Showing papers by "University of Southern Denmark published in 2023"

Beneficial non-specific effects of live vaccines against COVID-19 and other unrelated infections

Abstract: Live attenuated vaccines could have beneficial, non-specific effects of protecting against vaccine-unrelated infections, such as BCG protecting against respiratory infection. During the COVID-19 pandemic, testing of these effects against COVID-19 was of interest to the pandemic control programme. Non-specific effects occur due to the broad effects of specific live attenuated vaccines on the host immune system, relying on heterologous lymphocyte responses and induction of trained immunity. Knowledge of non-specific effects has been developed in randomised controlled trials and observational studies with children, but examining of whether the same principles apply to adults and older adults was of interest to researchers during the pandemic. In this Personal View, we aim to define a framework for the analysis of non-specific effects of live attenuated vaccines against vaccine-unrelated infections with pandemic potential using several important concepts. First, study endpoints should prioritise severity of infection and overall patient health rather than incidence of infection only (eg, although several trials found no protection of the BCG vaccine against COVID-19 infection, it is associated with lower overall mortality than placebo). Second, revaccination of an individual with the same live attenuated vaccine could be the most effective strategy against vaccine-unrelated infections. Third, coadministration of several live attenuated vaccines might enhance beneficial non-specific effects. Fourth, the sequence of vaccine administration matters; the live attenuated vaccine should be the last vaccine administered before exposure to the pandemic infection and non-live vaccines should not be administered afterwards. Fifth, live attenuated vaccines could modify the immune response to specific COVID-19 vaccines. Finally, non-specific effects of live attenuated vaccines should always be analysed with subgroup analysis by sex of individuals receiving the vaccines.

Predictors of caregiver burden in caregivers of individuals with traumatic or non-traumatic brain injury: A scoping review

Abstract: BACKGROUND: Caregivers of individuals with traumatic (TBI) or non-traumatic (nTBI) brain injuries are at risk of significant caregiver burden. Consequently, it is crucial to examine predictors of caregiver burden to enable early identification and intervention. OBJECTIVE: To examine predictors of caregiver burden in caregivers of individuals with TBI/nTBI. METHODS: A scoping review was conducted in the bibliographic databases PubMed, EMBASE (Ovid) and APA PsycInfo (EBSCO). Search terms included: ‘acquired brain injur*’, ‘traumatic brain injur*’, ‘brain injur*’, ‘non-traumatic brain injur*’, or ‘stroke*’ combined with ‘burden’, ‘caregiver burden’, ‘perceived burden’, or ‘caregiver strain’. The search was limited to articles written in English and published in academic journals between 2000 and March 2022. EndNote was used to manage the references and identify duplicates. RESULTS: Twenty-four studies were included. Care recipient-related predictors of caregiver burden included more severe injuries, functional disabilities (including decreased physical and neuropsychological functioning), and worse mental health. Caregiver-related predictors included more time spent caregiving, worse mental health, and unmet needs. For several predictor variables, evidence was mixed or vague. CONCLUSION: The results highlight which caregivers are at risk of caregiver burden and point to several areas of potential intervention to prevent caregiver burden. Future research should explore the relationship between characteristics of the caregiver and caregiver burden, including coping style, problem-solving techniques, and personality, as these have been sparsely investigated and are potentially modifiable through intervention. Further research is needed to elucidate if burden can be prevented by interventions targeting caregivers at risk. Addressing these gaps may clarify the link between caregiver burden and predictor variables and assist in development of interventions that may prevent burden.

