Search

Background: Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data. Objectives: To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic. Methods: We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person's index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient's first ED diagnosis. We applied propensity scorematched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022. Results: Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95% CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort. Discussion: Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the prepandemic 2017-2019 cohort, even after controlling for baseline levels of cooccurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare release from masking (RM) between Mandarin-speaking and English-speaking listeners with normal hearing for competing speech when target-masker sex cues, spatial cues, or both were available. Method: Speech recognition thresholds (SRTs) for competing speech were measured in 21 Mandarin-speaking and 15 English-speaking adults with normal hearing using a modified coordinate response measure task. SRTs were measured for target sentences produced by a male talker in the presence of two masker talkers (different male talkers or female talkers). The target sentence was always presented directly in front of the listener, and the maskers were either colocated with the target or were spatially separated from the target (+90°, -90°). Stimuli were presented via headphones and were virtually spatialized using head-related transfer functions. Three masker conditions were used to measure RM relative to the baseline condition: (a) talker sex cues, (b) spatial cues, or (c) combined talker sex and spatial cues. Results: The results showed large amounts of RM according to talker sex and/or spatial cues. There was no significant difference in SRTs between Chinese and English listeners for the baseline condition, where no talker sex or spatial cues were available. Furthermore, there was no significant difference in RM between Chinese and English listeners when spatial cues were available. However, RM was significantly larger for Chinese listeners when talker sex cues or combined talker sex and spatial cues were available. Conclusion: Listeners who speak a tonal language such as Mandarin Chinese may be able to take greater advantage of talker sex cues than listeners who do not speak a tonal language.

Key Points: Question: What is the prevalence of gabapentin use in individuals filling buprenorphine prescriptions for opioid use disorder (OUD), and what are its associations with drug-related poisoning? Findings: In this case-control study with crossover analysis of 109 407 individuals diagnosed with OUD initiating buprenorphine treatment, gabapentin use was not associated with hospitalization for drug-related poisoning after accounting for between-person confounding. Meaning: These findings contribute to the evidence base on the use of gabapentin as an adjunctive medication in individuals filling buprenorphine with OUD. This case-control study with crossover analysis assesses the differences between patients receiving and not receiving gabapentin alongside buprenorphine in the treatment of opioid use disorder and the drug-related poisoning risk associated with gabapentin. Importance: Gabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence. Objective: To assess the purpose and associated risks of off-label gabapentin use in OUD treatment. Design, Setting, and Participants: This retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day. Exposures: Days covered by filled gabapentin prescriptions. Main Outcomes and Measures: Primary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Results: A total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage. Conclusions and Relevance: Gabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed. [ABSTRACT FROM AUTHOR]

Differences in spectro-temporal degradation may explain some variability in cochlear implant users' speech outcomes. The present study employs vocoder simulations on listeners with typical hearing to evaluate how differences in degree of channel interaction across ears affects spatial speech recognition. Speech recognition thresholds and spatial release from masking were measured in 16 normal-hearing subjects listening to simulated bilateral cochlear implants. 16-channel sine-vocoded speech simulated limited, broad, or mixed channel interaction, in dichotic and diotic target-masker conditions, across ears. Thresholds were highest with broad channel interaction in both ears but improved when interaction decreased in one ear and again in both ears. Masking release was apparent across conditions. Results from this simulation study on listeners with typical hearing show that channel interaction may impact speech recognition more than masking release, and may have implications for the effects of channel interaction on cochlear implant users' speech recognition outcomes. [ABSTRACT FROM AUTHOR]

Antibody engineering has developed into a wide-reaching field, impacting a multitude of industries, most notably healthcare and diagnostics. The seminal work on developing the first monoclonal antibody four decades ago has witnessed exponential growth in the last 10–15 years, where regulators have approved monoclonal antibodies as therapeutics and for several diagnostic applications, including the remarkable attention it garnered during the pandemic. In recent years, antibodies have become the fastest-growing class of biological drugs approved for the treatment of a wide range of diseases, from cancer to autoimmune conditions. This review discusses the field of therapeutic antibodies as it stands today. It summarizes and outlines the clinical relevance and application of therapeutic antibodies in treating a landscape of diseases in different disciplines of medicine. It discusses the nomenclature, various approaches to antibody therapies, and the evolution of antibody therapeutics. It also discusses the risk profile and adverse immune reactions associated with the antibodies and sheds light on future applications and perspectives in antibody drug discovery. [ABSTRACT FROM AUTHOR]

