Neuromuscular Complications in COVID-19: A Review of the Literature

Coronavirus disease of 2019 (COVID-19) belongs to the betacoronavirus family which is known to cross species barriers and lead to high pathogenicity. There is rapidly growing evidence that COVID-19 infection can be associated with neuromuscular complications. A comprehensive literature review was conducted evaluating articles published related to neuromuscular complications in COVID-19.  In this review we focus our discussion on two ways that COVID-19 critically impacts neuromuscular medicine: (1) serious complications and outcomes associated with the viral infection and; (2) management considerations for neuromuscular patients on immunotherapies during the COVID-19 pandemic. &nbsp

The FORAGEKID game: hybrid-foraging as a new way to study aspects of executive function in development

In hybrid foraging, observers search for multiple exemplars of multiple targets (e.g. look for yellow and purple perler-beads in the handicrafts box). Adults can perform hybrid searches for, literally, hundreds of different target objects. How does this ability to handle memory load develop during childhood? We compared performance under different memory loads at different ages (5–6, 11–12, and +18 years-old) in our FORAGEKID hybrid foraging video game, where observers searched for different moving real-world toys. Especially under higher memory loads, younger children show an ineffective target switching search compared to a strategy featuring longer “runs” of one type of target, implemented by older children and adults. All observers follow similar "quitting" rules for moving to the next screen. The results show that FORAGEKID could be a useful tool for understanding the development of aspects of executive function: combining memory, attentional control, and decision/strategy processes within a single enjoyable taskThis work was supported by the European Union’s Horizon 2020 research and innovation program, Marie Sklodowska-Curie Actions, under grant FORAGEKID 793268, granted to Beatriz Gil-Gómez de Liaño at the University of Cambridge, Universidad Complutense de Madrid and BWH-Harvard Medical School, and by NIH EY017001 given to Jeremy M. Wolf

Damped Lyman-alpha Absorption Associated with an Early-Type Galaxy at Redshift z = 0.16377

We report new HST and ground-based observations of a damped Lyman-alpha absorption system toward the QSO 0850+4400. The redshift of the absorption system is z = 0.163770 and the neutral hydrogen column density of the absorption system is log N = 19.81 cm**-2. The absorption system is by far the lowest redshift confirmed damped Lyman-alpha absorption system yet identified, which provides an unprecedented opportunity to examine the nature, impact geometry, and kinematics of the absorbing galaxy in great detail. The observations indicate that the absorption system is remarkable in three respects: First, the absorption system is characterized by weak metal absorption lines and a low metal abundance, possibly less than 4% of the solar metal abundance. This cannot be explained as a consequence of dust, because the neutral hydrogen column density of the absorption system is far too low for obscuration by dust to introduce any significant selection effects. Second, the absorption system is associated with a moderate-luminosity early-type S0 galaxy, although the absorption may actually arise in one of several very faint galaxies detected very close to the QSO line of sight. Third, the absorbing material moves counter to the rotating galaxy disk, which rules out the possibility that the absorption arises in a thin or thick co-rotating gaseous disk. These results run contrary to the expectation that low-redshift damped Lyman-alpha absorption systems generally arise in the gas- and metal-rich inner parts of late-type spiral galaxies. We suggest instead that mounting evidence indicates that low-redshift galaxies of a variety of morphological types may contain significant quantities of low metal abundance gas at large galactocentric distances.Comment: 15 pages, LaTex, 4 figures, to be published in The Astronomical Journa

Quitting rules in hybrid foraging search: From early childhood to early adulthood

