McMaster University
  • Hamilton, Ontario, Canada
Recent publications
Advancements in Microelectromechanical systems (MEMS) have enabled the manufacture of affordable and efficient wearable devices. In sensor-based gait analysis, motion and biofeedback sensor devices are easily attached to different parts of the body. Instrumentation of gait using different sensor technologies enables researchers and clinicians to capture high-resolution quantitative motion data within and beyond the lab. Integration of advanced sensor technologies provides objective and rater-independent multimodal outcomes that complement established clinical examination. Multi-modal data capture in ecologically valid, patient-relevant habitual settings opens new possibilities to monitor fluctuating and rare incidents by informing different aspects of impaired gait. Interconnected device communication and the Internet of Things (IoT) provide the infrastructural platform to enable remote gait assessment. However, an extended period of motion data recorded by different sensor technologies results in a vast amount of unlabelled data. Computational methods and artificial intelligence techniques (e.g., data mining) provide opportunities to manage data collected in unsupervised environments. Although technological advancement and algorithms promote remote gait assessment, more work needs to be done in terms of analytical and clinical validation to achieve robust and reliable gait analysis tools that contribute to better rehabilitation and treatment.
Background Some studies suggest that patients with pulmonary hypertension (PH) may be at higher risk of complications and death after noncardiac surgery. However, the magnitude of these associations is unclear. Objectives To determine the associations between PH and adverse outcomes after noncardiac surgery. Methods We searched PUBMED and EMBASE for studies published from January 1970 to April 2022. We included studies that reported the association between PH and one or more outcomes of interest occurring after noncardiac surgery. Data were pooled using random-effects models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I²=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis (OR 4.02; 95% CI, 2.14-7.54; I²=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I²=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I²=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73–6.60; I²=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81–3.12; I²=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70–21.02; I²=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke (OR 0.93; 95% CI, 0.88–0.98; I²=0%; 3 studies). Conclusion PH is a predictor of morbidity and mortality after noncardiac surgery. High quality studies are needed to determine effective strategies for reducing postoperative complications in this population.
The potential of MRI to predict cartilage mechanical properties across an entire cartilage surface in an ex vivo model would enable novel perspectives in modeling cartilage tolerance and predicting disease progression. The purpose of this study was to integrate MR imaging with full-surface indentation mapping to determine the relationship between femoral cartilage thickness and T2 relaxation change following loading, and cartilage mechanical properties in an ex vivo porcine stifle model. Matched-pairs of stifle joints from the same pig were randomized into either 1) an imaging protocol where stifles were imaged at baseline and after 35 min of static axial loading; and 2) full surface mapping of the instantaneous modulus (IM) and an electromechanical property named quantitative parameter (QP). The femur and femoral cartilage were segmented from baseline and post-intervention scans, then meshes were generated. Coordinate locations of the indentation mapping points were rigidly registered to the femur. Multiple linear regressions were performed at each voxel testing the relationship between cartilage outcomes (thickness change, T2 change) and mechanical properties (IM, QP) after accounting for covariates. Statistical Parametric Mapping was used to determine significance of clusters. No significant clusters were identified; however, this integrative method shows promise for future work in ex vivo modeling by identifying spatial relationships among variables.
Converging evidence has suggested that disturbances in monetary reward processing may subserve the shared biosignature between major depressive disorder (MDD) and obesity. However, there remains a paucity of studies that have evaluated the deficits in specific subcomponents of reward functioning in populations with MDD and obesity comorbidity. We evaluated the association between effort-expenditure for monetary reward and neural activation in regions associated with reward-based decision making (i.e., the caudate nucleus, anterior cingulate cortex (ACC) and hippocampus) in people with MDD and obesity comorbidity. We acquired structural and functional magnetic resonance imaging (fMRI) in 12 participants and performed a spherical region-of-interest analysis (ROI) using previously defined peak MNI coordinates. A one-sample t-test was employed to compare ROI-specific blood-oxygen-level-dependent (BOLD) signal change during the task choice selection window (i.e., high-effort vs. low-effort task) of the effort-expenditure for reward task (EEfRT). We observed no change in activation of the caudate nucleus, ACC or hippocampus in participants with increased BMI when contrasting the high effort > low effort reward magnitude condition for the EEfRT. The findings from our exploratory study evaluated the disturbances in fundamental reward processes, including cost-benefit decision making, in people MDD and obesity. Future studies should further investigate this relationship with a larger sample size.