Redshift drift in a universe with structure. II. Light rays propagated through a Newtonian <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline"><mml:mi>N</mml:mi></mml:math> -body simulation

Abstract: The redshift drift is computed along light rays propagating through a simulated universe based on the Newtonian N-body simulation code GADGET-2 combined with a perturbed Friedmann-Lemaitre-Robertson-Walker metric in the Newtonian gauge. It is found that the mean redshift drift is equal to the drift of the mean redshift to the precision of the numerical computations and that this is due to a high degree of cancellation between two dominant components of the redshift drift. This result is contrary to earlier findings based on inhomogeneous cosmological models exhibiting cosmic backreaction. ewline\indent For simplicity, the results neglect contributions from optical drift. Based on a study of the redshift drift in a Lemaitre-Tolman-Bondi model, the optical drift effects are estimated to be at most of order 10\% of the redshift drift signal. In addition, it is found that the redshift drift contribution from peculiar acceleration of the emitter is negligible in the simulation setup. However, it is expected that the contribution from peculiar acceleration of the emitter is suppressed in the setup due to low resolution of structures and it is hence expected that this contribution will be larger for real observations.

Cosmic backreaction and the mean redshift drift from symbolic regression

Abstract: The possibility of obtaining symbolic expressions for cosmic backreaction is explored through a case study of so-called 2-region models. By using the publicly available symbolic regression algorithm AI Feynman, it is shown that the kinematical backreaction from a single 2-region model can be well described as a function of the mean redshift (or, equivalently, the volume averaged scale factor). A single expression depending on the redshift/scale factor as well as a model parameter, $f$, that can accurately describe the backreaction for a significant range of models is naturally more complicated but is also achieved with percent-level accuracy. ewline\indent Data sets of redshift drift in the 2-region models are also considered. Again utilizing AI Feynman, expressions for the redshift drift are found. In particular, an expression for the difference between the mean redshift drift and the drift of the mean redshift in terms of the kinematical backreaction is easily obtained for a single 2-region model. An accurate symbolic expression that describes this difference for an array of 2-region models is achieved by using the redshift as a feature instead of the kinematical backreaction.

Risk of Central Serous Chorioretinopathy in Male Androgen Abusers

Abstract: Male gender is an important risk factor of central serous chorioretinopathy (CSC), and studies have explored the pathophysiological role of androgens in CSC with conflicting results. In this study, we shed light on this hot topic by exploring the risk of CSC in a large cohort of male androgen abusers. This study included male androgen abusers identified through a nationwide anti-doping test program across Danish fitness centers from January 3 2006 to March 1 2018. For each case, we randomly sampled ten male controls using Danish nationwide registries. These controls were matched in age and date. Cases and controls were followed until May 16 2018. Data on diagnoses were extracted using the Danish National Registry of Patients using ICD-10 codes to identify cases with CSC. We included 1189 cases and 11,890 controls. Mean age at the time of doping sentence was 27.4 ± 6.9 years, and mean length of follow-up was 15.8 ± 3.6 years. We identified no cases of CSC in androgen abusers, and five cases of CSC in the control cohort. The difference between groups was not statistically significant (P = 1.0). Male androgen abusers were not at increased risk of CSC. Considering the lack of any signal in this large study, we speculate that if male androgen plays any direct role in the pathophysiology of CSC, its role may be subtle at best.

Gating by alpha band inhibition revised: a case for a secondary control mechanism

Abstract: In recent decades there has been a growing interest in the role of neuronal oscillations in the alpha band and how they support cognition. It is clear from intracranial animal recordings, that alpha oscillations are associated with inhibition as increases in alpha power co-occur with a decrease in neuronal activity. Nevertheless, several findings have put into question whether alpha-band oscillations, in general, can be controlled in a top-down manner to suppress visual distractors. Also, it has been questioned whether alpha oscillations can exercise gain control in the early visual cortex. We here point to a revised mechanism in which alpha oscillations are controlled by a secondary mechanism governed by the load of goal-relevant information. This view is compatible with perceptual load theory and biased competition, where distractor suppression is an indirect consequence of engagement. We will outline how this framework can be further tested experimentally and discuss the consequences for network dynamics and resource allocation in the working brain.