Many heterotrophic microbial eukaryotes are size‐selective feeders. Some microorganisms increase their size by forming multicellular colonies. We used choanoflagellates, Salpingoeca helianthica, which can be unicellular or form multicellular colonies, to study the effects of multicellularity on vulnerability to predation by the raptorial protozoan predator, Amoeba proteus, which captures prey with pseudopodia. Videomicrography used to measure the behavior of interacting S. helianthica and A. proteus revealed that large choanoflagellate colonies were more susceptible to capture than were small colonies or single cells. Swimming colonies produced larger flow fields than did swimming unicellular choanoflagellates, and the distance of S. helianthica from A. proteus when pseudopod formation started was greater for colonies than for single cells. Prey size did not affect the number of pseudopodia formed and the time between their formation, pulsatile kinematics and speed of extension by pseudopodia, or percent of prey lost by the predator. S. helianthica did not change swimming speed or execute escape maneuvers in response to being pursued by pseudopodia, so size‐selective feeding by A. proteus was due to predator behavior rather than prey escape. Our results do not support the theory that the selective advantage of becoming multicellular by choanoflagellate‐like ancestors of animals was reduced susceptibility to protozoan predation. [ABSTRACT FROM AUTHOR]

This study uses administrative data to show that pregnancy is a time period of increased opioid use disorder treatment utilization, although treatment discontinuation remains very high. OBJECTIVE: To examine the association between pregnancy and medications for opioid use disorder (MOUD) initiation and discontinuation among reproductive-aged people receiving treatment for opioid use disorder (OUD) in the United States. METHODS: We conducted a retrospective cohort study of people with gender recorded as female, aged 18–45 years, in the MerativeTM MarketScan® Commercial and Multi-State Medicaid Databases (2006–2016). Opioid use disorder and pregnancy status were identified based on inpatient or outpatient claims for established International Classification of Diseases, Ninth and Tenth Revision diagnosis and procedure codes. The main outcomes were buprenorphine and methadone initiation and discontinuation, determined by using pharmacy and outpatient procedure claims. Analyses were conducted at the treatment episode level. Adjusting for insurance status, age, and co-occurring psychiatric and substance use disorders, we used logistic regression to estimate MOUD initiation and used Cox regression to estimate MOUD discontinuation. RESULTS: Our sample included 101,772 reproductive-aged people with OUD, encompassing 155,771 treatment episodes (mean age 30.8 years, 64.4% Medicaid insurance, 84.1% White), of whom 2,687 (3.2%, encompassing 3,325 episodes) were pregnant. In the pregnant group, 51.2% of treatment episodes (1,703/3,325) involved psychosocial treatment without MOUD, in comparison with 61.1% (93,156/152,446) in the nonpregnant comparator group. In adjusted analyses assessing likelihood of initiation for individual MOUD, pregnancy status was associated with an increase in buprenorphine (adjusted odds ratio [aOR] 1.57, 95% CI 1.44–1.70) and methadone initiation (aOR 2.04, 95% CI 1.82–2.27). Discontinuation rates of MOUD at 270 days were high for both buprenorphine (72.4% for nonpregnant episodes vs 59.9% for pregnant episodes) and methadone (65.7% for nonpregnant episodes vs 54.1% for pregnant episodes). Pregnancy was associated with a decreased likelihood of discontinuation at 270 days for both buprenorphine (adjusted hazard ratio [aHR] 0.71, 95% CI 0.67–0.76) and methadone (aHR 0.68, 95% CI 0.61–0.75), in comparison with nonpregnant status. CONCLUSION: Although a minority of reproductive-aged people with OUD in the United States are initiated on MOUD, pregnancy is associated with a significant increase in treatment initiation and a reduced risk of medication discontinuation. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to develop an algorithm to predict gamma passing rate (GPR) in the volumetric‐modulated arc therapy (VMAT) technique. Materials and methods: A total of 118 clinical VMAT plans, including 28 mediastina, 25 head and neck, 40 brains intensity‐modulated radiosurgery, and 25 prostate cases, were created in RayStation treatment planning system for Edge and TrueBeam linacs. In‐house scripts were developed to compute Modulation indices such as plan‐averaged beam area (PA), plan‐averaged beam irregularity (PI), total monitor unit (MU), leaf travel/arc length, mean dose rate variation, and mean gantry speed variation. Pretreatment verifications were performed on ArcCHECK phantom with SNC software. GPR was calculated with 3%/2 mm and 10% threshold. The dataset was randomly split into a training (70%) and a test (30%) dataset. A random forest regression (RFR) model and support vector regression (SVR) with linear kernel were trained to predict GPR using the complexity metrics as input. The prediction performance was evaluated by calculating the mean absolute error (MAE), R2, and root mean square error (RMSE). Results: RMSEs at γ 3%/2 mm for RFR and SVR were 1.407 ± 0.103 and 1.447 ± 0.121, respectively. MAE was 1.14 ± 0.084 for RFR and 1.101 ± 0.09 for SVR. R2 was equal to 0.703 ± 0.027 and 0.689 ± 0.053 for RFR and SVR, respectively. GPR of 3%/2 mm with a 10% threshold can be predicted with an error smaller than 3% for 94% of plans using RFR and SVR models. The most important metrics that had the greatest impact on how accurately GPR can be predicted were determined to be the PA, PI, and total MU. Conclusion: In terms of its prediction values and errors, SVR (linear) appeared to be comparable with RFR for this dataset. Based on our results, the PA, PI, and total MU calculations may be useful in guiding VMAT plan evaluation and ultimately reducing uncertainties in planning and radiation delivery. [ABSTRACT FROM AUTHOR]