Background Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer. Methods A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%). Conclusions Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer. Registration The protocol was registered on PROSPERO (registration number: CRD42022334025).
Background: Prostate Specific Membrane Antigen (PSMA) - positron emission tomography (PET) guides metastasis-directed radiotherapy (MDRT) in prostate cancer (PrCa). However, its value as a treatment response assessment tool after MDRT remains unclear. Importantly, there is limited understanding of the potential of radiotherapy (RT) to alter PSMA gene (folate hydrolase 1; FOLH1) expression. Methodology: We reviewed a series of 11 men with oligo-metastatic PrCa (25 metastasis sites) treated with MDRT before re-staging with 18F-DCFPyL (PSMA) PET upon secondary recurrence. Acute effects of RT on PSMA protein and mRNA levels were examined with qPCR and immunoblotting in human wild-type androgen-sensitive (LNCap), castrate-resistant (22RV1) and castrate-resistant neuroendocrine (PC3 and DU145) PrCa cell lines. Xenograft tumors were analyzed with immunohistochemistry. Further, we examined PSMA expression in untreated and irradiated radio-resistant (RR) 22RV1 (22RV1-RR) and DU145 (DU145-RR) cells and xenografts selected for survival after high-dose RT. Results: The majority of MDRT-treated lesions showed lack of PSMA-PET/CT avidity, suggesting treatment response even after low biological effective dose (BED) MDRT. We observed similar high degree of heterogeneity of PSMA expression in both human specimens and in xenograft tumors. PSMA was highly expressed in LNCap and 22RV1 cells and tumors but not in the neuroendocrine PC3 and DU145 models. Single fraction RT caused detectable reduction in PSMA protein but not in mRNA levels in LNCap cells and did not significantly alter PSMA protein or mRNA levels in tissue culture or xenografts of the other cell lines. However, radio-resistant 22RV1-RR cells and tumors demonstrated marked decrease of PSMA transcript and protein expression over their parental counterparts. Conclusions: PSMA-PET may be a promising tool to assess RT response in oligo-metastatic PrCa. However, future systematic investigation of this concept should recognize the high degree of heterogeneity of PSMA expression within prostate tumors and the risk for loss of PSMA expression in tumor surviving curative courses of RT.
Background: Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children. Methods: Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months. Results: Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged. Conclusions: Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.
Background: SLC13A5 related developmental and epileptic encephalopathy (DEE) is an autosomal recessive condition characterized by neonatal seizures, fever sensitivity, status epilepticus, developmental delay and tooth anomalies. The neuroimaging spectrum of SLC13A5 related DEE is not fully known. We present a case of SLC13A5 related DEE with distinct neuroimaging findings and review the neuroimaging findings of all published cases of SLC13A5 related DEE. Methods: A retrospective case review and focused review of the literature was completed. Results: A 16-month-old male with a clinical phenotype consistent with SLC13A5 related DEE and a previously reported pathogenic variant in SLC13A5, c.655G>A, p.Gly219Arg and a novel likely pathogenic variant in SLC13A5, c.202C>T, p.Pro68Ser was identified. MRI at day 5 of life revealed wide spread punctate white matter lesions (PWMLs) affecting the subcortical white matter, periventricular white matter, splenium of the corpus callosum, posterior limb of the internal capsule, corticospinal tracts, midbrain, pons and medulla, mimicking a metabolic/infectious etiology. MRI at one month showed atrophy and evolution of white matter necrosis. One hundred and five cases of SLC13A5 related DEE were identified. Initial MRI was completed in 62 cases (59%). MRI was normal in 41 cases (66%) and abnormal in 21 (34%). White matter abnormalities were most common (n=15, 71%); PWMLs occurred in 8 cases (38%). Conclusion: Neuroimaging abnormalities may exist in a third of SLC13A5 related DEE cases. White matter abnormalities such as PWMLs appear most common. It remains unknown why some are susceptible to these lesions and how they affect long-term neurodevelopmental outcomes in SLC13A5 related DEE.