Changes in adult obesity prevalence in Denmark, 1987–2021: age–period–cohort analysis of nationally representative data

Abstract: During the last decades, the prevalence of obesity [body mass index (BMI): weight/height2), ≥30.00 kg/m2] among adults has increased considerably. We examined whether this increase in a high-income, welfare state, like Denmark was driven by age, period or cohort effects, which would inform preventive strategies aiming at reducing the prevalence.We used data from the National Representative Health and Morbidity Studies, which are representative surveys of the Danish adult population (age 16 years and above), conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017 and 2021 (N = 91 684). Participants reported height and weight, from which BMI was calculated after correction for systematic bias in self-reported data and non-response. Age, survey year and birth cohorts were mutually adjusted and adjusted for sex in generalized linear models.The obesity prevalence increased from 6.1% in 1987 to 18.4% in 2021, similarly in men (18.8%) and women (18.0%) and in all age groups. Age had an inverted u-shaped effect on the prevalence. Compared with individuals aged 16-24 years, the highest rate of obesity was seen for the age group 55-64 years [rate ratio 3.27, 95% confidence interval (CI): 2.58; 4.14]. The increasing rate for each recent survey year over time was compatible with a period effect without any birth cohort effects. The rate for obesity in 2021 was 4.16 in 1987 vs. 1987 (95% CI: 3.10; 5.59).Obesity prevalence in Denmark increased steadily during the period 1987 through 2021, primarily driven by secular changes over time across all ages and birth cohorts.

Machine Learning Cosmic Backreaction and Its Effects on Observations

Abstract: Symbolic expressions for cosmic backreaction and mean redshift drift in a range of 2-region models in terms of average quantities are presented. The demonstration that these expressions can be obtained constitutes the opening of a new avenue towards understanding the effects of cosmic backreaction in our universe: With a symbolic expression for the redshift drift at hand, the redshift drift can be used to constrain cosmological parameters including the large-scale expansion rate and backreaction. In addition, by introducing symbolic expressions for cosmic backreaction, this quantity can be constrained with observations such as redshift-distance measures.

