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Introduction Deutetrabenazine is approved for treatment of Huntington disease (HD)-related chorea and tardive dyskinesia (TD) in adults. Factors associated with deutetrabenazine persistence and adherence are not well understood. Methods Claims data from the Symphony Health Solutions Integrated Dataverse (2017-2019) were analyzed to identify real-world predictors of deutetrabenazine persistence and adherence in adults with HD or TD in the United States. Predictive models for persistence and adherence that considered patient demographics, payer type, comorbidities, treatment history, and health care resource use were developed. Results In HD, use of anticonvulsants (HR = 2.00 [95% CI = 1.03, 3.85]; P < .05), lipid-lowering agents (2.22 [1.03, 4.76]; P < .05), and Medicaid versus Medicare insurance (2.27 [1.03, 5.00]; P < .05) predicted persistence, whereas only comorbid anxiety disorders predicted discontinuation (0.46 [0.23, 0.93]; P < .05). Of these patients, 62.5% were adherent at 6 months. Use of 22642 treatments for chronic diseases (OR = 0.18 [95% CI = 0.04, 0.81]; P < .05) and Medicaid versus Medicare insurance (0.27 [0.09, 0.75]; P < .05) was associated with lower odds of adherence. In TD, use of lipid-lowering agents (HR = 4.76 [95% CI = 1.02, 20.00]; P < .05) predicted persistence, while comorbid schizoaffective disorder and/or schizophrenia (0.16 [0.14, 0.69]; P < .05) and sleep-wake disorders (0.18 [0.04, 0.82]; P < .05) predicted discontinuation. Of these patients, 46.7% were adherent at 6 months. Comorbid schizoaffective disorder and/or schizophrenia was associated with lower odds of adherence (OR = 0.26 [0.07, 0.91]; P < .05). Discussion Identifying factors predictive of discontinuation and/or nonadherence to deutetrabenazine may facilitate the development of personalized support programs that seek to improve outcomes in patients with HD or TD.

Renata Nunes Achar Fujii,1,2 Renata Kobayasi,1 Sylvia Claassen Enns,1 Patricia Zen Tempski1 1Centro de Desenvolvimento de Educação Médica (CEDEM), Universidade de São Paulo, São Paulo, SP, Brazil; 2Municipal University of São Caetano do Sul, São Caetano do Sul, SP, BrazilCorrespondence: Sylvia Claassen Enns, Centro de Desenvolvimento de Educação Médica (CEDEM), Universidade de São Paulo, Av. Dr. Arnaldo 455, 2 Floor, Room 2343, São Paulo, SP, Brazil, Tel +55(11) 3061 7472, Email dsenns@yahoo.com.brIntroduction: Extracurricular activities in medical education are defined as any social, philanthropic, non-mandatory, and unpaid activities. These activities promote interactions between students and the community in ways that both provide care and create learning opportunities and experiences for both students and the community at large. This study elaborates on the motivational aspects, learnings, and barriers that occur when students participate in these activities.Methods: This is a cross-sectional study of medical students in their first to fifth years. Qualitative analyses have been used to understand the motivation, barriers, and contributions associated with extracurricular activities participation.Results: Of the 586 students enrolled in the medical course, 462 students agreed to participate in the research. The students reported that they were motivated to participate in contributing to society, support their professional choices, integrate their knowledge, gain life experience, develop communication and leadership skills, learn to work in a team, and become more responsible, empathetic, and resilient. Barriers to participation were the limited number of available positions, selection criteria, lack of support from those involved, personal issues, poor time management, risk of lowered academic performance, and lack of physical and financial resources.Discussion: Medical students are motivated to participate in Community-based extracurricular activities (CBEA) and this experience leads to improvement in the curriculum and can develop fundamental skills and attitudes such as leadership, commitment, and responsibility. To maximize the benefits of these activities, schools must support students and ensure that they have the time and chance to participate without physical strain, that were barriers mentioned by the academics.Keywords: quality of life, education, medical, students, medical, community-institutional relationships

Despite ample attention in the literature for alignment patterns and case frames more generally, we know very little about how these elements of grammar spread from one language to another in a contact situation. Achieving a better understanding of this will help explain areal patterns in alignment and grammatical relation marking. In this contribution, we zoom in on a contact situation in the foothills of North-West Amazon, where languages of the Quechuan and Tukanoan families are in contact, and where previous authors have suggested that grammatical relation marking shows many potential contact effects. We find that, despite the absence of loanwords, abstract lexico-grammatical information associated with individual lexical items may spread from one language to another, especially within the class of sensation predicates. These can be characterized as lexically driven diffusion patterns, without formal borrowing, consistent with an overall characterization of the area’s sociolinguistics as loanword-avoiding.