Discrepancies in phase two and three studies can result in significant patient and financial burden, as well as the nonapproval of potentially efficacious drugs. We aimed to determine whether this discrepancy exists for clinical trials in inflammatory bowel disease (IBD). Electronic databases (MEDLINE and Embase) and clinical trial repositories were searched from 1 January 1946 to 12 March 2021, for paired phase two and three studies of advanced therapies for Crohn’s disease and ulcerative colitis. The primary outcome was to compare clinical remission rates between paired phase two and three studies for Crohn’s disease and ulcerative colitis. Multivariable mixed-model meta-analysis was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). The Cochrane risk-of-bias tool was used to grade the risk of bias. Of 2642 studies, 29 were included. Fifteen were phase three, 11 were phase two, one was phase one/two, and two were phase two/three. There were no differences in clinical remission rates between phase two and three studies for Crohn’s disease (OR, 1.07; 95% CI, 0.86–1.34; P = 0.54) and ulcerative colitis (OR, 0.81; 95% CI, 0.48–1.36; P = 0.43). Furthermore, there was a lack of any appreciable differences in study characteristics, inclusion criteria and patient demographics among paired phase two and three studies. Most studies were considered low risk of bias. Overall, paired phase two and three studies demonstrate similar clinical remission rates for advanced therapies in IBD. Whether this applies to newer outcomes, such as endoscopic and mucosal healing remains to be determined.
Acoustic sensing has attracted significant attention recently, thanks to the pervasive availability of device support. However, adopting consumer-grade devices (e.g., smartphones) to deploy acoustic sensing applications faces the challenge of device/OS heterogeneity. Researchers have to pay tremendous efforts in tackling platform-dependent details even in simply accessing raw audio samples, thus losing focus on innovating sensing algorithms. To this end, this paper presents the first Acoustic Software Defined Platform (ASDP): a versatile sensing and general benchmarking platform. ASDP encompasses several customized acoustic modules running on a ubiquitous computing board, backed by a dedicated software framework. It is superior to commodity devices in controlling and reconfiguring physical layer settings, thus offering much better usability. The tailored software framework abstracts platform details and provides user-friendly interface for fast prototyping, while maintaining adequate programmability. To demonstrate the usefulness of ASDP, we showcase several relevant applications based on it. The promising outcomes make us believe that the release of our ASDP could greatly advance acoustic sensing research.
Canadian policymakers have long been protective of their dairy industry despite reducing state interventions in other sectors. Recent preferential trade agreements (CPTPP, CETA, and CUSMA), however, have shown there are limits to this insularity. These new agreements have introduced dairy access concessions at a moment of flux within the rules-based international order. Why are there dairy concessions at this moment? This article combines political economic and ideational factors to explain this shift in Canadian trade policy. Applying discursive institutionalism, we observe a collapse of the dairy industry’s discursive power over sovereignty and federalism. This discursive breakdown is a function of (1) the legacy of earlier preferential trade agreements and (2) the success of challenger coalitions in persuading actors in favour of economic liberalization. Incorporating content analysis of public statements, we characterize this discursive breakdown within both federal and intergovernmental networks.
Background: Rates of enrolment in clinical trial in inflammatory bowel disease (IBD) have decreased dramatically in recent years. This leads to delays, increased costs, and failures to develop novel treatments. Aims: The aim of this work is to describe the current bottlenecks of IBD clinical trial enrolment and propose solutions. Methods: A taskforce comprised of experienced IBD clinical trialists from academic centers and pharmaceutical companies involved in IBD clinical research predefined the 4 following levels: 1) study design; 2) investigative center; 3) physician; 4) patient. At each level, the taskforce collectively explored the reasons for declining enrolment rates and generated an inventory of potential solutions. Results: The main reasons identified included the overall increased demands for trials, the high screen failure rates, particularly in CD, partly due to the lack of correlation between clinical and endoscopic activity, and the use of complicated endoscopic scoring systems not reflective of the totality of inflammation. In addition, complex trial protocols with restrictive eligibility criteria, increasing burden of procedures and administrative tasks enhances the need for qualified resources in study coordination. At the physician level, lack of dedicated time and training is crucial. From patients' perspective, long wash-out periods from previous medications and protocol requirements not reflecting clinical practice, such as prolonged steroids management and placebo exposures limit their participation in clinical trials. Conclusion: This joint effort is proposed as the basis for profound clinical trial transformation triggered by investigative centers, contract research organizations (CROs), sponsors, and regulatory agencies.