Re: Aducanumab-Related ARIA

Abstract: To the Editor: We enjoyed reading the recent commentary by Drs Wassef and Colletti1 in Clinical Nuclear Medicine to an opinion article published shortly before in the same journal.2 Not only because the authors support some of the stated opinions, but in particular because their communication is an impressive concentrate of existing literature in the field, which very few have presented in so little space, making it a recommended read for new researchers interested in dementia and Alzheimer disease (AD). Moreover, the commentary points to new developments focusing on presymptomatic detection and development of effective prevention and therapy. On a single point, however, we do not agree with Wassef and Colletti. This applies to the sentence: “Negative amyloid PET can reliably rule out AD.” It is far away from the impression we have. They refer to an article in which authors Scheltens et al3 state that amyloid PET has a high negative predictive value with regard to exclude the diagnosis AD. However, they do this without providing documentation for their claim, meaning that the statement can only be interpreted as the authors' own opinion. A number of prerequisites must be met for a study of diagnostic accuracy to provide valid predictive diagnostic values.4 One of them is a fairly reliable reference to compare with. However, when it comes to dementia and AD, such a reference does not exist. On the contrary, no one knows the correct context, including the cause of the disease or to what degree amyloid, tau, or other circumstances play an active role in formation and development of AD, or whether they are by-products or waste products. Therefore, all talk of specific predictive values should be silenced, as they are inherently unknown and will remain so until a greater understanding of AD and how it can be prevented or treated has been provided. And, frequently encountered statements that procedures, including amyloid PET, are “suitable,” “good,” “extremely useful,” and so on for diagnosing or ruling out the presence of AD are examples of circular reasoning5 and should not be taken for anything other than what they are: postulates. Reported AD diagnostic values are on uncertain grounds. If for no other reason, then it is for the fact that the diagnosis of mild cognitive impairment and AD, which the authors typically want to distinguish between and separate from normal cognition, has been based on variable national or international consensus criteria. These have constantly and concurrently been changed, from emphasis initially on clinical and pathological findings, then more on biomarkers and recently with a reinforcement of the clinical manifestations,6–9 all testifying to the uncertainty and ambiguity of the diagnosis of AD and the fact that the reference the authors of diagnostic trials have used is rarely the same. Actual values for the negative predictive value are rarely reported, but several studies indicate that a significant proportion of patients with clinical AD are amyloid negative by PET imaging; numbers range between 2% and 61%.10,11 This has often made authors look for other reasons of dementia than AD,12–16 suggesting that in their minds not the clinical impression but the presence or absence of amyloid PET positivity is what defines AD—yet another example of circular reasoning. On the whole, reports differ widely with regard to methodology, patient population, and clinical assessment, hampering comparison and leaving doubts as to whether AD-like cognitive decline is one or different diseases.17 In a recent large study across the AD clinical spectrum, amyloid abnormality was present in 84% of patients with clinical AD at age 50 years and decreased to 72% at age 90 years, meaning that the negative predictive value of amyloid PET is far from 100%.18 Our own, still relatively modest, experience supports the impression of a low negative predictive value of amyloid PET with regard to making the diagnosis of AD. In a cohort of the first 195 patients imaged with 18F-flutemetamol PET at the Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway, 64 patients were examined with both amyloid PET and lumbar puncture. 18F-flutemetamol PET is validated only for binary visual classification. A positive PET scan is one showing increased cortical uptake in 1 of 5 regions (frontal lobe, posterior cingulate and precuneus combined, lateral parietal lobe, lateral temporal lobe, or striatum). As many as 9 (30%) of 30 patients with a clinical diagnosis of AD had a negative amyloid PET.19 The AD diagnosis was made according to a comprehensive research protocol including detailed information from patients and their caregivers about symptoms, previous disorders, use of medication, demographic information, and, in addition, a battery of cognitive tests performed by 2 experienced memory clinic physicians: Mini-Mental State Examination, the Consortium to Establish a Registry of Alzheimer's Disease 10-item word list and constructional praxis exercise, the Clock Drawing Test, the Trail Making Tests A and B and the animal-naming test, the Controlled Oral Word Association Test, and the 15-word short form of the Boston Naming Test. The severity of the cognitive impairment was scored by an experienced rater using the Clinical Dementia Rating scale. These many tests are not part of the clinical routine, but together they give us a rather confident impression that these patients suffer from dementia of the AD type, although we know that this diagnosis cannot be made with certainty, either clinically or using biomarkers. Thus, our conclusion, which is supported by the mentioned studies,10,11 is that the negative predictive value of amyloid PET is rather approximately 70% to 75% than close to 100%, and hence, it is debatable whether amyloid PET has a meaningful place in the workup of patients with suspected or known dementia. As we see it, there is every reason to clarify exactly what are the predictive values of amyloid imaging in new and well-designed prospective studies because this is the key question. Not an easy task—because how does one make a certain diagnosis of AD? Nevertheless, one can solve the problem by doing something different, namely, perform FDG and amyloid PET in a treatment randomized controlled trial of well-characterized demented patients. Only if cerebral FDG uptake increases, while cerebral amyloid deposits decrease, is there evidence for a favorable effect of immunotherapy. If, on the other hand, FDG uptake decreases more in the treated group than in the placebo group, all further attempts with immunotherapy should be stopped. We support Wassef and Colletti1 in pointing to substrates other than amyloid and tau in a renewed effort to achieve a better management of AD. For a start, we have suggested looking more closely at the respective importance of infection, low-dose radiation, and not least atherosclerosis, the latter assessed by 18F-sodium fluoride PET imaging.20 Poul F. Høilund-Carlsen, MD, DMSc∗†Abass Alavi, MD‡Mona-Elisabeth Revheim, MD, PhD, MHA§ ∗Department of Nuclear Medicine Odense University Hospital University of Southern Denmark Odense, Denmark †Department of Clinical Research University of Southern Denmark Odense, Denmark ‡Department of Radiology Hospital of the University of Pennsylvania Philadelphia, PA §Division of Radiology and Nuclear Medicine Oslo University Hospital; Institute of Clinical Medicine, University of Oslo Oslo, Norway [email protected] [email protected]

