should be individualized and take into consideration the type of cutaneous lesions, presence of comorbidities, patient’s occupation, impact of the disease on the quality of life, and patient’s preferences. In addition to topical and systemic medications, adequate skin care is important.