In this work, we first consider the discrete version of information generating function and develop some new results for it. We then propose Jensen-discrete information generating (JDIG) function as a generalized measure, which is connected to Shannon entropy, fractional Shannon entropy, Gini–Simpson index (Gini entropy), extropy, Jensen–Shannon entropy, Jensen–Gini–Simpson index and Jensen-extropy measures. Finally, for illustrative purpose, we use a real example from image processing and provide some numerical results in terms of the Jensen-discrete information generating function and demonstrate that the JDIG measure introduced here is an useful criteria for measuring similarity between two images.
Introduction: In clinical trials, event adjudication is a process to review and confirm the accuracy of outcomes reported by site investigators. Despite efforts to automate the communication between a clinical-data-and-coordination center and an event adjudication committee, the review and confirmation of outcomes, as the core function of the process, still fully rely on human labor. To address this issue, we present an automated event adjudication system and its application in two randomized controlled trials. Methods: Centrally executed by a clinical-data-and-coordination center, the automated event adjudication system automatedly assessed and classified outcomes in a clinical data management system. By checking clinically predefined criteria, the automated event adjudication system either confirmed or unconfirmed an outcome and automatedly updated its status in the database. It also served as a management tool to assist staff to oversee the process of event adjudication. The system has been applied in: (1) the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial and (2) the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial. The automated event adjudication system first screened outcomes reported on a case report form and confirmed those with data matched to preset definitions. For selected primary efficacy, secondary, and safety outcomes, the unconfirmed cases were referred to a human event adjudication committee for a final decision. In the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial, human adjudicators were given priority to review cases, while the automated event adjudication system took the lead in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. Results: Outcomes that were adjudicated in a hybrid model are discussed here. The COMPASS automated event adjudication system adjudicated 3283 primary efficacy outcomes and confirmed 1652 (50.3%): 132 (21.1%) strokes, 522 (53%) myocardial infarctions, and 998 (59.7%) causes of deaths. The NAVIGATE ESUS one adjudicated 737 cases of selected outcomes and confirmed 383 (52%): 219 (51.5%) strokes, 34 (42.5%) myocardial infarctions, 73 (54.9%) causes of deaths, and 57 (57.6%) major bleedings. After one deducts the time needed for migrating the system to a new study, the automated event adjudication system helped to reduce the time required for human review from approximately 1303 to 716.5 h for the Cardiovascular Outcomes for People Using Anticoagulation Strategies trial and from 387 to 196 h for the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source trial. Conclusion: The automated event adjudication system in combination with human adjudicators provides a streamlined and efficient approach to event adjudication in clinical trials. To immediately apply automated event adjudication, one can first consider the automated event adjudication system and involve human assistance for cases unconfirmed by the former.
Background: Rapid growth and excess weight in early childhood are associated with obesity risk. While maternal preconception BMI has been identified as a potential risk factor, the role of paternal preconception BMI is less clear. Objectives: To examine the association between paternal preconception BMI and age- and sex-standardized WHO BMI z-score (zBMI) growth rates, zBMI, and weight status, in 0- to 10-year-old children. To determine whether these associations differed by child sex and maternal preconception weight status. Methods: A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!). Children (n = 218) underwent repeated measures of height and weight from birth to 10 years old. Piecewise linear mixed models were used to assess the association between paternal preconception BMI and child zBMI growth rates (zBMI SD units/month) between 0, 4, 30, 48 and 120 months of age. Linear mixed models were used to examine the association with child zBMI, and logistic generalized estimation equations (GEE) were used to assess the association with child weight status. Child sex and maternal preconception weight status were tested as effect modifiers. Results: Paternal preconception BMI was associated with child zBMI growth rate, mean zBMI and weight status in boys, but not girls. A 5 kg/m2 higher paternal preconception BMI was associated with approximately 0.01 zBMI SD unit/month higher growth rate for boys born to mothers with preconception overweight. Higher paternal BMI was associated with higher mean zBMI and increased odds of overweight and obesity in boys, with greater effects seen when mothers had preconception overweight compared to normal weight. Conclusion: Paternal preconception BMI was associated with child zBMI growth rate, zBMI and weight status in boys, with greater effects when the biological mother had preconception overweight or obesity. Further understanding of sex differences in paternal preconception weight effects in children is needed.