Conceptualising UN-ASEAN Policy Transfer

Abstract: Despite burgeoning normative debate over the either competing or complementary relationships between regionalism and universalism, practical questions over how regionalism interacts with global principles and why they grow either similar or divergent in various scenarios have received scant attention. This chapter provides a theoretical framework for understanding the process of policy interplay between the UN and ASEAN against the background of expanding overlapping spheres of authority between various layers of governance. Towards this end, it reviews ASEAN’s adoption of international norms in conventional ASEAN studies. In particular, four critiques of this body of work are developed. These include the failure of past work to put ASEAN’s norm adoption in a wider framework that considers the medium through which transfers of international ideas is attempted and the broader regime complex where ASEAN is situated. Building upon these critiques, a conceptual framework is developed. This framework integrates certain elements of the traditional ASEAN literature but is bolstered through the incorporation of insights from literatures on policy transfer and regime complex.

Before the ASEAN Convention: Trafficking in Persons as a Transnational Crime Conflated with Sex Trafficking

Abstract: This chapter gives an extensive review of the global and regional drivers that affected ASEAN’s trafficking policies throughout different phases of trafficking governance prior to the start of the negotiation of the ASEAN Convention against Trafficking in Persons, Especially Women and Children (ACTIP). This chronological analysis across three stages is useful in illustrating the main trends and patterns in changes of ASEAN’s policies on trafficking in comparison with the UN equivalents. Such empirical evaluation unveils critical junctures in UN-ASEAN policy harmonisation and creates ground for rigorous research of respective actors, processes, and circumstances associated with each policy alteration across stages. Various policy transfer mechanisms - coercion, lesson drawing or emulation - and forum-shopping activities in the TIP area are reviewed, highlighting their implications for ASEAN’s evolving policy agenda. Throughout this analysis, the chapter aims to illuminate how trafficking is perceived among different actors, whose voices and concerns are influential in policy debates, and how trafficking discourses have been shaped and contested in the regional policy area.

Cold water swimming as an add-on treatment for depression: a feasibility study

Abstract: Cold water swimming (CWS) involves taking a regular dip in cold, natural waters throughout the winter. The evidence for the health benefits of CWS has been anecdotal, or from small-sample size studies. The available literature reports that CWS abolishes general tiredness, improves mood, boosts self-esteem and improves general well-being. However, research on the effects and safety of CWS as an add-on to the regular treatment of depression is limited. The aim of this study was to investigate whether it is possible and safe for patients with depression to participate in CWS.The study was designed as an open-label feasibility study. All patients aged 20-69 years with a diagnosis of depression from an outpatient clinic were eligible for inclusion. The intervention consisted of twice-weekly, group-based CWS.Thirteen patients were initially recruited, and five patients participated on a regular basis. Although several patients had somatic comorbidities, all patients passed the somatic evaluation and were physically fit to participate in CWS. Patients who participated regularly in the CWS sessions had a well-being score of 39.2; at the end of the study, their score had increased to 54.0 and PSQI score at baseline was 10.4 (3.7); at the end of the study it was 8.0 ((3.7).This study indicates that it is possible and safe for patients with depression to participate in regular, supervised CWS. Furthermore, regular participation in CWS may improve sleep and well-being.

Equilibria in bottleneck games

Abstract: Abstract This paper introduces a bottleneck game with finite sets of commuters and departing time slots as an extension of congestion games of Konishi et al. (J Econ Theory 72:225–237, 1997a). After characterizing Nash equilibrium of the game, we provide sufficient conditions for which the equivalence between Nash and strong equilibria holds. Somewhat surprisingly, unlike in congestion games, a Nash equilibrium in pure strategies may often fail to exist, even when players are homogeneous. In contrast, when there is a continuum of atomless players, the existence of a Nash equilibrium and the equivalence between the set of Nash and strong equilibria hold as in congestion games (Konishi et al. 1997a).