Individuals with substance abuse disorder are at increased risk for the development of severe disease following COVID-19 infection. Furthermore, individuals in rural populations where access to healthcare is limited and rates of substance abuse tend to be higher are at increased risk compared to other regions. The Penn State Health Network serves 29 counties in central Pennsylvania that are largely rural. The current study assessed the electronic medical records for individuals in this population that were reported as having alcohol dependence, nicotine dependence or both (co-users) in addition to individuals with no history of drug use and the rate of developing primary and secondary health outcomes following COVID-19 infection. All patients in this study were determined to be COVID+ while in care. We found that overall, risk for requiring ventilation, developing pneumonia, and mortality within 30 days of diagnosis all increased with any substance use history, across both males and females and across all age groups. Moreover, rates of these outcomes were considerably higher in patients that were both alcohol and nicotine dependent suggesting additive effects of co-use. Rates of secondary effects also increased substantially across all use categories with these patients showing greater risk of developing liver, kidney, and pancreas maladies compared to patients with no history of substance use. Taken together, these findings reinforce previous studies showing that substance use increases the risks of significant disease following COVID-19 infection, giving insights into the health disparities that exist in rural populations. [ABSTRACT FROM AUTHOR]

A letter published in JAMA Psychiatry commends a systematic review on the prevalence of psychiatric comorbidities among people experiencing homelessness. However, caution is urged in interpreting the estimate that approximately one-fourth of people experiencing homelessness may have antisocial personality disorder (ASPD). The process of diagnosing ASPD and conduct disorder (CD) may involve value judgments that can contribute to misdiagnosis, particularly in the context of structural racism and the criminalization of homelessness. The letter emphasizes the need for comprehensive sociocultural context and more rigorous research in interpreting ASPD estimates among people experiencing homelessness. [Extracted from the article]

Fabrication of a physically flexible multi-layer metasurface composed of gallium-based liquid metal encapsulated in polydimethylsiloxane (PDMS) is reported. The second-order bandpass frequency selective surface (FSS) operating in the X-band is comprised of two modified Jerusalem cross resonator layers separated by an aperture layer. The multi-layer spatial filter has a total thickness of 4.81 mm ($\lambda _{0}$ /7.5). An inverse image mold of the FSS layer patterns is fabricated in silicon, and FSS patterned PDMS is replicated from the silicon mold. The FSS patterned PDMS is spray coated with liquid metal to fabricate a massive array of discrete conductor patterns in PDMS and subsequent encapsulation by an additional layer of PDMS. Multiple versions of the m $\times $ n metasurfaces have been fabricated and have been repeatedly tested for their bendability, stretchability, twistability, and foldability. The fabricated metasurface in a waveguide environment demonstrated a band-pass center frequency at 8.33 GHz which agreed well with the simulated frequency at 8.31 GHz. [ABSTRACT FROM AUTHOR]

While a typical way for diabetes therapy is discrete insulin infusion based on long-time interval measurement, in this paper, we design a closed-loop control system for continuous drug infusion to improve the traditional discrete methods and make diabetes therapy automatic in practice. By exploring the accumulative function of drug to insulin, a continuous injection model is proposed. Based on this model, proportional-integral-derivative (PID) and fuzzy logic controllers are designed to tackle a control problem of the resulting highly nonlinear plant. Even with serious disturbance of glucose, such as nutrition absorption at meal time, the proposed scheme can perform well in simulation experiments.

A flexible self‐healing metasurface using gallium‐based liquid metal encapsulated in polydimethylsiloxane (PDMS) operating in the X‐band (8–12 GHz) is reported. A band‐stop metasurface with center frequency at 9.82 GHz is designed using floating patches surrounding the respective end cap of a Jerusalem cross. A large‐scale (up to 10 × 10 array) metasurface is patterned in PDMS and a rapid manufacturing method of vacuum filling using ultra‐low pressure is used to yield parallel encapsulation of liquid metal in PDMS. The fabricated metasurface is physically flexible and its flexibility is repeatedly tested for bendability, stretchability (up to ≈89.13%), twistability, and foldability. Transmission characteristics of the flexible metasurface are measured in waveguide and free‐space environments and it is found that the band‐stop center frequency agrees well with the design. The flexible metasurface also is tested for its repairability and self‐healing characteristics. The metasurface is partially or fully cut at certain part and the partial/full cut part of the metasurface is repaired by applying external pressure or using Kapton tape/UV glue. Those repaired metasurfaces show restoration of original transmission characteristics with minimal shift in frequency and magnitude. [ABSTRACT FROM AUTHOR]