Canada implemented a series of laws regulating firearms including background checks and licensing, references, psychological questionnaires, prohibition of paramilitary style rifles, and magazine capacity restrictions in order to decrease the incidences and deaths from mass shootings. The associated effects of these laws were examined over the years 1974 to 2020. A model was constructed using difference-in-differences analysis of firearms and non-firearms mass homicide incidences and death rates. Mass homicides were defined as a homicide due to one event involving three or more deaths. Incidence rates of mass homicide by firearm were found to be 0.11 (95%CI 0.08, 0.14) per million compared to a non-firearm mass homicide rate of 0.12 (95% CI 0.10, 0.15) per million. Mass homicide death rates by firearm were found to be 0.39 (95% CI 0.29, 0.49) per million compared to a non-firearm mass homicide rate of 0.47 (95% CI 0.34, 0.61) per million. Overall, there is a gradual declining trend in the incidence of mass homicide by firearm (IRR 0.97 (95% CI 0.96, 0.98)) and by non-firearm (IRR 0.97 (95% CI 0.97, 0.98)). The decline in mass homicide death rate by firearm and non-firearm is IRR 0.96 (95% CI 0.95, 0.97), and IRR 0.97 (95% CI 0.96, 0.98) respectively. No specific associated decrease in mass homicide incidence rates or death rates with firearms legislation was found after the implementation of background checks and prohibition of full auto firearms in 1980, by the implementation of references and psychological questionnaires in 1994, by the restriction of magazine capacity in 1994, the prohibition of paramilitary rifles in 1994, or licensing in 2001.
Inhibitor development remains a major challenge in factor VIII (FVIII) replacement therapy. verITI-8 is the first prospective study of a recombinant factor VIII Fc fusion protein (efmoroctocog alfa; rFVIIIFc) for first-time immune tolerance induction (ITI) in males with severe hemophilia A and high-titer inhibitors (historical peak ≥5 Bethesda units [BU]/mL). In this single-arm, open-label, multicenter study, screening was followed by ITI (rFVIIIFc 200 IU/kg/day until tolerization or maximum of 48 weeks). Those who achieved ITI success entered a tapering period, returning to standard prophylaxis, and then entered follow-up. Primary endpoint was time to tolerization with rFVIIIFc defined by inhibitor titer <0.6 BU/mL, incremental recovery (IR) ≥66% of expected IR (IR ≥1.32 IU/dL per IU/kg), and half-life ≥7 hours within 48 weeks. Sixteen subjects received ≥1 rFVIIIFc dose. Twelve (75%), 11 (69%), and 10 subjects (63%), respectively, achieved negative inhibitor titers, an IR ≥66%, and a half-life ≥7 hours (ie, tolerance) within 48 weeks. Median (IQR) times in weeks to achieve these markers of success were 7.4 (2.2-17.8), 6.8 (5.4-22.4), and 11.7 (9.8-26.2), respectively. All subjects experienced ≥1 TEAE (treatment-emergent adverse event [AE]), and 1 reported ≥1 related TEAE (injection site pain). Nine subjects experienced ≥1 treatment-emergent serious AE (TESAE). No thrombotic events, discontinuations due to AEs, or deaths were reported during the study. As the first extended half-life rFVIII with prospective data in ITI, rFVIIIFc offered short time to tolerization with durable responses in almost two-thirds of subjects and was well tolerated. Trial registered at www.clinicaltrials.gov (NCT03093480).