Health-Related Quality of Life, Anxiety, and Self-Image in Young Patients With Crohn’s Disease and Ulcerative Colitis

Abstract: We examined health-related quality of life, anxiety, and self-image in patients aged 10-20 years with Crohn's disease (CD) and ulcerative colitis (UC) in remission. These areas are key concerns in clinical care. We used the IMPACT-III for health-related quality of life and The Beck Youth Inventory-II for anxiety and self-image. Linear regression models were used to compare CD to UC. We included 67 patients, 44 (66%) with CD and 23 (34%) with UC. The mean score for IMPACT-III, anxiety, and self-image for CD versus UC was 78 (±SD: 13) versus 78 (±SD: 15), 44 (±SD: 9) versus 45 (±SD: 8), and 10 (±SD: 9) versus 9 (±SD: 6), respectively. We found no difference between CD and UC. Despite remission, we found an elevated score of anxiety and a low score of self-image. When evaluating mental health status, a varied approach may be beneficial for researchers.

Resonans i dødens nærvær

Abstract: Den tyske sociolog Hartmut Rosa påpeger, at vi, i hvad han omtaler som accelerationssamfundet, har en tendens til at overse det ukontrollerbare – vi har glemt, hvad det vil sige at være i et modtagende resonansforhold med verden. Denne tendens har også betydning for vores forståelse af og forbindelse med det spirituelle i dødens nærvær. Livstruende sygdom forandrer livet og den planlagte livsbane. Man kan opleve sig afkoblet fra sig selv og verden i konfrontationen med en forandring af kroppen og hverdagslivet, der er uden for ens egen kontrol. Artiklen undersøger en mulig forståelse af ”det spirituelle” som resonansrum, der kan forbinde det døende menneske og dets pårørende med verden trods sygdom og forestående død. Artiklen tager afsæt i eksempler fra palliativ praksis reflekteret i lyset af Rosas resonansbegreb og de danske teologer Kierkegaard og Løgstrup. To forskellige dimensioner af betydning for resonans undersøges. En sanselig dimension, hvor æstetiske indtryk og relationer åbner for oplevelsen af forbundethed med livet i dødens nærvær samt ’Timeligheden’ som en refleksiv dimension, hvor der søges mening i livet op mod døden. Begge dimensioner kan potentielt forbinde mennesket med livet i dødens nærvær men gennem forskellige ’åbninger’: sproget og sansningen. Hermed lægges op til en bred forståelse af spiritualitet, der kan være et relevant fokus for mange faggrupper i det palliative felt. Men resonans er en modus og ikke et kvantificerbart mål. Et fokus på resonans fordrer derfor en tilgang, hvor praktikeren har øje for at åbne mulige resonansrum for det døende menneske.

Index

Abstract: Despite the high frequency of their interactions, the policy coordination process between the United Nations (UN) and the Association of Southeast Asian Nations (ASEAN) has been underexamined in global and regional governance and ASEAN studies literature. To chart this important terrain, this incisive book contributes to scholarship by investigating UN-ASEAN policy coordination in the case of trafficking in persons (TIP).

Automated grading system of retinal arterio-venous crossing patterns: A deep learning approach replicating ophthalmologist’s diagnostic process of arteriolosclerosis

Abstract: The morphological feature of retinal arterio-venous crossing patterns is a valuable source of cardiovascular risk stratification as it directly captures vascular health. Although Scheie’s classification, which was proposed in 1953, has been used to grade the severity of arteriolosclerosis as diagnostic criteria, it is not widely used in clinical settings as mastering this grading is challenging as it requires vast experience. In this paper, we propose a deep learning approach to replicate a diagnostic process of ophthalmologists while providing a checkpoint to secure explainability to understand the grading process. The proposed pipeline is three-fold to replicate a diagnostic process of ophthalmologists. First, we adopt segmentation and classification models to automatically obtain vessels in a retinal image with the corresponding artery/vein labels and find candidate arterio-venous crossing points. Second, we use a classification model to validate the true crossing point. At last, the grade of severity for the vessel crossings is classified. To better address the problem of label ambiguity and imbalanced label distribution, we propose a new model, named multi-diagnosis team network (MDTNet), in which the sub-models with different structures or different loss functions provide different decisions. MDTNet unifies these diverse theories to give the final decision with high accuracy. Our automated grading pipeline was able to validate crossing points with precision and recall of 96.3% and 96.3%, respectively. Among correctly detected crossing points, the kappa value for the agreement between the grading by a retina specialist and the estimated score was 0.85, with an accuracy of 0.92. The numerical results demonstrate that our method can achieve a good performance in both arterio-venous crossing validation and severity grading tasks following the diagnostic process of ophthalmologists. By the proposed models, we could build a pipeline reproducing ophthalmologists’ diagnostic process without requiring subjective feature extractions. The code is available ( https://github.com/conscienceli/MDTNet ).