In hybrid foraging, observers search for multiple instances of multiple target types. Children regularly perform such tasks (e.g., collecting LEGO pieces or looking for different teammates within a game). Quitting rules (When do you leave the search?) are important in foraging (e.g., I found enough LEGOs or teammates). However, the development of quitting behavior has not yet been experimentally studied, and it could give us significant information about executive function development. We tested 279 observers (4–25 years old) using classic feature and conjunction foraging. The results show that while children’s performance improved with age, all groups made similar "quitting" decisions roughly following optimal choices as defined by Charnov’s Marginal Value Theorem (MVT), with the youngest 4–5 years old children quitting slightly earlier. It seems that mature quitting rules in search operate relatively early in development, suggesting that those rules are quite basic aspects of the human cognitionThis work was supported by the Research Grant Project PSI2015–69358-R (MINECO/FEDER) “Ministerio de Economía y Competitividad” (MINECO), and “Fondo Europeo de Desarrollo Regional” (FEDER), given to Beatriz Gil-Gomez ´ de Liano ˜ as PI. Also, part of the research of this study was done thanks to the Fulbright Commission, and the European Union’s Horizon 2020 research and innovation program, Marie Sklodowska-Curie Actions, under grant FORAGEKID 793268, also granted to Beatriz Gil-Gomez de Liaño at the University of Cambridge, Universidad Complutense de Madrid and BWH-Harvard Medical School, and by NIH EY017001 given to Jeremy M. Wolf

Practice patterns in the management of myasthenia gravis: a cross-sectional survey of neurologists in the United States

Background: Management of myasthenia gravis (MG), a rare immunoglobulin G autoantibody–mediated neuromuscular junction disorder, is driven by physician experience. To gain insight into current practices and physician needs, neurologists’ use of guidelines and disease activity evaluations to manage MG was assessed. Methods: In November and December of 2020, a quantitative, cross-sectional, 51-item, online survey–based study was used to collect data from 100 community neurologists, from 31 US states, who treat MG. Differences across ratio variables were analyzed via Chi-square and t tests, at a significance level of P<0.05. Results: Of respondents, 76% reported using clinical judgment rather than guidelines to inform treatment decisions, and only 29% reported awareness of the updated 2020 International Consensus Guidance for Management of Myasthenia Gravis. Treatment patterns reported include use of prednisone-equivalent corticosteroid doses ≤10 mg/day for ≥6 months (76% of respondents). When corticosteroids are contraindicated or after failure of an initial nonsteroidal immunosuppressant therapy (NSIST), immunoglobulin therapy is the respondents’ preferred initial treatment in patients with acetylcholine receptor antibody–positive generalized MG (vs a second NSIST). Respondents expressed interest in more guidance on crisis management, initiating/titrating maintenance medications, and managing patients with comorbidities. Conclusions: Respondents to this survey reported varied approaches to MG management and, in some clinical settings, heavier reliance on clinical judgment than on available consensus-based guidance. Also observed was potential underutilization of NSISTs in patients for whom corticosteroids are contraindicated, with reliance, instead, on immunoglobulin

Quantitative sensory testing in a large cohort of neuropathy patients: QST in Neuropathy

Background: Quantitative sensory testing (QST) is a subjective but reliable and quantifiable method to detect patient thresholds to different sensory stimuli. QST is used to measure small- and large-fiber nerve function and can be used in conjunction with other diagnostic modalities in the evaluation of peripheral neuropathy (PN). The utility of QST to distinguish among different types of PN, however, has not been explored. The objective of the study was to evaluate if different patterns of QST abnormalities could distinguish between PN types. Methods: This single-center retrospective cohort study evaluated the frequency of QST abnormalities to vibratory, cold and heat detection thresholds in a large population of PN cases evaluated at the University of Texas Southwestern Medical Center peripheral neuropathy clinic between 1995-2000. PN was categorized by etiology. Results: A total of 559 QST studies were performed in this study. The average age of patients (n=557) was 60 years with a male-to-female ratio of 1:1. The most common diagnosis was cryptogenic sensory polyneuropathy (CSPN, n=294), followed by Charcot–Marie–Tooth disease (n=84)). Meta-regression of vibration and cold indicate that the expected proportion of abnormal responses is less for the vibration test (p = 0.0002), relative to the cold test. However, no differences were observed between diagnoses. Conclusions: Though abnormal QST thresholds were seen in most patients with PN, patterns of QST abnormalities do not distinguish between different types of PN. The routine clinical utility of QST is likely limited

Attentional development can help us understand the inattentional blindness effect in visual search