Nickel‐rich cathode materials with small amounts of tungsten (W) dopants have attracted extensive attention in recent years. However, the chemical state, crystalline form, compound chemistry, and location of W in these layered cathodes are still not well‐understood. In this study, these missing structural properties are determined through a combination of macro‐, to atomic‐sensitive characterization techniques and density functional theory (DFT). W‐doped LiNiO2 (LNO) particles, prepared with mechanofusion and coprecipitation methods, are used to probe changes in the structure and location of W‐species. The results indicate that W is mainly distributed on the surfaces and inside grain boundaries of the secondary particles, regardless of the doping method. Electron energy loss spectroscopy (EELS) mapping confirms the simultaneous presence of W, O, with and without Ni in the grain boundaries as well as W‐ and O‐rich regions on the very surface. The W‐rich areas inside the grain boundaries are found to be in two forms, crystalline and amorphous. This paper suggests the presence of kinetically stabilized‐Li4+xNi1‐xWO6 (x = 0, 0.1) with the possibility of LixWyOz phases in LNO which are consistent with the electron microscopy, X‐ray absorption and diffraction data. The multiple roles of W in this complex microstructure are discussed considering the W distribution.
Background. There has been a recent transition from typical to atypical antipsychotics in managing schizophrenia. This has been attributed to the acute side effects experienced by patients on typical antipsychotics that lead to nonadherence. However, the treatment cost with typical antipsychotics is cheaper (preferred in low-income settings), and there is no difference in the effectiveness, efficacy, discontinuation rate, or side effect symptom burden with atypical antipsychotics. This study is aimed at determining the prevalence of nonadherence and the associated factors to typical antipsychotics among patients with schizophrenia attending a psychiatric outpatient clinic at a rural tertiary facility in Uganda. Method. A cross-sectional study among 135 patients with schizophrenia for at least six months on typical antipsychotics (mean age of 39.7 (±11.9) and 55.6% were female) from a rural tertiary facility in Uganda. Data were collected regarding sociodemographics, adherence, insight for psychosis, attitude towards typical antipsychotics, side effects, satisfaction with medications, and explanations from health workers about medications and side effects. Logistic regression was used to determine the factors associated with nonadherence. Results. The prevalence of nonadherence was 16.3%, and the likelihood of being nonadherent was more among the poor (monthly earning below the poverty line). However, having reduced energy was associated with reducing the likelihood of having nonadherence. Conclusion. The prevalence of nonadherence was lower than many previously obtained prevalence and was comparable to nonadherence for atypical antipsychotics. However, to reduce nonadherence, we need all stakeholders (such as the government, insurance companies, and caregivers) to assist patients living in poverty with access to medication.
Although temporally nonadjacent key relationships (e.g., Key X →Key Y→ Key X) are ubiquitous within tonal music, the full extent to which they are perceived is uncertain. Previous research suggests that memory for an initial key remains active up to 20 s after modulation; however, homophonic textures were used in these studies, leaving open the possibility that surface features such as figuration may contribute to nonadjacency effects. In two experiments, we investigated this issue by measuring goodness of completion ratings for stimuli in which musical surface features were manipulated. Two types of surface feature were tested: figuration and activity (total number of notes per stimulus). Stimuli were composed of three parts: (1) nonadjacent section (in either the same or a different key to the probe); (2) intervening section (in a different key to the probe); and (3) probe (a cadence in either the same or different key as the nonadjacent section). In Experiment 1, we tested whether the presence of surface features resulted in higher goodness of completion ratings for the probe; in Experiment 2, we manipulated nonadjacent key relationships to ascertain the effect of surface features on global perception of key. Results showed that figuration and activity contributed to goodness of completion ratings, particularly in stimuli where these features matched each other in the nonadjacent sections. Moreover, the presence of surface features strengthened the perceived relationships between the keys of nonadjacent sections, thereby appearing to contribute to the global perception of phrase. In sum, although from an analytical perspective surface features are often considered to be less important hierarchically, our results indicate that they contribute significantly to the perception of nonadjacent key relationships.
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18,122 members
Behnam Sadeghirad
  • Departments of Anethesia and Clinical Epidemiology & Biostatistics
Omar M. Bdair
  • Department of Mathematics and Statistics
Matiar Howlader
  • Department of Electrical and Computer Engineering
Carlos Alberto Cuello-Garcia
  • Health Research Methods Evidence and Impact
Loubna Akhabir
  • Department of Medicine
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