Disjunctive answer options complicate communication – a linguistic analysis of the danish EQ-5D (5 L) version

Abstract: Introduction: EQ-5D is an internationally acknowledged tool for assessing health-related quality of life. Our aim was to examine how pragmatic dynamics may influence answers to the EQ-5D-5 L in items where the structure of answer options is disjunctive. Methods: We performed a 3-step linguistic analysis building on the seminal work of Grice, including (1) examination of the lexical meanings of the answer options, (2) considerations of how conversational maxims might affect the respondent’s interpretation of compatible answer options under a single item, and (3) analysis of how the questionnaire’s context might counteract the problem of omitted answer options by shifting the meaning of context-sensitive expressions. Results: All items with disjunctive answer options exhibit both compatibilities and omissions. In combination with the disjunctive form of answer options these features of the EQ-5D-5 L complicates the communicative task for respondents relying on conversational norms to identify the most suitable answers to the instrument’s questions. Discussion: In items where answer options have a disjunctive structure, respondents relying on Gricean conversational maxims will have to depend on their individual understanding of fine-grained details concerning the questionnaire’s purpose and may have to weigh how conflicting norms should be balanced. While such dynamics are likely to go undetected in cognitive interviews, linguistic analysis may help to identify them.

Early Experience With an Endocrinology Preoperative Fast-Track Program for Optimizing Spine Surgery Candidates With Poorly Controlled Diabetes Mellitus

Abstract: Previous studies demonstrated an increase in adverse outcomes for patients undergoing elective surgeries with poorly controlled diabetes mellitus. At a large, tertiary-care spine center with a notable population of patients with poorly controlled diabetes, an Endocrinology Fast-Track (EFT) program was developed to improve patient optimization before elective spine surgery. The purpose of this study was to report our early experience.Seventy-five patients who were scheduled for elective spine surgery were noted to have Hgb A1c > 7 on preoperative evaluation. Thirty-two patients accepted referral to the EFT program and 43 declined (non-EFT). Mean preoperative Hgb A1c was similar between groups (EFT: 8.79 versus non-EFT: 9.26, P = 0.221). The Fast-Track program included counseling, education, and medical management.Patients in the two groups were similar in number of females (EFT: 17 versus non-EFT: 17, P = 0.348), age (EFT: 57.7 versus non-EFT: 60.6, P = 0.280), and body mass index (EFT: 34.6 versus non-EFT: 33.0, P = 0.341). A smaller number of smokers were there in the EFT group (1) compared with the non-EFT group (15, P = 0.003). The proportion of patients on insulin (EFT: 19 versus non-EFT: 23, P = 0.814) and oral hypoglycemics (EFT: 29 versus non-EFT: 39, P = 0.983) was similar between the two groups. Surgical clearance for patients with a documented preoperative Hgb A1c of < 7 or equivalent fructosamine level was significantly better in the Fast-Track group compared with the non-Fast-Track group (91% versus 42%, P = 0.000). Although most patients who declined the Fast-Track program did not obtain clearance for surgery, mean Hgb A1c was improved at the latest follow-up in both groups for those who obtained surgical clearance (7.10 versus 6.78, P = 0.470).A novel EFT program was successful in obtaining acceptable blood glucose control in patients recommended for spine surgery who had poorly controlled diabetes mellitus on preoperative evaluation. The improved blood glucose control was maintained at the latest follow-up.