David Isaacs,1 Alexandra P Key,2– 4 Carissa J Cascio,4– 6 Alexander C Conley,2,6 Harrison C Walker,7 Mark T Wallace,3,5,6,8,9 Daniel O Claassen1 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 3Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA; 4Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA; 5Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA; 6Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; 7Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; 8Department of Pharmacology, Vanderbilt University, Nashville, TN, USA; 9Department of Psychology, Vanderbilt University, Nashville, TN, USACorrespondence: David IsaacsDepartment of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, USATel +1 615 936-0060Fax +1 615 936-1229Email david.a.isaacs@vumc.orgBackground: Sensory hypersensitivity, defined as heightened awareness of and reactivity to external stimuli, is a bothersome symptom that affects up to 80% of adults with Tourette syndrome (TS). Such widespread prevalence suggests sensory hypersensitivity is a core feature of the disorder, but its severity and association with other clinical features of TS remain largely unexplored. Complicating matters, sensory hypersensitivity has been observed in two neurodevelopmental disorders commonly comorbid with TS: obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD).Objective: We sought to measure sensory hypersensitivity in TS patients relative to healthy controls and to investigate the relationship of sensory hypersensitivity with OCD and ADHD symptoms in the context of TS.Methods: We recruited 34 adults with TS or chronic tic disorder to undergo evaluation with the Yale Global Tic Severity Scale (YGTSS) and a battery of validated self-report instruments assessing sensory hypersensitivity (Sensory Gating Inventory, SGI; Sensory Perception Quotient, SPQ), premonitory urge (Premonitory Urge to Tic Scale, PUTS), OCD (Dimensional Obsessive-Compulsive Scale, DOCS), and ADHD (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V). Age- and sex-matched healthy controls were recruited to complete SGI and psychiatric measures.Results: SGI and SPQ scores strongly correlated (rs = − 0.73, p < 0.0001) within patients. SGI total score was significantly higher in patients versus controls (119.0 vs 67.6, U =− 5.3, p < 0.0001), indicating greater sensory hypersensitivity in the tic disorder group. SGI score correlated modestly with PUTS, DOCS, and ASRS-V scores but not with YGTSS total tic score. Hierarchical linear regression analysis revealed that, of the tested variables, only DOCS score contributed significantly to mean SGI score, with β ranging from 1.03 (p = 0.044) to 1.41 (p = 0.001). A simple linear regression model with DOCS as the independent variable accounted for 31.9% of SGI score variance.Conclusion: Sensory hypersensitivity is prominent in adults with tic disorder and is independently associated with obsessive-compulsive symptom severity.Keywords: Tourette syndrome, tic disorder, sensory hypersensitivity, sensory sensitivity, obsessive-compulsive symptoms

Lidewij Henneman,1 Christi J van Asperen,2 Jan C Oosterwijk,3 Fred H Menko,4 Liesbeth Claassen,5 Daniëlle RM Timmermans5 1Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; 2Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 4Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, the Netherlands; 5Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, the NetherlandsCorrespondence: Lidewij HennemanDepartment of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB, Amsterdam, the NetherlandsTel +31 20-4449815Email l.henneman@amsterdamumc.nlPurpose: Counselees’ preferences are considered important for the choice of risk communication format and for improving patient-centered care. We here report on counselees’ preferences for how risks are presented in familial breast cancer counseling and the impact of this preferred format on their understanding of risk.Patients and Methods: As part of a practice-based randomized controlled trial, 326 unaffected women with a family history of breast cancer received their lifetime risk in one of five presentation formats after standard genetic counseling in three Dutch familial cancer clinics: 1) in percentages, 2) in frequencies (“X out of 100”), 3) in frequencies plus graphical format (10× 10 human icons), 4) in frequencies and 10-year age-related risk and 5) in frequencies and 10-year age-related risk plus graphical format. Format preferences and risk understanding (accuracy) were assessed at 2-week follow-up by a questionnaire, completed by 279/326 women.Results: The most preferred risk communication formats were numbers combined with verbal descriptions (37%) and numbers only (26%). Of the numerical formats, most (55%) women preferred percentages. The majority (73%) preferred to be informed about both lifetime and 10-year age-related risk. Women who had received a graphical display were more likely to choose a graphical display as their preferred format. There was no significant effect between the intervention groups with regard to risk accuracy. Overall, women given risk estimates in their preferred format had a slightly better understanding of risk.Conclusion: The results suggest that the accuracy of breast cancer risk estimation is slightly better for women who had received this information in their preferred format, but the risk format used had no effect on women’s risk accuracy. To meet the most frequent preference, counselors should consider providing a time frame of reference (eg, risk in the next 10 years) in a numerical format, in addition to lifetime risk.Keywords: risk communication, breast cancer, genetic counseling, patient preference, understanding, risk accuracy

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilitate a future consensus-based statement (e.g. via a modified Delphi) and series of recommendations. The panel convened weekly online meetings from October 2021 to December 2022. Research considerations addressed the nosographic status of disorders of consciousness, case ascertainment and verification, selection of dependent variables, choice of covariates and measurement and analysis of outcomes and covariates, aiming to promote more homogeneous designs and practices in future observational studies. The goal of this review is to inform a broad community of professionals with different backgrounds and clinical interests to address the methodological challenges imposed by the transition of care from acute to chronic stages and to streamline data gathering for patients with disorders of consciousness. A coordinated effort will be a key to allow reliable observational data synthesis and epidemiological estimates and ultimately inform condition-modifying clinical trials.