Introduction: Inattentional Blindness (IB) is the failure to notice an unexpected, usually salient stimulus while immersed in a different, often demanding attentional task. More than just a laboratory curiosity, IB is an important phenomenon to understand because it may be related to real-world errors such as missed “incidental findings” in medical image or security searches. Interest in individual differences in susceptibility to IB has produced a number of studies showing inconclusive results. Methods: Here, we tested IB in a sample of 277 participants, 4-25 years old performing a visual search task. On two critical trials, an unexpected letter and an unexpected word were presented among photorealistic objects. Results: There was a clear age effect with younger individuals showing higher IB levels. IB correlated with attentional control in visual search and with Continuous Performance Test-CPT for d-prime, response times and attentional shifting measures. These effects disappeared if age was controlled. There were no general effects of intelligence (IQ; RIST) or gender. Younger observers showed a negative correlation of IB for the word with the verbal components of the RIST IQ-proxy (no effect for the letter). Discussion: These results support a relationship between IB and cognitive-developmental changes, showing that maturation of attention and executive processes can help us understand the intriguing phenomenon of (sometimes) missing what is in front of our eyesThis work was supported by the Research Grant Project PSI2015-69358-R (MINECO/FEDER) Ministerio de Economía y Competitividad (MINECO) and Fondo Europeo de Desarrollo Regional (FEDER) and the ongoing project PID2021-122621OBI00 (Ministerio de Ciencia e Innovación de España) granted to BG-G. It was also supported by the Fulbright Commission, and the European Union’s Horizon 2020 Research and Innovation Program, Marie Sklodowska-Curie Actions, FORAGEKID 793268, also granted to BG-G, as well as by the NIH EY017001 granted to J

Primordial large-scale electromagnetic fields from Gravitoelectromagnetic Inflation

We investigate the origin and evolution of primordial electric and magnetic fields in the early universe, when the expansion is governed by a cosmological constant $\Lambda_0$. Using the gravitoelectromagnetic inflationary formalism with $A_0=0$, we obtain the power of spectrums for large-scale magnetic fields and the inflaton field fluctuations during inflation. A very important fact is that our formalism is {\em naturally non-conformally invariant}.Comment: Accepted for publication in Physics Letters

Cocreating Culturally Responsive Resources With Communities Using Design-Based Implementation Research: The Challenges of Online Research

This case study highlights the methodological and practical implications of modifying an investigation with community partners to fit an online format. Research interactions took place between November 2020 and June 2021, under the social distancing restrictions imposed by the COVID-19 pandemic. Twelve Latinx parents/caregivers participated in co-designing culturally relevant college and career readiness resources for Latinx families. A research partnership of two school faculty and a community partner collaborating with university faculty, staff, and students led the study using design-based implementation research (DBIR) as the primary methodological approach. The means of communication and resource sharing with parents were Zoom videoconferencing, WhatsApp text messaging, social media, and phone calls. Parents also received printed materials sent through students attending school under a hybrid modality (face-to-face and online classes). The use of online environments posed challenges in getting participants fully engaged in the co-design process. Some parents lacked technological skills or access to adequate technology, leading to communication barriers in some cases. The implementation phase, a significant component of DBIR, could not be achieved online. This case is about the strategies put forward by the research team to overcome the restrictive research conditions, the adaptations made throughout the process to facilitate community engagement, and lessons learned. It is an invitation to think about the implications of the decisions made by the research team and reflect on creative solutions to address the challenges faced

Efficiency and accuracy of visual search develop at different rates from early childhood through early adulthood

Abstract: Most studies of visual search across the life span have focused on classic feature and conjunction searches in which observers search for a fixed, simple shape target among relatively homogeneous distractors over a block of multiple trials. In the present study, we examine a more realistic task in which participants (4 to 25 years-old) look for images of real objects, presented amongst a heterogeneous array of other objects. The target is unique on every trial, unlike in previous developmental studies of visual search. Our new touchscreen-based “Pirate-Treasure” search also allows the testing of younger children within a video-game-like task. With this method, we tested a large sample (n = 293) of typically developing children and young adults. We assessed the developmental course of different search metrics like search efficiency, motor response differences, and accuracy (misses and false-alarm errors). Results show the most rapid time courses in development for accuracy. Search slopes reach the young adult level most slowly. The intercepts of the Reaction Time (RT) × Set Size function are often attributed to nonsearch perceptual and motor components of the task. The intercept time course is intermediate between accuracy and slope. Interestingly, these developmental functions follow time courses proposed in neuropsychological models of executive function development. This suggests that a single, video-game-like search task could be useful in routine assessments of cognitive development